THE ITYDEOPATHIC ENCYCLOPEDIA. f^ X 111 MUSCLES OF THE FRONT FIGURE. A PLATISMA MYOIDES— broad muscle of the neck. a STERNO-HYOIDEUS — muscle between the breast and tongue bones. h MASTOIDE US— mastoid muscle. B DELTOIDES — the muscle covering the shoulder-joint. C BICEPS BRACHII— two-headed muscle of the arm. D PRONATOR RADII TERES— pronating muscle of the arm. E SUPINATOR RADII LONGUS— supinating muscle of the arm. F FLEXOR CARPI RADIALIS— radial flexor of the wrist. G PALMARIS LONGUS— long bending muscle of the hand. H FLEXOR CARPI ULNARIS— ulnar flexor of the wrist. I PECTORALIS MAJOR— large muscle of the chest. K OBLIQUUS DESCENDENS— oblique descending muscle. L L RECTUS— straight muscle. L LINEA SEMILUNARIS— semilunar line. M LINEA ALBA— white line. N POUPART'S LIGAMENT— Poupart's ligament. O SARTORIUS— the " tailor's muscle." P TENSOR VAGINA FEMORIS— stretcher of the fascia lata. U PSOAS MAGNUS— large lumbar muscle. V VASTUS EXTERNUS— great external muscle. W RECTUS FEMORIS— straight femoral muscle. X VASTUS INTERNUS— great internal muscle. Y GASTROCNEMIUS— muscle of the calf of the leg. y SOLEUS — a broad flat muscle of the leg. Z TIBIALIS ANTICUS— anterior muscle of the leg. MUSCLES OF THE SIDE FIGURE. A DELTOIDES — muscle covering the shoixlder joint. B BICEPS BRACHII— two-headed muscle of the arm. C BRACHIALIS INTERNUS— internal muscle of the arm. D SUPINATOR RADII LONGUS— long supinator of the radius. E TRICEPS— three-headed muscle. F TRAPEZIUS — trapezium-shaped muscle. G LATISSIMUS DORSI— lateral muscle of the back. H SERRATUS MAJOR ANTICUS— large serrated anterior muscle. I OBLIQUUS DESCENDENS EXTERN US— external oblique de- scending muscle. K GLUTEUS MAXIMUS— largest thigh muscle. L GLUTEUS MEDI US— middle-sized thigh muscle. M RECTUS FEMORIS— straight muscle of the thigh. N VASTUS INTERNUS— great internal muscle. O VASTUS EXTERNUS— great external muscle. P TENDONS OF THE SEMIMEMBRANOSUS AND SEMITEN- DINOSUS MUSCLES, forming the inner hamstring. Q TENDON OF THE BICEPS FEMORIS, forming the outer hamstring. R ILIACUS INTERNUS— internal iliac muscle. S GASTROCNEMIUS EXTERNUS— external muscle of the calf. T SOLEUS— a broad flat muscle of the leg. U PERONEUS TERTIUS— fibular muscle of the leg. V i;XTENSOR LONGUS DIGITORUM PEDIS— long extensor muscle of the toes. W TIBIALIS ANTICUS— anterior muscle of the leg. -'^ b' V f" • / Vll MUSCLES OF THE BACK FIGURE. A ]\IASTOIDE US— mastoid muscle. B TRAPEZIUS — trapezium-shaped muscle. a INFRA SPIXATUS— the muscle beneath the spine of the . scupula. h TERES MINOR— long round smaller muscle. r TERES MAJOR — long round larger muscle. C LATISSIMUS DORSI— lateral muscle of the back. D DELTOIDES — muscle covering the shoulder-joint. / TRICEPS BRACHL\LIS— three-headed muscle of the arm. g ANCONEUS— muscle of the elbow. h EXTENSOR CARPI RADIALIS LONG US— long radial ex- tensor of the wrist. E SACRO LUIvIBALIS — muscle of the sacrum and loiuii. F LONGISSIMUS DORSI— long muscle of the back. G GLUTEUS MEDIUS— middle-sized muscle of the thigh. H GLUT.EUS ]\IAXIMUS— largest muscle of the thigh. I SEMITENDINOSUS— half-tendinous muscle. K SEMIMEMBRANOSUS— half-membranous muscle. L BICEPS FEMORIS— two-headed thigh muscle. M GASTROCNEMIUS EXTERNUS— external muscle of the calf. V THE FOliKAlUI AM) IIANP. ix MUSCLES OF THE FORE-AllM AND HAND. A PRONATOR TERES— long round pronator muscle. B SUPINATOR RADII LONGUS— long radial supinator. C FLEXOR CARPI RADIALIS— radial flexor of the wrist. D PALMARIS LONGUS— long muscle of the palm. E PERFORATUS, & PERFORANS— perforated, and perforating muscles. G ABDUCTOR POLLICIS MANUS— abductor of the thumb. H PAL^IARIS BREYIS— short muscle of the palm. K EXTENSOR POLLICIS— extending muscle of the thumb. K EXTENSOR PRIMI INTERNODII— extensor of the first finger. L EXTENSOR CARPI RADIALIS BREVIS— short radial exten- sor of the -wrist. M EXTENSOR CARPI RADIALIS LONGUS— long radial exteu sor of the Avrist. N EXTENSOR DIG ITORUM— extensor of the fingers. O EXTENSOR CARPI ULNARIS— ulnar extensor of the wrist. P ANCONEUS— muscle of the elbow. (i EXTENSOR SECUNDI INTERNODII— supinator and exten- sor of the thumb. R EXTENSOR MINIMI DIGITI— extensor of the little finger. S FLEXOR CARPI ULNARIS— ulnar flexor of the ^vrist. BONES OF THE HAND. A CARPUS — bones of the wrist. B METACARPUS— bones of the hand. C DIGITUS PRIMUS— bones of the thumb. D PHALANGES— bones of the finjrers. BONES OF THE FOOT. A OS CALCIS— heel-bone. B TARSUS— bones of the instep. C METATARSUS— bones of the foot. D PHALANGES— bones of the toes. XI PURIFICATION OF THE BLOOD. The figure is an ideal view of the circulation in the lungs and sys- tem. From the right ventricle of the heart (2), the dark, impure blood is forced into the pulmonary artery (3), and its branches (4, 5), carry the blood to the left and right lung. In the capillary vessels (6, 6) of the lungs, the blood becomes pure, or of a red color, and is returned to the left auricle of the heart (9) by the veins (7, 8). From the left auricle the pure blood passes into the left ventricle (10). By a forcible contraction of the left ventricle of the heart, the blood is thrown into the aorta (11). Its branches (12, 13, 13) carry the pure blood to every organ or part of the body. The divisions and subdivisions of the aorta terminate in capillary ves- sels, represented by 14, 14. In these hair-like vessels the blood become^ dark colored, and is returned to the right auricle of the heart (1) by the vena cava descendens (15) and vena cava ascen- dens (16). The tricuspid valves (17) prevent the reflow of the blood from the right ventricle to the right auricle. The semilunar valves (18) prevent the blood passing from the pulmonary artery to the riglit ventricle. The mitral valves (19) prevent the reflow of blood from the left ventricle to the left auricle. The semilunar valves (20) prevent the reflow of blood from the aorta to the left ventricle. To efi'oct the complete purification of the whole mass of blood, in an adult of ordinary size, requires a pint of atmospheric air to be taken into the lungs at each inspiration ; and as the usual num- ber of inspirations is about eighteen per minute, the daily supply amounts to three thousand two hundred and forty gallons, or one hundred and thirty-five gallons per hour. TMK HYDROPATHIC ENCYCLOPEDIA: A SYSTEM OF HYDROPATHY AND HYGIENE, I. OUTLINE OF ANATOMY, ILLUSTRATED, n. PETi-SIOLOGY OF THE HUMAN BODY, m. HYG1E^•IC AGENCIES AND THE PRESERVATION OF HEALTH. IV. DIETETIC AND HYDROPATHIC COOKERY. V. THEORY AND PRACTICE OF WATER-TREATMENT. I VI. SPECIAL PATHOLOGY AND HYDRO-THERAPEUTICS INCLUDING THE NATURE, CAUSES, SYMPTOMS, AND TREATMENT OF ALL KNOWN iUSEA.SES. Vn. APPUCATION TO SURGICAL DISEASES. Vm. APPUCATION OP HYDROPATHY TO iUDWITERT AND THE NURSERY. DESIGNED AS A GUIDE TO K-AlLEI^nND STUDENTS AND A TEXT-BOOK FOR PHYSICIANS. ^'BY K. T. TRALL, M.D. OTitf) Numerous ISnflrabcU illustrations. VOLUME 1. NEW YORK: FOWJl^EK AND WELLS, PUBLISB VKS, Boston : i No. 142 Washington St. \ NO. 308 BROADWAY 1857 1 PHiLAPELnn 1 ; \ No. 231 Arcli S^v»^ ./\^* ^ CntLTcd, a:cording to act ^f Congress, in the yeaj* 185 1, oy FOWLERS AND WELLS, te the <:i*>Tk'« Oflicc of the Di^trat Cjurt of the United States for the Southern Dtatr'ai of New York. » 1 V i"^~ PREFACE In the infancy of a system, so comprehensive in its principles and so multitudinous in its details as to embrace all the laws of hygiene, and all the facti of anatomy, physiology, and organic chemistry, it can hardly be expected that its literature will bo otherwise than crude and incoherent. Of the many valuable woi'ks extant on Water-Cure, no one embodies all the departments of science relating to the cure of disease and the preservation of health, into a consistent and philo- sophical system ; nor do all of them together treat of, or even mention, the majority of subjects or diseases inseparably con- nected with, and forming parts of a complete plan of hydro-thera- peutics. In attempting to supply this desideratum, the author has, through the kindness and liberality of the publishers, been enabled to avail himself of nearly all that has been published in this coun- try and Europe directly or remotely connected with Hydropathy, as well as an extensive range of pjivate correspondence, and written but unpublished experience in domestic practice. The great number of topics embraced in the scope of the ^^'ork, rendered the utmost brevity of language indispensable ; hence, in advancing new doctrinal propositions, and in controverting posi tions deemed erroneous, but little space was left for details an explanations. For imperfections in style and arrangement, the only available apology is, the many cares incident to the medical direction of two hydropathic establishments during the whole time occupied in the preparation of the work. New York. 15 Laight Street, 185i». ANALYSIS OF THE C0NTEN18. INTRODLCTION. UiSToxv ' >• •!' II ' INK— Tlit^ Karlicfit AmioiU rhysiciaus- The Early Grecian Physi- cian*— itic nnd th«' Kmpirical Physit-iaus— Medical Philosophers — Hippo- crnVf— ■ rr-^ilnr ! I'ysiciHii — The AlexaiiUrijui School — The Keguiars banished fr, .• I'ractitioncr — Th.' i'rtumaties and Eclectics — The first J . Arabian School — The Monks and Alchemists — The Chem- j, .)! Kuipirics — The Regular and Irregular Coutioversy — '1 —Revival of the Hippucratean Doctrine — 'I'he Fermenta- ti, . rhysicians — The Vitaiists — The Solidists — The Metapb.ys- Icjti l'hy»u lu;l^— i^u. 2i:..i.vi;- — lJ;illcr — The Seiui-iinimists — CulUn — The Brunonian System — Medicine at the end of the Eighteenth Century — Medicine in the United States 9-3S HuTOKY OK BATHtNO.— Ancient Bathing — Bathing in the Middle Ages— Bathing Habita of ditt"i;rrnt Nations — Medicated Baths— Medicaf Testimony in favor of the Remedial Use of Water 36-52 PART I— ANATOMY. Chapter I. Of thk Bones: Osteology. — r-tructure ot Bone — Development — Stages of Ossification — The Skeleton — Vertebral Column — Bones of the Uead — Sutures of the Skull— Orbits ol the Eye — The Teeth — Bones of the Chest — The Thorax — Upper Ks.- Iremitica— Pel vis — I.tjwer Extremities — Sesamoid Bones 53-78 CuArTEB II. Of thk Ligamknts: Syndesmology. — Vertebral Joints — Neck-joint — LowiT jaw — (,'osto-vrrt«bral — Costo-stcrnal — Sternal — Vcrtebropelvic — Pelvis— Sacro- rocrytji'Mti — Puhic — St'rno clavicular — Shoulder — Elbow — Wrist — Carpal — Carpo-me- Ijicarpnl— MeUicarpophalangeal — Phahmgeul — Ifip — Knee — Ankle — Tars;d — Tarsti-me- tatursnl — Mt talarso-phalaii j;ud — Toe 78-3:2 CUATTER III. Ok THK McscLKs : MYOLOGY. — Structure — Development — Cranial Group — Orbitiil. Ocular — Nasal — Superior Labal — Inferior Labid — Maxillary — Auricular- Si:- •' ■ ' ' •' ■ '^- '■ ' ■ rynireal — Linguinal — Pharyngeal — Palatal — Prevertebral — • ' -.—Of the Abdomen — Of the Trunk — Periuea! — Upp< r Ex- tj . . 92-1-26 CliArTRR IV. l»K THE Pasci«: ApoxEunoLOGV. — Cellulo-fibrous Fascia — Aponeurotic FmcIr — Temporal — Cervical — Thoracic — Abdominal — Inguinal Hernia — iliac Fasci;-. — Pc'.ric— perineal— Upp'T Extremity— Lower Extremitj-- Femoral Hernia 1J7-J31 Cmapt *« V. Or THK Arteries: Axgeiology.— Structure— Distribution— Intercom- II ■ - ■ ii''p — Aorta — Innijniinata — Carotids — Temporal — Maxilhiry — Is — Thyroid Axis — Internal Mammary — Axillary — Bracli- i- -c Aorta— Abdominal Aorta — Gastric-^Hepatic — Splenic — MetenUTlc — rpcrraanc — lliacs — Femoral — Popliteal — Tibials — Plan tar— Pulmnna- ry i:U- Uj* t'tiAPTKR VI Ok thk Veins: Angeiology.— Structure — Of the Head— Diploe— Brain — Sinu«r« — Of thn Neck — L'pper Extremities- Axillary, Subclavian, Lower Extremi- tiod — Popliteal— Femora!— Ol the Trunk- Venae Cavse — Portal System — V.na Portto — Pulmonary 148-155 Cmapti R VII. Of the Lymphatics : Anoeiology. — Absorbent System— Valve;— Lyiisphntic Glands — Lnrt- ids — Thornric Duct 1 415-161 CiiAPTKR VIII. Ok th'- ' '- ' ^; Ni-rnnLOGY. — Structure— Ganiilions and Nervous r.'.ntern — Nervecell*- >i],-g — Brain- Cerebrum — ( "ivbelhu:)— Mndulla Ob- lonpatiw -Spinal C^rd— ^ rv.-s— Spinal Nerves — OrgaJiic Nerves— Ganglionic »-"y«<""' lai-ijw c N T l: X T s Chapter IX. Organs of the External Senses.— ?rgnn cf Smell — Orgau of Sight — Organ of Hearing — Organ of 'iaste — Organ of Touch lS9-:203 Chapter X. Of the Viscera : Splanchnology. — Urart — Larynx — 'I'rachea — Thy- roid Gland — Lungs — Pleura — Abdominal Regions — Peritoneum — Alimentary Canal — Pharynx — CEsophagus — Stomach — Intestines— Liver — Gall-bladder — Pancreas — Spleen — Supra-renal Capsules — Kidneys — Pelvic Viscera — Mammary Glands — General Anat- omy of the Foetus _ 2U4-'J34 PART IL— PHYSIOLOGY Chapter L Of the Tissues. — General Characters of the Tissues— Development of Cells — Areolar llssue— Muscular — Nervous — Motory System — Sentient System — Re- flex System — Mental System — Philosophy of Mind — Nervous Influence — Rationale of Muscular Action — Mesmeric Phenomena — Order of Structural Development. . 235-2.50 Chapter II. Of the Special Senses. — Sensation — Sense of Touch— Sense of Taste — Sense of Smell— Sense of Hearing — Philosophy of Sound — Sense of Sight 250-25"} Chapter III. Of Voice and Speech. — Voice — Speech — Vowels — Consonants — Diph- thongs — Triphthongs — Tones — Pitch — Volume — Compass — Musical Notes — Ventrilc quism 257-29 yHAPTEn IV. Of the Individual Functions. — Digestion — Circulation — Respiration — Abfiorption — Nutrition— Secretion — Excretia — Caloritication — Endosmose and Ex- osmose 260-287 riHAPTER V. Of Temperaments. — Nervous — Sanguine— BiUous — Lymphatic . 287-2'JU Chapter VI. Races of Men. — Caucasian — Mongolian — Ethiopic — American — Malay — Origin of Races — Theory of Population 290-294 PART III.— HYGIENE. Chapter I. Of Air. — Vital Property of Air — Quantity Respired — Purity of Air — Change of Air — Position and Habits affecting Respiration — Catching Cold — Purifying the Air— vSleeping Rooms — Stoves and Fireplaces — Lamps — Candles — Gas-burners — Public C.in- veyances 295-304 Chapter II. Of Light. — Relation to Organization — Physiological Influences — Thera- peutic Considerations — Sanatory Inferences 304-307 Chapter III. Of Duink. — Nature's Beverage — Is Man a Drinking Animal? — Quantity — Temperature — Artificial Drinks — Natural VVaters — Purification — Adulterations 307-320 Chapter IV. Of Food. — Chemical Elemrnts — Proximate Elements — Aliments, or Foods Proper — Animal Food — Vegetable Food — Cou(iinienis 320-363 Chapter V. Of Temperature. — Vicissitudes of Weather — Generation of Animal Heat — Capacity to Endure P^xternal Heat — Artiticial Heat — Hcalthl'ulness of Climate — Com- mon Colds — ?.Ieau Tempen-.tures 36.3-3fi7 Chapter VI. Of Exercis:c. — Necessity for Exercise — Physiology of Exercise — Varie- ties — Exercises of Children — Times for Exercising : 3(^7-370 Chapter. VII. Ok Sleep.— Definition — Phenomena — Natural Term of Sleep — After Meals — Position during Sleej) — licda and Bedding 370-374 Chapter VIII. Of Clothing. — Physiological Nature of Clothing — Materials — Color — Particular Garments — Bed and Body Linen — General Rules 374-377 Chapter IX. Of Bathing. — Reasons for Bathing — Methods — Time and Temperature ol Baths — Precautions 377-378 Chapter X. Of the Excretions. — Relation to Nutrition — Involuntary i-vacuations — Voluntary Evacuations 379-380 Chapter XI. Of the Passions. — Mental Hygiene — Passions as Afl'ecting Health — Healthful Exercise — Relation to Longevity — Relation to the Secretions — Physiological Law of the Passions 38 L-383 Chapter XII. Of Longevity.— Natural Duration of Life — Examples of Longevity — Natural Death — Advantages of Longevity — Special Means — Occupations as Affecting Longevity 383-Ii96 PART IV.— DIETETICS. Chapter I. Dietetic Character of Man.— Bible Evidence — Anatomical Evidence-- Physiological Evidence — Medical Evidence — Ckemical Evidence — Experimental Evi- dence... 397-417 vi CONTENTS. rHAPTitm II. HronoPATHic CooKKRV. — Prnctical Co:is:dcrati«in8 — Prcparariors of Ani- mal Food— l'r«|iariiUoiia ot Vi-gclnble Food — iireads- — .Seeds — Mushes — Graels and i?oup»— l'u.idinL'8 — l'a*try — Cak.-s— Hoots— Oretn Vegetables — Fruits — Nuts— Condi- menu 417-141 Chafti^m 111. DiETABiKS. — Gcueral Uules lor Invalids — Therapeutic Divisions of Diet— I>irl lor Tuhlic Inatitutions 441-400 IWRT v.— THEORY AND PRACTICE. MAi'TKB I. iHiLosorHV OK WatekCubk. — Relations ot Water to the Healthy Organ- i>ro— .Modus Out-randi— Watt-r and Urugtieatiuent Contiasted— Rationale of Drug-med- scatioti «>-~^ CMArrKR 11. Watek-Cube l'Bf>CKSSKS. — Wet-shect Packing— Half-pack — Douche — KuM .1:.: ^\^•t sheet — Hip, or Sitzbath — Half-balh — Plunge — Footbath — Head-bath — «) • ract-bhlh — Dry Pack, or r^weatingbath — Vapor-bath — Wave-bath — River- b' ith — Fountain, or .^prnj-bnth — Portable f^hower bath — Atfusion — Tow«'\ or '"' • !res8 Path — Warm and Hut Baths — Swimming-bath — Eye and r -Oral, or Mouth-bath — Arm-hath — Hand-bath — Finger-bath— L' . \ir-bath — Fomentiitioua — llandagts — Chest- wrapper — Abdom- hi -Vfiiuoii — Temperature of Baths — Duraticm of Baths — General Rules for U\ iiathing — Water-drinking — Lavements and Injections 22-59 Chaj-tku ill. Cbisks. — Docriue of Crisis — Forms of Crisis — Management of Crises — Kationale of Crisis 59-67 Chapter IV. Ok the Pclsb. — Nature of the Pulse — Varieties of Pulse — Indications of the I'uise 67-71 PART VI— PATHOLOGY AND THERAPEUTICS. CiiAPTBK I. Or Fevers. — Classifiratlon of Fevers — General Characters — Causes — The- ory — Type — Rationale — Crisis — Duration — General Treatment — Ephemeral — Inflam- matory — Yellow — Nervous — Putrid — .*^hip — Spotted — Cainji — Jail — llospital — Marsh — Typhuid — H«-niittent — Intermittent — Symptomatic — .Small-pox — Chicken-pox — Cow- pox — Measlen — Scarlatina — Erysipelas — Miliary — Plague 72-107 Chattkr !!. Vi^rEBAL Inflammations. — Theory of Inflammation — Rationale — Varie- li< - — General Treatment — Phrenitis — Quinsj- — Laryngitis — Croup — M' irt, or I'leurisy — Carditis — Hepatitis — Splenitis — Gastritis — Enteritis — i\... ...... ,,.-teritia— Orchitis 108-1^2 rMArTEB III. AuTiiniTis. — Podagra, or Gout — Rheumatism — Lumbago — Sciatica 122-1S8 CiiAi»Tra IV. Indiokstion. — Dyspepsia — Liver Complaint — Misdentition — Colic — Chol- era — Diarrbea — Inleolinal Concretions — Worms — Hemorrhoids, or Piles 12S-150 Chaftkr V. Flixks.— Catarrh — Influenza — Dysentery 151-1.33 Chaptrr VI Caciikx'ES. — Censumption — Marasmus — Atrophy — Anbseniia — Tabes — l-.i,...,. .-1 ..,._! ,. .t y,c — Heimoptysis — Hajmatemesis — Haematuria — Scurry — Pleth- or .M'lnn(,sia — Catacausis 154-180 Cmat !■ . iiii. 1'.-: \.K.s OF THE E.u».— Otitis— Otorrhoea—Deaftiess— Otalgia— For- eifrn liixin • and lii-r.ts 137-195 Cmaptkh IX. ERvriiK.MATO(;s I.nflam.matioxs. — (Edematous— Erysipelatous — G«u- KTeBous—AnsUiraical—Chillilain— Fret— Nettle-rash— Aptha, or Thrush— Pemphiijus— ^^'"'*» 195-203 CiiAPTKa X. s.— Convulbions — Epilepsy— Hysterics — Tremor — Debnuni It —St. Vitus' Dance— Raphania—Rarbiers—Coueh— ^y s — Bronchitis— Sternalgia—Pleuralgirt— ''■. II— Subsultus — .^tretchii.g— Hydrophobia ?:•' ■ — K, ,.j,*\ -( i;unp — Muscular Distortion of the Spine — Mu»cular .*'t ly Neck 204-239 ^"*^"" ^^. , '7 f^'KNKRAL ToBpiTiDE.— Asphyxia- Ecstasy— CatJ.kpsy— I^thnrKy—Apnpifxy— Palsy _ _ 2;J9-^45 *^*f^-Ifi« '^' o ^''"'^f"^^'r^'5°*»S*'''^*"-"<^P«^c--'^Plenic-I'"°'-^eaHc--.MeVenU>ric-^ iDtcsUnal— Omental— Coirphcated _ *>18-''")3 'J N T E N T S. vii % Chapter XIII. Dropsical Diseases. — Anasarca -CEdema — Hydrocephalus — Spina- bifida — Ilydrothorax — Ascites — Hydrops Ovarii — Hydrops Tubalis — Hydrops Uteris Hydrocele — Emphysema — Puerperal Tumid Leg — Tropical Tumid Leg 25:2-261 CHAPTER XIV. Diseases of Mis-ossification. — Rickets — Cretinism — Mollities Ossium — Fragilitas Ossium — Osthexy — Exostosis 262-264 Chapter XV. Diseasks of Sensation. — Headache — Neuralgia — Sleeplessness — Rest- lessness — Antipathy — Vertigo — Syncope — Morbid Sight — Morbid H „-aring — Morbid r^mell— Morbid Taste— Morbid Touch 264-272 Chapter XVL Mental Diseases. — Insanity — Melancholy — Madness — Fury — Despond- ency — Hallucination — Sentimentalism — Hypochondriacism — llevery — Absent-minded- ness — Mental Abstraction — Brovvn-sludy — Somnambulism — Sleep-talking — Fatuity — ■ Irrationality — Imbecility 273-280 Chapter XVII. Diseases of the Vocal Avenues.— Catarrh — Ozaena — Polypus- - Snoring — Wheezing — Speechlessness — Dissonant Voice — Stammering — Misenuncia- tion 280-284 Chapter XVIII. Diseases of the Sexual Function. — Mismenstruation — Amcnor- rhoea — Dj^smenorrhoea — Chloro.sis — Leucorrhoea — SpermorrhcEa — Venereal Dis( ases — Satyriasis — Nymphomania — Di.splacements 285-296 Chaptep. XIX. Diseases of the Urinary Organs. — Suppression of Urn.'- — Ischuria — Strangury — Diabetis — Eneun^sis — Urinary Diarrhea — Vicarious Urination — Gravel — btone. -T 296-300 Chapter XX. Diseases of the SKiN.^-Roseola — Gum Rash — Lichenous Rash — Pru- ricinous Rvish — Millet Rash — Wvter-blebs — Herpes — Rhypia — Eczema — Veal Skin — Mole — Freckles — Sunburn — Orange Skin — Piebald Skin — Albino Skin — Cyanosis — Lou- sines.? — Insect Bites — W()rms — Dandruft' — Leprosy — Psoriasis — Icthyiasis — Impetigo — Porrigo — Ecthyma — ScaUies, or Lch — Morbid Sweat — Morbid Hair 301-31 1 Chapter XXI. Poisons. — Acids — Alkalies — Neutral Salts — Mercurial — Arsenical — An- timonial — Lead — Coppe)- — Bismuth — Tin — Silver — Gold — Iron — Zinc — Manganese — Io- dine — Phosphorous — Sulphur — Chrome — Bromine — Alum — Platina — Barytes — Metallic Salts and Oxides — Narcotics — Acrids — Mushrooms — Poisonous Fish — Serpents and In- sects 311-324 PART VIL— SURGERY. CiiAPTEH I. Surgical Appliances. — Instruments — Compress — Ligature — Sponge — Adhesive Plaster — Tents and Pledi.:ets — !)ry-cupping — Bandages — Splints — Caustics- Torsion — The Tourniquet — Congelation — Fomentations — Emetics — Anaesthesia — Hae- mastasis — Transfusion 325-331 Chapter II. Wounds. — Distinctions — General Consequences — Treatment 332-334 Chapter III. Injuries. — Concussion — Compression — Bruises — Strains — Burns and Scalds — Part-icvjlar Wuuuds and Iisjuries 334-339 Chapter IV. Tumors. — Whelk — Sycosis — Warts — Corns — Bunion — Onyxis — Gangli- ons — llanula — Epulis — Bronchocele — Whitlow — Schirrus and Cancer — Fungus Haema- todes — Bone cancer — Carbui:ole — Lupus — Aneurism — Varix — White Swelling — Hy. drops Articuli — Varicocele — IlEsmatocele — Sarcocele — Hernia Humoralis — Cystic Sarcoma — Polj'pi — Enlarged Pro.-tate Gland 340-355 Chapter V. Ulcep-s. — Furunculus — Parulis — Fever Sores — Caries and Necrosis — Fis- tula in Ano — Fistula in Periniio — Strictures and Fissures — Salivary Fistula — Fistulas Lauhrymalis 356-364 Chapter VI. Abscesses. — Empyema — Maxillary Abscess — Mammary Abscess — Onyx — Lumbar, or Psoas Abscess — Hip-disease — Prostatic Abscess 365-368 Chapter VII. Herni.^, or Ruptures. — Varieties of Hernia — Technology — P.ath- (ilo>?ical Distinctions — Special Causes — Diagnosis — General Treatment — Radical ('.urn 369-377 Chapter VHI. Deformities. — Hare-lip — Tiod-tongue — Enlarged Tonsils and Uvula — Squinting — Superfluous Fingers and Toes — Web lingers — Wry Nock — Spina Bifida — Spinal Curvatures — ^^lercurializcd Tongue — Pseudarlhrosis — Club-foot — Contracted Sinews 377-384 Chapter IX. Dislocations. — Technology — Dislocation of the Jaw — Clavicle — Shoul- der — Llbow — Wrist — Carpal and Metacarpal — Fingers — Hip — Knee — Ankle — Foot — Toes 385-407 Chapter X. Fractures. — Technology — Fractures of the Cranium — Nose — Lower-jaw — Scapula — Clavicle — Sternum — Ribs— Spine — Pelvis — Humerus — Elbow — Fore- arm- Wrist— Hand— F'agers— Thigh— Patella— Lrg— \nkle— Foot 407-423 Tm CONTENTS. CHArTKH XI. Taiwicvlar Opkhations. — Trephining — paracentesis Capitis — Paracen- ti.'s!^ Oru'i— F!^•.u!:^ !.Mi hry malis — T'litropium and Ix-tn-piuni — AnchyJoblcp'naion and t;\:i iinii Lnffopiithalmos — Bl< iilmridoplastice and Khinorrbape — 1,1 , itoiny — Kfratoplagtice — Cituplatti'-c — Chelio and Genio plas- t;. tion, AbborptioTi, or Solutitm — IVcthdravving — Pumping^ the t^t -Inoculation — Qisophagotomy — {-'hoking — Laryngtoiuy — Tra- ch' > Abdominis — I'araccntesis Vesicaj — Imperforate Anus — Imper- fori*:-- Licthru — LiUiuulripBy and Lithotomy — Amputation — Ligating and Compressing^ Arwrua 423-437 PART VIII.— MIDWIFERY. CiiAPTF.R I. HiSTOKV OK MiDWiFKRY. — AncicHt Midwifery — Modern Midwife: y — F.; malu Authors wnd Practitioners — Man luidwilcry — Who should be Midwives? . A'.id-4i'.j CiiAPTEB II. Kepkodcction. — Theories of Reproduction — Transmission of Organiz i- tion — '11x0 Mart lageable Age — physiological Law of Marriage 443—147 CilAPrKR in. I'livsioLOGY uF THE FffiTV s. — Foptal Development — Fcetal Circulation — 'I'Uri Thymus (iland — The Placenta — The Umbilical Cord — The Liquor Amnii. 447-4.jJ CiiApTBB IV. Obstetrical Anatomy. — IJonos of the Ptlvis — Cavity of the Pelvis— Di'tmcters of the I'elvi.': — Deformities of the Pelvis 45"J-45J CiiAPTKH V. I'REO.NA.NCY. — >'igns of rrfgiiiincy — Dm||tion of Pregnancy — Extra-uter ino Prognnncy — Supertoetation — Pathology of the Foetus — Hygienic Management dur- ing l'r«'gnnncy — Accidents of Prcgmmcy 455-460 Chapter VI. Pahtuhition. — Rationale of Labor — The Pains of Childbirth — Medicating Labor Pains — Natural Labor — Diagnosis of Presentations — Stages of Labor — Position (luring Labor — Mkinagcnient during Labor — The Albr-birth — After-management — Convalescence of Lying in Women — Accidi^nts during the Lying-in Period... 461-475 chapter VII. Infant Nursing. — Dress of Infants — Bathing — Food — Drink — Sleep — Exerciec — Kxcretions — Teething — Drugging — Infantile Diseases 475-482 Chapter Vlll. Complicated Labors. — Tedious, or Protracted Labors — Preternatural Pi ■ ■ _■ ■ • ••: VI ..:-.,- — Face Presentations — Breech Presentations — F Mons of the Superior Extremities — Compound I': — Prolapsed Cord- — Retained Placenta — Hem- «)rriiage — c'unvuisiuus — i^ufrperai Mania — Letcerations 463-49"} ArpKNDix — Thcoiy of Conception f9?-4&l flYDROPi\THI(; ENCYCLOPEDIA, INTRODUCTION. Before t^e prevailing medical practice can be revoluUonized, and a system introduced at variance with established usages — in direct antag- onism with the general habits, customs, education, and prejudices of the people ; in utter contempt of the teachings and practices of great and venerable names, and opposed to the pride, interest, reputation, and even conscientious convictions of a learned, honorable, and influen- tial profession — the intelligent portion of the comnmnity will demand reasons the most profound and evidences the most conclusive, while the illiterate will require an accumulation of facts and details absolutely overwhelming. The philosophy of life and health, the laws of the human organism, and its relations to suiTOunding nature, have been, in my judgment, al- ready sufficiently demonsti'ated to satisfy the intellectual mind of the former class, and their application lo the preservation of health and cure of disease amply demonsti'ated by actual experiment for the ex- ercise of the faith of the latter ckss. All that seems necessary now, in order to achieve that great reform in human society, which shall restore to the individuals who compose it " sound minds in sound bo- dies," and that exalted state of happiness which human nature is sus- ceptible of, even in this world, is, to commend these great truths to the thoughts and feelings of human beings in such a manner that they shall be exemplified in their lives. A short sketch of the origin and progress of what is called medical science will exhibit the baseless fabric we are laboring to demolish ; and a brief review of the history of bathing, as it has been employed rem- edially in all ages of the world, will prove that the Water-Cure, though in its infancy as a system of the healing art, has had, in all its essentia particulars, the snnction of the most learned men of all professions in 10 INTRODUCTION. all ages. These topics, therefore, preseat themselves as forming a prrtiiient introduction to this work. iMaiiy of thf hlsto*" ••»1 datu rehitive to these subjects are collected from liostock's History of Medicine, and Bell's work ou Baths and the Water R«'^imen. In the application and genemlization of these data, and in relation to the principles to which they refer, I have, how^ever. ditfored often and widely from these authors niSTOEY OF IMEDICINE. Writers generally agree that medicine first became a profession anions the Eiiyjuians. Its origin, however, is involved in fabulous and impenetrable obscurit}'. In Egjpt and in most of the earlier nations the priests were the practitioners of the healing art ; and unfortunate was it for the human race when medicine was "elevated to the dignity of a distinct profession." To me the priest appeai-s to be the proper person to teach the body as well as the soul " the straight and narrow way." The functions of mind and body ai-e so intimately related, all the powers of the one and organs of the other constantly acting and reacting on each other, that I cannot imagine how it is possible for the spiritual or physiological teacher to do full justice to man in either re- lation of his existence without understandins; the laws of both. JsTar, I would have the same person exercise the function of priest, doctor, lawyer, and schoolmaster ; and that individual who can present to his f»*llow-rreatures the most harmonious whole of a human being — who ran best teach in theory, and most faithfully exemplify in practice, tlie laws of being in his moral, physiological, legal, and social relations, should belong to the learned profession and be a leader among men. Tin: Karlikst A.nciknt Physicians. — The Egyptian priests prac- Ui"'\ the healing art by means of magical incantations, which, of • nurse, produced their good or bad impressions through the medium of the imagination, the elTicacy of their prescriptions bearing a pretty exact ratio to the superstition and credulity of their patients. The medical practice of the Assyrian priests consisted mainly of magical aits, while the actual learning they possessed was carefully concealed in a mystical technicality. Among the early Jews the priests, who were tlw physicians also, treated the leprosy and other di^^eases with various ceremoni<^ to affect the imagination, at the same time enforc- ing.judiriou? regulations to avoid the sources of contagion, and promote personal cleanliness Tmk Kauly Grkcia.n PnvsriAN? —In G .eece the genius of Hip- HISTORY OF MEDICINE. 11 pocrates first caused medicine to be regarded as a science, though Chiron, who hved about 1300 e.g., is accredited for having introduced the healing art to his countrymen, ^sculapius, a pupil of Chiron, is considered the first person who made medicine an exclusive study and practice. His sons, Machaon and Podalirius, are celebrated in Ho- mer's Iliad for then- medical skill, though, as they were employed principally as surgeons in the Greek armies, then* medication was doubtless mostly confined to cmde yet simple methods of dressing wounds and recent injuries, which were exceedingly common in that warlike age. The descendants of iEsculapius, called Asclepiadoe, were the priests of the temples ; and the temples were the hospitals to which the sick were brought, where the priests performed numerous imposing ceremonies to inspire confidence, and gave various directions conducive to temperance, cleanliness, and simplicity of diet. The temples were located in the most salubrious places, and in them frequent ablutions were recommended for the sick ; these w^ere, no doubt, the real cura- tive agencies. W« have no knowledge that iEsculapius, or his immediate successors, ever conceived the idea of curing diseases by drugs administered inter- nally. Ablutions, bandages, fomentations, ointments, mechanical sup- port, and the application of balsamic and astringent herbs, with the occasional use of wine or other stimulating substances, constituted their whole and their ample materia medica ; and these were aE employed externally. The Dogmatic j^^d the Empirical Physicians. — For several centuries succeeding the age of iEsculapius and his sons, we have no records that medicine made the least progi-ess. Numerous temples w^ere erected in honor of iEsculapius, ^\ilo was deified as the god of medicine ; and in these temples a practice obtained among the patients of recording on a tablet, for the benefit of others, a statement of their diseases and the means by which they were relieved, thus converting the temples into schools of medicine. But then there w^ere men of superior sagacity and inordinate selfishness, who desired to turn the common knowledge to individual cidvantage. The temples of Uos and Gnidos became rival establishments. One assumed to be philosophical, by uniting reason w^ith experience, while the other professed to be goverr^d solely by facts and observations. Thus arose two medical Beets — tiie Dogmatists and the Empirics, who long divided the medical world, and whose influence is not yet extinct, for we find at tnis day many physicians who follow wherever theory leads, regardless of facts or consequences ; and another set of practitioners who are merely 12 INTRODUCTION. routine imitators, without a particle of pretension to any rational HN >tf!ll. Mkdk AL 1'milosopukrs.— i*ytlmj,^oi-as, in the sixth century before Christ, \\f\s tlie pioru-t-r of n class of scholars of general information and philosophinil mind, who gave much attention to the mvestigation of the Btructures, functions, and diseases of the human body. He established a school at Crotona, to which students resorted from most parts of Greece and Italy. Mor« than twenty years of his life were spent in Kg>'pt, Chaldea, and Eastern Asia, and he prosecuted the study of com|)arutive aujitomy I)y dissecting animals. His pupils were not ex- clusively devoted to medical studies, but were among the men most celebrated for general erudition in that and in the succeeding age. Aniong the most illustrious of his followers were Democritus and Hera- clitu.s, the f( inner being regarded as the first person who attempted the dissection of a human subject. Acrou is mentioned by Pliny as among the first who undertook to apply philosophical reasoning to medicine. Herodicus is considered the inventor of gjarinastic exercises, which the Greeks regarded as an important branch of the healing art. Hiri'ocRATKS. — One of the most sagacious, observing, and indus- trious men that ever lived was the "Coan Sage," who has been enti- tled the " Father of Medicine." Hippocrates was a pupil of Herodicus, brought uj) among the Asclepiadac, in the temple of Cos. He traveled much in foreign countries, devoting himself to the study and practice of medicine with untiring energy, and his works became text-books for many ages; even to this day his leading docti'ines are extensively rec- ognized. His practice has been called a rational empiricism ; in other wonl?. a careful observation of facts, and a reasoning process based ujx)!! their ron-equences. His first philosophical proposition regarded fire as the primitive source of all matter, the four elements being a result of the collision and combination of its ever-moving particles; and his li'ading physu)!ogical proposition was, the existence of a general presiding principle of vitality for the whole body, and a special vital power in each organ. If we substitute the modern term, electricity, for his "fire," and the modern phrases, organic sensibility, and special centre of organic perception, for what he calls "nature" and "power," we shall very nearly harmonize his ideas with those entertained by pomo of the ablest livii ' -logists. His docti-ine that the fluids Were the primar>' seat . o was never disputed, save by some email factions of medical nu-n, u!itil about the commencement of the •ightejMith ce^iturv und oven r)ow it has at least as many advocates b» HISTORY OF MEDICINE. 13 opponents. In his system the combinations of the four elements of fire, air, earth, and water, with their four qualities of hot, cold, moist, and diy, gave rise to the four humors of the body, blood, phlegm, bile, and black- bile, which originally tended to produce the four temperaments, and which in their turn contributed to the excess or defect of»each of the humors. These speculations, crude and fanciful as they may be, at least indicate a powerful tendency in the mind to analyze and systematize. The doctrine of crises originated with Hippocrates. He noticed that fevers evinced a tendency to terminate on particular days, which he called critical ; and he observed that there is a tendency in all dis- eases to a cure by some eruption or evacuation. His practice was consistently founded on the indications presented by these phenomena. Modern physicians have been most unfortunate in overlooking or disre- garding these fundamental truths, which happily are now being re- established by the water-treatment. His materia medica was derived wholly from the vegetable kingdom, the horrid chemicals, metallic salts^ and oxides, acids, and spirituous compounds, which have since " demon- strated the eflQciency of our arms," in. killing pain and patients, being then unknown. Purgatives, sudorifics, diuretics, and injections were his principal internal lemedies, while externally he employed bleeding, issues, ointments, plasters, and liniments. The following extract from Bostock shows a remarkable congruity between the leading practical idea of Hippocrates, and the doctrine universally acted upon by hydropathic practitioners ; "The gi'eat principle which dh'ected all his operations was the supposed operation of 'nature,' in superintending and regulating all the actions of the system. The chief business of the physician is to watch these operations, to promote or suppress them according to circum- stances, and perhaps,' in some rare cases, to attempt to counteract them. The tendency of this mode of practice would be to produce extreme caution, or rather inertness, on the part of the practitioner, and we accordingly find that Hippocrates seldoin attempted to cut short any morbid action, or to remove it by any decisive or vigorous treatment. Considering the state of knowledge on all subjects when he lived, it must be admitted thatihis plan of proceeding was much more salutary than the opposite extreme, and that it had likewise the good effect of enabling the practitioner to make himself better acquainted with the phenomena of the disease, and, by observing the unaided efforts of nature, to form his indications with more correctness, and to determine to Avhat object he ought more particularly to direct his attention." It must be admitted that the bleedings, active purgatives, the sweat- ings and diuretics of the Hippoeratean practice were inert comr^r^d U INTRODUCTION with the more profuse bleedings of the moderns, and their hundreds of mineral poisons; but the constantly accumulating number of chronic diseases, and the greater fatality of acute, certainly favor the idea that our modern .Esculapians, though much more iwwcrful doctoi-s, ai-e much Uss successful ones. Thk First "Irregular" Physician.— Subsequent to the age of Hipixicrates, medicine remained stationary for several centuries. His sons, Thcssidus and Draco, his son-in-law Polybus, Diodes of Carystus, and Praxagoras of Cos, ai-e the only names distinguished among his immediate successors One of their coutemporaiies was a Dr. Chiysip- pus, who opjwsed bleeding and the employment of active purgatives ; he was, however, regarded as a sort of "uTegulai'," who did not pay due deference to the authority of gi'eat names. Plato and Aristotle, like most of the ancient Greek philosophers, were conversant witli the medical doctrines of their day, though not practicing physicians. The latter published the fii-st works on anatomy and physiology, and all his \vi"itiugs, though full of refined vagaries, held a strong influence over the public mind for many centuries after his death. The Alexandrian School. — The Ptolemies founded a medicai ecliool at iVlexandria about 300 b.c. The most fam&us of its professors were Erasistratus and Heroj)hUus, who dissected bodies of criminals obtained of government. Erasisti'atus, having been a pupil of Chrysip- pu.*", adopted his opinions against bleeding and violent remedies, profess- ing to trust nature more and art less. Herophilus paid particular nttention to the action of the heart, and w\is the first to give any thing like an accurate description of the various kinds of pulse. Soon after the institution of the Alexandrian school a division of medical men occurred, by which the practice of physicians proper, or dietetics, and druggist;?, and surgeons, became distinct vocations ; and uot lung after this event the gi'eat schism occurred which divided modiral men into two sects, the Dogmatists and Empirics, already mentioned. All the medical men of the day, and for several succeed- ing ages, were attached to one or tlie other of these rival parties. The Regulars Banished from Rome. — After the decline of Grecian lit*'niture. medicine, as a distinct pursuit, made no progi-ess for a long time. During the warlike days of Rome, she was, for six hundred years, without a physician who made the healing art a pro- fcssior. The superstitious and :erenionios of the Greeks were ti'ans- HISTORY OF MEDICINE. 16 Dorted to Rome, and plagues and other epidemics were attempted to be stayed by such rites as would propitiate the offended deities. Pliny states that about two hundred years before the Christian era, the first regular physician, by the name of Arcagathus, established himself as a practitioner at Rome. He was received at first by the people with respect and even reverence, but so severe was his practice, and so un- successful its results, that disgust succeeded admiration, and caused the citizens to prohibit the practice by law, and banish its professors from the land. About a century after, Asclepiades, of Bithynia, a pupil of Epicuras, went to Rome as a teacher of rhetoric. Being unsuccessful, he turned his attention to medicine, by which he acquired gi'eat popularity. His practice was very mild and cautious, and as he denounced with vehe- mence the harsh measures of some of his predecessors, he was then regarded by his contemporaries, and is now by medical historians, as a sort of irregular, or quack. He was the first to arrange diseases into the classes of acute and chronic. His pupil, Themison, of Laodicea, founded a third medical sect, called the Methodic, who adopted a kind of eclectic system, combining parts of the systems of the Dogmatists and Empirics. Like his master, his philosophical notions were mainly derived from Epicurus. Diseases he referred to states of contraction and relaxation, and remedies were divided into two classes, asti'ingents and relaxants. The Methodic theory regards the solids as the primary seat of disease, thus opposing directly the Hippocratic doctrine, or humoral pathology. The First Heroic Practitioner. — The next individual of note whose discoveries or vagaries have had an important bearing on medical practice was Thessalus, who lived half a century later than Themison. By pompous pretensions, swelling self-sufficiency, and abundant cun- ning, he acquired gi'eat reputation and wealth ; he treated all his pre- decessors and contemporaries with the utmost contempt, and even took to himself the modest title of the Conqueror of Physicians. He intro- duced a new method of medical treatment, called metasynocrisis, which, unhappily for mankind, "has been too much followed by the medical world. It consisted in producing an entire change in the state of the body, instead of merely regulating, correcting, and removing morbid actions and symptoms after the Hippocratic plan. It may possibly startle the non- medical reader to be informed that a principle so manifestly absurd, and promulgated by its author dy fabricator for no other purpose than to get gold and fame, was generally adopted by subsequent medical writers, and is '^\v tlie principal ccnaer-stone of orthodox medical 16 INT n o u i: '■: 1 1 o N , practice. Until the acUoiit of Thc^salus, the phj'sicians were content to study the iiulicitioiis of nature, aid and assist her efforts, and remove obstacles in her way. Since his time faith in the integi-ity of nature has steadily declined, and reliance on the power of art as steadily ad- vanced, until we behold a body of learned professors of the healing art sending the most deadly and desti'uctive agents to ravage within the domain of vitality, liecdless of, or faithless to, the great tmth that nature, and nature alone, is the true physician. Soranus and C. A^relianus are the next Roman physicians of celeb- rity. They were strict Methodics, and theii wTitings did much to dvance the particuhr notions which they had imbibed ; then* remedial measures were, however, ver}- mild, and licnce generally successful. But it is wortliy of especial remark, as evidence of the powerful influ- ence of a preconceived tiieory over the exercise of judgment, that modern writers, who have generally adopted the heroic notions of Thessalus, condemn the practice of these Methodics for its want of vigor and promjJtness. Its success was no argument in its fiivcr so long ns it >\'anted power ! Abstinence, the batli, frictions, and external ap- plications were tlieir leading remedial measures. Topical bleeding was also employed, though general blood-letting was rai'ely resorted to ; narcotics and oleaginous applications were frequently used, and gi-eat attention paid to pure air ; sometimes a moist air was enjoined. The Pneumatics and Eclectics. — During the first two centuries of the Christian era the Methodic sect prevailed, yet the peculiar speculations of differcr.t individurds were gi-idually inti'oduced, causing at length the formation of several subdivisions, or new sects, of medical practitionei-8, the most prominent of which were the Pneumatics and the Eclectics, or Epit>ynthetics. Pneumatology and eclecticism are not therefore quite as modern notions as man}- have supposed. The PneumiUics evidently had a glimpse of the trae idea of vitalitj^ yet were incapable of expressing it rationally. They taught that the human boily was composed of solids, fluids, and spirits. Their ideas of tlie sj)iritual agency in the production and cure of disease were etrikingly analogous to the modern doctrine of the nervous influence. The moat eminent ^vl•itor of this sect was Aretreus. His practice was more active and less expectant than that of the Methodics. The most celebnited of the Eclectics was Archigenes, of Appamea. who practiced at Rome in the time of Trajan. His A\Titings are ex- tremely obscure and chimerical, yet he acquu-ed gi-eat popularity and influence ; perhaps he is as much indebted to the uninteUigible chai'ac ter of his works as to any other circumstance for his faiCB. HISTORY CF MEDICINE. 17 Celsus is the first native Koman physician of whom we ha\e any account. He wrote several books on medicine, which show tliat sm*- gery and pharmacy had made considerable progi*ess. It is difficult to class him with either of the sects of his day ; in practice he pursued mainly the method of the Asclepiadcs. His origin, or the age in which lie lived, are not precisely known, though it is conjectured that he lived in the reigns of Augustus and Tiberius. The First Pharmacopceia. — In the reigns of Claudius and Nero a class of ^vl•iters became famous by their pharmaceutical preparations. The most notorious among them were Scribonius Largus, who made h book of nostrums and indiscriminate formulae, and Andromachus, who compounded a medicamentum of sixty-one ingredients. It was called the theriaca, and its most essential constituent, from which its name was derived, was the dried flesh of ^^pers ! This preparation has since been recommended, by regulcU* physicians, for almost every known disease, and was even retained in the pharmacopceias of the schools until the beginning of the present century. lu fact, the cod- liver oil of this day has not been a greater hobby with modern physi- cians, than with the ancients was the viperous compound of Androma- chus, who, for his marvelous learning and skill in mixing together the most incongi'uous articles in the most nonsensical manner, was honored with the title of Archiator, or Principal Physician — a title bestowed by the Roman emperors, and continued for several centuries. Pliny, though not practically a medical man, was, nevertheless, fa- miliar with all that was taught on the subject in his time. He repre- sents the prevailing practice as essentially empirical, consisting of va- rious vegetable and animal mixtures, administered with scarcely any inquiry whatever into theu' mode of operation. Dioscorides Avas a distinguished author at the same period. An elaborate treatise which he %vrote on materia medica was the standard production for many ages subsequently. It contains descriptions of all articles then employed in*medicine, with an account of their supposed virtues, much more curious, however, than useful. Galen. — The name and history of Galen are more familiar to modern practitioners of the healmg ai*t than are any other ancient physicians. Thoroughly educated in all the schools of philosophy, he selected from them all, except the Epicurean, which he totally rejected. He was a native of Pergamus, b it, after ti-aveling extensively, at the request of the Emperor Aurelius settled in Rome. His works num- ber nearly two hundred treatises on alL subjects directly or remotely 18 I N T R D D U C T 1 N. connected with medicine. In the formation of opinions he was entirely- independent, paying veiy little respect to authority ; and so gi-eat was the reputation he acquired for learning, skill, and wisdom, that his opinions were regarded by many as oracles. In theory he was with ho Dogmatists, and in practice he professed to venerate and act upon the principles of Hippocrates. In Galen's time the Roman empire began to decline ; and the gene- ral decay of science and literature in the middle ages succeeding, has left little to record in the shape of innovation. Sprenzel has pithily characterized the medical writei-s of the third and fourth centuries as " frigid compilers, or blind empirics, or feeble imitators of the physician of Pergamus." Oribasius, who lived in the fourth centuiy, Aetius in the fifth, and Alexander Trallianus and Paulus ^Egina in the sixth, wrote books which professed but little more than to be compilations of, and commentaries on, the works of Galen The Arabian School. — With the death of Paulus, about the mid- dle of the seventh century, terminated the Greek school of medicine. The Arabians, who conquered a large portion of the semi-civilized world, destroyed the immense Alexandrian library, yet the Arabian phy- sicians had adopted the opinions of Galen, and followed his practice im- plicitly. But a new school soon arose among them, ownng to the inven- tion of chemistr5% and its being made subservient to medicine. One of the most celebrated Ai-abian jihysicians was Rhazes, bora at L-ak, in Persia, in the ninth century. His writings, though mostly comments on Galen and the Greek physicians, contain an original and elaborate treatise on the theory and treatment of small-pox and measles. In his writings on surgery and pharmacy are found indications of the em- ployment of chemical remedies, which formed so important and so dis- astrous an era in medicjil history soon after. After Rhazes flourished Ali Abbas, a physician and writer, who ob- tained the tirio of magician ; and about a century later appeared on the stage Avicenna, who acquired a reputation among his countiymen not inferior to that of Galen. He was born at Bokhara, a.d. 980, and was carefully educated in the schools of Bagdat, His published works were nun>erous, and his " Canon Modicinae," a kind of encyclopoedia of ex- isting medirnl sciences, was the text-book in nzost of the Arabian, and even European, schools for several centuries. Mesne the elder, Mesue the younger, and Albucasis were among the last Arabians of distinction who ^^T0te much on medical subjects. Avenzoar, and his pupil Averroes, natives of Spain, wrote voluminously HISTORY OF MEDICINE. 19 in the Arabic language, and enjoyed great celebrity, but their works have added nothing substantial to those of their predecessors. With Averroes terminated the Arabic or Saracenic school of medi- cine, the great reputation of which is mainly owing to the circumstance that, from the eighth to the twelfth centuries, Avhen all Europe was sunk in deep bai'barism, the principal remains of a taste for literature and science existed among the Moors and Arabs. Medical historians give the Arabians credit for having added many vegetable products, and a few metallic salts and oxides, to the catalogue of remedies. The spii'it of the age, then, among those eminent m the profession — not un- like the spirit of the present day — was that of emulation in wi'iting the greatest number of books, and finding out new substances which could be taken into the stomach and applied externally, and called medicines. The intelligent reader will not fail to perceive that thus far, in medical histoiy, the merit of successfiil practice, amid all the conflicting notions that have by turns prevailed, is fairly attributable to hj^gienic regula- tions, particularly as regards diet and bathing ; while the necromancy and the drugging may be regarded as having been accidentally useful or injm'ious, according to ch'cumstances. This principle, which is the ti'ue key to the intei-pretation of medical testimony, will become more and more apparent as we proceed. The Monks and Alchemists. — From the twelfth to the fifteenth centuries the practice of medicine, in those countiies best known to us, was principally in the hands of the monks, whose healing resources were mainly drawn from magical arts and asti'ological superstitions. The mystery of this system enabled the practitioners to acquire an un- bounded influence over the ignorant masses. Chemistry, or, rather, alchemy, was then prosecuted with much ardor, with the view of discovering a method of transmuting the baser metals into gold, and of preparing a universal medicine — conceits which seem to have been very generally entertained by theHearned of that period; and the pursuit of them led to many experiments and the introduction of many chemical preparations into the materia medica, and, indeed, laid the foundation of the mineral drag system of the present day. Most of the alche- mists and medical pretenders were knaves of the lowest character, or dupes of the most marvelous credulity, and a few were, according to Bostock, " compounds of knavery and folly." The only medical schools of any note were the Neapolitan, of Monte-Cassino and of Salerno. The latter, which was the first to grant diplomas, maintained some reputation until eclipsed by those of Bologna and Paris, in the thirteenth century. About this time anatomy aO INTRODUCTION. was ftttentively studied by dissections. The first English physician ot" note was Aiiglicaiius, who published a work in the early part of the fourteenth century, entitled, "Medicinae Compendium," made up of ivifiing disquisitions on insignificant topics. The European feudal system now began to be sliaken by the crtn eudes; Couslantiuople was captured by Mahomet the Second, about the middle of the fifteenth centur}' ; about thirty yeara after the min of the Byzantine empire the Reformation occun-ed ; and about the eame period the art of printing was invented; all of which events tended to give a powerful impulse to the world of mind, and re-awaken investigation in all the departments of science, literature, and the aits. Still, the gi-eat body of mediciil ^^Titers, for want of philosophical prem ises by which to direct scientific researches, and in utter destitution of all ascertained principles to which they could refer the facts developed by anatomical, pathological, and chemical knowledge, busied themselves in collecting, arranging, republishing, expounding, and commenting on the multitudinous works of Hippocrates and Galen. Their labors only tended to multiply books ah*eady too numerous, and mystify ideas al- ready too confused. The alchemic art was at length ti'ansferred from Arabia into the Eu- ropean countries, where it was pursued with as much assiduity as by the Arabs themselves. Medical chairs were established in various universities in Europe during the thirteenth century ; medical lectures were given in the universities of Vienna and Paris, and schools were established in Padua, Pavia, Milan, Rome, and Naples. Linacre, who was educated at Oxford, spent some time in Italy and at the court of Florence, and on returning to England succeeded in establishing medi- cal professorships at Oxford and Cambridge, and laid the foundation of the London College of Physicians. Thi: Chemical Physicians. — The next important event in medical history was the formation of the chemical sect. Chemistiy, after hav- ing been employed in various pharmaceutical processes, was applied to pliysiolog)'. iKitholngy, and therapeutics ; hence the origin of chemical doctors. The chemical physicians advanced their theories, which were us wild and extravagant as any preceding, ones, with great boldness and nssurancp, and for a long time the Galenists and Chemists were the rivjd sects of the medical world. But the Galenists had an ever-pres- ent champion in the very name of Galen, who may well be called the Prince of Medical Philosophers. He was a philosopher — a natural, philo'jopher; for he studied nature closely, deeply, profoundly, and de- d»ced his principal indications of cure from an accurate observation of HISTORY OF MEDICINE. 21 her laws. But his system was destined to be oveitlirown by an ad- venturous vagi'ant, who, in all the mental, moral, and physical elements and proportions of a complete and thorough quack, never had his equal on earth. The Prince of Empirics. — And now appeared upon the stage of action an individual — Paracelsus by name^ — whom the whole medical world denounces as a base, impudent, and unprincipled charlatan, yet to whom the same medical world is more indebted for the present /stem of allopathic drugging than to all other physicians who have dver lived. It is to him that we owe the intfoduction of the antimonial and mercurial practice which constitutes the gi'eat strength of the popular materia medica, and, I may add, its terribly devastating power on human constitutions. Aureolus Phillippus Paracelsus Theophrastus Bombast de Hoheu- heim, as he delighted to style himself, was born at Enseidlen, in Switzer- land, in 1493. His father, who was a physician, took great pains in his education, and he became a proficient in physic and surgery; but becoming charmed witli the study of alchemy, his iiiiher committed him to the instructions of Trithemius, abbot of Spanheim, who was renowned for knowledge in the secrets of alchemic art. Paracelsus, by bold pretensions, and a few lucky adventm'es in the field of medigal practice, became celebrated among the learned of his day, and was made a medical professor in Basil, in 1527, where he re- ceived for a short time a large salaiy. In the "pride, pomp, and cir- cumstance" of this honored position, he burned, with great solemnity, the works of Galen and Avicenna, declaring to the astonished and probably admiring multitude that, as he had found the philosopher's stone, mankind had no further use for the medical works of others. It is recorded of Paracelsus that he performed some gi-eat cures. It is certain that some of his gi'eat cures were the exact prototypes of many gi-eat cures performed daily among us at the present time, and not very much to the advantage of the patients. For example, he cured the celebrated printer of Basil, Jerohemus, of a pain in the heel, after " every, thing else had been tried in vain." There is, however, a qualification of the story. The ti'eatment moved the pain from the heel to the toes, which became entirely stiffened, and although the patient had no more pain, he soon died of apoplexy ! How far a certain accident had to do with his singularly eiTatic and profligate life, is worthy of a passing thought. In early childhood he was made a eunuch from an unfortunate mutilation by a sow, and as he grew up he became a perfect ha^er of womankind, while a love of INTkODUCTlON. mere notoriety seemed to have become the passion by which he was ruled. ilis principal doctrine, that the human body is composed of the three elements of salt, sulphur, and mercury, was stolen fi'om the writings of Viileuline, and his principal remedies in all diseases were mercury, antimony, and opium. If tiie reader fad to discover any relation be- tween such theory and such practice,* he is in no worse predicament than he will find himself, in most cases, if he attempt to trace the con- nection between most of the medic*J theories and practices in tiiis more enligiiteued day. Tlie medicjU life of Paracelsus may be stated in few words. He surreptitiously appropriated another man's lavention as his own, prac- ticed the vilest aiLs of cliarlataury, assumed the most pompous titles, proclaimed that he had discovered a universal panacea, the long-sought elixir riife, by which life could be prolonged to an indefinite period, lived a dissipated vagabond, and died prematurely at the age of forty- eight. Thk Regular and Irregular Controversy. — Although Pai'a- celsus introduced a new era in medical practice, and had, like most otlier noted cliaractei"s of lofty-sounding pretensions and brazen-faced unpudence, abundance of followers, still many of the *' old-school" physicians held out against the innovations of his disciples. Thus originated a contest between the Galenists and Chemists, which -satis prolonged through tlie sixteenth century. The Galenists were the regulars, and the Chemists were the emph'ics, of that period The former dealt out prodigiously multitudinous compounds, and tlie latter made a bold stand with fewer but much more potent agents, while each sect accused the other of killing their patients, I fear with too nmch truth. The Paracelsian doctors ultimately triumphed, and, as a singularly striking exemplification of the strange inconsistency between the fancies and facts of misnjuned medical science, it may be told that the medical world has long since repudiated every vestige of the arts, pretensions, and doctrines of Paracelsus and his apostles, yet retained, imitated, and greatly extended their practice ; for, notwithstanding raotlern chemists have added several hundreds of other chemical preparations to the materia medica of the great Quicksilver Quack, liiere ih hardly a disease in the catalogue of human ailments in which the employment of mercurj-, antimony, and opium is not recommended by tlie standard authors and living teachers of the Jrug system. The Anatomical Puvsic?/ .1.— While the discussions between HISTORY OF MEDICINE. 2» the contending parties just noticed were gi'adually extending the influ- ence of the empirical practitioners, and circumscribing that of their adversaries, the science of anatomy began to be more accurately culti- rated, which circumstance gave rise to a sect of physicians called the Anatomists. Vesalius, about the middle of the sixteenth century, })rosecuted this department of knowledge with unwearied assiduity. He was followed by Eustachius and Fallopius, who acquired gi'eat reputation for anatomical skill. The anatomical physicians, however, did not introduce any thing original in relation to the theory or the practice of medicine. They were divided concerning the opinions of Galen, and may be subdivided into his defenders and his opposers ; be- tween these sub-sects long and acrimonious discussions occurred, not concerning what was true or what was false, but whether the notions of Galen were right or ^vTong. Revival of the Hippocratean Doctrine. — During the seven- teenth century the docti'ines of Hippocrates again became the prevail- ing medical philosophy. Anatomy made rapid progress ; Harvey dis- covered the circulation of the blood ; Asselli, Rudbeck, and Baitholine traced out the absorbent system ; and Malpighi, Hooke, and others, explained the structure and functions of the lungs. Boyle disengaged chemistry from the mystery by which it was smTounded, and explained its true province to be, not the manufacture of solid gold, nor liquid nostrums, nor gaseous theories, but "an investigation into the change of properties which bodies experience in their actions upon each other." Still the chemical physicians kept up the popularity of their practice by mixing with it not a little of the magical ceremonies and asti'ological pretensions so rife a few centuries before. Some of them acquired extraordinary popularity, and many of them, paiticularly in England; become apparently sincere fanatics to their own system. Among these were Fludd, who manifested implicit faith in astrology; Kenelm Digby a man of rank and refined education, who published an account of th mystical virtues of the "sympathetic powder;" and Valentine Greatrix, who cured all diseases by the imposition of the hand. " These circum- stances," says Bostock, "are interesting, not merely as forming a part of the history of medicine, but as displaying a singular feature in the history of tlie human mind ; demonstrating the difficulty which exists :n eradicating from it errors and follies, even the most gross and palpa- i)le, when they have once become deeply rooted." Although the discoveries alluded to in anatomy had tm'ned the atten lion of medical men more to vital actions, as aflbrding a better explicatiou of the phenomena of disease fhan chemical changes, and had generally 24 INTUOL JCTION. restored the humoral pathology of Hippocrates, the practice of medi- j cine did uot undergo a corresponding change. The Anatomists were \ ttuxious of course to have their pharmacopoeia include " all the modern niprovements," hence they pursued a mixed or compound practice, by j Hiding the mercury, antimony, and opium of Paracelsus, and other | drugs of more recent production, to the bleeding, purging, sweating, : etc., of the eai-lier i>hysician3. In fact, they incorporated nearly all that was known of a poisonous or desti'uctive natm'e among their lUcrapcuticid agents, and omitted nearly nil that was really worth pre- [ ecrving — attention to diet, regimen, bathing, cleanliness, etc. i Thk Fkrmextatiomsts. — Another sect of physicians now arosQ | or, rather, a branch of the Chemists, who attempted to blend the I cnide chemistry of the day, and the cruder physiology, mto a com- ' pound philosophical system. The leading doch'ine adopted by this ' sect was, that certain fermentations in the blood, and other fluids, were ] tlie causes of the different states of health and disease ; certain hu- j mors were acid ; others alkaline ; and, as one or the other predomi- nated, a con-esponding specific disease was the result. Thus fever | was an acidulous disease, requiring alkaline remedies, etc. This notion \ was eloquently advocated by Sylvius, who filled the medical chair at j Leyden, and became the fashionable doctrine in France and Germany ; tor a considerable time. Willis, of England, was also an able defender : of the chemical doctrines ; he published a work in 1759 on fermenta- j tion and fever, wherein he attempted to prove that every organ in the ' body had its own peculiar fermentation, a morbid state of which con- j slituted disease. '■ Sydenham, who has been called the English Hippocrates, agi'eed \ with Willis in the theory of chemical fermentation, but adopted the j Hippocratic doctrine, that the primary changes in disease take place in ; tlie fluids instead of the solids. He also agi-eed with Hippocrates that , disease was an eflfort of nature to get rid of noxious matters, and, like j his great prototj-pe, adapted his remedial agencies mainly to the regu- 1 lation of the actions of the system. Though his practice has been i called feeble and inert, it would be difficult to name an equally success- ' ftd i)hy9ician among the bolder practitioners who have wielded more • potent drugs since his day. i Notwitlisfnnding numerous discoveries had been made, and many j facts accumulated up to tiiis date in chemistry, anatomy, and physi- ol()g\', it m at least questionable whether any more rational views were eiitertain«'d of the true nature of disease than were advanced by Hip- pocrates nciirlv three thousand years before ; and it is positively certain j HISTORY OF MEDICINE. 26 hat none among the most eminent of the new schools or sects of more modern date, have been more successful in cui'ing; diseases than were Hippocrates, Galen, and Sydenham. The Mathematical Physicians. — Mathematical science Imving made considerable progress during the latter part of the sixteenth centuiy, the medical theorizers of the day seized upon its facts to effect another docti'inal revolution ; hence arose a sect whose members composed the Mathematical school. Borelli, a profound mathematician, undertook to explain certain functions of the body on mechanical [)rinciples ; and his pupil, Bellini, maintained that all the actions of the cody were under the influence of gravity and impulse, and that all the vital functions could be elucidated by an application of the principles of hydraulics and hydrostatics. The new hypothesis soon ranked among its converts many of the most learned men of the age, and the Mathe- matical physicians became formidable rivals to the Chemical. The phenomena of disease were accounted for by, or, rather, referred to, the mechanical terms of derivation, lentor, obstruction, friction, resolu- tion, etc. ; but, as has been the case in most instances from the creation of the world to a.d. 1851, the practice had little or no relation to the theory. Diseases were treated by the Mathematical physicians with the remedies of the Chemists and Galenists. Indeed, the practical pai-t of medicine was regarded then, as it had been long before, and has been long since, of secondary importance to the theory. The minds of medical men were mainly devoted to theoretical speculations, and vastly more talent was wasted in endeavoring to establish and pro- mulgate favorite dogmas, of no earthly use, except to render the au- thors of them famous, than was expended in investigating ti'uth or curing diseases. The ViTALiSTS. — The next medical sect in order was the Vitalists. It originated with Van Helmont, and finally triumphed over both the Chemical and Mathematical sects. Van Helmont at first belonged to the Chemical school ; but to its doctrines he added the idea of a specific agent residing in, or attached to, the system, which controls its own spontaneous actions, and also the actions of remedial age^its. This conception was doubtless the ideal germ of the vital principle of later physiologists, and the vis mecUcatrix natures of the present day ; nor is it radically different from the idea of the efforts of nature as enter- tained by Hippocrates. Van Helmont proposed nothing new in the way of curing diseases, contenting himself with mere matters of opinion ; and the commiini- 16 INTRODUCTION cntion of his doctrines did not allay the wordy wai-fare still waged be- tween the Chemists and iMathematicians, until it was revived and re- fined by the genius and energy of the next successful adventurer in the field of niediad theory. This was Stahl, who was born at Anspach, in IGuO. He undoubt- edly saw the sad deficiencies and gross errors in the prevailing theories. and, perceiving that neither chemical nor mechanical reasoning, nor both, could ever explain the phenomena of life, he refeiTed vitfd ac- tions to the operation of a principle he called anima. From a close obsen-ation of the intluence which tlie mind exercises over the body, he came to the conclusion that all the vital functions w^ere produced and sustained by the influence of an animating and superintending spiritual principle. This principle prevents or repairs injuries, coun- teracts or removes morbific causes, and, in fact, appears to be the ag- jfregate of what modern physiologists speak of as the crganic instincts. But, as an exception to the general rule, the theory of Stahl did in- tluence his practice very considerably, for, instead of the rash and dangerous potencies and process-es then in vogue, his view^s, in the lan- guage of an eloquent historian, "tended to repress the energy of the practitioner still more than the pathological doctrines of Hippocrates. They did, indeed, cause him to trust more to his presiding deity — the great physician. Nature — and less to artificial drugs and destnactives. Happy would it have been for the human race if a more inert practice lind continued to this day, to " repress the energy of the practitioner," tor sad experience, and the constantly accumulating catalogue of human ills and chronic n)aladies, unheard of in former days, sufficiently dem- onstrate that success in curing disease holds a much nearer relation to the inertness than to the energj' of the practitioner, as far as active poisons are concerned. The doctrines of Stahl, and the extraordinary metaphysical acuteness with which they were supported, had ah extensive influence on medi- cal o})inions ; but about that period there were so many rival medical schools evolving new theories, each advancing their claims to notice with p-eat 7.eal and ability, that it was impossible for any one hypothesis to be ctMiiTally rcccivod. Thk Soliihsts. — Hoffman, the conlempoi-ary of Stahl, was also his colleague in the University of Halle, as well as his rival, and an equal aspirant for name and tlnne. He wTote voluminously, and the princi- pal theoretical notion which he originated was a modification of the Stnhlian doctrine of vitality. Instead of refeiTing the operations of the •nimal oconon.y to an anima, ho imputed them to a nervous injiiience. HISTORY OF MEDICINE 27 This was almost a distinction without a difference, but it served his. purpose. The details of his practice were essentially those of the Chemica. and Mathematical physicians, possessing no new feature whatever. His pathology' united the notions of the Humoralists and Solidists, and he advanced the doctrine of tone and atony ^ or spasm and relaxation of the moving fibres — a doctrine which long influenced the writings of his successors, and which was, no doubt, derived from the ancient notion of constriction and relaxation. His writings are sa4d to abound in inconsistencies and contradictions. In ]G71 Glisson published a treatise, in which he advocated the doc- ti'ine of muscular in-itability, explaining it as a specific property attached to the living fibre, in opposition to the humoral pathology of Hippo- crates, which until this time had generally prevailed. Toward the close of the seventeenth cenitury, Bagliva, an eminent medical scholar, systematically opposed the Hippocratic pathology, placing all the causes of disease in an altered condition of the solids. These two writers laid the foundation for the overthrow of the humoral pathology and the introduction of solidism, which has been very generally received by the medical profession to the present time. It is now, however, decidedly on the decline. But this revolution in theory had no perceptible effect on the prac- tice. Whichever hypothesis the physician adopted was the samo to the patient. The prescriptions were alike in either event. The Metaphysical Physicians. — Soon after the revival of letters, the greatest scholars among medical men were incessantly laboring to apply the inductive philosophy inti-oduced by Bacon, and found so suc- cessful in advancing other departments of philosophy, to the study of medicine as a science. How signally they failed, let the record of in numerable theories which have come and gone, like the changes of the moon, testify. This failm-e was not owing to a want of learning, or ambition, or industry, or integrity of pui-pose. It is atti-ibutable purely to the want of the true starting-point. The learned world was full of book-made philosophies, brain-racked theories, and closet-engendered metaphysics. The minds of medical authors were all more or less warped and beclouded Avith the speculations of their predecessors and teachers. There was no one of sufficient originality' of intellect and independence of mind to '^ast off the ti-emendous incubus of venerated authority, and go directly to the truth itself for the evidence of ti'uth — to ask nature to interpret her own laws. Destitute of all demonstrable premises upon which to predicate their investigations, and from which to extend their inquiries, each one seems to have conceived a hypo- /8 INTROiJUCTION. iliesis, or detected an error, and then studied and wrote to mamtain the one or refute the otJier. The dh'cction of men's minds was too my:jlically niftapliysical for the prosecution of ti'ue philosophical re- search. How few men have ever lived who had mental capacity even lo think of a fiiijt principle ! BoERHAAVK. — No One ranks higher in the annals of modern medi- cal history than Boerhaavc, who was contemporaneous with Stahl and [loJTinan. He was a professor at Leyden, and in practical judgment lias been justly regarded as superior even to Galen. But in groping among the dm'k chimeras of his predecessors he was unable to find any thing more eudm-ing than mere conjectm'e and gi-atuitous assumption upon which to establish a new system. He attempted, however, to form and fashion out of the discc .'dant materials before him a theory and practice which should combine the excellences of all systems, and be truly eclectic. But any system, embodying such conflicting opinions OS were found in the speculations of the different schools, must neces- sarily contain the seeds of early dissolution ; and accordingly we find that the system of Boerhaave did not long survive him. His nephew, Kauw Boerhaave, his successor, Gaubius, and Gorter, a professor of Harderwyc, wrote extensively on medical subjects, but to little account, save to restore the vital agency in explaining the phenomena of disease, which Boerhaave had nearly discarded. Van Swietcn, professor in the medical school at Vienna, was a fol- lower of Boerhaave, and the ablest supporter of his views. He wrote extensive commentaries on the multitudinous aphorisms of his prede- cessor, but they were of little practical value. Hallkk. — This distinguished scliolar, who has been called the father of modern physiology, was a pupil of Boerhaave. He possessed a mind singularly oi'iginal and comprehensive, and afler long and patient re- search into the nature of the functional powers of the human body, made a substantial improvement in physiological science. Disregarding nil the authority of learned names and mere theories, he established the doctrine of the iiritahility and sensibility of the muscular and nei j- ous systems. His Elements of Physiology "introduced a new era int® medical science." His peculiar views were warmly controverted by many distinguished \\Titer9, and as warmly supported by others. T'lE Semi-Ammists. — Wliile Haller's doctrines were sti-engthened and confirmed by numerous experiments instituted by Z'mmerman, Coldani, Fontnnn, Tissrt. Zinn, and Verschuir, they were powerfully HISTORY OF MEDICINE. 29 opposed by Wliytt and Porterfield, of Scotland, whose reasonings, however, though able and acrimonious, have been characterized as much more metaphysical than physiological. Whytt succeeded in founding a sect called the Semi- A limists, whose principal distinctive tenet was a vital or sentient principle compounded of the docti'ines oi Stahl and Haller, evidently intended ts a middle theory between the two. Sauvages, professor at Montpelier in 1734, was one of the main sup- porters of the Semi-Animist sect. He was the first to arrange diseases into classes, orders, genera, and species, constituting a methodical nosology. Still we have no evidence that these conti'oversies, modifi- cations, revolutions, or improvements materially affected the prevailing method of ti'eating diseases at the bedside. CuLLEN. — William CuUen, who was the successor of Whytt in the University of Edinburgh, achieved as brilliant a reputation as Haller, and effected as great a revolution in medical practice as Haller did in physiology. In discriminating the phenomena of disease, Culien was unrivaled; and he was the first medical innovator for ages whose theory and practice were consistent with and sh-ictly related to each other. His "First Lines of the Practice of Physic" were in fact text-books in our medical schools less than a quarter of a centuiy ago. His works on nosology and materia medica have never been excelled in rigid powers of analysis and accuracy of observation, and his opinions are often quoted as high authority by medical journals of the present day. But his carefully elaborated theories were wanting in the one thing needful for an enduring system — an ascertained first principle, and hence were destined to pass away like the baseless fabrics of a thousand other theoretical visions whiuh preceded and succeeded him. No one now pretends to acknowledge or defend his theories, though many physicians, perhaps a majority, follow essentially his practice, thus exhibiting another of those glaring absurdities which stamp with incon- sistency ahiiost every page of medical history. The Cullenian system of ti'eating diseases may be resolved into a single indication, that of counteracting the symptoms. Thus in a fever he would reduce by bleeding, niti'e, and other antiphlogistics, in the hot stage ; stimulate with bark, wine, tonics, etc., in the cold stage ; and obviate spasm, putrescency, etc., with narcotics, alkalies, acids, etc., in the intermediate or sweating stage. Nothing can be more absurd than such a practice in a fever which passes tlu'ough all these stages once a day, or every other day for several weeks, for it keeps one hand con- tiaually working against the other It amounts tc nothing but treating 80 INrilODUCTION. toniporai-y and ever-changing symptoms on a plan of antipathy or an- tagonism, without any rt'gard to the permanent state of the constitution, or natural course and termination of the disease. Yet, as already inti- mated, it is tlie prevailing allopathic practice. It should bo mentioned that Culleii recognized the self-preserving and self-rngulating jninciple of vitality; but he improved on the notions of Stahl, Van Helmont, and Hoffman, in explaining it as an inherent property of organization, which he called the vis medicatrix nature, or remedial power of nature, rather than a superadded sentient principle. TiiK BiiLNOMAN System. — The Cullenian school found a rival in the bold vagaries of what has been called the Brunonian theory, in an eai'ly period of its existence. A Dr. Brown, of Edinbui-gh, who had been a personal and professional friend of Culleu, became, from some cause — ])robably spleen, jealousy, or disappointment — his bitter antago- nist, and a vehejnent opposer of his doctrines. To effect his purposes of ambition and opposition he advanced a new medical doctrine. He did not trouble himself about authorities, facts, experiences, or reasons, but simply assumed his principles, announced his doctrines, laid down his pnictice, supported the whole with lofty pretensions, and found many followers among men of learning and science, and in many med- ical schools whose professors adopted his doctrines. Brown maintained that life was a forced state, analogous to the flame of a candle ; that any thing which affects the living body acts as an excitant or stimulant upon a specific projDerty it possesses, which he termed excitability. Thus defective excitement or stimulation produces accumulation of excitability, oi indirect debility, while excessive stimu- lus produces exhausted excitability, or du-ect debility; and that all diseases are referable to one or the other of these states, requiring Btimuh.ting or reducing measures, as the excitability is exhausted or accumulated. The practice that naturally results from such a theory or phantasy is bleeding in one class of diseases, aud brandy in the other; and, in truth, the world is much indebted to the genius or the impudence of John Brown for the extensive use of alcohol and alcoholic mixtures in modern medical prescriptions. The poetical and refined Darwin deserves a passing notice here, as a fruitless theorist and elaborate speculator. His "Zoonomia" is cer- tainly a monument of genius, but destitute of any sound philosophical principles, and his medical notions are now universally regarded as purely fanciful. Medicine at the End of the Eighteenth Century. — At the HlSTOlir OF MEDICINE. 31 conclusion of the eighteenth century, L.e physicians on the continent of Europe generally pursued the eclectic plan of Boerhaave. Among the French, Lieutaud, who published in 1749 a gi'eat work called "Sy- nopsis Universse Praxeos Medica?," was the most celebrated. In Ger- many, De Haen published a work equal to Lieutaud's, called " Ratio Medendi," but he bitterly opposed all the new notions of that period, and waiTed against Haller's docti'ines, and against the practice of inocula- tion. The most celebrated medical schools in Europe were those of Paris, Vienna, and Leyden. The medical schools of Italy also enjoyed a high reputation. Bonet and Mangel there introduced the shady of pathological anatomy, which was followed up by Valsalva and Morgagni, who made extensive post-moitem examinations, and recorded the ana- tomical appearances of the stractm-es. One source of error, however, pervaded all their observations, as it does post-mortem investigations at this day. It is this. Structural appearances after death denote the effects of disease ; and these morbid changes were and are often mis- taken for or confounded with the causes of disease. Burserius was the only theorist of any note that Italy produced at this time, but his works are only admired for the elegance of the lan- guage in which they are written. The Italians adopted the Brunonian system; but the fatality attending its practical application caused its utter abandonment, and a return to the equally u'rational theory but somewhat less fatfd practice of the Cullenian school. The Egyptian physicians were more disposed to prosecilte anatomical and physiological re- searches than to form systems of any kind. With the progress of chemistry during the eighteenth century, many of tlie feebler articles and more complicated compounds of the pharma- copoeias were substituted by more simple yet more powerful metallic and mineral preparations and vegetable exti-a-cts — powerful in the sense of the sti'ength or force of the impression, not in reference to the quality, or kind, or utility of that impression ; and if this was an im- provement in pharmacy, as medical historians usually inform us, there was assuredly some progress made in the dealing, if not the healing prt. It was an improvement by which apothecaries have profited to Lhe extent of many millions of doHai's. Medicine in the Present Century. — The historian who care- fully and without prejudice surveys the present state of the medical profession will observe one of the strangest anomalies which the humar mind can contemplate. He will observe a leai-ned profession, adorned with as bright a galaxy of names — scholai-s, philosophers, and phiian- thropists — as any p]-ofe£v>ion in any age of the Vv'orld could ever boast. 32 INTRODUCTION. devoting themselves, with a zeal and industry worthy of all praise, to the study and pi-actice of medicine, yet having no confidence at all in their own system, and, stninger still, wondering and complaining that the great masses of the people have no confidence in it ! Bostock has admitted that "our actual information does not increase, in any degree, in proportion to our experience." The solution of this rcmaikablo problem will be found as we pioceed. Never was any department of human knowledge prosecuted with greater assiduity and energy than have been all the sciences collateral to the practice of physic, during the last fifty years. Anatomy, chem- istry, and operative surgery have, indeed, made wondei-ful and sub- stantial i)rogress. Pathology has been gi'eatly advanced. Physiology has been diligently studied, but unfortunately with little success. Time, facts in physiology have multiplied exceedingly, and hyr^theses into which they have been woven have added greatly to the numerical strength of medical libraries ; but as far- as demonsJrating the laws of life, or increasing our means for the cure of disease, I may safely assert what Bostock admits, viz., " So far as the practice of medicine is concerned, the benefit is rather in anticipation than in existence." In anatomy, surgery, and materia medica. Great Britain and Amer- ica have jjroduced many illusti'ious names, among whom may be men- tioned Hunter, Munro, Bell, Cooper, and Pereira, of the old, and Wistar, Horner, Physick, Mott, Eberle, and Dunglison, of the new, world. In physiolog;y, anahiical chemistiy, and anatomy the Ger- mans have taken the lead ; and pre-eminent among those who have acquired distinction are Camper, Blumenbach, Soemmering, Meckel, Tiedeman, Sprengel, liosenmuller, Mtiller, and Liebig. In pathology and phnrmacy the French have outsti'ipped all other nations, and the labors of Pinel, Andral, Breschet, Broussais, Corvisart, Cniveilliler, JDujiuytren, and Laennec have obtained a world-wide celebrity; while in physiology the French school has given us the works of Bichat, Cuvier, Richerand, Majendie, and others. Italy is far behind the other countries named, yet it has produced a few eminent medical scholars, among whom are Scarpa, Mascagni, Ronaldo, and Tommasini. But while this tribute is due to the talents and acquirements of the medical [)hilosophers of this nge, it must be remembered that all their vast aiTay of learning, and all their multitudinous writings, have done nothing toward placing th** healing art on a true philosophical founda- tion. They have rather tended to render the confusion of ancient iogmas woj-so confi)unlete record of the bathing customs of all nations, and of the remedial uses to which water has been applied by medical men, w'ould furnish us with many more examples of what has been done amiss, than of what is worthy of imitation. Somehow or other at some time or other, the idea came to possess the minds of practitioners of the healing art, and through them the minds of the people generally, that impure waters were more healthful for sick persons than pure. Con- sistently with this ridiculously absurd vagary, those springs of Avater which contain Ih.e gi'catest amount and variety of impurities, are the most cele- brated as resorts for health-seeking invalids. And this silly conceit re- ganling the remedial intluence of drugged w^aters has extended to their external as well as internal employment; hence all manner of artificially medicated, mineralized, saline, alkaline, acid, oleaginous, spirituous, gasified, and compound haths and fumigations have found advocates in the raiiks of the medical profession. It seems to be inconceivable to the book-biased minds of most regular physicians that pure water can dissolve and Wiish away the impurities of the body better than impure water. In their view some foreign agent, something extraneous, some- thing powerful must be taken or applied to desti'oy the morbid entit}% or counter-irritate the diseiised condition, or "force a healthy action." When it is considered that the solvent property of water is exactly pro|)()rtioned to its freedom from all extraneous ingi-edients held in solution, the strange hallucination that prefere sulphur, iodine, iron, saline, and other unclean springs, to the pure element as it distils from the clouds of Ijeaven, for medicnl purposes, will have to be put down to the account of those things on this ea.vth which are wholly unaccountable. Ancitnt Bathiv-j. — Almost a* far back as we r an trace liistoricaJ MISTOEY OF BATfllNa 37 data, Ave fin I furounJ: of various domestic baths. The earliest Bible account of Ivitiiinc!; speaks 6f the daughter of Pharaoh and her attend- ants going down !o \\ui Nile. Homer speaks of the bathing habits of many of his heroe?. Hercules was indebted to Minerva and Vulcan for the refreshing influence of warm baths. Althenseus informs us that it v/as the custom of antiquity for women and virgins to assist strangers in their ablutions. Among Oriental nations the means for bathing were provided as an act of hospitality for travelers. Both the Old and New Testaments frequently mention bathing as a sanatary and healing process, and as a religious rite. With all the ancient nations frequent ablutions or immersions were typical of moral purity. Moses, Jacob, Aaron, Job, as well as the more ancient patri- archs, enjoined and practiced bathing as a means of both bodily and spiritual purification. Jews, Christians, Mahometans, and Pagans have all agreed in one tenet, the baptism of personal cleanliness. Elisha the prophet directed Namaan the leper to bathe seven times in the Jordan. Our Saviour commanded the blind man fro wash in the pool of Siloam. Many of the sick were sent to the healing waters of Bethesda. The Gree]< and Egyptian priests washed themselves in cold water several "imes a day. Bathing in the Middle Ages. — But in process of time, as the customs of societies and nations became more complicated and sensual, bathing degenerated almost into a means of mere sixury and sensuous indulgence. Though the Egyptians first reduced bathing to a systema- tized part of the medical practice of their day, and for ordinary purposes recommended cold ablutions in preference to warm baths, as the habits of the people became luxurious and enervating, the cold ablution for health was substituted by the w^arm immersion for pleasure. The Greeks adopted the bathing customs of the Egyptians, and at- tached public baths to their gymnasia; and a bathing room for guests was a common apartment in their private houses. Socrates, Aristotle, and Plato speak of baths as in common use. tlippocrates, the "flither of medicine," recommended them for many hygienic and therapeutic purposes. The Spartans were in the habit of plunging their new-born infants *ntd cold springs. The members of their adult population wove cer- tainly fiiir specimens of /igorous health and powerful frames. But m.edical theorizers have explained this fact in another way. They assert that the practice killed all the tender children, the robust only being able to survive it ; so that all who lived through it and grew up to manhood were robi st and healthy in spite of the bathing. But tho 4 83 INTRODUCTION. usrierlioii is wholly gratuitous, and, notwithstanding it is the prevailing ■ opinion of the medical faculty, there is not a p.-u'licle of evidence to , sustain it. I have seen too many children in New York city who have | been bathed in cold water IVoni birth, every one \vithout exception j becoming remarkabl-y robust and healthy compared with non-bathed ' or warm-water-wushed ones, to give the least credence to a statement j which seems to have been made on mer« theoiy, without any investi- | gation at all. The ancient Germans were much addicted to cold batliing. The ; Gauls, the powerful progenitors of the British race, had sacred fount- \ ains, which were resorted to for the purpose of bathing and healing I diseases; and in England many cold springs have been celebrated for their curative virtues. | In the days of Roman pride and luxuriance public and private baths I were consti-ucted on a magnificent scale ; and the agriculturists, sol- diei"S, and laborers would frequently batlie in the Tiber. After the j aqueducts were built, by which an abundant supply of water was in- j troduced to Home, warm batlis became general ; and, instead of being ! employed for cleanliness and health, they were soon regarded as a j mere source of luxury, and thus became a means of physiological j degeneration and efleminacy. Public buildings, called thermae, for i warm bathing, increased rapidly, and in the days of Nero, who erected { a most sumptuous one, the}* numbered eight hundred or more. With j the baths were connected grounds for sporting and athletic exercises, "i and extensive libraries. The baths of Caracalla had sixteen hundred j marble seaf, 2apable of seating three thousand persons, and w^ere or- | namented with two hundred pillars. But surpassing aU others in size | and splendor were those of Diocletian. It is related that in theii* con- , ptiTJction he employed forty thousand Christian soldiers, whom he i caused to be massacred as soon as the w^ork w^as completed. Such are ; the consequences of perverting the practice of bathing for the sake of that " cleanliness which is next to godliness," and tliat health of body ''• which contributes so powerfully to a sound mind, to a mere lustfiil en- \ joyment. The warm bath degenerated into the hot, and feasting and i gluttony bccnmo parts of the purpose for which a Roman bathing I establishment was frequented. i The Greeks, too, constructed immense bathing establishments, and ! furnished them ^^•ith all the appliances of health and luxury, as cold, | warm, hot. and vai)()r Iwitlis ; but unfortunately, as in most cases where ; good and evil are placed before the judgment and sensuality of human nature, the latter proved victorious. Lounging in warm -svater, and j anointing the body with an immense profiision of oils, soaps, and per ' HISTORY OF BATHING. 89 fumes, became favorite amusements, followed, of course, by indolence and enervation. When Alexandria was conquered by the Moslems it contained four thousand baths, constructed on the Roman plan ; and when the Span- iai'ds conquered Granada the bathing habits of the Moors, and also their language and dress, were proliibited, as a means of their con- version. In most of the large Fjuropean towns, in the "barbarous ages," public baths were erected, where the people bathed each Saturday evening. The early Christians of Gaul had baths constructed in their convents. Pope Adrian I. recommended the parochial clergy to visit the baths, in giand procession, every Thursday. The institutions of chivalry required the knight to be subjected to a complete ablution be- fore receiving his armor. The Order of the Bath, still retained in England, originated from the circumstance that the candidate was knighted while immersed to the chin in a highly decorated bath. Bathing Habits of Different Nations. — The people of Swit- zerland are said by Marcand to bathe more generally than those of any other countiy. The baths at Baden have been as celebrated for their abuses as for their uses, having been resorted to during the sitting of the Council of Constance, more for luxury and debauchery than for health. Such is not the case, however, at present. In Italy the numerous warm and mineral springs are much resorted to, especially in the northern pait, where immersion and douche bath- ing are common. To most of their celebrated springs the poor are allowed free access ; and attached to some of them are hospitals for invalid soldiers. The Germans have long been accustomed to warm bathing. Char- lemagne had a bath consti'ucted, capable of accommodating one hun- dred persons at a time, and it was his custom to sit in council in a large warm bath of the waters of Aix. During the prevalence of leprosy, in the middle ages, bathing w^as enjoined as a religious duty ; and as diseased persons commenced frequenting the public watering-places, the people generally resorted more to the rivers. At present bathing at the regular establishments is quite systematized, yet the people are more generally negligent in regard to the practice than formerly. In Russia vapor baths have long been and are stiU celebrated. In their establishments the vapor is obtained by pouring water on heatea stones, and the temperature is raised to 122°, and even 133'^. The vapor bath is follow^ed by tepid, and then cold ablutions, and sometimes a lake or river plunge- or a roliing-in-the-snow bath. Rubbing the 40 INTRODUCTION. body aiKl lutheriug it with sonp arc usually pai'ts of the Russian procesjs. The FiiilandLM-s resort often tc the dry and moist sweating baths, the vapor for the dry being 122'^, and for the moist 140^^ to IGT^-. The latter process is painfully suftbcative and exti-emely debihtating. Most of the peasantry have bath-houses, used by men and w^omen promis- cuously. They are constantly in the habit of passing from the atmo- sphere of their bathing-rooms, which ai-e heated to 167=*, to the open air out-doors, where the thermometei is down to 24^ below zero, ti'an- sitions, which, astonishing as they appear, do not seem to produce any nnmediate inconvenience. Throughout Sweden, Norway, and Lapland baths ai-e very com- mon. The Oriental nations have the most numerous and splendid bathing establishments of the present day. The public baths of Turkey are spacious edifices of hewn stone. The temperature of the rooms is about 100°, where the bather soon gei." into a perspiration by the heated air, and is rubbed, kneaded, Btretcned, lathered, and perfumed, and finally w^ashed with tepid or cold water to his liking. Smoking and coffee succeed the operation. The long-continued wai'm and hot bathing gives to their females a pe- culiarly pale, peach-like softness of skin, indicative of lassitude and de- bilitj' rather than health and strength. In fact, luxury, mere animal gratification, seems to be the only purpose thought of in most of the bathing establishments of the East. The Persians rival the Turks in magnificer.ee, if not in convenience. But the manner of bathing differs materially from the Turkish. The toilet is the leading idea of a Persian bath. Instead of rubbing, sham- pooing, etc., the attendant, or operator, is mainly occupied in staining the beard and hair black, the feet and hands yellow, and the nails of the fingers and toes of a deep red. In Egypt and India bathing is practiced in a manner very similar to that of the Turks. In Cairo there are about seventy public baths. In addition to the manipuLitions of a Turkish bath, the attendant of the Egyptian bather rubs the soles of the feet with a kind of rasp, made of baked clay. It is customary for betrothed females to go in gi-and procession to the bath a day or two before marriage, accompanied by intimate friends and relatives. The three stages of the bathing process consist of sweating, rubbing, and washing. Aromatic unctions are gei?~ erally employed, and the Persian fashion of dyeing the nails with a preparation of henna is very much in vogue. The East India baths are conducted similarly to those of the Egyp HISTORY CF BATHING. 41 tian. The women of quiility spend much time in them, and seem to realize in their use only a source of sensuous pleasure. The Mahometans are requh-ed to bathe three times a day. Among them a depilatory pomatum, to remove the hair, is often applied ; it is 1 oraposed of sulphuret of arsenic and quick-lime mixed with fat. The Bramins ai'e under the same religious injunction to bathe as the pjfuliometans. 'I'Jie Hindoos of all classes perform their devotional pilgrimages to {ii« (xanges and the Jumna, to bathe in their sin-absolving waters. Among the North American Indians bathing, especially in rivers, has j.Kvays been a general practice. Some tribes in the vicinity of the Kocky Mountains use the sudatory or hot sweating bath, followed by the cold plunge. Some of the extreme northern tribes make a squai*e mud box on the edge of the river, in which they sit and enjo3^ a vapor bath, with steam raised by means of hot stones and jugs of water. This is rather a fashionable recreation among tliem, and is often prac- ticed in parties for social amusement. On the frontiers a bath is con- structed of wicker-v»'ork, the tip of which is covered with skins. William Penn saw an Indian chief, in the "colony of Pennsylvania," eiitirely cured of an attack of fever, by a thorough steaming, followed by several plunges in the river, for which purpose a hole was cut through the ice. The Peruvians have numerous public bnths, both from hot springs and from their hundreds of miles of aqueducts. The Abysinians are represented by the h-aveler, Bmce, as in the habit of ti'eating the violent fevers of that country with cold water ex- lernally and internally. The Mexicans originally bathed in a sort of oven, into w^hich the I athe.r crept when sufficiently heated, and, by pouring water on the liot stones, raised a vapor and produced copious sweating. Kentish riffirms that lliis bath is resorted to as a remedy for stings of insects and bites oi poisojutus reptiles; it is employed also by women after child- birth. Tlie ^"'ren(■,l^ were, long ago generally accustomed to batliing. Vapor nv.d other batlis were numerous in Paris at an early period of its his lory. Irately the vapor baths, which are frequent along the banks of the Seine, are eni[)Ioyed as preparations for the w\Ti-m-vrater bath. That they are visited, however, more for entertainment than from any sense of hygienic virtue is evident from the fact, that they have been occasionally closed for a time by the public authorities, and were once prohibited during the prevalence of a contagious disease. In Paris there are at | 'resent ni-my warm^ cold, and vapor bathing establish 42 I N T R D U C T I X. meats, some of which are very properly connected with the hospitals. v-zold bathi unJ swiiuuiiug schoc/L-. fur each sex separately, abound on the banks of the Seine. In Enj-liind bathing iustitutiuus arose and declined with those of Koine. Soon after the conquest of England by the Xorraans the lep- rosy made its appearance, when bathing habits revived again, and in treating the disease the rold bath was generally resorted to. About the middle of the sixteenth century the bathing practices of the peo- ple again degenerated to mere luxury ; and, up to the present time, its warm, hot, mineral, and sulphurous springs have been quite a fashion- able resort for that class of fashionable invalids w^hose complaints are closely connected with ftishionable indolence. Now, however, cold bathing is increasing in favor, and promises to become general. Dr. Bell thinks it has ali-eady been carried to an esti-erae for medical pur- poses ! The people of the United States have never yet been overmuch given to bathing in any manner. The more wealthy in our cities re- sort to the bathing-houses occasionally, and in the warm season many of the city and countiy people amuse themselves by swimming in our rivers, lakes, ponds, and at various places on the sea shore. Some pei"?ons content themselves with washing the whole body once a week ; others once a yeai*; and a few^ are satisfied without washing at alL Every well-wisher of the human race wili hope they will remain as they are in this respect, rather than imitate the sensualizing bathing customs of the old world. But attention to the general subject of batJiing is fast awakening among us, and there is everj^ reason to believe the great masses will ere long become sufficiently intelligent to adopt daily bathing as a physiological, hygienic, moral, social, and eminently Christian duty and privilege. Our largest cities. New York, Piiila- delphia, and Boston, have within a few years supplied themselves w4th an abundant supply of good soft water; many other cities and villages are about following the example, and the people in our country places are fa-^t turning their attention to the benefits of having pure water for both bathing and drinking purposes. Bath-rooms, in the cities above named, are beginning to be regarded as indispensable apaitments of public buildings and private dwellings. The numerous hydropathic establishments springing up in all parts of the country are perliaps the most efficient insti'umentalities in indoctrinating individuals and families into the theory of personal cleanliness ; and with all the agencies named we may regard the jirospect for this nation to become "re- deemed, regenerated, disenthriiled," from obstructed pores and fouJ eecretioDs, as very promis'ng. HISTORY OF BATHING. 43> MtoiCATED Baths. — A brief notice in this place of the various metliods of impure bathiug, invented by superstitious ignoramuses and learned ^Esculapians, may serve a better purpose than mere amuse- ment for the reader. A medicated bath, in the popular medical sense, is water or hot air charged with some drug or extraneous ingi*edient. In ancient times medicinal baths of oil, oil and w^ater, milk, milk and wine, and eveu of blood, were emplo^^ed. More recently, baths made of the steepings of the husks and other refuse matters of grapes, and of olives, after the expression of their juice and oil, have been employed ; and still later gelatine, dissolved in water, has been recommended by physicians, prob- ably as a nutritious bath ! Mud baths or earth baths have been employed in Germany, France, Italy, and other places. The process of a mud bath is technically called illutation. A kind of artificial illutament — presuming mud to be the natural one — for anointing the body, was rsade of oil and the perspira- ble matter scraped off the skins of the Greek athletse. Doubtless it possessed as much virtue as any of the "all-healing ointments" of the present day. Warm dung baths are not unknown among medical prescriptions on the continent of Europe. Bees-eggs baths, made of wax, honey, and the excrement ci oees, have been among the acknowledged outAvard medicaments, and proba bly have worked their due proportion of wonderful cures. The Sand bath, called arenation, is known to many Eastern civilized and semi-civilized nations. The body is covered up with the warm sand and exuvial matters on the sea shore, so as to produce active sweating. Other substances, as earth and sulphur, salt and grain, have been used for arenation. Insolation baths have enjoyed a high reputation. The body is Avi'apped up in the hide of an animal, or in leather, and then exposed to the heat of the sun until sweating takes place. Occasionally the body is turned so as to expose ail sides to the sun about equally, not very unlike the operation of roasting a goose on a spit before the fire. The process is followed by washing in alum or sulphur water. Some- times the patient is laid on a bed of wormwood, chamomile, sage, peniiyroj-al, or other herbs. Epithems, poultices, and fomentations, which are really local baths, have been employed extensively both in ancient and modern times. Bags of heated sand, ashes, salt, oats, barley, etc., have each been supposed to possess peculiar virtues; while caiTots, hard soap, basswood roots, flaxseed, Indian meal, bread and milk, yolk of eggs, scraped ii intr:»duction. potatoes, with a great variety of barks, roots, aud herbs have in thou- sands of instances filled the spectator with amazement by producing : eftects very like those of a common rag dipped in common water. Sulphur funiiisations were among the ancient baths ; and several j modern authors liave written learned treatises on their employment i for the itch. It is not many years since the administration of the Civil : Hospitals of Paris appointed a commission of learned men to examine ' into the merits of the sulphm* fumigating treatment in this disease. It I may excite the risibles of those who have seen the itch effectually I cured by a single soap-suds bath, to be told that among the many sat- j isfactorv conclusions to which the iui-y of investigation arrived was the I fict that, "on an average, thirteen fumigations and a period of seven | daj's were sufficient to cure the disease." Vinegar fuynigations have been employed since the days of Hippo- 1 crates. Resinous, aromatic, and emollient herbs have been employed in ' fomentations for 3000 years, and are in repute still. General fumigations to the whole body, with a variety of mineral ; preparations, are now recognized processes of the allopatliic materia i medica. The articles in most common use are the mercurials — calo- j mcl, corrosive sublimate, and cinnibar — the protoxide of zinc, and deut- ! oxide of arsenic. Suljyhuretled hydrogen gas, or hydro-sulphuric acid, is also employed ' in the same way. Nitro-muriatic acid, for foot and other local baths, is a common pre- scription. Pulmonary insufflation, cajled by some atrimatrics, has been lauded ' as a curative process in consumption and other diseases of the lungs. It consists mainly in inhaling some kind of foul air, made filthy by ani- mal excrementitious matters, or by burning or smoking certain sub- i stances, so as to fill the room and the patient's lungs with their ftimes, as turpentine, tar, gum, resin, stj'rax, vinegar, sugar, old leather, old ' rags, etc. i The terminal point of the ridiculous in this line of practice was ; reached when Dr. Beddoes published his book, recommending patients \ to sleep in cow stables, and inhale the fi-esh stench of that delectable ' locality, or, to speak learnedly, the "factitious gases," which are the common air mixed with exhalations from the skin, lungs, kidneys, and '. intestines of the animals. But Dr. Beddoes stands not alone in the I glory of finding out cures for consumption. Almost all conceivable kinds of impure and disease-producing airs, as well as impure and dis- ; ease-producing waterg, have had the sanction of the medical profession ' as remedies / i iIISTORY OF BATHING. Professor Rcid gives us a list of thirty-four "factitious atmospheres," to be employed for medicinal purposes. The catalogue is worth record- ing, if for no other purpose, to aid some future vu-tuoso in making up a museum of obsolete medical curiosities: 1. Dry ah-; 2. Dry and hot air; 3. Dry and cold an-; 4. Rapid and hot air; 5. E.apid and cold air; 6. Moist ail-; 7. Moist and warm; 8. Moist and cold; 9. Rapid, moist, and warm; 10. Rapid, moist, anr* ,ald ; 11. Steamed aii-; 12. Highly oxygenated, by an admixture of oxygen ; 13. Less oxj^genating, by diluting air with nitrogen ; 14. Deoxidating, by adding agents to abstract a part of the oxygen; 15. Niti'ous oxide — intoxicating gas; 16. Niti'ous acid; 17. Nitric acid; 18. Chlorinated; 19. Sulphurous; 20. Car- bonic; 21. Ammoniacal; 22. Prussic; 23. Acetic; 24. Arsenical; 25. Mercurial; 26. Alcoholic; 27. Ethereal; 28. Benzoic; 29. Camphor- ic ; 30. Lavender; 31. Orange; 32. Cinnamon; 33. Creosotic ; 34. Hydro-sulphate of ammonia. Iodine has lately found a place in medical books as a fumigator, or Etrimatric agent. Iodine with alcohol was introduced by Sh' Charles Scudamore, who also employed the tinctures of opium, conium, ipecac, deadly nightshade, digitalis, Prussic acid, and chlorine. The hydriodate ofjjotassa, wliich is so frequently the efficiently evil agent in the sai'sapai-illas of the shops and the newspapers, is consider- ably employed atrimati-ically. Chlorine inhalation has had its day of fame in curing consumptions, the only drawback to which is the fact that the patients died. Tobacco has had its merits confessed by the facult}'. The smoke of tobacco cigars and camphor cigarettes has been recently recom- mended for aifections of the throat, chest, and lungs, by the professors of our New York medical schools. Peruvian hark, oak hark, myrrh, preparations of iron, suhnitrate of hismuth, hepar sulphuris, ivhite vitriol, blue vitriol, alum, sugar of lead, and lunar caustic, all reduced to impalpable powder, and applied by inhalation, are among the methods at the present time commended to us by living medical teachers, for the treatment of diseases of the air passages. Gas baths are rather a modern notion. Chlorine gas baths have been exhibited for diseases of the liver, and carbonic acid gas baths are recommended for "every thing in general." Soap baths are mentioned in medical books. They ai'e certainly useful to those who do not wash frequently, and among medicated baths ought to rank as number one. Medicinal water baths, made of the watenB of our fashionab^ adul- 4e INTRODUCTION. terated springs, are employed more or less, and many imitations of | tliem are manufactured at home. They are merely water impregnated | ^vith various mineral, earthy, alkaline, and saUne ingredients. Any | person, by throwing a handful of dirt, a shovelful of coal or wood ashes, a siwonful of salt, and a piece of chalk into a barrel of pure Croton \ water, can make as good a medicated bath, or as healthful a medicated ; drink, as can be found at Saratoga, Avon, or Cheltenham. , The anesthetic agents, ether and chloroform, which are properly | ntrimatrics, are now well known, and, except for surgical purposes, are I ' I destined to have a short-lived popularity. i Finally, we have the grease bath. This is the very latest external j application which has emanated from the allopathic school. It consists ! in rubbing the whole surface oi the body frequently with various : unguents, as fat bacon, hog's lard, suet, tallow, etc., etc. It originated with Dr. Schneeman, physician to the King of Hanover, and in treating ' eruptive fevers, and many other diseases, is highly recommended by j Dr. Taylor, of England, and a Dr. Lindsly, of Washington City. As a | species of factitious unction it deserves to rank with the factitious ' atmosphere practice of Dr. Beddoes. ! Medical TESxnioNy ix Favor of the Remedial Use of Wa TER. — From the days of Hippocrates to Priessnitz, the most eminent \ physicians of all countries have spoken almost as extravagantly in praise j of the medicinal employment of water as do the hydropaths — the hy- dro-maniacs, as they are sometimes called, of the present time. Yet directly in the face of this testimony its employment as a remedial agent had steadily declined, until recently revived by the wonders told of Graefenberg. 1 Hippocrates wrote much in favor of the good effects to be derived from water both in health and disease. He declared that the bath, in : cases of pneumonia, soothes ^he pain in the side, chest, and back, con- i cocts the sputa, promotes expectoration, improves the respiration, and ' allfiys lassitude. He advised pouring cold water on inflamed and swelled joints, in gout and rheumatism, and in spasms, luxations, and ' fractures. i Galen placed water in the highest rank of his materia medica. He regarded the bath, followed by exercise and friction, as one of the chief parts of a system of perfect cure. He has left the following record : ; " Cold water quickens the actions of the bowels, provided there be no constrictions from spasms, when warm water is to be used. Cold \ drink stops hemorrhages, and sometimes brings back heat. Cold i drinks are good in continued and ardent fevers. They discharge the j HISTORY OF BATHING-. 47 peccant and redundant humors by stool, or by vomiting, or by sweat." In biliousness, spasms, headache, fever of the stomach, hiccup, cholera morbus, obstinate ophthalmia, plethora, he recommended tepid and w^arm water-drinking, with the ti-ansition bathing — hot followed by tepid or cold. Celsus, in treating affections of the head, directs a warm sweating bath, foHow^ed by the tepid and cold bath, with an additional quantity of cold water to the head. He recommends water in fuUness of the stomach, headache, weak vision, d«>afness, tremors, sinking, pains in the joints, diarrhea, piles, and in hysterical and hypochondriacal affection ; and praises the bath in low fevers, digestive disorders, and diseased kidneys. He also advises cold immersion in skin diseases and in hy- drophobia. Asclejpiades, of Bithynia, though regarded as an empiric by the orthodox doctors of his day, advocated cold water internally and ex- ternally in hiccup, sour eructations, and nocturnal emissions. Oribasius testified to the value of water-ti'eatment in a manner sim- ilar to that of Galen. JEtius directed baths in protracted fevers, convulsions, retention of urine, lassitude, and nervous pains, although he added to the water one fifth part of heated oil. Rhazes advocated bathing in nearly all diseases. His water-treat- ment of small-pox was far more successful than any drug practice has proven since. Avicenna was also a strenuous advocate for the watery regimen in a multitude of diseases, especially asthma, colics, and dropsy. He rec- ommended infants to be bathed daily in tepid water. It is a sad pity that Avicenna, the Arabian Galen, has not more imitators in this respect among modern physicians. Hoffjnan pronounced water a universal remedy. His language is * " We assert that water is a remedy suited to all persons, at all times ; that there is no better preservative from distempers ; that it is assur- edly serviceable both in acute and chronic diseases ; and, lastly, that its use answers to all indications, both of preservation and cure." Boerhaave has wi'itten : No remedy can more effectually secure health and prevent disease than pure water. Haller, as a testimonial of its value, drank nothing hut water ; and the same is recorded of Demosthenes, Milton, and Locke. Floyer certifies : Water resists putrefaction and cools burning heat and thirst, and helps digestion. He recommended cold bathing in a variety of diseases. 48 INTRODUCriON. Baynard supposed good water to possess healing and balsamic prop- erties. He \\x\s a strong advocate for bathing as a remedy. Gregory regarded water as a tonic to the digestive organs. The celobnited Clieyne exclaimed : Without all peradventure, water was the primitive original beverage, and is the only simple fluid fitted for diluting, moistening, and cooling. JMacijuart in an especial manner recommended men of science and 5ettei"8 to make water their fovorite drink, assuring them that their ideas would be more precise, their judgment sounder, and their senses more delicate. Londe, and Levy, French authors on hygiene, speak emphatically in favor of the utility of water in preserving health. »•% by means of cold acidulated drinks, and fric- tions to the whole body, with pounded ice. Rev. John Hancock, an English clergj^nan, in 1722, published a tract in advocacy of water as the best remedy for fevers and the plague. He cured agues, scarlet fever, small-pox, measles, jaundice, and coughs, by copious water-drinking. John Smith, CM., English, ^vrote a book about a century ago, which is full of testimonials to the curative powers of water in nearly ail the prevalent diseases of the day. Its title was, " The Curiosities of Com- mon Water," and a larg-e proportion of its pages is a compendium of the opinions of many celebrated physicians in favor of the employment of water as a general remedy. Among his authorities are Manwar- ing, Keill, Prat, Duncan, Elliot, Allen, Harris, Van Heyden, and Pitt, all eminent in the medical profession. Geoffrey, French, more than a century ago, advocated the free use of water as a preventive of the plague. Hecquel, French, about the same time, advocated the use of water as an almost universal specific. Ponimc, French, at a later period, wrote in favor of cold water- drinking and warm bathing for various remedial and hygif-nic purposes, and particularly for the treatment of hysterical and hypochondriacal disorders. Rondeletius, French, published cases of gout cured by cold water as a beverage, as also did his countryman, Martinus. Riverius, French, treated female complaints, particularly mismen- struation, successfully by the use of water alone. De Hahn, German, directed free bathing and cold water-drinking during an epidemic fever at Breslau, in 1737, and his practice was far more successful than that of his competitors, who persisted in the em- ployment of active drugs. Theden, German, emploj'ed cold water and ice successfully in sti*an- gulated hernia, inflammations, malignant fevers, and small-pox. Sturm, a Polish surgeon, testifies to the successful treatment of epi- demic cholera, by means of as much warm water as the patients were able to drink, a glassfiil being administered every ten or fifteen min- ute'^. T-5 50 INTRODUCriON, Those celebrated medical philosophers and physicians, Harvey^, Louret, Cocchi, Sanclorius, Marziano, and Barthez, advocated and practiced cold applications to gouty swellings, and inflammations. Ambrose Pare declaimed that the true vulnerary, or dressing for wounds, was water alone. Michael Angela Blondl, Italian, wrote an essay, in 1542, on water as a remedy for gun-shot wounds. Gabriel Fallopius, of Venice, Felix Palaiius, of Trebia, and Jou- hart, JMartel, and Lamorier, of France, sti'ongly advocated water-dress- ings in surgical cases, instead of the more mystified and often mis- chievous plasters, balsams, liniments, lotions, or poultices. Larrey, the most celebrated operative surgee ^'-ance ever produced, used water-dressings generally. Kern, of Austria, praised the uses of water in the treatment of wounds, and even laid claim to the discovery of its superior merit. M. Jose, of Amiens, recommended cold water in the treatment of wounds, burns, plilegmons, erysipelas, and gangrene. Macartney, of Dublin, advises the fi-ee and methodical employment of water-dressings in wounds AVith him irrigation was a favorite mode of application. Lancassani, in 1753, Caldani, in 1767, Leanfer, in 1780, and Percy m 1785, published conclusive evidences of the superiority' of water alone to all the medicated fluids and compounds known, for surgical diseases. Dr. Wright, of England, in 1777, employed cold ablutions extensively and successfully in the treatment of fevers. Dr. Currie. of Liverpool, commenced the ti-eatment of fevei-s by cold aflusions in 1787. For several years he treated scarlet and tj-phus fevers, small-pox, and other diseases, principally by bathing, and with a success universally admitted to have been fai" greater than that of the ordinary drug-ti'eatraent. His work on the subject was published in 1797. Dr. Robert JacJcson, of the British army, had equal success in the same practice, the facts of which he published in 1791, at which time he had been in the habit of ti'eating fevers by cold afiusions for nearly twenty years. Giannini, of Milan, strongly recommends cold immersion in typhus and petechial fevers. Dr. Timer, of Prussia, in 1825, treated measles by cold bathing, and with remarkable success, as compared with his drugging contemporaries. Dr. N. Smith, of New Haven, Conn., was in the habit of dashing cold water on the bodies of patients in cases of typhoid fever, so as tc drench both the body linen and bedding. HISTORY OF B.rHIKG. 51 Dr. Forbes^ present editor of the ablest medifial journal of Europe, nnd one of the physicians to her Majesty Queen Victoria, confesses that in a large proportion of the cases of gout and rheumatism the Water-Cure seems to be extremely efficacious. He says further; "In that very large class of cases of complex disease, usually known under tlie name of chronic dyspepsia, in which other modes [Why wait to tiy " other modes ?"] of treatment have failed, or been only partially successful, the practice of Priessnitz is w^ell deserving of trial. In many chronic nervous affections and general debility we should anticipate great benefit from this system. In chronic diarrhea, dysentery, and hemorrhoids the sitz bath appears to be frequently an effectual remedy." Dr. Johi Bell, author of the ablest historical woi'k on bathing extant, has treated scarlatina in the Pennsylvania Hospital for many years by cold bathing, with the most satisfactory success. Although he does not entirely reject all other remedies, he admits that there is no other remedy than water which unites, to any thing like the same extent, efficacy with safety and immediately pleasurable results. He says : " How often have I seen the little sufferer, with burning heat and delirium, and unable to obtain sleep or repose of any kind, tranquillized immediately by the cold affusion, and fall into a sweet and refreshing sleep immediately afterward." Such is a part of the testimony volunteered by the regular profession in favor of the system we advocate. The reader will bear in mind that nearly aU the authorities thus far quoted are eminent authors, professors and practitioners of the allopathic school. After examining such a flood of evidence in favor of nearly all that is claimed by the hydi-opathists, the question naturally arises. Why is it, if regular physicians, in aU ages, and of aU countries, have found water-treatment so superior in the gi-eat mass of human maladies, that the medical faculty of the present day, as a body, employ it so little, in fact al:f 'ost wholly neglect it, nay, bitterly and vehemently oppose it? This is indeed a sti-ange problem, but it can be solved. The minds — professional minds — of medical men tf this day are as mystified and twistified, as superstitious and fantastical, as u'rational and absurd, so far as medical logic is concerned, as were the minds of med- ical men in that by-gone age when charms, magic, incantations, and necromancy were among the remedial resources. And so their minds will remain until they have some fixed basis, some settled princi- ples to reason from. A man may be in possession of any amount of book knowledge, he may know all the facts of aU the sciences in exist- ence, yet if he doe,s not recognize the principles to whbh those facts 62 I N T R D U C T 1 N. relate, his writing and his talking may be unintelligible jargon, and his practice a promiscuous medley of tinith and error. A man may under- stand all the letters of the alphabet, and all the words of the dictionary, And yet make bad words and sentences unless he is also acquainted with the principles of the construction of language. The ancient priests and monks placed their patients in aiiy, salubri- ous situations, enjoined strict abstemiousness or the simplest food, gave water for drink, and prescribed sufficient washing or bathing for thor- ough cleanliness, and then performed their magical ceremonies. Their patients recovered ; natm-e worked the cure, and the doctor got the credit. Our more learned modern physicians, more abundantly supplied with disease-killing missiles, permit or recommend the grossest food, give poisoned or drugged waters instead of pure, pay scarcely any attention to hygienic regulations, bathe insignificantly, empirically, or not at all, and pour down the pov^erful remedies. Their patients die ; nature gets the bLime, and the doctor is excused, for surely no one could have done more! The rock on which the water-ti-eatment has ever been ^v^ecked is eclecticism. Few minds, such is the bias of education, seem able to comprehend how it can be possible for a disease to be removed without a Hide medicine of some sort. It may be very little, infinitesimal, the thutieth dilution, or a ten-millionth pait of a drop of the tincture of a shadow, or the weakest decoction of catnip or canary seed ; still it must be something z/«natural, or nature cannot be assisted ! And if medicine of any kind or any strength is employed as an auxiliary, notwithstand- ing the use of water is regarded as the leading medication, the little, charming, mysterious influence of the drug will gi-adually gain upon the imagination, and in the end expel the water part of the practice as surely as weeds will run out flowers in an uncultivated field. It is like mixing brandy and water to make a beverage. Every one will admit that in such an admixture the water is the only strictly necessary and useful part of the drink ; yet by employing them in combination no man ever had his taste for water increase, and that for brandy decrease. The contrary has always been the fact. The safety and the ultimate triumph of the Water-Cure system depeL:^3 on seeping it clear of all •' entangling alliances," and on that alono. PART I. ANATOMY. DEFiN:dTi3N3. — Anatomy is the science of the structures of an or- ganized body. An organized body consists of an assemblage of parts, each of which is called an organ, and all mutually related to, and depend- ent on, each other. All organized bodies are either animal or vegetable Comjiarative anatomy teaches the sti'uctures of animals. Human anat omy contemplates a knowledge of the sti'uctures of all the organs and parts of the human body, and their relations to each other. Those sti"uctures which exist in all parts of the body are called gen- eral ; those which are found only in particular parts are termed special. The entire organism consists of solids^ in different degrees of density, wad fluids, which circulate through them. The solids are bones, teeth, cartilages, ligaments, muscles, nerves, vessels, viscera, membranes, skin, hair, and nails. The fluids are blood, chyle, lymph, saliva, gastric juice, 'pancreatic juice, synovia, mucus, and serum. Bile, sweat, ui'iae, etc., are excretions. Organic Elements. — Reduced to their ultimate constituents by fihemical analysis, almost the entire bulk of the body, except the bony tissue, is found to consist of oxygen, hydrogen, nitrogen, and carbon The bones and teeth contain a large proportion of phosphate and car- bonate of lime. A very small proportion of other substances, considered to be elementary, are regarded by chemists as essential constituents. These are phosphorous, sulphur, silicon, chlorine, iodine, bromine, fluo- rine, p)otassium, sodium, calcium, magnesium, iron, manganese, and aluminum. To this list some late chemists have added arsenic and cojjper ; and even lead and gold have quite recently been found in organized bodies, and have quite absurdly been put down as con- stituents. Some of these elements, however, are only occasionally found in the human body, particularly arsenic, c >\y3er, lead, and gold ; hence a more 64 ANATOMY. rational inference is, that they are accidental ingredients, instead of ele- mentar}' constituents. When it is considered how extensively metallic substances and min- eral preparations are employed as medicines, and how generally metallic vessels, liiible to oxidation, are used in cooking, to say nothing of the casual admixtures of drags kept about dwellings, for various domestic purposes, wi<^h the articles of food and drink, it need not be sm-prising that chemists should now and then detect ingi-edients in the solids and fluids of the auman body which have no natm^al relation to the organ- ism, save as incidental poisons. Proximate Principles. — The combination of the ultimate elements in various proportions forms the different organic substances called proxi- mate elements, or principles. The most important are albumen, Jibr in, and gelatin, which form the basis of the nenous, muscular, and cel- lular tissues. The refinements of chemical analysis have added or produced several other substances, which are put down as proximate. Most prominent among them are osmazome, procured by steeping mus- cular flesh in water or alcohol; pepsin, found in the gasti'ic glands; globulin, in the blood corpuscles; spennatin, in the semen; keratin, in the hair and skin ; heniatin, in the bile, etc. Most of these are probably mere products of the process of analysis ; and there is no end to the " elements," proximate or ultimate, that could be produced by subjecting animal matters to chemical actions and re-agents. Thus chemists, in experimenting upon the bile, have al- ready "found," as distinct principles, bilin ; fellinic acid; cholinic acid ; taurin ; dyslysin ; cholepyrrhin ; biliphcein ; biliverdin ; bili- fulvin ; cliolesterin ; oleate, mangarate, and stearate of soda ; chloride of sodium ; sulphate, lactate, midi phosphate of soda ; phosphate of lime. I can see no reason why a hundred or a thousand others may not be developed by similar experiments, which certainly tend much more to the complication of scientific words and phrases than to the demon- stration of true science. Tissues. — Each distinct solid structure is called a tissue. All tissues, however diversified in form, are produced from cells originating in a mass of soft, liquid matter, and they present the same general chaiac- teristics in all parts of the body. Every portion of the animal organism is formed of nucleated cells, which are constantly maturing, and as the body is undergoing continual decay and reproduction, they are always found in various stages of development. The divisions of tissues, and their vita propoities, will l^e treated of in the physiological pait of t'lis work. OSTEOLOGT. 65 CHAPTER 1. OF THE BONES— OSTEOLOGY. The osseous sti-ucture constitutes the framework of the body. It gives form, firmness, and individuality to the physiological character and affords surfaces and points for the connection of ligaments which hold the bones in position, and the attachment of muscles which move them. The proportion of the bony stiiicture to the gene- ral bulk may be seen at a glance in Fig. 1. The proximate constituents of bone ai'e — Cartilage . . (parts) 32.17 Blood-vessels . . . . 1.13 Phosphate of lime . . 51.04 Ca>'->>onate of lime . . 11.30 Fluate of lime .... 2.00 Phosphate of magnesia . 1.16 Soda, chloride of sodium 1.20 100.00 Structure of Boise. — The bony sti^ucture is a dense, com- pact, subfibrous basis, filled with minute cells, and traversed in all directions by branching and inosculating canals, called Ha- versian, which give passage to vessels and nerves. These cells ai"e irregular in form and size, and give off numerous branch- ing tubes, which, by communi- cating with each other in various directions, constitute a veiy del- icate network. KELATIOA' 01 BOXES TO BULK. C6 ANATOMY. Fiff. 2. A microscopic view oi the minute structure of bone is shown in Fi{j. 2. 1. One of the Haversian canals, surrounded by concertric lamellse. 2. The same, with the cells and tu- buli. 3. Area of one of the canals, 4 4. Direction ot the medullary, or central canal. The upper part oi the cut represents several long cor- puscles, or cells, v^ith their tubuli . the lovirer part exhibits the outlines of several other canals. Investing Membrane. — All the bones are invested with a dense fibrous mem- bi'ane, called periosteum, ex- cept at their articulating sur- faces, which are lined by a thin layer of cartilage. That portion of the periosteum which covers the skull bones is called pericranium ; and when it is prolonged over external cartilages, it is termea perichondrium. The internal cavities of long bones, and the canals find cells of oth- ers, are lined by a membrane called medullary, and filled with an oily substance, called medulla, or maiTOW. MINUTE STRUCTURE OF BONE. DEVELorMENT OF BoNE. — The osseous, like all organized struc- tures, is found to exist primordially in a state of exti'emely minute vesicles, or cells. Each cell is composed of a thin membrane, enclosing n fluid matter, in which is a small, denser mass, constituting the nucleus Bround which the cell itself was originally developed. Within each nucleus may usually be found one or more smaller gi-anules, or cells, called nucleolus, or nucleoli. And whether there are within these nucleoli yet smaller vesicles, and within them more minute nucleoli 9till, and so on, must be left to imagination. The human mind must gnisp infinit}- before it can comprehend the primal atom, or starting- point, of vital organization. Stages of Ossification.— The first recognizable change of ordinary vesicles toward bony stiucture is an assemi>lage of minute cells, of a gelatinous or jelly-like consistence. In the piocess of growth these cells are separated by intercellular substance, which is ti-ansparent and fluid at first, but gradually becomes condensed and opake. Then the fartilaginoui B*age of ossificnt bi: exists In the cartilaginous substance OSTEOLOGY. 57 vascular canals are formed by a union of ce'ils in ro\vs, and the lique- faction of the adhering surfaces. The next distinct change is into osseous substance. This is effected by the concentration of all the vascular canals to central points, each one of which is called i^unctum ossijicationis. As the earthy particles are deposited around the centi'al [loint, the surrounding caitilaginous cells become elongated, and within each cell two or three nucleoli are developed. Each of these second- aiy cells soon attains the size of the parent cell, the membrane of which disappears, and the newly-formed ceEs are separated by freshly effused intercellular substance. Still progi-essing, each newly-formed ceU produces four, five, or six young cells, which desti'oy the parent membrane, and attain a larger size than the parent cell, being —^ of an inch in diameter, all the cells being separated as before by in- tercellular substance. This process of reproduction is repeated yet again, each cell producing as many as its parent before, Vv'hich form in clusters of from thhty to fifty. The clusters are oval in figure, and are disposed longitudinally to the axis of the bone, while the cells them- selves are aiTanged transversely. Very fine and delicate fibres, within the intercellular substance, commencing at the ossifying point, and ex- tending through every part of the bone, longitudinally in long, and radiatingly in flat bones, are, lastly, formed, and complete the process of ossification. These fibres embrace each cluster of cells, and send branches between the individual cells of each group, by which the net- work of bone is formed, while the areola and Hervas4an canals are formed by the conjunction of the cells. A highly magnifying power shows tlie ossific fibres to be composed of minute cells, of an elliptical form, and having central nucleoli. THE SKELETON. The skeleton of an adult person consists of two hundred and forty- six distinct pieces : Bones of the head .... 8 Ear — ossicula auditus ... 6 Face 14 Teeth 32 Back — vertebral column . . 24 Ribs — twelve pairs .... 24 Tongue — os hyoides ... 1 Upper extremities —arm, wi'ist, and fingers 6-i Breast — sternum 1 Pelvis — ^hip, sacrum, and coc- cyx 4 Lower extremities — leg, in- step, and toes 60 Sesamoid — kneej^an, and bones in tendons . .... 8 246 58 ANATOMY. Anatomists Jistinguish tiu'ee kinds of bones : the long, Jlatj and irregular. The long appertain to the limbs, the arms, legs, fin- gers, and toes ; the flat enclose cavities, as the brain and pelvis ; the u'- regular are mostly found about the base of tile skull, face, ti'unk, wrist, and instep. VERTEBRAL COIiUMN. The bones of the back, constituting the vertebral column, are divided into thirty-thi'ee pieces in the young person, but in ad- vanced life the nme lower pieces unite into two. Each piece is called a vertebra. The whole are divided into true and false. The true are the tw^en- ty-four upper ones, and the false are the nine lower ones. The true are subdivided into seven cervical, belonging to the neck, twelve dorsal, form- ing the central portion of the back proper, and Jive lumbar, pertaining to the loins. The false are divided into the sacrum, which consists originally of five pieces, and the coccyx, originally consisting of four pieces. The vertebral column is the central axis of the body, and the part of the skeleton first developed in all vertebrated aiiivials. Each veitobra, except the upper cervical, whicii has no body, con- sists of a body, by which it is articulated with the adjoining vertebrae ; two lamina, or plates, v/liich anJi backward and enclose the passage foi the s])inal cordj a spinous p:ocess, which projects backward for OSSEOUS SYSTEM. OSTEOLOGY. 5€ Fig. 4. ].^:4 the attachment of muscles; two transverse processes projecting laterally from each side of the laminae foi the attachment of muscles; and four articular j^ro cesses^ which project upward and downward fron:. tlie lamin88, for articulation with adjoining vertebrsB Fig. 4 represents the vertebral column entire, seen from tne left side. 1. Two seml-facettes, which articulate with the head of the rib. 2. Spinous process. 3, 4. Two foramina, each re- sulting from the union of two vertebrse. 5. Cervical region and its corresponding curve. 6. Dorsal region and its corre- sponding curve. 7. Lumbar region and its corresponding curve. 8. Sacrum. '.4 The distinctive parts of a vertebra are seen in Fig. 5. 1. The body, concave in the centre, and rising- into a sharp ridge on each side. 2. The lamina. 3. The part called pedicle, rendered con- cave by the superior inter- vertebral notch. 4. Spinous process, its extremity bifui'- cated. 5. Transverse pro- cess. 6. Vertebral foramen. 7. Superior articular pro- cess. 8. Inferior articular process. Fig. 5. A CERVICAL, VERTEBRA. fEKTEBRAL COLTTMN The first cervical vertebra supports the hea:/, from which circumstance it is called the atlas. It is a simple ring of bone, and moves laterally, as well as forward and backward to some extent on the second cervical, which is called the axis. The axis has a large body, and a strong, tooth- 7 like process, called odontoid, which rises perpen- dicularly, and is articulated with the anterior arch of the atlas, while its posterior surface is firmly bound by a strong transverse ligament. The atlas (turning on the axis) moves the head, as though it were tm'ning on a pivot. The seventh cervical is called prominens, because its spinous process projects backward beyond the others, forming the prominent part of the back of the neck. This prominence is terminated by a tuber ie, to which the strong ligament of the neck ligcv^mtum nucha, is attached. 60 ANAIOMY. The dorsal vertebrie are marked on each side by articulating sur- fiices, facets, for receiving the head of the ribs. In size the dorsal are midway between the cervical and lumbar. The lumbar vertebra are the largest; their bodies are thicker before than bcliind; their spin;d cavity is large and oval, and their spinous processes are thick and broad. The sacrujn is of a ti'iangular figixre, concave in front and convex posteriorly. It is marked by four transverse ridges, which indicate the consolidation of five sepai'ate pieces. The coccyx, which terminates the vertebral column below, is com- posed of four small pieces, which giadually unite in one ; and this one becomes consolidated to the sacrum soon after the middle period of life. '^.no whole vertebral column represents two pyramids, with bases applied to each other ; the sacrum and coccyx constituting the lower, and all the vertebrae, except the atlas, forming the upper. The bodies are broad in the cervical region, naiTower in the middle of the dorsal, and again broad in the lumbar region. The spinous processes are hori- zontal in the cervical, gi-adually becoming oblique in the upper part of the doi-sal, nearly vertical and inbricated in the middle of the back, and again horizontal toward the lower part. The transverse processes grad- ually increase in length from the axis to the first dorsal vertebra ; in the dorsal region they project obliquely backward, and diminish sud- denly in length in the eleventh or twelfth, where they are veiy small. The intervertebral foramina are openings formed by the juxtaposition of the vertebral notches ; they are smallest in the cen'ical region, gi-adually enlarging to the lumbar. The vertebral groove extends the whole length of the column on either side of the spinous processes, for lodging the principal muscles of the back. ' bo>'p:s of the skull. Phey are divided into those of the cranium, and those of the face. The cninial, like all flat bones, are formed with two plates, or tables, and an intervening cellular network, called diploe, which contains an oily, medullary substance. This structure is admirably calculated to protect the brain from shocks, blows, etc. The cranial bones are eight in number, and the facial fourteen : Cranial Bones, Oojipital, Frontal, Sphenoid, Two parietal, Two tempera. Ethmoid. OSTEOLOGl 61 Facial Bones. Two nasal. Two palate, Two superior Kiaxillary, Two inferior turbinated. Two lachrymal, Vomer, Two malar. Inferior maxillary. Fig. 6. BONES OF THE HEAD. In Fig. 6, A represents the frontal bone. B B. Parietal. C C. Temporal. D D. Sphe. noid. E E. Malar. F F. Superior maxillary. G G. Inferior maxillary. H. Occipital. I. Nasal, a a. Mastoid process of the temporal bone. The Occipital hone forms the base and back part of the cranium. Its external surface is marked by two transverse ridges ; in the middle of the upper one is a projection, at which point the bone is very thick and strong. Tyros in phrenology have sometimes mistaken this projection for the hump of parentiveness. About an inch below this projection is the foramen inagnum, a large opening for the connection of the spinal cord with the brain. On each side of this orifice are processes, called condyles, for articulating with the atlas. The internal surface of the occipital bone is divided by a crucial ridge into four fossce. In tJie up- per fossae are lodged the posterior lobes of the cerebrum, and in the two inferior the lateral lobes of the cerebellum. In front of the fora- men magnum is a projection called the basilar jprocess, on which rests the medulla oblongata. The Parietal hones ai'e quadrilateral in form, situated at the side and vertex of the skull, and connected with each other by a sti-aight suture, sailed sagittal. On the external surface of each bone is an arched G «J2 ANATOMY. line, called the tempoi il ridge. The internal sui-face is marked by numerous furrows, which lodge the ramifications of the middle me- ningeal nileiy, and by digital fosses, coiTesponding with the convolu- tions of the brain. The Frontal bone is situated at the anterior part of the cranium, forming the forehead, and a part of the roof of the nostrils and orbits of the eyes. Each lateral half of the bone projects forward, forming the frontal eminences. Below these points are the superciliary ridges, which support the eyebrows. Between these ridges is a rough pro- jection, called nasal tuberosity, behind which is a canal, called the longitudinal sinus. On the side of the bone is the temporal ridge, ani below this is a depression, called the temporal fossce. The sharp^ prominent arches, wliich form the upper part of the orbits are called the internal and external angular processes. Between these processes is a rough excavation, which receives the nsisal bones, and a projection, called the nasal spine. The internal surface is divided by a grooved ridge ; in the gi'oove the longitudinal sinus is lodged, and to the edges of the ridge the falx cerebri is attached. On the orbital portions ai-e foss(B coiTesponding to the convolutions of the anterior lobes of the cerebnim. The Teynporal bones are situated at the side and base of the skull, and are divided into squamous, mastoid, and petrous portions. The squamous portion forms the anterior pait of each bone, and the thin, ti'anslucent part of the temple. A long, ai'ched process pro- jects from its external surface, called the zygoma. Its internal sur- face is iiTegularly depressed by the convolutions of the cerebinim. The mastoid portion forms the back pait of the bone. Beginners in phrenological science, on feeling behind the ears, have often mistaken its projection for an enormous " combativeness." It is thick, rough, and piercod with numerous holes for the passage of very small arteries and veins. Interiorly, a part of it is excavated into numerous cells, which belong to the o;-gan of heai-ing. In front of it is the meatus avditorius cxtcrmis, or external ear passage. The petrous poition is exti-emely hai'd and dense. In shape it is a throe-sidod pyramid. Near the middle of its posterior surface is the enti-ance of the meatus auditorius internus, about one third of an inch in depth. At the bottom of the meatus is a fossa, called reniform ; it is divided by a sharp ridge into an upper and lower compartment ; this ridge is prolonged for some distance upon the anterior waU of the meatus, and marks the situation of the facial and auditory nerves, which constitute the seventh pair, and enter the meatus. The basilar surface is rough ar.l irregular, and assists to form the OSTEOLOGY 63 under surface of the base of the skull. To a smooth fossa, called glenoid, the condyle of the lower jaw is articulated. At the inner angle of this fossa is the forairten of the Eustachian tube. The Sphenoid bone is situated at the base of the skull, and enters into the formation both of the cranium and face. Its shape has been compared to a bat with its wings extende-1. It is divided into a centi'al portion, or hody ; lesser wings, consisting of two small triangular plates projected from the anterior and upper part of the body ; greater wings, expanding laterally from each side of the body ; sjnnous processes, ex- tending backward from the base of the gi'eater wings ; and pterygoid processes, extending downward from the gi-eater wings. On the su- perior surface of its body are seen the optic foramina, which ti-ansmit the optic nerve and ophthalmic arteries. The posterior surface is flat, rough, and articulated with the basilar process of the occipital bone. The lesser loings form the posterior parts of the roof of the orbits, and are ti-aversed by the optic foramina. The greater wings form part of the middle fossae of the base of the skull, and assist in forming the outer walls of the orbits. The external border of the spinous pirocess is articulated with the squamous portion of the temporal bone ; its internal border is gi-ooved for the reception of the Eustachian tube. The pterygoid processes form the lateral boundaries of the posteiior nares. The Ethmoid hone (sieve-like) is a square, cellular bone, between the orbits at the root of the nose. It is named from a number of small openings which perforate the surface. It consists of a thin central plate, which assists in forming the septum of the nose, and tivo lateral masses. From the upper part of the septum a sti'ong process projects into the cavity of the skull, called crista galli, to which the falx cerebri is attached. On each side of the crista galli is a grooved plate perfo- rated by numerous openings, the crihriform lamella, which supports the bulb of the olfactory nerve, and gives passage to its filaments, and also to the nasal branch of the ophthalmic nerve. The lateral masses are composed of cells. The internal surface forms the external boundary of the upper part of the nasal fossae. The external surface enters into the formation of the inner wall of the orbit. What is called the superior turhinated hone is a thin, curled plate of the internal surface, consti-tuting the upper margin of a nar- row fissure — the superior meatus of the nose. Below the meatus another thin plate curls outward ; it is called the middle turhinated hone. The Nasal hones are small, quadrangular pieces, forming the bridge and base of the nose They are convex superiorly^ and slightly con- A N A T M Y. tnve on their under surface, which is grooved for the nasal branch of the ophthalmic nerve. The Sujjcrior Maxillary hones form the whole of the upper jaw, and assist in forming the orbit, nose, cheek, and palate. The body of each is triangular ; its interior is hollow, forming the antrum ; and its lower part presents the alveolar jnocesses, for containing the upper teeth. The 2^'^sterwr surface forms part of the zygomatic fossa, over wliich a projection extends to the malar bone, called the malar process. A process called nasal articulates with the frontal and nasal bone. Be- tween the opening of the anti-um, which is an in-egulai' hole on its nasal surface, and the nasal process, is a deep vertical groove, called sulcus lachrymalis, which is formed into a canal by the kchiymal and inferior turbinated bones, constituting the nasal duct. The margin of the nasal process is niai'ked by a small tubercle, which serves to guide the knife of the surgeon in operating for fistula lachrymalis. The palate process projects horizontally inwai'd — its upper sm-face forming the floor of the nares, and its under surface a part of the roof of the mouth. Each Lachrymal hone is a thin, ovaJ plate, situated at the anterior and inner angle of the orbit of the eye. A portion of its external sur- face assists in forming the orbit ; another portion is concave, and lodges the lachrymal sac. The internal surface assists in forming the nasal fossPB and nasal duct. The Malar hones are the quadi'angular pieces which form the prominences of the cheeks. The external surface of each has many smaU openings for the passage of •filameats of nerves and minute arte- ries. A process, called frontal, ascends to aiticulate with the external angular process of the fi'ontal bone, and form the outer border of the orbit. It is united to the zygoma of the temporal bone by a pro- cess called zygomatic, and to the superior maxillary by the maxillary proress. The Palate bones are situated at the back part of the nares, and enter into the formation of the palate, side of the nose, and the poste- rior part of the floor of the orbit. Each bone resembles the letter L, the perpendicular and horizontal portions presenting each two quadri- lateral surfaces. The Inferior Turbinated bones are light, spongy, iiTegulai-ly cm-ved bones, projecting inward towai'd the septum narium, or partition of the nose. Each one is attached to the maxUlaiy bone in front, and the palate bone behind. The Vomer is a thin quadrilateral piece, forming the back and lower part of the septimi of the nose. OSTEOLOGY 65 The Infeiior Mc lillary bone, or lo^^er jaw, is an arch of bone contain- ing the unrjer lovv of teeth. Its distinctive parts are shown in lig. 7. 1. The body. 2. The ramus. 3, The eymphisis, or point of union. 4, Fossa tor the depressing muscle of the lower ;'aw. 5. Mental foramen. 6. External oblique ridge. 7. Groove for the facial artery. 8. The angle. 9. Extremity of the milo-hyoidean ridge. 10. Coronoid process. 11. The condj-les, v/hich articu- late with the glenoid cavity of the tem- poral bone. 12. Sigmoid notch. 13. In- ferior dental foramen. 14. Milo-hyoidean groove. 15. Alveolar process, i. The middle and lateral incisor tooth of one side. I. The canine tooth, b. The two bicuspids, m. The three molars. LOWER JAW. SUTURES OF THE SKULL. The bones of the skull are connected with each other by sutures y^sutura, a seam), of which anatomists distinguish several varieties ; the most important are serrated^ saw-teeth-like ; squamous^ or scaly ; liar- monia, or apposite ; and schindylesis, fissure-like. The most prominent cranial articulations are the coronal, sagittal^ and lambdoidal sutures, all of which are serrated. The coronal ex- tends transversely across the crown of the skull, uniting the frontal bone with the two parietal. The sagittal forms the longitudinal seam along the vertex, and unites with two pai-ietal bones. The lambdoidal diverges at an acute angle from the posterior exti-emity of the sagittal, uniting the occipital and parietal bones. The squamous unites the squamous portion of the temporal with the parietal and sphenoid bones. Other sutures are named according to the bones, or parts of bones, which they connect. E-EGiONS. — The skull is divisible into four regions — superior, lateral, inferior, and anterior ; or, vertex, side, base, and front. I'he suj^erio? region i^ bounded by the frontal eminences in front, temporal ridges and parietal eminences on each side, and by the upper curved line and pro- tuberan^e of the occipital behind. The lateral is subdivided into tern- jmral, mastoid, and zygomatic portions. The inferior region is sub- divided into a cerebrcd, or internal, and a basilar, or external, surface. The cerebral surface is again subdivided into anterior, middle, and posterior fossa. The face constitutes the anterior region. h6 AK ATOMY. Fis. 8. Fig. 6 exhibits several mi:%7te peculiaritiea of structure not described in the text. i. Tha frontal portion of the frontal bone. 2. Nasal tuberositv. 3. Supra-orbital ridge. 4. Optic foramen. 5. A fissure, called sphenoidal. 6. Another fissure, called sphono-raaxillary, 7. The lachrymal fossa. 8. Opening of the an- terior nares, the vomer in the centre, on which the figure is placed. 9. Infra-orbital foramen. 10. Malar bone. 11. Symphisis, or point of .union of the lower jaw. 12. I^Iental foramen. 13. Ramus of the lower jaw. 14. Parietal bone. 15. Coronal suture. 16. Temporal bone. 17. Squamous suture. 18. Upper part, or greater wings, of sphenoid bone. 19. Commencement of temporal ridge. 20. Zygoma of temporal bone, forming, with the malar, the zygomatic arch, under which is the zygomatic fossa. 21. The mastoid process. FRONT VIEW OF THE SKULL. Fig. 9. Fig. 9 represents the cerebral surface ol the base of the skull. 1. One side of the anterior fossa. 2. Lesser wing of the sphenoid. 3. Crista galli. 4. Foramen Cfficum. 5. Cribriform lamella of the eth- moid. 6. The process called olivary. 7. Foramen opticum. 8. Anterior clinoid process. 9. The carotid groove on the side of the sella turcica, for the internal carotid artery and cavernous sinus. 10, 11, 12. Middle fossa of the base of the skull : 10 marks the great ala of the sphe- noid ; 11, the squamous portion of the temporal bone ; 12, the petrous portion. 13. The sella turcica. 14. Basilar portion of sphenoid and occijjital bones. The uneven ridge between 13 and 14 is called dorsum cphippii, and the prominent angles of the ridge constitute the posterior clinoid processes. 15. Foramen rotupdum. 16. Foramen ovale. 17. Foramen spinosum ; a small opening between 17 and 12 is called kiatiis Fallopii. 18. Posterior fossa of the base of the skull. 19, 19. The groove for the lateral sinus. 20. The ridge upon the occipital bone, to which the falx cerebelli is at- tached. 21. Foramen magnum. 22. Meatus auditorius internus. 23. Jugular foramen. INNER B.VSE OF THE SKTJLL. ORBITS OF TUP: EYE. These are hollow cones for tho lodgment of the eyeballs, with their OSTEOLOGY. 67 muscles, vessels, and nerves, and the lachrymal glands. The superior boundary is formed by tlie orbital plate of the frontal bone, and by part of the lesser wing of the sphenoid ; the inferior by part of the malar bone, and by the orb.tal process of the superior maxillary and palate bones ; tne internal by the lachrymal bone, the external surface of the ethmoid, called os planum^ and part of the body of the sphenoid ; and the external by the orbital process of the malar bone, and the great Bla, or wing of the sphenoid. Communicating ^vith the orbit are nine openings for the ti'ansmission of arteries, veins, and nerves. The Nasal Fossee are irregular cavities in the middle of the face, bounded ahove by the nasal bones, ethmoid and sphenoid ; heloio by the palate processes of the palate and superior maxillary bones ; outivardly by the superior maxillaiy, lachrymal, ii .ferior turbinated, superior and middle turbinated bones of the ethmoid, palate, and internal pterygoid plate of the sphenoid. The partition between them is formed by the vomer and the perpendicular lamella of the ethmoid. Each nasal cavity is divided into tliree UTegular longitudinal passages, called meatuses^ by three projecting processes of bone from the outer wall — the superior, middle, and inferior turbinated bones. The inferior or lower meatus is much the largest. THE TEETH. The human animal is provided with two sets of teeth : the first are Fig. 10. those of childhood, called deciduous^ or milk teeth. The sec- ond ai'e permanent. The teeth of childhood are tvventy : eight in- S^ cisor, or cutting, four m canine, and eight mo- lars, or grinding teeth. Fig. 10. — a. Central in- cisor, h. Lateral incisor. c. Canine, d. First molar. e. Second molar. TEMPORARY TEETH. Tlie permanent teeth are thirty-two, sixteen in each jaw. The eight centi'al are called incisors, or cutting ; next are the four canine, or eye teeth *, then the eight bicuspids, or small double ; and lastly, twelve molu/s, or gi'inding. Each lat^^ral half of each jaw, reckoning from the centre, contains two incisors, one canine, two bicuspids, and three molars* I G8 ANATOMY. PERMAA'ENT TEETH. In Fig. 11, a is the central incisor, b. Lateral incisor, c. Cuspid, or canine, d. First bicuspid, c. Second bicuspid. /. First molar, g: Second molar, h. Third molar. A tooth is composed of a firm external crust, called enamel ; the tooth bone proper, called the ivory ; and a cortical substance, called cementum. The enamel covers the exposed surface of the crown, and Fi-. 12. IJVFANr TEETH, AND ni;DIiil>-r3 OF THE PERMAA'EJTl OSTEOLOGY 69 the cementum forms a thin coating over the root of the tooth. Its Btructiire is similar to bone, and exhibits numerous calcigerous cells and tubuli. The cementum becomes thicker in old age, and gives rise to appearances in old persons called exostosed ; the same appearances are also produced by mercury and other di'ugs. In Fig. 12 are seen the number, aiTangement, and nervous coLinec- tioii of a complete set of infant teeth, with the rudiments of the second set, or permanent teeth. The cut represents the jaws of a child at the age of about four years. Periods of Dentition. — The temporary teeth usually appear in the following order, the lower teeth generally preceding the upper : In the seventh month the two middle incisors ; in the nintli the two lateral incisors ; in the twelfth the first raolares ; in the eighteenth the canine ; and in the twenty-fourth the two last molares. This order, however, is subject to considerable irregularity. The permanent teeth generally appear : First molares, at 6.^ years. Two middle incisors, 7th year. Two lateral incisors, 8th year. First bicuspids, 9th year. Second bicuspids, 10th year. Canine, 11th to 12th year. Second molares, 12tli to 13th year. Last molares, ]8th to 21st year. The last grinding tooth, from its late development, is called dens sapienta, or wisdom tooth. Occasionally it does not appear till twenty- five or thirty years of age, or even later. The Hyoid, or tongiie bone, called os hyoidcs, is situated at the base of the tongue, supporting it and the upper part of the larynx. It consists of a central body, two processes, which project backward, called the greater cornua, and two lesser cornua, ascending from its angles. Fig. 13 is a front view of it. 1. The convex or antero- '^o- ^'^• superior side of the body. 2. Gnrater cornua of the left side. 3. Lesser cornua. In early life the cornua and body are con- nected by cartilages and ligaments which be- come ossified in old age. OS HYOIDES. BONES or THE ttiKST. The sternum, or breast bone, in front, and the twelve pairs of ribs on the sides, constitute the thorax. The Sternum is situated in the centi'al line of the front part of the chest; its upper end lies within a few inches of the vertebral column, while its inferior extremity projects considerably foi*ward. Its 70 ANATOMY. upper end is called inanybriun, to each side of wricli the clavicle ia attached. The middle portion is called the body, and the inferior ex- tremity terminates in the xijplwid, or ensiform cartilage. Fig 14. 9va7, An anterior view of the thorax ia represented in Fig. 14. 1. The ma- nubrium. 2. Body. 3. Ensiform cartilage. 4. First dorsal vertebra. 5. Last dorsal vertebra. 6. First rib. 7. Head of first rib. 8. Its neck. 9. Its tubercle. 10. Seventh rib. 11. Costal cartilages of the ribs. 12. Last two false ribs. 13. The groove along the lower border of each rib. The Ribs. — The first or upper seven pairs ai*e called sternal, or true ribs, because they are articulated with the sternum. The five lower pahs are called false, or as- ternal, and are connected with each other in front by cartilages. The ribs increase in length from the first to the eighth, and then diminish to the twelfth. In breEtdth they diminish from the first to the last, excepting the two lower ones. The first is horizontal, and all the rest oblique, the anterior end falling considerably below the vertebral end. Each rib is curved to correspond with the arch of the thorax, and t^visted upon itself. Near the vertebral extremity the rib is bent upon itself, forming an angle for the attachment of the tendon of the sacro-lumbalis muscle. Behmd this angle is the rough elevation called the tubercle. The vertebral end of the rib is expanded into a head for ai-ticulation with two contiguous vertebrae. The tVN'o lower false ribs are much shorter than the others, and are called Jloating ribs. The sternal ends of the ribs ai*e cartilaginous, thus contributing mainly to the elasticity- of the thorax ; infold age these costal cartilages are more or less ossified. The first seven cartilages articulate with the Btemum ; the three next with the lower border of that immediately preceding; and the last two lie free between the abdominal muscles. Each rib articulates with two vertebrae posteriorly, and one costal carti- lage in front, except the first, tenth, elevemh, and twelfth, which are only articulated with a simple verte *n each THE THORAX. OSTEOLOGY. 71 BONES OF THE UPPER EXTRElNnTIES. Each upper extremity comprises the clavicle, or collar bone ; the scapula, or shoulder blade ; the humeras, or arm bone ; the ulna and radius, bones of the fore-arm; the bones of the carpus, or wrist; and the metacarpus and phalanges of the fingers. The Clavicle, or collar bone, extends across the upper part of the Bide of the chest, from the upper end of the sternum to the point of the shoulder, where it is articulated with the scapula. Its position is some- what oblique, and in shape it resembles the italic letter /. The Scapula, or shoulder blade, is a flat, ti'iangular bone, occupying the space from the second to the seventh rib, upon the posterior aspect and side of the thorax. The anterior surface is concave, and marked by several oblique ridges. The posterior surface, called dorsum, is con- vex, and divided into two unequal portions by a ridge, called the spine. The superior harder is the shortest ; one of its terminating extremities is called the superior angle, and the other the coracoid process. The anterior angle is the thickest portion of the bone, and forms its head. On this head is a shallow articulating surface called the glenoid cavity, which receives the head of the humerus. Above and overhanging the glenoid cavity rises a projection called the acromion. Fig. 15. on the anterior border of which is an oval articular surface for the outer end of the clavicle. A strong, curved prominence rises from the upper part of the neck, called coracoid process, which gives attachment to several ligaments and muscles. The position and form of the scapula and clavicle may be seen in Fig. 1. The Humerus, or arm bone, is long, cylindrical, and divisible into a shaft and two extremities. The upper extremity is divided into a head, w^hich is artic- ulated with the scapula, nec/v, and greater and lesser tuberosity. The lower extremity is divided into two articular surfaces, the external of which 's a rounded prominence, called eminentia capitata, which articu- lates with the head of the radius ; the internal is con- -cave, and articulates with the ulna. Fig. 15 is a front view of the right humeral bone. 1. The shaft. 2. Head. 3. Neck. 4. Greater tuberosity. 5. Lesser tuberosity. 6. A groove called bicipital. 7, 8. Bicipital ridges. 9. A rough surface to which the deltoid muscle is attached, 10. A foramen for nutrient vessels. 11. Eminentia capitata. 12. The troclilea. 13. External condyle. 14. Internal jondyle. 15, 16. Condyloid Tidges. 17. Fossa for receiving thrj coronoid process of the Qlaa. <6 /2> HUMERUS 72 A N A T M Y. 1 Fig. 16. The Ulna and Radius are the bones of the fore-arm. The uhm is a long bone, slender in the middle, and lai-ger at its upper than its lower extremity. The upper end forms principally the articulation of the elbow; the lower end is excluded friim the ^vi'ist joint by an inter- veninoste- rior sacro-ischiatic ligaments. The upper border of the anterior forms part of the boundary of the great' sacro-ischiatic foramen ; and its lower border a part of the lesser sacro-ischiatic foramen. The superior border of the posterior forms also a part of the lesser sacro-ischiatic foramen, and its lower border a part of the boundary of the perineum. The two ligaments convert the sacro-ischiatic notches into foramina. Sacro-Coccygean Joint. — Between the sacrum and coccyx yb a soft fibrous cartilage. The bones are held together also by the ante- rior and posterior sacro-coccy gean ligaments. This articulation admits of a backward motion during parturition. Pubic Joint. — The ossa pubis are connected together by an inter- osseous cartilage, the anterior, posterior, superior, and sub-pubic liga- ments, which variously cross the symphisis, or place of union. The articulation becomes movable during parturition, and admits of a slight separation of the bones. 81 ANATOMY. The numerous vacuities in the walls of the pelvis, aud their closure by ligamentous structures, diminish materitdly the pressure on tiie soft pai'ts during the passage of the head of the foetus. Note. — The obturator ligament or memhrane is a tendo-fibrous ex- pansion sti-etched across the obturator foramen. It is not concerned in articulation, but gives attachment to the obtui-ator muscles, and leave* a space in the upper part of the foramen for the passage of the obturator vessels and nerves. Sterno-Clavicular Joi>t. — The breast and collar bones are con- nected by the anterior^ posterior, sterno-clavicular, inter-clavicular, and cosio-clavicular ligaments, an interarticidar cartilage, and two synovial membranes. Tlio motions of this aiticulation ai*e gliding and circum- duction. This joint is the centi-e of the movements of the shoulder. In dislocations of the sternal end of the clavicle, the costo-clavicular ligament, called also rhomboid, is ruptured, occasioning a peculiar de- form it)'. Fig. 29. Fig. 29 shows the ligaments of th« Bterno-clavicular and costo-sternal articu- lations. 1. Anterior sterno-clavicular liga- raenL 2. Inter- clavicular ligament 3. Costo-clavicular. 4. Interarticular carti- lage. 5. Anterior costo-sternai ligamentg of the first and second ribs. Sc-apulg-Clavicular Joint — The shoulder blade and breast bone are connected b}^ two sy- novial membranes, an interarticu lar cartilage, a superior acromio' clavicular, an inferior acromio- clavicular, and a coraco-clavicular ligament. This articulation admits of a gliding and rotatory move- ment. Note. — The shoulder blade has two ligaments, cor aco- acromial and transverse, v*'hich are proper to itself. The first is a thick ti-iangular band, forming a protecting arch over the shoulder joint. The second crosses the notch in its upper border, thus converting it into a foramen. STERNO-CLAVICULAR JOINT. The Shoulder Joint. — The scapula and humerus form a ball-and- socket articulation ; its ligaments are the capsular, coraco-huvieral, and gltnoid. SYNDESMOLOGY. 86 The ligaments of the scapula and shoulder joint are seen in Fig 30. 1. Superior acromio- clavicular. 2. Coraco-clavicular. 3. Coraco- acromial. 4. Transverse. 5. Ccipsular. 6. Co- raco-humeral. 7. The long tendon of the biceps muscle issuing from the capsular liga- ment, and entering the bicipital groove. The capsular ligament encircles the heads ' of the scapula and humerus. The coraco-humeral is a broad band between the coracoid process of the scapula and the gi'eater tuberosity of the humerus. The glenoid is a car- tilaginous band around the margin of the glenoid cavity, which it deepens. The synovial membrane of this joint is very extensive, and the articu- lation admits of every kind of motion. Fig. 30. SHOULDER JOINT. Fig. 31. The Elbow Joi>"r. — At this articu- lation the humerus, ulna, and radius are connected by four ligaments in addition to its synovial memhrane. They are the anterior^ composed of fibres, which pass vertically, transversely, and obliquely, forming a broad membranous layer, between the anterior surface of the humerus and the coronoid process of the ulna and orbicular ligament ; the posterior, a broad loose layer between the posterior surface of the humerus and the olecranon ; the internal lateral, a thick triangular layer passing between the inner condyle of the hu- merus to the margin of the gi*eater sigmoid cavity of the ulna ; and the external lateral, a strong narrow band descending from the external condyle of the humerus to the orbicular ligament and ridge of the ulna. The motions of this articulation are flexion and ex- tension, the former being limited by the coronoid process, and the latter by the olecranon. An internal view of the ligaments is seen in Fig. 31. 1. Ante- rior. 2. Internal lateral. 3. Orbicular. 4. Oblique. 5. Inter- osseous. 6. Internal con iyle of the humerus, which conceals the j^lbq w JOINT II*< post wor ligament. TERNALLY 8 P8 ANATOMY. Fig. 32 is an external view of the elbow articulation. 1. Hu merus. 2. Ulna. 3. Radius. 4. External lateral ligament in- serted below into the orbicular (5). 6. The posterior extremity of the orbicular, spreading out at its insertion into the ulna. 7. Anterior ligament. 8. Posterior ligament. Radio-Ll>ar Joint. — The radius ana uina are held together by an inter articular cartilage, the lower surface of which enters into the articulation of the \vi*ist ; the orbicular ligament, which sur rounds the head of the radins, and is attached at each end to the exti'emities of the lesser sigmoid cavity ; the oblique ligament, a narrow slip betweea the coronoid process and the inner side of the ra- dius ; the interosseous ligament, a broad aponeurosis between the ridges of the radius and ulna ; and the anterior inferior, and posterior inferior ligaments. The orbicular ligament is necessai'ily ruptured in dislocations of the head of the radius. The lower part of the interosseous ligament is perforated for the passage of the anterior interosseous artery. The posterior interosseous artery passes backward between the oblique ligament and the upper border of the interosseous ligament. This ligament affords an extensive surface for the attach- ment of muscles. The movements of this joint are, the rotation of the radius upon the ulna ; the forward rotation is called pronation, and the backward supina- tion. The head of the radius also turns upon its own axis within the orbicular ligament and the lesser sigmoid notch of the ulna; and inferiorly a concavity in the radius moves on the rounded head of the ulna. The anterior and posterior inferior ligaments ai'e chiefly concerned in limiting the movements of the radius, and hence, in great muscular efforts ai'e frequently ruptured. The Wrist Joint. — This articulation is formed by the anterior^ posterior, internal lateral, and external lateral ligaments, with the sy- novial membrane. Its motions are flexion, extension, adduction, ab- duction, and circumduction, in all of which movements the articular surfaces glide upon each other. The \vi-ist joint is an example of the articulation called ginglymoid. The radial artery rests on the ex- ternal lateral ligament as it passes backward to the first metacarpal 8pac«. ELBOW JOINT EX- TERNALLY. SYNDESMOLOGY. 87 Fig. 33. The ligaments of the wrist and hand are seen an- teriorly in Fig. 33. 1. Interosseous membrane. 2. Anterior inferior radio-ulnar ligament. 3. Antez'ior Ugament of the wrist. 4. Its external lateral. 5. Its internal lateral. 6. Palmar ligaments of the carpus. 7. Pisiform bone, with its ligaments. 8. Ligaments connecting second range of carpal bones with the me- tacarpal, and these with each other. 9. Capsular liga- ment of the carpometacarpal articulation of the thumb. 10. Anterior ligament of the metacarpo-phalangeal ar- ticulation of the thumb. 11. One of the lateral hga- rnents of that articulation. 12. Anterior ligament of the metacarpo-phalangeal articulation of the index finger. 13. Lateral ligaments of the same joint ; the corresponding ligaments are seen in the other ai'ticu- latioiis. 14. Transverse ligament connecting the heads of the metacarpal bones of the index and middle fin- gers ; the sanie ligament is seen between the other fingers. 15. Anterior and one lateral ligament of the phalangeal articulation of the thumb. 16. Anterior and lateral ligaments of the phalangeal articulations of the index finger ; the anterior ligaments are re- moved in the other fingers. The Carpal Joints. — The carpal bones ai'e connected by ligamentous bands, which pass transversely and longitudinally fi'om bone to bone on the back, caUed dorsal ligaments ; by palmar ligaments, which have a similar disposition in front ; by interosseous cartilages between the bones ; and by a strong ligamentous band connecting the bones of the two sides, called anterior annular ligament. Five distinct synovial memhranes enter into the carpal articulations. Between the bones of each range there is a slight movement of flexion and extension. WRIST JOINT The Carpo-Metacarpal Joints. — The second row of carpal bones articulates with the metacarpal finger bones by dorsal and palmar liga- ments ; and the metacarpal of the thumb is joined to the trapezium by a true capsular ligament. The metacai'pal bones of the four fin- ger are connected at their bases by dorsal, palmar, and interosseous ligaments. The thumb, shoulder, and hip joints are the only ones in the body having true capsular ligaments. The movements of the carpo-metacarpal articulations ai'e limited to a slight degi'ee of sliding motion, except in the case of the metacarpa. bone of the thumb with the ti'apezium, which has flexim, extension^ adduction, abduction, and circumduction. 88 ANATOMY Mktacarpo-Phalangf.al Joints. — The metacarpal and finger bones are united hy anterior tibro-cartilaginous ligaments, sti'ong, nar- row lateral ligaments, and strong ligamentous bands, called transversa. ligaments. These articulations have the motions of flexion, extension, a limited adduction and abduction, and a slight degree of circumduction. Phalangeal Joints. — The finger bones are connected by an an- terior and two lateral ligaments. The extensor tendon performs the i office of a posterior ligament, as with the preceding articulations. j The movements are flexion £md extension. Fig. 34. The Hip Joint. — The head of the femur is received into the cup- shaped cavity of the acetabulum, forming a ball-and-socket joint. Its ligaments are the cajJsular, which embraces the acetabulum superiorly, and the neck of tlie femur inferiorly ; the ilio-femoral, an accessory Attachment to the anterior portion of the capsular; the ligamenlum teres, which holds the centre of the head of the femm* to the acetabu- lum ; the cotyloid, a cartilaginous cord around the margin of the ace- tabulum, which cavity it serves to deepen ; the transverse, ex- tending across the notch of the acetabulurL ; and the syyiovial membrane, which invests the hea< of the femur, and spreads around the hgamentum teres. The hip joint has an extensive range of movements — flexion, ex- tension, adduction, abduction, cir- cumduction, and rotation. The ligaments of the pelvis and hip joint are partly shown in Fig. 34. 1 Lower part of the anterior common lig iment of the vertebrai, extending down ward over the front of the sacrum. 2 Lumbosacral. 3. Lumbo iUac. 4. Ante rior sacroiliac. 5. Obturator membrane, 6. Poupart's ligament. 7. Gimbernat'e 8. Capsular. 9. lUo-femoral, or acces 8ory. The fossa at the bottom of the acetabulum is filled by an adipose mass, covered by synovial membrane, which serves as an elastic cushiou to the head of the bone durins: its movements. PELVIS AND HIP ANTERIORLY. SYNDESMOLOGY. 89 Fig. 35., PELVIS AND Hir LATERALLY. A side view of the ligaments of the pelvis and hip joint is Efien in Fig. 35. 1. Oblique sa- cro-iliac. 2. Posterior sacro-is- chiacic. 3. Anterior sacro-ischi- ntic. 4. Great sacro-ischiatic for- amen, o. Lesser sacro-ischiatic foramen. 6. Cotyloid ligament of the acetabulum. 7. Ligamen- tum teres. 8. Edge of the cap- sular. 9. Obturator membrane ;)artly exhibited. The Knee Joint. — The femur, tibia and fibu- la, and the patella, are con- nected at the knee joint bj^ thirteen ligaments ; the first-named five are exter- nal, and the next five are internal to the articulation, and the remaining three are mere folds of synovial membrane. The anterior, or llgamentum jMtella, is a prolongation of tho tendon of the extensor muscles of the thigh downward to the tubercle of tho tibia, enclosing the patella ; the iwsterior is a broad expansion covering the whole back part of the joint; the internal lateral is a broad layer extending between the internal condyle of the femur and the inner tuberosity of the tibia; the two external lateral connect the external condyle of the femur to the outer part of the head of the tibia, and the external semilunar cartilage of the articular surfaces with the fibula. Within the joint are the anterior and posterior crucial, which connect the head of the tibia with the condyles of the femur ; the trans- verse, a slip of fibres extending between the semilunar and internal cartilages; the coronary, short fibres connecting the borders of the semilunar cartilages to the head of the tibia and surrounding liga- ments. The semilunar cartilages are two falciform fibrous plates around the margin of the head of the tibia, serving to deepen the articular surface for the condyles of the femur. The synovial membrane of this joint is the most extensive in the skeleton, investing the cartilaginous surfaces of the condyles of the femur, of the head of the tibia, and of the inner surface of the patella. Between it and the ligamentum pateli) is a mass of fatty substance 90 ANATOMY. which presses the membrane toward the mteriorof the joint, and occu- Fi?. 36. Kfii ■£ JOINT AXTE- RIORLY. pies the fossa between the condyles. A slender, conical process of synovial membrane, called Ligamentum mucosum, proceeds from the transverse ligament. Its apex is connected with the anterior part of the condyloid notch, and its base is lost in the mass of fat which projects into the joint beneath the patella. The alar ligaments ai'e two fringed folds of synovial membrane, ex- tending fi-om the ligamentum mucosum along the edges of the mass of fat to the sides of the patella. Fig. 36 exhibits a front view of the ligaments, l. ITie ten- don of the quadriceps extensor muscle of the leg. 2. Patella. 3. Anterior ligament. 4, 4. Synovial membrane. 5. Internal lateral ligament. 6. The long division of the external lateral. 7. Anterior superior tibio-fibular ligament. Fig. 37. Fig. 37 gives a posterior view of the ligaments. 1. The fasciculus of the posterior ligament. 2. The tendon of the semi-membranous muscle, from which the posterior ligament is derived. 3. The process of the tendon which spreads out in the fascia of the popliteus muscle. 4 VThe process which is sent inward beneath the internal lateral ligament. 5. Pos- terior part of the internal lateral ligament. 6. The long division of the externnl lateral. 7. Its short division. 8. Tendon of the popliteus cut short. 9. Posterior superior tibio-fibular ligament. The movements of this joint are Jlexion and extension, with a slight degree of rotation when the knee is semi-flexed. TiBio-FiBULAR Joints. — The bones of the leg are firmly connected together at each ex- tremity by five ligaments : the interosseous, transverse, anterior, and posterior, to which is to be added the synovial inemhrane. The movements between these bones is a very slight degree of yield- ing or sliding motion. KNEK JOIXT POSTE- RIORLY. Thf Ankle Joint.— This is formed by the tibia and fibula with their malleolar processes above, and the asti-agalus below, connected by three ligaments: the anterior, a thin membranous layer; the in- ternal lateral, or deltoid, a triangular layer of fibres attached above to SYNDESMOLOGY. 91 the internal malleolus, and below to the astragalus, caxis, and scaphoid; and the external lateral, which consists of three separate bundles of fibres, proceeding from the external mal- Pio. 33 leolus. the anterior of which is attached to the asti'agalus, the posterior to the back part of the same bone, and the middle to the outer side of the os calcis. The motions of this joint are flexion and ex- tension. Fig. 38 is an external view of the ankle articulation. 1. Tibia. 2. External malleolus of the fibula. 3, 3. Astragalus. 4. Os calcis. 5. Cuboid. Anterior fasciculus of the external lateral ligament attached to the astragalus. 7. Its middle fasciculus attached to the calcis. 8. Its posterior fasciculus attached to the astragalus. 9. Anterior ligament. ANKLE JOINT EXTERNALLY. Fig. 39 is a posterior view of the ankle joint. 1. Lower part of the interosseous membrane. 2. Posterior inferior hgament con- necting the tibia and fibula. 3. Transverse ligament. 4. Internal lateral. 5. Posterior fasciculus of the internal lateral. 6. Middle fasciculus of the external lateral. 7. Synovial membrane. 8. Os calcis. The Tarsal Joints. — The bones of the tarsus are connected by dorsal ligaments, which pass from each bone to all others contiguous : the plantar, which connect their under surfaces similarly, and the interosseous, of which there are five, situated between adjoining bones. These articulations admit of a slight degree of motion — -forward, backward, and laterally ; and between the first and second range of bones adduction and abduction, with slight ^e.rion and extension take place. ANKLE JOINT POSTERIORLY. Tarso-Metatarsal Joints. — The ligaments connecting the tarsal and metatarsal bones are also dorsal, plantar, and interosseous. The synovial membranes are three. The only motion is a slight yielding to pressure. Metatarso-Phalangeal Joints. — The bones of the metatarsus are connected with those of the toes by ligaments, called plantar, lateral, and transverse, so arranged as to admit of flexion, extension, adduction, and abduction. The expansion of the extensor tendon sup' plies th© place of a dorsal ligament. 92 ANATOMY. Fig. 40. II / SOLE OF THE FOOT. The Toe Joints. — The phalanges of the toes have the same lignmentous connection as those of the fingers, and the same variety and extent of motion. The ligaments of the sole of the foot are seen iu Fig. 40. 1. Os cakis. 2. Astragalus. 3. Tuberosity of the scaphoid. 4, Long calcaneocuboid ligament. 5. Part of the short calcaneo- cuboid. 6. Calcaneo-scaphoid. 7. Plantar tarsal. 8, 8. Ten- don of the peroneus longus muscle. 9, 9. Plantar tarso-meta* tarsal ligaments. 10. Plantar ligament oi the metatarso- phalangeal joint of the great toe ; the same ligament is seen upon the other toes. 11. Lateral ligaments of the metatarso- phalangeal joint. 12. Transverse ligament. 13. Lateral Uga- ments of the phalanges of the gi'eat toe ; the same ligaments are seen upon the other toes. Note. — In amputations at the tai'so-raetatarsal joint, it must be understood that the metatai-sal bone of the second toe is strongly wedged between the internal and external cuneifonn bones, being the most firmly articulated of all the metatarsal bones. CHAPTER III. OF THE MUSCLES— MYOLOGY. 1 HE musoes are the moving organs of the body, They are com- posed of parallel fibres, of a deep red color, constituting lean flesh. These fibres are held together by a delicate web of areolar tissue, which becomes condensed and so modified toward the extremities of the muscles as to form glistening fibres and cords, called tendons, by which they are attacli.ed to the surface of the bones. The greater portion of the bulk of the body is composed of muscu- lar tissue. In the limbs the muscles invest and protect the bones and Bome of the joints. In the tmnk they are spread out to enclose cavi- ties, and form a defensive wall, capable of yielding to external press- ure and again returning to its original position. The tendons of broad muscles are often spread out, forming expansions called aponeuroses. M YOLO dr. 93 The names of muscles are generally de- Fig- resses the lower }»vw, also produces ti-action on the integuments of the neck. 2. Sterno-cleido-mastoid is the large oblique muscle of the neck ; arises fron^ the sternum and clavjrle ; inserted M 1 L G Y. 89 into the mastoid process and occipital bone. Uses. — "When both act together the head is bowed forward ; either one acting singly draws the head toward the shoulder, and carries the face toward the opposite side. When the clavicular portions act more forcibly than the sternal, they give steadiness to the head, enabling it to support great weights. The Laryngeal Group. — This gi'oup is subdivided into depressors and elevators of the os hijoides and larynx. The depressors are four : 1. Sterno-hyoideus, a ribbon-like band arising from the back of the upper bone of the sternum and inner exti'emity of the clavicle ; in- serted into the back of the os hyoides. 2. Sterno-thyroideus, a broader band, arising from the sternum with the preceding, and from the carti- lage of the first rib ; inserted into the oblique line of the great ala of the thyroid cartilage. 3. Thyro-hyoideus, arises fi'om the oblique line of the thyroid cartilage ; inserted into the lower part of the body and great cornua of the hyoid bone. 4. O?no-hyoideus, arises from the upper border of the scapula and transverse ligament of the supra- scapular notch ; inserted into the lower border of the body of the hyoid bone. Uses. — All these muscles pull down the os hyoides and laiynx. The first three draw them downward in the middle line ; the latter inclines them to one or the other side, according to the position of the head. The elevators are four muscles: 1. Digastricus, a two-bellied mus- cle, arising from the inner side of the mastoid process of the temporal bone ; inserted into the lower jaw near its centre. 2. Stylo-hyoideusy a slender muscle, arising from the middle of the styloid process ; in- serted into the centi'al part of the body of the os hyoides. 3. Mylo- liyoideus, a triangular plane, forming, with its fellow, the floor of the mouth ; arising from the molar ridge of the lower jaw ; inserted into the body of the os hyoides, and into the raphe of the two muscles. 4. Genio-hyoideus, arising on the inner side of the centre of the lower jaw; inserted into the upper part of the body of the os hyoides. Uses. — All these muscles raise the os hyoides when the lower jaw is closed, and act upon the lower jaw when the os hyoides is drawn down and fixed by its depressors. The LiNGUiNAL Group. — Five muscles : 1. Genio-hyo-glossus ; thia is the proper muscle of the tongue ; arises, narrow and pointed, from a tubercle on the inner side of the centre of the lower jaw; inserted by a fan-shaped attachment into the whole length of the tongue and body of the os hyoides. 2. Hyo-glossus, a square plane, arising fi'om the great cornua anc Sody of the os hyoides ; inserted into the side of <.00 ANATOMY. the tongue. 3. Lingualis, consisting of a small bundle, running from the base to the apex of the tongue. 4. Stylo-glossus, arising from the styloid process and stylo-maxillary ligament; inserted into the sub- stance and side of the tongue. 5. Palato-glossus, constituting, with its fellow, the constrictor of the isthmus of the fauces ; is extended between the soft palate and base of the tongue. Uses. — The various du-ections of the fibres of the linguinal muscles give the tongue every conceivable variety of motion. The palato- glossi, assisted by the uvula, close the fauces completely in the act of deglutition. The Pharyngeal Group. — Five muscles: 1. Constrictor inferior^ arises from the upper rings of the trachea, cricoid and thyi'oid carti- lages ; inserted into the middle of the pharynx. 2. Constrictor medius^ arises from the gi-eat cornu of the os hyoides and stjio-hyoidean liga- ment, and its fibres, radiating from the origin, are inserted into the pharynx and basilar process of the occipitis. 3. Constrictor superior^ arises from the molar ridge of the lower jaw., the internal pteiygoid plate, and the pterygo-maxillary ligament ; inserted with the preceding. 4. Stylo-pharyngeus, arising from the inner side of the base of the styloid process ; its fibres spread out beneath the miicons membrane of the ])harynx, and are inserted into the posterior border of the thyroid cartilage. 5. Palato-plm.ryngeus, arises from the soft palate ; inserted into the inner surfiice of the phaiynx and posterior border of the thy- roid cartilage. Uses. — The cousti'ictors contract upon the food as soon as it passes into the phaiyux, and convey it downward to the oesophagus. The stylo-pharyngei draw the phaiynx upward and widen it laterally ; and the palato-pharyngei draw it upward and assist in closing the opening of the fauces. Palatal Group. — The muscles of the soft palate are tiiree ; their situation is indicated by their names. They are : 1. Levator palati, which raises the soft palate. 2. Tensor palati, which extends the palate laterally, so as to form a septum between the pharynx and pos- terior nares. .3. Azygos uvula, which shortens the mTila. Pr^evertebral Group. — Five muscles: 1. Rectus anlicus major, arises from the anterior tubercles of the transverse processes if the third, fourth, fifth, and sixth ceiTical vertebrse ; inserted into the basilar process of the occipitis. 2. Rectus anlicus minor, arises from the side of the atlas ; inserted with the preceding. 3. Scalenus anticus, a tri- MYOLOGY. 101 Fig. 48. angular muscle, arising with the rectus anticus major; inserted into the inner border of the first rib. 4. Scalenus posticus ; arises from the posterior tubercles of all the cervical vertebrae, except the first; inserted into the first and second ribs by fleshy fibres. 5. Longus colli, a long flat muscle, consisting of two portions, the upper arising from the anterior tubercle of the atlas, and inserted into the transverse processes of the third, fourth, and fifth cervi- cal vertebrae ; and the loiver arising from the bodies of the second and third, and transverse processes of the fourth and fifth, and passing down the neck, to be inserted into the bo- dies of the three lower cervical and three upper dorsal vertebrae. Uses. — The rectus major and mi- nor preserve the equilibrium of the head upon the atlas ; and when act- ing with the longus colli, flex and rotate the head and vertebrae of the neck. The scaleni flex the vertebral column, and assist in elevating the ribs in inspiration. The Laryngeal Group will be described with the anatomy of the larj'nx. la Fig. 48 the mo prominent muscles of the head and neck ve seen. A. Occipito- fVontaUs. B. Attollen. aurem. C. The con- cha. D. Orbicularis palpebrarum. E. Com- TJi'essor naris. F. Zygomaticus major. G. Levator labii superioris alseque nasi. H. Zygomaticus minor. I. Levator anguli oris. K. Masseter. L. Depressor anguli oris. M. Stcrno-cleido mastoideus. O. Depressor la- bii inierioris. P. Orbicularis oris. Q. Tem- poral/s. R. Splenius. S, Trapezius. T. Stei7.o-hyoideus. a. Helix, b. Anti-helix. c. Concha. ft; \ MUSCLES OF THE HEAD AA'D NECK MUSCLES OF THE BACK. The muscles of the back are divided into six layers. First Layep —I^wd muscles: 1. Trapezius ; arises &oia the u^pet ]02 ANATOMY. rurved line of the occipitis, ligament of the neck, and spines of the | dorsal vertebrae ; inserted into the spine and acromion of the scapula, j and scapular third of the clavicle. 2. Latissimus dorsi, coverms; the | Fig 49. "J EXTERNAL MUSCLES OF THE BACK. In Fig. 49 the first, second, and part of the third layer are seen ; the first on the right, and the second on the left side. 1. Trapezius. 2. The tendinous portion which forms, with the corresponding part of the opposite muscle, the tendinous ellipse on the back of the neck. 3. Acromion process and spine of the scapula. 4. Latissimus dorsi. 5. Del- toid. 6. Infra spinatus, teres minor, and teres major, all muscles of the dorsum of the scapula. 7. Extrrnal oblique. 8. Gluteus medius. 9. Glutei maximi. 10. Levator nnguli scapu'ae. 11. Rhomboideus minor. 12. Rho""hoideu3 major. 1.3. Splenius capi- tis; the comiplexus is immediate!}' above, and overlaid oy it. 14. Splenius colli ; partially seen. 15. Vertebral aponeurosis. 16. Serratus posticus interior. 17. Supra-spinatus. 18. Infra-spinatus. 19. Teres minor. 20. Teres major. 21. Long head of the triceps, passing between the t«res minor and major to the upper arm. 22. Scrratus magnua, proceeding forward from its origin at the base of the scapu.'„ 23. Internal oblique. M Y L Cf It lOA whole lower part of the back and loins ; arises from the spines of the seven lower dorsal and all the lumbar vertebrae, sacral spines, back part of the crest of the ilium, and three lower ribs ; the fibres converge as they ascend, cross the lower angle of the scapula, curve around the lower border of the teres major, and ai-e inserted into the bicipital groove of the humerus. Uses. — The upper fibres of the trapezius draw the shoulder upward and backward, the middle directly backward, and the lower downward and backward. The latissimus dorsi draws the arm backward and downward, and rotates it inward ; if the arm be fixed it will draw the spint to that side, and raise the lower rib, thus aiding inspiration ; if both arms be fixed, both muscles will draw the whole trunk forward, as in climbing, walking on crutches, etc. J JTE. — The ligameiitum nuchce is a thin cellulo-fibrous layer between the jccipital bone and spine of the seventh cervical vertebrae. Second Layer. — Three muscles: 1. Levator anguli scapulfs ; arises from the transverse processes of the four cervical vertebrae ; inserted into the upper angle and posterior border of the scapula. 2. Rhomboideus minor ; arises from the spines of the two last cervical vertebrae and ligamentum nuchae ; inserted into the posterior border of the scapula. 3. RJiomhoideus minor ; arises from the spines of the last cervical and four upper dorsal vertebrae ; inserted with the preceding. Uses. — The levator lifts the upper angle of the scapula, and with the rhomboidei carry the shoulder upwai'd and backwaixl. Third Layer. — These muscles all arise from the spines of the ver- tebi-al column, and pass outwardly. There are three of them : 1. Serratus jJosticus superior; arises from the spines of the lower cervical and upper dorsal vertebrae ; inserted into the upper borders of the upper ribs. 2. Serratus p>osticus inferior ; arises from the spines of the two last dorsal and three upper lumbar vertebrae ; inserted into the lower borders of the four lower ribs. 3. Tlie splenius muscle, arising from the lower part of the ligamentum nuchae, and spines of the four lower cervical and six upper dorsal vertebra ; inserted by two divisions, the first, called sj)lenius capitis, into the occipital bone, and the second, called splenius colli, into the transverse processes of the upper cervical vertebrae. Uses. — The serrati are muscles of respiration ; their actions antago- nize, the posterior drawing the ribs upward to expand the chest, and the inferior drawing down the lower ribs, and diminishing the cavity of tlie chest, thus rendering the first an inspire tvry, and the second an JOI ANATOMY. expiratory muscle. The splenii of one side draw the vertebral col- ■ umn backwiird and to one side, and rotate the head toward the cor- \ responding shoulder. The splenii of both sides acting together draw i the head forward ; they antagonize the sterno-mastoid muscles. I Fourth Laykr. — Sen en muscles: 1. Sc "ro-lumhalis ; arises from the back part of the cresl of the ilium, postenar surface of the sacrum i und lumbar vertebraB ; inserted by separate tendons into the angles of 1 the six lower ribs. 2. Longissimus dorsi ; ames with the preceding; \ inserted into all the ribs between their tubercles and angles. 3. Spinalis '• dorsi ; arises from the spines of the two upper lumbar and throe lower ; doi'sal veitebrre ; inserted into the spines of all the upper dorsal verte- , bra?. 4. Cervicalis ascendens ; arises from the angles of the four upper ' ribs ; inserted into the ti-ansverse processes of the four lower cervical | vertebr;e. 5. Transversalis colli ; arises from tlie ti'ansverse processes \ of the four upper dorsal vertebrae ; inserted into the like processes of the five middle cervical. G. Trachleo-mastoid ; arises from the trans- ' verse processes of the four upi)er dorsal and five lower cei-vical verte- 1 bra? ; inserted into the mastoid process. 7. Coniplexus, a large muscle, i forming, with the splenius, the great bulk of the back of the neck ; arises fi-om the transverse processes of the four uj)j)er dorsal, and transverse and articular processes of the five lower cervical vertebrae ; i inserted into the occij)ital bone, near its spine. Uses. — These muscles hold the vertebral column erect, and assist in , steadying the head ; the complexus contracts the muscles on the ante- i rior side of the neck ; when the muscles of one side act alone, they i produce a rotation of tlie head. ! Fifth Laykr. — Seven muscles: 1. Scmi-spinalis dorsi ; arises from '< the transverse processes of the six lower dorsal, and is inserted into the ! spines of the four upper dorsal vertebrcE. 2. Semi-spinalis colli ; arises \ from the ti-ansvei-se processes of the four upper dorsal, and is inserted into the spines of the rive upper cervical vertebrae. 3. Rectus posticus major ; '. arises from the spines of the axis ; inserted into the lower curved line j of the occipitis. 4. Rectus posticus minor ; arises from the sj)inou3 i tubercle of the atlas ; inserted into the occipitis, below the former. 5 Rectus lateralis ; arises from the transverse process of the atlas : in- [ serted into the occipitis, external to the condyle. G. O-bliquus inferior; , arises from the spine of the axis ; inserted into the exti'emity of tht j transverse process of the atlas, 7. Obliquus superior; ames where ' the preceding is inserted ; inserted ia*o the cecipitis, between the ' •urved lines. MYOLOGY. 106 Uses. — ^Th-3 semi-spinalep contribute to the support of the back in the erect position ; tho recti produce the antero-posterior, and the obliqui the rotatory movement of the atlas on the axis. Sixth Layer. — Five muscles: 1. MuWJidus sjnnce^ consisting of bundles of fibres, arising from the transverse processes of all the ver- tebrae from the sacrum to the axis ; inserted into the spines of the first or second veitebra3 above their origin. 2. Levatores costarum, con- sisting of twelve distinct fasciculi on each side, which arise from the trans- verse processes of the d.orsal vertebrae, and are inserted into the ribs below, 50. m- between the tubercles and angles. 3. Siqyra-spinalis^ composed of fjisciculi ansing from the lower cervical and upper dorsal vertebra? ; inserted into the spine of the axis. 4. Interspinalcs, small slips arranged in pairs, situated between the spines of all the vertebrie. 5. Liter- transvcrsales, small quadrilateral slips between the ti'ansverse {processes of all the vertebriE. Uses. — The levators raise the poste- rior parts of the. ribs in inspimtion ; the others are auxiliaries to tlie larger mus- cles in supporting the body, and holding the bones in jiosition. In Fig. 50 are seen the fourth and fifth, and part of the sixth layer. 1. Origin of the .sacro-lumbalis and longissimus dorsi. 2. .Sacro-lambalis. 3. Longissitnus dorsi. 4. Spinalis dorsi. 5. Cervi- calis ascendens. 6. Transversalis colli. 7. Trachleo-mastoidcus. 8. Complexus. 9. Trans- versalis colli. 10. Semi-spinalis dorsi. 11. Semi- spinalis colli. 12. llectus posticus minor. 13. Rectus posticus major. 14. Obliquus superior. 15. Obliquus inferior. 16. Multitidus spinas. 17. Levatores eostarum. 18. Intcrtransversales. 19. Ciuadratus lumborum. INJVER MUSCLES OF THE BACK MUSCLKS OF THE THORAX. The principal muscles of the thomx belong sJsj to the upper ex» tremity. Tliose >voper to the thoyax are three ; i06 ANATOMY. 1. External intercostals 2. TiUernal Interccstals. 3 Triangularis sterni. The intercostals are eleven internal and eleven external planes of muscular and tendinous fibres, situated obliquely betrween the adjacent ribs, and filling the intercostal spaces. The fibres of the external are directed obliquely d-wnward and inward, and those of the internal ob- liquely downw;ird a jd backward, so that they cross each other. The triangularis sterni is situated within the chest, connecting the side of the sternum and sternal exti'emities of the costal cartilages with the cartilages of the sfv^ond, third, fourth, fifth, and sixth ribs. The lower fibres of this muscle are continuous with the diaphragm. Uses. — The intercostals raise or depress the ribs, as they act fi'om above or below, being thus both inspiratory aiid expiratory. The tri- angulai'is is a muscle of expiration, by drawing down the costal carti- lages. MUSCLES OF THE ABDOMEN. The muscles ®f the abominal region are nine in number : 1. Obliquus externus ; this is the external, flat, descending muscle; its fibres arise by fleshy digitations from the eight lower ribs, and spread out to a broad aponeurosis, which is inserted into the outer part of the crest of the ilium for one half its length, into the anterior supe- rior spine of the ilium, spine of the pubis, pectineal line, front of the pubis, and linea alba. Note. — The lower border of the aponeurosis, between the spines of the ilium and pubis, is rounded from being folded inward, and forms PouparCs ligament. GimhernaVs ligament is that part of the aponeu- rosis inserted into the pectineal hne. The linea alba is a white tendi- nous slip extending along the middle of the abdomen from the ensiform cartilage to the os pubis. Externally, on each side of it, ai*e two curved lines, extending from the sides of the chest to the pubis, called the lincce semilunares ; these lines are connected with the linea alba by several cross lines, usually three or four in number, called linea; transversa!. Just above the crest of the pubis is a ti'iangular opening, formed by the sepai'ation of the fibres of the aponeurosis, called the external abdominal ring. Through t'lis ring passes the spermatic cord in the male, and the round ligament of the uterus in the female ; both are iiivested in their passage 1 y a thin foscia derived fi'om the edges of the ring, called inter column j.r, or spermatic fascia. In ingui- nal hernia the pouch, in projecting through th's opening, receives aa aJJitional covering ft-om this spermatic fascia. MYOL.")GY. 107 Fig. 51. N';.; n/./;y/' MUSCLES OF THE TRtTNK. in Fig. 51 are seen the muscles of the trunk anteriorly. The superficial layer Is seen on the left side, and tli* deeper on the right. 1. Pectoralis major. 2. Deltoid. 3. Ante- rior border of the latissimus dorsi. 4. Serrations of the serratus magnus. 5. Subclavius of the right side. 6. Pectoralis minor. 7. Coracho-brachialis. 8. Upper part of the biceps, showing its two heads. 9. Coracoid process of the scapula. 10. Serratus mag- nus of the right side. 11. External intercostal. 12. External oblique. 13. Its aponeu- rosis ; the median line to the right of this number is the linea alba ; the flexuous line to the left is the linea semilunaris ; the transverse lines above and below the number are the linear transversa3. 14. Poupart's ligament. 15. External abdominal ring; the margin above is called the svpcrior or internal pillar ; the margin below the inferior or external pillar; the curved inten-olumnar fibres are seen proceeding upward from Poupart's ligament to strengthen the ring. The numbers !4 and 15 arc situated upon the fascia lata of the thie'^ : the opening to the right of 15 is called saphenous. 16. Rectus of the right side. 17. Pyramidalis. 18. Internal oblique. 19. The common tendon of the internal oblique and transversalis descending behind Poupart's ligament to the pectineal Jne. SO. The arch formed between the lower curved border of the internal oblique and Paupart's liga- ment, beneath whi^h the eoermatic cord passes, and hernia occurs. f08 AN ATOM!. 2. Internal oblique ; called the middle ascending flat muscle. It arises from the outer half of Poupart's ligament, fi-om the middle two thii-ds of the crest of the ilium, and from the spines of the lumbar ver- tebraj ; and is inserted into the pectineal line, crest of the pubis, liuea alba, and five lower ribs. 3. Cremaster ; arises from the middle of Poupart's ligament ; it forms a series of loops upon the spermatic cord, and some of its fibres are inserted into the tunica vaginalis, the rest into the pectineal line of the pubis. 4. Transversalis ; this is the internal flat muscle ; it arises from the outer thii-d of Poupart's ligament, internal lip of the crest of the ilium, spines and transverse processes of the lumbar vertebrae, and fiom the six lower ribs, indigitating with the diaphragm ; inserted into the pecti- neal line, crest of the pubis, and linea alba. 5. Rectus ; arises by a flat tendon tiom the crest of the pubis ; in- serted into the cartilages of the fifth, sixth, and seventh ribs. 6. Pyramidalis ; arises from the crest of tlie pubis in front of the rectus ; inserted into the linea alba midway between the umbilicus and pubis. 7. Quadratus lumhorum ; arises from the last rib and ti*ansverse processes of tlie four upper lumbar vertebras ; inserted into the crest of the ilium and ilio-lumbar ligament. 8. Psoas parvus ; a ?7'5e5 from the tendinous arches and intervertebral substance of the last dorsal and first lumbar vertebrce ; inserted by an expanded tendon into the ilio-pectineal line and enninence. 9. Diaphragm ; this forms a muscular partition between tlie cavities of the chest and abdomen. In shape it is somewhat conical, and is composed of two portions, called greater and lesser muscles. Tho greater muscle arises from the ensiform cartilage, inner surfaces of tho six inferior ribs, and ligamentum arcuatum externum and internum ; from these points its fibres converge to the central tendon, into which thej^ ai-e inserted. The lesser muscle arises by two tendons from the bodies of the lumbar vertebrae ; these tendons form two large fleshy bellies, called crura, w^hich ascend and are inserted into the centra tendon. Note. — The ligamentum arcuatum externum is .he upper border of the anterior lamella of the aponeurosis of the ti'ansver-salis. The liga- mentum arcuatum internum, or praprium, is a tendinous arch across the psoas magnus muscle as it emerges from the chest. The tendinous centre of the diaphragm is called the central tendon. Between the Bides of the ensiform cartilage and the cartilages of the adjoining ribs is a triangular space where the muscular fibres of the diaphragm are MYOLOGY. lOS ¥u wanting ; this space is closed by tlie peritoneum on the abdominal side, and the plem-a on the side of tlie chest. Sometimes, from violent ex- ertion, a portion of the alimentary canal is forced through this space, producing what is called phrenic or diaphragmatic hernia. There are three openings in the diaphi'agm : one in the centre, for the passage of the inferior vena cava ; an elliptic opening in its muscu- lar portion, formed by the two crura, for the passage of the (zso'phagus and •pneumo gas trie nerves ; and a third, called the aortic, formed by a tendinous arch which passes from the tendon of one crus to that of the other; beneath this the aorta, thoracic duct, and right vena azygos pass. There are also small openings in the lesser muscle on each side for the grt-at splanchnic nerves. Uses. — The oblique muscles flex the thorax on the pelvis ; either, acting singly, would twist the body to the opposite side. Either trans- versalis will diminish the size of the abdomen, and both consti'ict it? general cavity. The recti and pyramidaiis together pull the thorax forwai-d ; the latter alone are tensors of the linea alba. The quadratus lumborum draws the lower rib down- ward, and serves to bend the verte- bral colamn to one side. The psoas parvus extends the iliac fascia, and assists in flexing the back. The dia- phragm assists the abdominal muscle in expiration. Fig. 52 is a side view of the muscles of the trunk. 1, Costal region of the latissimus dorsi. 2, Serratus inagnus. 3. Upper part of external oblique. 4. Two external inter- costals. 5. Two internal intercostab. 6. Transversalis. 7. Its posterior aponeurosis. 8. its anterior. 9. Lower part of the left ! -ictus. 10. Right rectus. 11. The arched opening where the spprmatic cord passes and hernia takes place. 12. The gluteus maxi- mus, and medius, and tensor vaginae femoris muscles invested by fascia lata. All the abdominal nmscles are respiratory, and constitute the chief forces in the act of expiration. Con- sidering the lungs as a bellows, they constitute the handles ; they are aided in this office by the muscles of the sh^scles of the tf.uxk laterallic. loins and back, ^nd to some extent by the upper muscles of the ti'unk, 10 no ANATOMY. They compross the cavity of the abdomen in all directions, thus aiding llie expulsion of the contenfs of the stomach, bowels, gall-ducts, blad- der, and uterus, and also raucous and in'itating substances fi-om tlie bronchia, windpipe, and nose. MUSCLES OF THE PERINEUM. Tliese muscles pertain to the H.--?thra, the outlet of the bowels, an he organs of generation. There are eight of them. In the male ai-e: 1. Accelerator urinee ; arises from the centre of the perineum ; its fibres, dividing, are inserted into the ramus of the pubes and ischium, and into the fibrous substance and spongy body of the penis. 2. Erector penis ; arises from the ramus and tuberosity of the ischium, and, curv-.. ing around the root of the penis, is instrtc I intc the upper surface of its corpus cavernosum. 3. Comirressor urelxrce; arises from the ramus of the ischium, and inner surface of the arch of the pubes on each side of the symphisis ; inserted into the back part of the urethra, fi-om the apex of the prostate gland to which they are attached, to its bulbous portion. 4. Transversus pcrinei ; arises from the tuberosity of the ischium ; inserted into the tendinous centi'e of the perineum. 5. Sphincter ani, a thin band suiTOunding the opening of the anus. 6. Sphincter ani internus, a muscular ring formed by an aggregation of the circular fibres of the rectum. 7. Levator ani, a thin plane of mus- cular fibres on each side of the pelvis, between the os pubis and spine of the ischium ; inserted into the lower part of the coccyx, rectum, base of the bladder, and prostate gland. 8. Coccygeus^ a ti'iangular layer arising from the spine of the ischium ; inserted into the side of the coccyx and lower pait of the sacrum. The uses of these muscles are expressed by their names. In the female the perineal muscles are smaller, and are modified to the dif- j ference in org:i nidation. The muscle coiresponding with the accelei'ator arinie in the male, is called constrictor vagince ; and the analogue of the erector penis, >s called erector cliloridis. I MUSCLES OF THE UPPER EXTREMITY. These may be conveniently grouped according to dififerent regions j \{ the limb. i Thoracic Region. — This region comprises three anterior and one i lateral muscle: 1. Pcc/ora//s 7;ifl;o?-; ^rws from the sternal two thirds i of the clavicle, the whole length of the sternum, the cartilages of all the i tiue ribs excejjt the first ani last, and from tl>e aponeurosis of the ex- i ternal obrujue muscle ; insc\ 'ed by a broad tendon into the anterior ; bicipital ridgo cf tlio luur.evrg. 0. Pectoralis minor ; crises by three i MYOLOGY '111 digitations from the third, fo'irth, and fifth ribs ; inserted into the cora- coid process of the scapula. 3. Subclavius ; arises from the cartilage of the first rib ; inserted into the under surface of the clavicle. 4. Serratus magnus ; arises by fleshy serrations from the nine upper ribs, excepting the first ; inserted into the whole length of the base of the scapula anteriorly. % Udes. — The pectoralis major di'aws the arm against the chest ; its upper fibres assist in raising, and its lower in depressing the shoulder. When its fixed point is at the shoulder, it assists in elevating and expand- ing the chest. The minor pectoral muscle acts with the former, and assists in the rotatory movement of the scapula upon the chest. The subclavius draws the clavicle downward and forward in steadying the shoulder. All th'^e muscles are called into action in forced resph'ation, but cannot act unless the shoulders are fixed. The seiTatus raises the ribs, and thereby increases the cavity of the chest in inspiration. When it acts upon the scapula, the shoulder is drawn forward, as in many cases of diseased lungs and deformed chests. Scapular Region. — Six muscles: 1. Suhscajyularis ; arises fi'om nearly the whole of the under surface of the scapula ; inserted by a broad, thick tendon into the lesser tuberosity of the humerus. 2. Sujpra- spinatus ; arises from the whole of the supra-spinous fossa ; inserted into the upper depression of the great tuberosity of the humerus. 3. Infraspinatus ; arises from the whole of the infra-spinous fossa; in- serted into the middle depression upon the greater tuberosity of the humerus. 4. Teres 7ninor ; amc5 from the middle third of the lower border of the scapula; inserted into the lower depression on the gTea-ter tuberosity of the humerus. 5. Teres major ; arises from the lowei third of the inferior border of tlie scapula ; inserted into the posterior bicipital ridge. 6. Deltoid, a large triangular muscle forming the con- vexity of the shoulder ; arising from the outer third of the clavicle, tho acromion process, and from the whole length of the scapula ; its fibres converge to the middle of the outer side of the humerus, where they are inserted into a rough elevation. Uses. — Tlie subscapularis rotates the head of the humerus inward ; when the arm is raised it draws the humerus downward. It is a powerful defence to the shoulder joint. The supra-spinatus raises tha arm feebly from the side ; the infra-spinatus and teres minor rotate tho head of the humeras outward ; the teres minor assists its rotation in- ward, carrying it also toward the side, and somewhat backward. The most important use of the supra-spinatus, infra-spinatus, and teres minor is to protect the joint against vlisplacement, for wb^ch purpose theif 112 ANATOMY. tendons, with that of the subscapularis, are in immediate contact, forming a part of its liga- mentous capsule. They are, consequently, generally ruptured in luxations of the shoulder joint. Fig. .53 exhibits the muscles of the anterior aspect of the upper arm. 1. Coracoid process of the scapula. 2. Coraco-clavicular ligament passing outward to the scapular end of the clavicle. 3. Coraco-acromial ligament, passing outward to the acromion. 4. Subscapularis. 5. Teres major ; through the triangular space above the dorsalia Ecapulaj vessels pass. 6. Coracobrachialis. 7. Biceps. 8. Upper end of the radius. 9. Brachialis anticus ; a por- tion of this muscle is seen on the outer side of the tendoa of the biceps'. 10. Internal head of the biceps. Fig. 54. MUSCLES OF THE UPPER ^f j-jje humerus ARM. „. . , Biceps ; anscs by two tendons, one, called the short head, from the coracoid process ; the other, the long head, which passes through the capsular ligament of the joint, from the upper pait of the glenoid cavity; inserted by a rounded tendon into the tubercle of the radius. 3. Brachialis anticus, a broad muscle covering the anterior surface of tlie lower part of the humerus ; arises from fleshy sensations on both sides of the insertion of the deltoid, the anterior surfiice of the humerus, and from the intermuscular septa attached to the con- dyloid ridges ; its fibres converging are in- Fig. 54 is a posterior view of the upper arm, showing the triceps muscle. 1. Its external head. 2. Its long, or scapular head. 3. Its internal, or sh( rt head. 4. Olecranon process of the ulna 5. Radi^cs. 6. Ca^au- lar U^ameat. Humeral Regio>'. — Four muscles: first thi-ee are anterior, the last posterior. Coraco - brachialis ; arises from the cor- acoid process ; in- serted into a rough line on the inner side of the middle 2. the 1, ^'^ TBICEPS MUSCX^. MYOLOGY. 118 ftevtcd into the coronoid process of the ulna. 4. Triceps extensor cuhiti^ a three-headed muscle ; the external head arises from the humerus, below the insertion of the teres minor, and from the intermuscular septum; the internal head arises from the septum and the humerus, below the insertion of the teres major ; the middle, or scapular head, arises from the upper third of the inferior border of the scapula ; the three heads unite, and form a broad muscle, which is inserted into the olecranon of the ulna. Fisr. 55. Brachial Region. — This group comprises twenty muscles: the first five constitute the anterior superficial layer ; the next three the anterior deep layer ; the seven succeeding the posterior superficial layer ; and the five remaining the posterior deep layer. 1. Pronator radii teres ; arises by two heads, one from the inner condyle of the humerus and adjoining fascia, the c4^her from the coronoid process of the ulna ; inserted into the middle third of the oblique ridge of the radius. 2. Flexor carpi radialis ; arises from the inner condyle and intermuscular fascia, and its tendon, passing through a groove formed by the scaphoid and trapezium, is inserted into the base of the metacarpal bone of the index finger. 3. Pal- maris longus ; arises with the preceding ; in- serted into the annular ligament and palmar fiiscia. 4. Flexor suhlimls digitorum ; arises fi'om the inner condyle, internal lateral ligament, coronoid process of the ulna, and oblique ridge of the radius, and divides into four tendons, which pass beneath the annular ligament into the palm of the hand ; inserted into the base of the second phalanges ef the fingers. 5. Flexor carpi idnaris ; arises ry two heads, one fi'om In Fig. 55 is seen the superficial layer of the muscles of the fore-arm. 1. Lower part of the biceps, with its tendon. 2. Part of the brachiahs anticus. 3. Pait of the triceps. 4. Pronator radii teres. 5. Flexor carpi radialis. 6. Palmaris longus. 7. One of the fasciculi of the flexor sublimis digi- torum. 8. Flexor carpi ulnaiis. 9. Palmar fascia. 10. Palmaris brevis. 11. Abductor pollicis. 12. One portion of the flexor bi-evis pollicis. 13. Supinator longus. 14. Extensor ossis metacarpi. and extensor primi internodi; gvpERj-iciAL A]N'TERI09 pollicis, curving around the Ic wer border o* tb ; fore-aroi. LAYER. (14 A X A T O AI y Fig. 56. the inner condyle, the other from the olecranon and Vcpper two thh'ds of the inner border of the ulna; its tendon is inserted into the pisiform bene, and base of the metacarpal bone of the little finger. 6. Flexor 'profundus digilorum ; arises fro n the upper two thirds of the ulna and part of the interosseous membrane, and terminates in four tendons, which pass beneath the annular ligaments, to be inserted into the base of the last phalanges. 7. Flexor lonp-us i^ollicis ; arses from the upper tsvo thirds of the radius and part ci the interosseous membrane ; its tendon passes beneath the annular ligament to be inserted into the last phalanx of the thumb. 8. Pronator quadratus ; arises from the ulna; inserted, vito the lower pait of the obliqus line on the outer side of the radius. lu Fig. 55 is seen the deep layer of muscles of the fore-ai-m. 1. Internal lateral ligament of tiie elbow joint. 2. Anterior ligament. 3. Orbicular ligament of the head of the radius. 4. Flexor profundus digitorutn. 5. Flexor longus pollicis. G. Pronator quadratus. 7. Adductor pol- licis. 8. Dorsal interosseous muscle of the middle finger, and palmar interosseous of the ring finger. 9. Dorsal inter- osseous muscle of the ring finger, and palmar interosseous of the little finger. 9. Supinator longus ; arises from the exter- nal condyloid region of the humerus, and, pass- ing along the radial border of the fore-arm, ia inserted into the styloid process of the ulna. ] 0. Extensor carpi radialis longus ; arises from the humerus below the preceding; inserted into the base of the mctacarjml bone of the index finger. 11. Extensor carpi radialis brevis ; irises adjoining the preceding; inserted into the base of the metacarpal bone of the middle finger. 12. Extensor communis digitorum ; arises with the preceding, and divides into four tendons, which are inserted, into the second and third phalanges of the fingei-s. 13. Extensor minimi digiti, is an offset from the extensor communis; inserted into the last two phalanges. 14. Extensor carpi ulnaris ; arises from the external condyle and upper two thirds of the border of the ulna; inserted into the metacarpal bone of the little finger. 15. Anconeus, a small ti*iangular muscle, arising from the outer con- OKEP antehioh LAYEi . dylc ; inserted in the olecranon and upper end of the ulna- MYOLOGr. 116 In Fig. 57 is seen the superficial layer of the muscles of the posterior aspect of the fore-arm. 1. Lower part of the biceps. 2. Part of the brachialis anticus. 3. Lower part of the triceps inserted into the olecranon. 4. Supinator Jongus. 5. Extensor carpi radialis longior. 6. Extensor carpi radialis brevior. 7. Tendons of insertion of these muscles. 8. Extensor digitoruni communis. 9. Extensor minimi digiti. 10. Extensor carpi ulnaris. 11. Anconeus. 12. Part of the flexor carpi ulnaris. 13. Extensoi ossis mctacarpi and extensor primi internodii, lying together. 14. Extensor secundi internodii ; its tendon is seen cross ing the two tendons of the extensor carpi radialis longior nnd brevior. 1.5. Posterior annular ligament. The ten- dons of the common extensor are seen upon the back of the hand, and their mode of distribution on the dot sum of the fingers. 16. Supinator brevis ; arises from the ex- ternal condyle, lateral and orbicular ligament, and the ulna, and winds around the upper part of the radius, to be inserted into tb'. upper third of its oblique line. 17. Extensor ossis metacarjpi 'polllcis ; arises from the ulna, ra- dius, and interosseous membrane, and is in- serted into the base of the metacarpal bone of the thumb. 18. Extensor ]}rinii internodii pollicis ; arises from the interosseous mem- brane and ulna, and is inserted into the base of the first phalanx of the thumb. 19. Ex- tensor secundi internodii p)ollicis ; arises with the preceding, and is inserted into the base of the last phalanx of the thumb. 20. Extensor indicis ; arises with and a little above the two preceding ; inserted into the aponeurosis form- ed by the common extensor tendon cf the index finger. Fig. 57. SUPERFICIAL, LAY POSTERIORLY ER NoTK. — The tendons of the flexor and extensor muscles of the fore arm are provided with synovial buj-sas, as they pass beneath the annular ligament ; those of the back of the wrist have distinct sheaths formed by the posterior annular ligament. These bursee are small membran- ous sacs filled with a mucous fluid, and they serve as soft cushions for the tendons to play upon, in a situation exposed to a gi'eat degree and rapidity of motion. The advantages and even necessity of an additional covering, or distinct sheath, for the tendons on the back of the wrist, is obvious, from their exposed situation and feeble protection by flesh and integument. no ANATOMY Fig. 58. Fiff. 58 exhibits the deep layer of muscles on the poa terior aspect ot" the iore-arm. 1. Lower part of tho hu- I mcrus. 2. Olecranon. 3. Ulna. 4. Anconeus. 5. Su | pinator brevis. 6. Extensor ossis metacarpi pollici3. •' 7. Extensor primi intemcdii pollicis. 8. Extensor se. i cundi internodii poUicis. 9. Extensor iudicis. 10. First ] dorsal interosseous ligament. The other three dorstil interossii are seen between the metacarpal bones of their j respective fingers. ; I Uses. — The pronator radii teres and pro- \ nator quadratus rotate the I'adius upon the ' ulna, producing pronation of the hand. Tho ! flexor carpi radialis and uhiai'is bend the , wrist ; the flexor sublimis and profundus j bend the second and last joints of the fingers; \ the flexor iongus pollicis bends the last joint ; of the thumb. The palmaris Iongus draws i the palmar fascia tense, and assists in the ! flexion of the wrist and fore-arm. The an- j coneus assists the triceps in extending the fore-arm upon the arm; the supinatus Iongus \ and brevis produce supination of the fore- j arm, and antagonize the pronators ; the ex- j tensor carpi radialis longior and brevier, and ' ulnaris, extend the wrist, antagonizing the ' two flexors of the carpus. The extensor j communis digitorum extends the fingers, an- tagonizing the flexors, sublimis, and profun- dus. The extensor ossi metacarpi, primi intei'nodii, and secundi internodii pollicis, are the special extensors of the thumb, and coun- terbalance the actions of the flexor ossis metacarpi, flexor brevis, and flexor Iongus poUicis. The extensor indicis extends the first finger, and is hence called "indicator;" the extensor minimi digiti is the spe- cial extensor of the little finger, enabling it to be extended distinctly from the other fingers. MUSCLES OF THE HAND. Radial Region. — Four muscles: 1. Ahductor pollicis ; arises fi-om the scaphoid and annular ligament; inserted into the base of the first phalanx of the thumb. 2. Flexor ossis metacarpi; arises from tho trapezium and annular ligament ; inserted into the whole length of the metacarpal bone. 3 Flexor brevis pcllicis : its external portion arisei . DEBP LAYER POSTERIOKLT. IvI Y : L G Y. 117 with the preceding ; its internal from the t: apezoides and os magnum ; both are inserted into the base of the first phalanx of the thumb, hav- ing each a sesamoid bone in the tendon to protect th-e joint. 4. Ad- ducltW poinds ; arises from the whole length of the metacarpal bone of the middle finger, and its converging fibres are inserted into the base of the first phaJanx. Uses. — These muscles, as their names import, produce in the thumb the movements of abduction, adduction, and flexion. Fig. 59. 1"he muscles of the hand are seen in Fig. 59. 1. Annular ligament. 2, 2. Ori- gin and insertion of the abductor pollicis, the middle portion being removed. 3. Flexor ossis metacarpi. 4. One portion of the flexor brevis pollicia. 5. Its deep portion. G. Adductor pollicis. 7, 7. Lum- bricales, arising from the deep flexor ten- dons, on which the numbers are placed, the tendons of the flexor sublirais having been removed from the palm. 8. One of th'i tendons of the* deep flexor, passing b&twoen the two terminal slips of the tendon of the flexor sublimis, to reach the last p^ialanx. 9. Tendon of the flexor longus pollicis, passing between the two portions of the flexor brevis to the las* phalanx. 10. Abductor minimi digiti. 11. Flexor brevis minimi digiti; the edge of the flexor ossis metacarpi is seen project- ing beyond the inner border of the flexor brevis. 12. Prominence of the pisiform bone. 13. First dorsal interosseous muscle. MUSCLES OF THE HAWD. Ulnar Region. — Four m.uscles : 1. Pahnaris hrevis ; a thin plane, arising from the annular ligament and pabuar fascia, and passing ti'ans- versely inward, is inseited into the integuments on the inner border of the hand. 2. Abductor minimi digiti ; a small taj)ering slip, arising from the pisiform bone ; inserted into the base of the first phalanx of the little finger. 3. Flexor brevis minimi digiti ; a small muscle, am- ing from the unciform tone and annular ligamenl inserted into the base of the irst phalanx. 4. Flexor ossis metacarpi ; arises with the preceding ; inserted into the whole length of the metacarpal bone of the little finger. Uses. — These muscles are subservient to the motions of the little finger. Palmar Region. — Three sets of muscles : ?. Lumhricales ; four 118 ANATOMY. in number, jrisuig from the tendons of the deep flexor, and inserted into the aponeurotic expansion of the extensor tendons on the radial side of the fingers. 2. Palmar interossei ; three in number, each arising fi-om the base of the metacarpal bone of one finger, and are insertea \ into the base of the first phalanx and aponeurotic expansion of the ex- j tensor tendon of the same finger, the middle one being excepted. 3. i Dorsal interossei ; these are situated in the four spaces between the ' metacarpal bones ; they arise by two heads from the adjoining sides of i the base of the metacai'pal bones ; inserted into the base of the first phalanges, and aponeurosis of the extensor tendons. I Uses. — The lumbricales are auxiliaiy to the deep flexors ; the ' palmar interossei are adductors, and the dorsal interossei abductoi*s ; hence each finger is furnished with its proper adductor and abductor, | two flexors, and, with the exception of the middle and ring fingers, ' which have but one, two extensors. The thumb has a flexor and ex- ! tensor of the metacai'pal bone ; and the little finger a haetacarpal flexor, j i MUSCLES or THE LOWER EXTREMITY. 1 These have usually been arranged into groups corresponding with the regions of the hip, thigh, leg, and foot. 1 ]MuscLES OF THE Hip. — There are nine muscles of the hip, which ' together constitute the Gluteal Region : 1. Gluteus maxiinus ; ' this is the thick quadrangular mass of flesh forming the convexity of j the nates, or buttocks. It arises from the back part of the crest of the ! ilium, the posterior surface of the saciTim and coccyx, and the great ' sacro-ischiatic ligament; passing obliquely outward and downward, it is - inserted into the rough line between the ti'ochanter major to the linea '< aspera ; by means of its tendon it is continuous with the fascia lata [ covering the outer side of the thigh. Between its broad tendon and the femur a large bursa is situated. 2. Gluteus medium; arises from; the outer lip of the crest of the ilium for four fifths of its length, and ! from the dorsum ilii and surrounding fascia ; its fibres converge to the ] outer part of the ti'ochanter major, into which its tendon is inserted. ' 3. Gluteus minimus; arises from the surfar e of the dorsum ilii; its! fibres converge to the anterior border of the trochanter major, where ' they are inserted by a rounded tendon. 4. Fyriformis ; a pear-shaped i muscle, arising from the anterior surface of the sacrum and ilium ad- ■ joining; it passes out of the pelvis through the gi-eat sacro-ischiatic ' foramen ; inserted, by a rounded tendon, into the trochanteric fossa of i the femur. 5. Gemellus superior ; a small slip arisins^ from the spine { of the ischium, and inserted into the tendon of the obturator internus, j and into the trochanteric fossa. 6. Obturator internus : arises from I MYOLOGY 119 die inner surface of the interior wall of the pelvis ; passes out of the pelvis through the lesser sacro- ischiatic foramen, and is inserted into the trochanteric fossa. Fig. GO shows the deep muscles of the gluteal region. 1. Exteraal surface of the ilium. 2. Posterior surface of the sacruEC 3. Posterior sacroiliac ligaments. 4. Tuber osity of the ischium. 5. Great or posterioi eacro-ischiatic ligament. 6. Anterior or less- er sacro-ischiatic ligament. 7. Trochanter major. 8. Gluteus minimus. 9. Pyriformis. 10. Gemellus superior. 11. Obturator inter- nus, passing out of the lesser sacro-ischiatic foramen. 12. Gemellus inferior. 13. Quad- ratus femoris. 14. Adductor magnus, its upper part. 15. Vastus exteruus. 16. Biceps. 17. Gracilis. 18. Semitendinosus. 7. Gemellus inferior ; arises {rom the anterior point of the tuberosity of the ischium ; inserted into the trochanteric fossa and tendon of the obturator interuus. 8. Obturator exteruus ; arises from the obturator membrane and suiTOunding bone ; its tendon passes behind the neck of the femur, to be inserted into the trochanteric fossa. 9. Quadraius femoris, a square muscle arising from the external border of the tuberosity of the ischium ; inserted Hito a rough line, called linea quadratic on the posterior border of the trochanter major. Uses. — The gkitei are abductors of the thigh, when acting from the pelvis ; when the thigh is their fixed point, they steady the pelvis on the head of the thigh bone, as in standing ; they also assist in carrying the leg forward in walking ; the minimus I'otates the limb slightly in- ward : the medius and maximus rotate it outward. The other muscles of this gi'oup are called external rotators, their office being to rotate the limb outwardly, everting the knee and foot. DEEP GLUTEAL MUSCLES. MUSCLES OF THE THIGH. These are divided into three regions — anterior, internal, and posterior. Anterior Femoral Region. — Six muscles : 1. Tensor vagina femoris, a short fiat muscle on the outer side of the hip, arising from the crest of the ilium, near its anterior superior spine ; inserted between two layers of the fascia lata at one fourth down the thigh. 2. Sartoriua 120 ANATOMY. ! (tailor's muscle) ; a long ribbon-like muscle, arising from the anterior i superior spinous process of the ilium, and the notch below, and cross- ] ing the upper part of the thigh obliquely, descends behind tJie mner ! Qpndyle of the femur, and is inserted into the inner tuberosity of the \ tibia by an aponeurotic expansion. 3. Rectus ; a straight muscle, \ arisino- by two tendons, one from the anterior inferior spinous process i of the ilium, the other from the upper lip of the acetabulum ; insert- ] ed by a broad, strong tendon into the upper border of the patella. 4. Vastus e.rternus ; arises from the inner border of the patella; inserted \ into the femur and outer side of the linea aspera. as high as the base of the trochanter. 5. Vastus internus ; arises from the inner border j of the patella ; inserted into the femur and inner side of the linea i aspera as high up as the anterior interti'ochanteric line. 6. Crureus ; i arises from the upper border of the patella; i inserted into the front aspect of the femur, as i high as the anterior intertrochanteric line. Note. — The two vasti and crureus together constitute the triceps extensor cruris. Fig. 61 shows the muscles of the anterior femoral region. 1. Crest of the ilium. 2. Its anterior superior spinous pro cess. 3. Gluteus medius. 4. Tensor raginae femoris ; its insertion into the fascia lata is seen inferiorlj- . 5. Sartorius. 6. Rectus. 7. Vastus externus. 8. Vastus internus. 9. Pa- tella. 10. Iliacus internus. 11. Psoas magnus. 12. Pecti- neus. 13. Adductor longus. 14. Part of the adductor mag- nus. 15. Gracilis. Uses. — The tensor vngiuce femoris stretches the fascia lata, rendering it tense, and slightly in- ' verting the limb ; the sartorius bends the leg ^| upon the thigh, and the thigh upon the pelvis, "' carrying the leg across that of the opposite side '■ — tlie tailor's sitting position • when fixed below 1 it assists the extensors of the leg in supporting the ' tiTiuk. The four remaining muscles extend the 3 leg upon the thigh. By their attachment to the patella, which acts as a fulcrum, they are advan- ; tageously disposed for great power. Wlien their ; fixed point is from the tibia they steady the thigh , upon the leg ; and the rectus, bj^ its attachment to the pelvis, serves to atilance the trunk upon i A.]TTERIOm FEMOR.VL MUSCLES. the lower ey^'-emity. MYOLOGY. 121 Internal Femoral Region. — Seven musc.fes : 1. Iliacus intcrnus; n Hat radiated muscle, arising from the inner corcave surface of the ilium, and, joining with the tendon of the psoas, is inserted into the trochanter minor of the femur. 2. Psoas magnus ; arises from the intervertebral substances, part of the bodies and bases of the trans- Verse processes of the lumbar vertebra, and from tendinous arches thrown across the constricted portion of the last dorsal and four upper lumbar vertebrae, and, passing along the margin of the brim of the pelvis and beneath Poupart's ligament, its tendon, united with that of the iliacus internus, is inserted into the posterior part of the trochanter minor, a bursa being interposed. 3. Pectineus ; a flat quadrangular mwscle, arising from the pectineal line of the pubis and surface of bone in front ; inserted into the femur, between the anterior intertrochan- teric line and the Unea aspera. 4. Adductor longus ; arises bj^ a round tendon from the front surface of the pubis below the angle ; inserted into the middle third of the linea aspera. 5. Adductor hrevis ; arises from the body and ramus of the pubis ; inserted into the upper third of the linea aspera. 6. Adductor magnus ; a broad ti'iangular muscle ; arises from the ramus of the pubes and ischium, and tuber ischii, and, radiating outward, is inserted into the whole length of the hnea aspera and inner condyle of the femur. 7. Gracilis ; a slender muscle, aris- ing from the body of the os pubis, and ramus of the pubis and ischium : inserted into the inner tuberosity of the tibia. Uses. — The iliacus, psoas, pectineus, and adductor longus bend the thigh upon the pelvis, and rotate the entire limb outward ; the pecti- neus and adductors move the limb outward powerfully. The gi-acilis assists hi adduction, and contributes also to the flexion of the leg. Posterior Femoral Reg- "N — ^Tliree muscles ; 1. Biceps femoris ; double-headed, one head arisih^ in common with the semi-tendinosus, the other from the lower two thirds of the linea aspera; inserted by a strong tendon into the head of the fibula ; a portion of its tendon is continued into the fiiscia of the leg, and another is attached to the outer tuberosity of the tibia. 2. Semi-tendinosus ; remarkable for its long tendon ; arises from the tuberosity of the ischium with the long head of the biceps ; inserted into the inner tuberosity of the tibia. 3. Semi-membranosus ; named from its tendinous expansion ; arises fi-om the tuberosity of the ischium in front of the preceding ; inserted into the back part of the inner tuberosity of the tibia. ]Sl"oTE. — The biceps forms the outer hamstring; the tendons of the semi-tendinosus, semi-membranosus, gi'acilis, and sartorius form the inner liamstrino;. i-n 122 A N A T M y. Uses. — These muscles are the du-ect flexors of the leg upon the thigh; those fibres which originate fr; m below also balance the pelvis on the lower extremities. The biceps everts the leg when partially flexed, and the semi-tendinosus turns it inward when partially flexed. Fig. 62. Fig. 62 exhibits the muscles of the posterior femoral and gluteal region. 1. Glu».'us medius. 2. Gluteus maxinus. 3. Vastus externus covered in by fsscia lata. 4. Long head of the biceps. 5. Its short head. 6. Semi-tendinosus. 7. Semi- membranosus. 8. Gracilis. 9. Part of the inner border of thp adductor magnus. 10. Edge of the sartorius. 11. The popli- teal space. 12. Gastrocnemius ; its two heads. MUSCLES Ol i'FE LEG. They are divided into three regions : anterior tibial, fibular, and posterior tibial. Anterior Tibial Region. — Four muscles: 1. Tibialis anticus ; arises from the upper two thirds of the tibia, the interosseous membrane, and the deep fascia; its tendon passes thi'ough a distinct sheath in the annular ligament, and is inserted into the inner side of the internal cuneiform bone, and base of the metatarsal bone of the great toe. 2. Extensor longus digitorum ; arises from the head of the tibia, upper three fourths of the fibu- la, interosseous membrane, and from the deep fascia ; below it divides into four tendons, which pass beneath the annular ligament, and are insert- ed into the second and third phalanges of the four lesser toes. 3. Peroneus tertius ; arises from the posTERiAL FEMORAL jgwer fouith of the tibia ; inserted into the base of MUSCLE. , , ■ <>,,., -n the metatarsal bone oi the little toe. 4. ±jxtensor proprius pollicis ; arises from the lower two thirds of the fibula and interosseous memfrane ; inserted into the base of the last phalanx of the great toe. Uses. — The first two are direct flexors, bending the foot upon the leg; acting with the tibialis posticus, they direct the foot inward, and with the peroneus longus and brevis, outward. They help to main- tain the flatness of the foot during progi'ession. The extensor longus digitorum and extensor proprius pollicis are direct extensors of the toes ; they also assist the flexion of the entire foot upon the leg. When acting from beZ^w they ir.crense the firmness of the ankle joint MYOLOGY. 123 63. Posterior Tibial Region. — Seven muscles; the first three make the superficial group; the last four the deep layer: 1. Gastrocnemius ; arises by two heads from the two condyles of the femur, which, uniting to form tlio bellied part of the leg, are inserted, by means of the tendo Achillis, into the lower part of the tuberosity of the os calcis, a synovial bursa being interposed between the tendon and bone. 2. Plantaris, a very small muscle, arising frcm the outer condyle of the femur, and inserted, by a long, slender tendon, into the os calcis, by the side of the tendo Achillis. 3. Soleus, a broad muscle, arising fi-om the head and upper third of the s'>ula, and oblique line and middle third of the tibia; its fibres converge to the tendo Achillis, by which it is inserted into the OS calcis. Uses. — These three muscles of the calf draw powerfully on the os calcis, lift the heel, and contin- uing then- action, raise the entire body. They are the principal muscles in walking, leaping, and danc- ing. When they are fixed below they steady the leg upon the foot. The superficial muscles of the posterior aspect of the leg are shown in Fig. 63. 1. Biceps, forming the outer hamstring. 2. The tendons forming the inner hamstring. 3. Popliteal space. 4. Gastrocnemius. 5, 5. Soleus. 6. Tendo Achillis. 7. Posterior tuberosity of the os calcis. 8. Tendons of the peroneus longus and brevis, passing behind the outer ankle. 9. Tendons of the tibialis posticus and flexor longus digitorum, passing into the foot oehind the ankle. 4. Popliteus ; arises by a rounded tendon from a deep groove on the outer side of the external condyle of the femur, beneath the external lateral ligament, and spreading obliquely over the head of the tibia, is inserted into the bone above its oblique line. 5. Flexor longus pollicis ; arises from the lower two thirds of the fibula, and passing through a groove in the astragalus and os calcis, is inserted into the bone of the last phalanx of the great toe. 6. Flexor longus digitorum ; arises from the surface of the tibia, below the popliteal line; its tendon passes through a sheath with the tibialis posticus behind the inner malleolus, and then through a second sheath connected with a groove in the astragalus and os calcis, into the sole superficial, of the foot, where it divides into four tendons, which tibial :mtjscles are inserted into the base of the last phalanx of the four lesser toes, perforating the tendons of the flexor brevis digitorum. 7, Tibialis 124 VNAro::r. posticus , arises by Vivc lieads from the adjacent sides of the tibia and j fibula their whole length, and from the interosseous membrane; its , tendon i-uns into the sheath with the flexor longus digitorum. passes ; through its proper sheath over the deltoid ligament, and is inserted I into the tuberosity- of the scaphoid and internal cuneiform bone. Uses. — The popliteus flexes the leg upon the thigh, at the same time , carrying it inwai'd, so as to invert the leg. The flexors are connected ; in the foot by a tendinous band, so that they act together in bending : the toes. The tibialis posticus extends the tarsus upon the leg, antag- | onizing the tibialis anticus. These last two combine in adducting the ■ foot. j Fibular Region. — Two muscles: 1. Peroneus longus; arises from ' the head and upper third of the outer side of the fibula, and terminates i in a long tendon which passes behind the external malleolus, and obliquely across the sole of the foot ; inserted into the base of the j metatai'sal bone of the great toe. 2. Peroneus brevis, lies beneath the ' former, arising from the lower half of the fibula, and terminates in a ! tendon which passes behind the external malleolus, and through a ' groove in the os calcis, to be inserted into the base of the metatarsal j bone of the little toe. Uses. — The peronei are extensors of the foot, conjointly with the j tibialis posticus, and antagonize the tibialis anticus and peroneus tertius. ; All of these acting together maintain the foot in a flat position, as in | walking. j MUSCLES OF THE FOOT. 1 These may be arranged, according to theh* situation above or below, i into those of the dorsal and those of the plantar regions. i Dorsal Region. — Two muscles: 1. Extensor brevis digitorum; arises from the outer side of the os calcis, crosses the foot obliquely, ! and terminates in four tendons, one of which is inserted into the first i phalanx of the great toe, and the others into the sides of the long e^- j lensor tendons of the second, third, and fourth toes. 2. Dorsal inter \ ossei ; these are placed between the metatarsal bones. 1 Plantar Region. — The muscles of this region are subdivided into I four layers. | First Layer. — Three muscles: 1. Abductor pollicis, lies along the i inner border of the foot, one head arising from the inner tuberosity of the OS calcis, the other from the internal annular ligament and plantar fascia; inser'ed into the first phalanx of the gi'eat toe, and internal sesa- M Y L G x. 125 moid bone. 2. Abductor minimi digiti, lies along the outer border of the foot, arising from the outer tuberosity of the os calcis, and plantar fascia; inserted into the base of the first phalanx of the little toe. 3. Flexor hrevis digitorum, situated between the two preceding; arises from the under surface of the os calcis, from the plantar fascia and intei-muscular septa ; inserted, by four tendons, into the base of the second phalanx of the fou'* lesser toes. The first layer of muscles in the sole of the foot is shown in Fig. 64. 1. Os calcis. 2. Posterior part of the plantar fascia divided transversely. 3. Abductor pollicis. 4. Abductor minimi digiti. 5. Flexor brevis digitorum. 6. Tendon of the flexor lougus pollicis. 7, 7. Lumbricales. Second Layer. — Two muscles : 1. Musculus accessorius ; arises by two slips from either side of the under surfoce of the os calcis; inserted into the outer side of the tendon of the flexor longus digitorum. 2. Lumbricales, four muscular slips, arising from the tibial side of the tendon of the flexor longTs digitorum ; inserted into the expan- sion of the extensor tendons, and base of the first phalanx of the four lesser toes. The third and part of the second layer of muscles of the sole of the foot are seen in Fig. 65. 1. Divided edge of the plantar fascia. 2. Musculus accessorius. 3. Tendon of the flexor longus digitorum. 4. Tendon of the flexor Icngus pol- licis. 5. Flexor brevis pollicis. 6. Adductor pollicis. 7. Flexor brei is mininii digiti. 8. Transversus pedis. 9. Dorsal and plantar interossei. 10. Convex ridge formed by the ten- don of the peroneus longus in its oblique course across the foot. Third Layer. — Four muscles : 1. Flexor bre- vis poinds ; arises from tho side of the cuboid, and from the external cuneiform bone ; inserted by two heads into the base of the first phalanx of the great toe. Two sesamoid bones are found in these tendons. 2. Adductor pollicis ; arises from the cuboid bone and sheath of the tendon of the peroneus longus, and from the base of the third and fourth metatarsal bones ; inserted into the base of the first phalanx of the gi-eat toe. 3. Flexor hrevis minimi digiti; arises from the base Fig. 64. FIRST LAYER PLANTAR MUSCLES. Fig. 65. PLANTAR MUSCLEa 126 ANATOMY. Fig. 66. ni h ^EJlF ITLANTAIl MUSCLES. Fi?. 67. of the metacarpal bone of the little toe, and sheath of the peroneal tendon ; inserted into the base of the first pliiilanx of the little toe. 4. Transversus pedis ; arises by fleshy slips from the heads of the metatarsal bones of the four lesser toes ; inserted into the base of the first phalanx of the gi'eat toe, its tendon being blended with that of the adductor pollicis Fig. 66 shows the deep-seated muscles in the sole of the foot. 1. Tendon of the flexor lon^s pollicis. 2. Tendon of the flexor communis digitorum pedis. 3. Flexor accessorius. 4, 4. Lumbricales. 5. Flexor brevis digitorum. 6. Flexor brevis pollicis pedis. 7. Flexor breris minimi d'giti pedis. Fourth Layer. — One set of muscles : Interossei plantares ; three in number, placed upon the metatarsal bones ; arising by the base of the me- tatarsal bones of the three outer toes ; inserted into the inner side of the extensor tendon and base of the first phalanx of the same toes. The interossei plantares are seen in Fig. 67. 1. Abductor tertii. 2. Abductor quarti. 3. Interossei minimi digiti. Uses. — All the muscles of the foot act upon the toes, the action and nature and situation of each muscle being expressed by its name. The move- ments of the toes are flexion, extension, adduc- tion, and abduction. The gi'eat toe, like the thumb, is provided with special muscles for inde- pendent action. The lumbricales ai'e assistants to the long flexor ; and the transvei*sus pedis is placed across the foot for the purpose of di'awing the toes together. The firm articulations of all the metacarpal bones, and the great strength and number of th9 ligaments and tendons of the leg, ft-et, and toes, are admirably adapted for combining power of en- durance with facility of motion ; the toes genei*al]y have four flexors, tAVO extensors, four adductors, and four abductors ; while the gi'eat toe, in addi- tion, has two distinct flexors, tvvo extensors, one TLANTA* INTEBC8SR . adductor, and one abductor. A.PONEUROLOGY. m CHAPTER IV. OF THE FASCIA— APONEUROLOGY. The soft structures and delicate organs of the body are every where invested -,vith protecting coats, or bandages, called fascice. They are composed of lamina3 of various thickness, and are divided into cellulo- fibrous and aponeurotic. The cellulo-jihroiis fascia invests the whole body between the skin and the deeper parts, and affords a medium of connection between them- It is composed of fibrous tissue, arranged in a cellular form, the cells containing adipose substance, thus affording a yielding and elastic structure, through which the minute vessels and nerves pass to the papillary layer of the skin, without obstruction or injury from pressure. By dissection it may be separated into twa^layers, between which the subcutaneous vessels and nerves fire found. In some situa- tions this fascia is condensed into strong inelastic membrane, as in the deep fascia of the neck and thorax, and the sheaths of vessels. Fi-. G8. Fig. 68 is a transverse section of the neck. showing the deep cervical fascia and its nu- merous prolongations, forming sheaths for the ditl'erent muscles. 1. Platysma myoides. 2. Trapezius. 3. Ligamentum nucha;, from which the fascia may be traced forward beneath the trapezius, inclosing the other muscles of the neck. 4. Division of the fascia to form a sheath for the sterno-mastoid mus- cle (.5). G. Point of reunion. 7. Union of the deep fascia of opposite sides of the neck. 8. Section of the sterno-hyoid. 9. Omo-hy- oid. 10. Sterno-thyroid. 11. Latei'al lobe of the thyroid glnnd. 12. Trachea. 13. iEso- phagus. 14. Sheath containing the common carotid artery, internal jugular vein, and pneumogastric nerve. 15. Longus colli; the sympathetic nerve is in front. 16. Rec- tus anticus major. 17. Scalenus anticus. 18. Scalenus posticus. 19. Splenius capitis. 20. Splenius colli. 21. Levator anguli scapulas. 22. Complexus. 23. Trachleo-mastoid. 24. Transversalis colli. 25. Cervicalis ascen- dens. 26. Semi-spinalis colli. 27. Multi.fidus spinas. 28. A cervical vertebra; the transverse processes are seen to be traversed by the vertebral artery and vein. The aj)oneurotic fascia is strong and inelastic, composed of parallel tendin»^is fibres, connected by others passing in different directions. DISTRIBUTION OF THE FASCIA. 128 A ^' A T M Y. In the limbs it fci'nis distinct sheaths, inclosing all the muscles and ten dons, constituting the deep f;isc'a. It is firmly connected to the bones, and to the prominent points of the clavicle «rapula, elbow, wi'ist, pelvis, knee, ankle, etc. Its pressure assists the muscular action and the cir- culation of fluids. In the palm of the hand and sole of the foot it is a powerful protection to the sti-uctures. PP.l IPAL FASCIJ::. Temporal Fascia. — The fascia of the temple is a sti'oug aponeurotic membrane covering the temporal muscle on each side of the head. Cervical Fasclcs. — T.he fasciae of the neck are divided into the superficial ^vhich is a psrt of the common superficial fliscia of the entire body, and the deep, a sti-ong cellulo-fibrous layer which invests the muscles of the neck, and retains and supports the vessels and nerves. Thoracic Fascia. — The thoracic fascia is a dense layer of cellulo- fibrous menibrane stretched horizontally across the superior opening of the thorax, and forming the upper boundary of the chest, as the dia- phragm does the lower. It supports the heart in its situation, and also the large blood-vessels, windpipe, and aesophagus, which pass through it. Abdominal FascicB. — The lovrer part of the walls of the abdomen, and the cavity of the pelvis, are supported on their internal surface with a layer of fascia; at the bottom of the pelvis it is reflected inward to the sides of the bladder. In diflerent situations irs parts are called fascia transversalis, iliac, and pelvic fascia. The transverse and iliac fasciae meet at ihe crest of the ilium and Poupart's ligament; the pelvic is confined to the cavity of the true pelvis. These fasciee are important in their relations to inguinal hernia. There are two Kuids of inguinal hernia, oblique and direct. In the oblique, the intestine escapes from the abdominal cavity into the sperm- atic canal, through the interned abdominal ring; this ring is situated in the fascia transversalis, about midway between the spine of the pubis and superior anterior spine of the ilium, half an inch above Poupart's ligament. The bowel pushes along a pouch of peritoneum which forms the hernial sac, and distends a process of the ti-ansverse fascia. After emerging from the intei-nal ring, it passes beneath the lower borders of the transversalis and internal oblique muscles, and finally through the external abdominal ring in the aponeurosis of the external oblique muscle. While passing the internal oblique, it receives tha cremfister muscle as an additional investment, and upon protruding from tbfc externa' nng, still another fi-om the intercolumnar fascia. APONEUROLOGY. 129 Hence the coverings of an inguinal hernia from the surfoce to the bowel are ; 1. The integument 2. Superficial fascia. 3. Inter- columnar fascia. 4. The cremaster nmscie. 5. Transversalis fascia. G. Peritoneal sac. The sjyermatic canal is about an inch and a half in length, and in the normal condition gives passage to the spermatic cord in the male, and l,he round ligament of the uterus, with its vessels, in the female. It is bounded at its inner termination by the internal, and at its outer ex- tremity by the external, abdominal ring. It is also bounded in front by the aponeurosis of the external oblique ; behind by the ti'ansversalis fascia and the conjoined tendon of the internal oblique and transversalis; above by the arched borders of the same muscles ; below by the grooved border of Poupart's ligament. Of oblique inguinal hernia there are three kinds: 1. Coynmon oblique; already described. 2. Congenital; this has no proper sac, but is con- tained vfithin the tunica vaginalis; the other coverings are the same as in the first variety. It results from the pouch of the peritoneum, which is carried downward into the scrotum by the descent of the testicle in the foetus, not closing, so that the intestine is forced into the open canal. 3. Encysted ; a protrusion of the intestine in which the pouch of the peritoneum forming the tunica vaginalis, being only partially closed, and remaining open exte]-nally to the abdomen, admits of its passing into the scrotum behind the tunica vaginalis. The surgeon, in operat- ing, divides three layers of serous membrane, the first and second being those of the tunica vaginalis, and the third the peritoneal layer, or ti'ue hernial sac. Direct inguinal liernia is so called when the bowel passes directly through the external ring, forcing before it the opposing parietes. Its coverings are the same as in the oblique hernia, except that the con- joined tendon of the internal oblique and transversalis muscles form its fourth investment, instead of the cremaster muscle. Direct inguinal hernia never attains us great bulk as the oblique form; all these varieties may descend into the cavity of the scrotum, and afe then called scrotal hernia. Iliac Fascia. — The iliac fascia invests the psoas and iliacus muscles; beneath the femoral arch it forms a part of the sheath of the femoral vessels. Pelvic Fascia. — This is attached to the inner surface of the os pubis, and along the margin of the pelvis, from which it descends into the j^elvic cavity, where it divides into two layers, the pelvic and ohturator. Tjin pelvic layer is reflected inward from neai* the symphisis pubis to Uie neck of the bladder, forming the anterior vesical ligaments; au 130 ANATOMY. ascending reflected portion encloses the sides of the bladder and vesical plexus of veins, and forms the latei-al ligament of the bladder. Other reflexions constitute layers for investing the lower portion of the ali- mentary canal. The obturator layer passes downward, covering the obtmnitor internus musJe. and encloses the internal pudic vessels and nerves. Perineal Fascice. — The svperjicial perineal fascia is a thin apo neurotic layer covering the muscles of the genital portion of the peri- neum. The deep perineal fascia^ called also Canipefs, and triangular ligament, is sti'etched across the pelvis, so as to constitute a defence to its outlet. Fig 69. In the side view of the viscera of the pelvis, Fig. 69, is shown the distribution of the perineal and pelvic fasciee. 1. Symphisis pubis. 2. Bladder. 3. The recto- vesical fold of peritoneum, passing from the anterior sur- face of the rectum to the back part of the bladder. 4. The ureter. 5. The vas deferens. 6. Right vesicula seminalis. 7. Prostate gland divided by a longitudinal section. 8, 8. Sec- tion of a i-ing of elastic tissue encircling the prostatic portion of the urethra at its commence- ment. 9. Prostatic urethra. 10. Membranous portion. 11. The commencement of the cor- pus spongiosum penis, the bulb. 12. Anterior ligaments of the bladder. 13. F.dgeofthe pelvic fascia reflected upon tlie rectui^. 14. Location of a plexus of veins, between the pelvic and deep perineal fascia. 15. The deep perineal fascia; its two layers. 16 Cowpnr's gland of the right side. T"'. Superficial perineal fascia, ascending in front of flie root of the penis to become continuous with the dartos of the scrotum (18). 19. Layer of the deep fascia prolonged to the rectum 20. Lower part of the levator ani. 21. The inferior segment of the funnel-shaped process givt-n off from the posterior layer of the de«p perineal fascia, which is continuous with the recto-vesical fascia; the attach- ment of this fascia to the recto-vesical fold of peritoneum is seen at 22. Fascia of the Upper Extremity. — The superficial contains between its layers the superficial nerves, veins, and lymphatics. The deep is thick upoii the dorsum of the scapula, but thin in the axillary space In the fore-arm it is very strong at the elbow and wi-ist joints, uniting with the ligamentous structures. In the latter joint it forms the pos- terior annular ligament. The palmar fascia occupies the middle and Bide of the hand, its centi'al portion spreads over the heads of the meta- carpal bones, where it divides into slips which are attached to the phalanges. PELVIC FASCIA. A N G i; 1 L G Y. 131 Fascice of the Lower Extremity. — As in the upper extremity, the superficial fascia of the lower contains between its layers the superficial ressels and nerves. At the groin these layers are separated by the lymphatic glands. The deepfascic of the thigh is called, from its gi-eat eiiXenU fascia lata. It is sti-ongly connected with tlie prominent points of bone around the hip, knee, a^id ankle joints. The sheath of the femoral vessels is a continuation of the abdominal fascia down the thigh. In this sheath is an interval between the vein and its inner wall, the upper opening of which is called the femoral ring. This ring is bounded in front by Poupait's ligament behind by the os pubis, inter- nally by Gimbernat's ligament, and externally by the femoral vein, and is closed only by a thin layer of areolar tissue, called septum, crurale, which retains the lymphatic gland in position, and the peritoneum. FEMORAL HERNIA. When violent or long-continued pressure is made on the abdominai viscera, a poi'tion of intestine may be forced through the femoral ring into the interval or space in the sheath of the femoral vessels, consti- tuting femoral hernia. The proti'uding intestine pushes along the peritoneum and septum crurale. If the causes continue, the intestine will be forced forward through an opening, called saphenous, in the fascia lata, carrying along two additional coverings, the sheath of the 'emoral vessels, or fascia proper, and another investment, called the :rihriform fascia ; next curving upward over Poupart's ligament, the hernia becomes fixed beneath the superficial fascia and skin. Its direc- tion being therefore doivnward, then forward, and then upward, the efforts to reduce it must be directed in the reverse order. The fascia of the leg is thickened toward the ankle joint into naiTow bands, which form the annular ligaments. The plantar fascia forms strong layers, which invest the tendons and joints of the foot and toes. . CHAPTER V. OF THE ARTERIES— ANGEIOLOGY. The arteries constitute that pait of the circulating system whicji carries the blood from the heart to all parts of the body. They are d<*nse, cylindrical tubes, which form thej' retain when emptied of 132 ANATOMY, blood, and even after death, from which ch-curastance the ancients regarded them as au'-vessels.* x^he aorta, which proceeds from the left ventricle of the heart, and branches, contain the pm"e or arterial blood, and, with the veins which return this blood ag-ain to the heait, constitute the greater or sys- temic circulation. The puZ- inonary artery, which conveys the venous or impure blood to the lungs, with its correspond- ing veins, is called the lesser or pulmonary circulation. The iS'erves accompany the Arteries in'eve- ry pan of ttf. svslem. Structure of Arteries. — Arteries are composed of thi'ee coats : the external is cellular, or areolo-fibrous ; the middle is muscular, or, rather, a mixed tissue of elastic and conti-actile fibres ; and the z«- ternal is nervous, or a serous membrane, thi'oughout whose substance are ramified the nerves of organic life. The outer coat is firm and strong ; the middle is thick and soft; and the internal thin and pol- ished. ARTERIAL. SYSTEM, Distribution of Arteries. — All the arteries of the general sys- tem are branches of the aorta, which divide and subdivide to their final ramifications in the capillaiy system. From the aorta most of the branches pass off at right angles, which moderates the impetus of the blood ; but in the extremities the branches leave the main artery at an acute angle, w^hich favors the most rapid circulation. When an artery divides, the area of its branches is always greater than that of the sin- * The term angeiology has been applied to the vascular system ; it includes the blood- reseels, arteries, and veins, and the lymphatics. A N G E 1 L G Y. 13S glo trunk ; and the combined area of the ulthnate ramifications of all the arteries is vastly greater than that of the aortic trunk. This ar- rangement allows a more quiet motion of the vital current in the ex- treme vessels, where decomposition and recomposition of structures are effected. All the arteries are invested with a fibro-cellular sheath, which also contains their accompanying veins, and sometimes a nerve. LxTERCOMMUMCATioN OF Arteries. — In all parts of the body the arterial tubes communicate with each other by branches passing be- tvv^een, called inosculations, or anastomoses. These connections in- crease in frequency as the vessels diminish in size, so that their final distribution is a complete circle of inosculations. The advantage of this provision against obstructions which are most liable to occur in the smaller branches is obvious. When an artery is divided, or its cavity obliterated, the anastomosing branches above enlarge and make up the loss of blood by a collateral circulation. The arteries do not terminate directly in veins, but in an intermediate system, called the capillary, an extremely minute network of vessels and nerves, from which the veins arise. THE SYSTEMIC ARTERIES. Aorta. — The aorta arises from the left ventricle of the heart, opposite the articulation of the fourth costal cartilage with the sternum, and arches backward and to the left, and then descends on the left side of the spine to the fourth lumbar vertebra. It is hence divided into ascend- ing, arch, and descending, the descending portion being subdivided into thoracic and ahdominal. At ite commencement there are three dilata- tions, called its sinus, corresponding with the three semilunar valves. The coronary arteries ai'e the only branches given off by the ascend- ing aorta; they arise just behind the semilunar valves, pass through the grooves betvveen the auricles and ventricles, and are distributed to the substance of the heart. Arteria Innominata. — The arteria innominata arises from the arch of the aorta, is an inch and a half in length, and ascends obliquely toward the right side in front of the ti-achea ; behind the right sterno- clavicular joint it divides into the right carotid and right subclavian. Common Carotid Arteries. — The right common carotid arises from the bifiarcation of the innominata, and ascends the neck perpen- dicularly to the upper border of the thyroid cartilage, where it divides into the external and internal carotids. The left arises from the ai-ch. of the aorta, ascends the neck, and divides like the right. IH AN/ T M Y. Fi-. 71. Fig. 71 shows the relations of tho large vessels proceeding from the root of the heart, that viscis being removed. 1. Ascending aorta. 2. Arch. 3. Thoracic aorta. 4. In- nominata ; this divides, at 5, into right carotid, which, at 6, subdi- vides into external and internal carotid ; and 7, the right subcla- vian. 8. Axillary. 9. Brachial 10. Right pneumogastric nerve. 11. Left carotid. 12. Left subcla- vian, 13. Pulmonary. 14. Left pulmor.ary. 15. Flight pulmonary. 16. Trachea. 17. Right bronchus. 13. Left bronchus. 19, 19. Pul- racnary veins. 20. Bronchial ar- teries. 21. Intercostal. External Carotids. — Each externa] carotid, pass- ing through the deep por- tion of the parotid gland, ascends nearly perpendicu- larly to the space between the neck of the lower jaw and the meatus auditorius, where it divides into the temporal and internal maxil- lary. It gives off nine branches ; the first three anteriorly, the next three superiorly, and the last Xhrce posteriorly'. 1. Superior thyroid; curves downward to the th\Toid gland, where it is distributed. It sends a liy- oid branch to the mu.scles of the hyoid bone, and superior and inferior laryngeal, and muscular branches to the larynx. 2. Linguinal ; ascends obliquely to the under surface of the tongue, running forward in a Berpentine direction to its tip, where it is called the ranine artery; it gives off the hyoid, dorsalis linguce, and sublingual branches. A branch of this latter branch is often divided in cutting the fraenum linguse in tongue-tied children. 3. Facial; this arises above the os hyoides, and descends obliquely to the submaxillaiy gland, where it is embedded : it then curves around the body of the lower jaw, ascends to the angle of the mouth, and thence to the angle of the eye, giving off, below the jaw, inferior palatine, submaxillary, submental, and pterygoid branches, and on the face the masseteric, inferior labial, inferior coronary superior coronary, and lateralis nasi branches. 4. Mastoid ; turns downward to be distributed to the sterno-mastoid LARGE CARDIAC VESSELS. ANGEIOLDGY. 185 Fig. 72. muscle and lyirphatic glands of the neck. 5. Occipital passes back- ward a little below the tacial, forms a loop with the hypo-glossal nerve, and 13 disti'ibuted upon the occiput, anastomosing freely with the opposite occipital, the temporal, and auricular arteries. It gives off the inferior meningeal to the dura mater, and the princeps cervicis, a large branch which descends the neck betw^een the complexus and semi-spinalis colli, and inosculates with the deep cervical branch of the subclavian. This branch establishes an important collateral circulation between the branches of the carotid and subclavian, after the ligatm-e of the common carotid. 6. Posterior auricular ; ames above the level of the digasti-ic and stylo-hyoid muscles, and ascends belov/ the parotid gland, to be distributed, by two branches, to the external ear and side of the head, anastomosing with the occipital and temporal. It sends off the stylo- mastoid branch to the tympanum and aquaeductus Fallopii. The ante- rior arteries of the ear are branches of the temporal. 7. Ascending pharyngeal ; arises near the external carotid bifurcation, and ascends to the base of the skull, where it divides into two branches — meningeal, which, passing through the foramen lacerum posterius, is distributed to the dura mater, and pharyngeal, which supplies the pharynx, tonsils, and Eustachian tube. 8. Parotideans; four or five branches distributed to the parotid gland and adjacent integuments. 9. Transver- salis facei ; arises from the ti'unk within the parotid gland, crosses the masseter muscle, and is distributed to the temporo-maxillary articulation, and muscles and integuments of the side of the face, inosculating with the facial and infi-a-orbital. Fig. 72 is a plan of the common carotids, with the branches of the external. 1. Common carotid. 2. External carotid. 3. Internal ca- rotid. 4. Carotid foramen in the petrous ijortion of the tempora. bone. 5. Superior thyroid. 6 Lingual. 7. Facial. 8. Mastoid 9. Occipital. 10. Posterior aurio ular. 11. Transver.se facial. 12. Internal maxillary. 13. Temooral _ ,. . ,. , 1 CAEOTIDS AND BRANCHII 14. Ascending pharyngeal 186 ANATOMY. The Temporal Artery. — This terminal branch of the external carotid ascends over the root of the zygoma, where it divides into two branches ; 1. Anterior temporal ; distributed over the front of the temple and arch of the skull, anastomosing witn its fellow, the frontal and supra-orbital. 2. Posterior tenqjoral ; curves upward and back- vrard, inosculating with its fellow, the occipital and posterior auricular It sends off three branches — the orbitar to the palpebi'al arteries, the middle temporal to the temporal muscle, and the anterior auricular to the ear. The I>"ternal Maxillary Artery. — The other terminal branch of the external carotid passes inward behind the neck of the lower jaw to the deep structm'es of the face. Its branches ai'e : 1. Tympaniticj disti'ibuted to and around the drum of the ear, passing through the glenoid fissure. 2. Inferior dental ; descends to the dental foramen, and enters the canal of the lower jaw with the dental nerve. It sup- plies the teeth of the lower jaw, sending small branches along the canals in their roots. A branch also emerges at the mental foramen and anastomoses with the facial arteries. 3. Meningea media ; passes through the foramen spinosum of the sphenoid bone, and becomes the middle artery of the dura mater, its branches ramifying through a part of that membrane and the bones of the skull. 4. Meningea parva ; enters the cranium through the foramen ovale, and is distributed to the dura mater, giving off a twig to the nasal fossae and soft palate. 5. Muscular branches ; disti'ibuted to the muscies of the maxillary region. 6. Superior dental; descending, winds around the tuberosity of the upper jaw, and gives branches to the back teeth, gums, and the anti'um 7. Infra-orbital ; enters the orbit of the eye, and passes along the infra- orbital canal, sending branches to the orbit, anti'um, teeth of the upper jaw, and integuments. 8. Ptery go-palatine ; a small branch sent to the upper part of the pharynx and Eustachian tube. 9. Spheno- palatine, or nasal ; enters the upper meatus of the nose, and supplies the mucous membrane of its septum and walls, and sphenoid and ethmoid cells. 10. Posterior j^alatitie ; descends along the posterior palatine canal, and is disti'ibuted to the palate. A branch called Vidian, passes backward to the sheath of the Vidian nerve and Eustachian tube. Internal Carotid Arteries. — From the bifm*cation of the com- mon carotid, each internal carotid curves slightly outward, then ascends nearly perpendicularly tlu'ough the maxillo-pharyngeal space, to the carotid foramen in the os petrosum. It nrxt passes irnvard along the carotid canal, forwcrd by the sella turcica and then upward, piercing ANGEIOLOGY. 137 the dura tnater, and dividing into three terminal branches. These re- markable angular curves greatly diminish the force of blood thrown into the substance of the brain. The cerebral portion of the artery gives off the following branches : 1 . Ophthalmic ; it enters the orbit through the optic foramen, passes to the inner angle of the eye, and divides into two groups of branches, the first being distributed to the orbit and surrounding parts, and the second supplying the muscles and globe of the eye. These branches are named from their distribution : Lachrymal, supra-orbital, posterior ethmoidal, anterior ethmoidal, pal- pebral, frontal, nasal, muscular, anterior ciliary, short ciliary, long ciliary, and centralis reiince. 2. Tympanitic ; this enters the tym- panum through a small foramen in the carotid canal. 3. Anterior me- ningeal ; distributed to the dvu-a mater and Casserian ganglion. 4. Anterior cerebral; passes forward along the longitudinal fissure be- tween the two hemispheres of the brain, and gives branches to the optic and olfactory nerves, anterior lobes, third ventricle, corpus callo- Bum, and inner surface of the hemispheres. The two anterior cere- bral arteries are connected soon after their origin ; the anastomosing ti'unk is called the anterior communicating artery. 4. JMiddle cerebral; passes outward along the fissure of'Sylvius, and divides into three branches, which supply the anterior and middle lobes of the brain, and the corpus sti'iatum. 5. Posterior communicating ; passes backward, and inosculates with the posterior cerebral. 6. Choroidean ; a small branch sent off to the choroid plexus, and walls off the middle cornua. The Subclavian Arteries. — The right arises from the innomi- nata, and the left from the arch of the aorta. Each emerges from th'^ chest by passing over the first rib between the anterior and middle Bcaleni muscles. Its primary branches are five, most of which are given off before it arrives at the upper rib. The first three ascend ; the remaining two descend. 1. Vertebral; this is its largest branch* it passes through the foramina in the transverse processes of all the cervical vertebrae, except the lower, and enters the skull through the foramen magnum of the occipitis. At the lower border of the pons Varolii the two arteries unite to form the basilir. The vertebral and basilir arteries send off the following secondary branches : Lateral spinal, to the spinal cord and membranes ; posterior meningeal, to the dura mater, cerebellar fossfe, and falx cerebelli ; anterior spinal, to the spinal cord ; posterior spinal, to the spinal cord ; inferior cerebellar, to the lower surface of the cerebellum ; transverse, to the pons Varolii and adjacent parts of the Drain ; superior cerebellar, to the upper sur- face of the cerebellum; and posterior cerebral, to the posterior lobea '.38 ANATOMY. of the cerebrum. A remarkable connection of arteries at the base of the brain, formed by the interior communicating branch, anterior cere« brals, and internal carotids in front, and by the posterior communicat- ing, posterior cerebrals, and basilir behind, is called the circle of Willis. Fig. 73. Fig. 73 exhibits the communi- cation of the arteries constituting the circle of Willis. 1. Vertebral arteries. 2. The two anterior spinal branches united to form a single vessel. 3. One of the pos- terior spinal arteries. 4. Poste- rior meningeal. 5. Inferior ce- rebellar. 6. Basilir, giving ofl transverse branches to either side. 7. Superior cerebellar. 8. Posterior cerebral. 9. Posterior communicating branch of the internal carotid. 10. Internal ca- rotid, showing its curvature within the skull. 11. Ophthal- mic, divided across. 12. Middle cerebral. 13. Anterior cerebral, connected by, 14. The anterior communicating artery. 2. Thyroid axis ; this is a short ti'unk, dividing soon affcer its origin into four branches : Inferior thyroid, distributed to the thjToid gland, and send- ing twigs to the ti"achea, CIRCLE OF WILLIS. laiynx, and oesophagus ; supra-stapular, distributed to the muscles on the upper surface of the Bhoulder blade, sending a twig to the trapezius ; posterior scapular^ passing across the neck, supplying the muscles beliiud the scapula, and giving bmnches to those of the neck ; with the branches of the exter- nal carotid, subclavian, and axillary, it establishes an important anasto- motic communication ; superficial cervical, disti'ibuted to the deep muscles and glands of the neck, and sending twigs through the inter- vertebral foramina to the spinal cord and m&mbranes. 3. Profimda cervicis ; passes backward below the lower cervical vertebra, and then ascends the back of the neck, inosculating with branches of the occi< pital and scapular. 4. Superior intercostal ; descends behind the pleura upon the necks of the first two ribs, supplying their spaces, and inosculating with the first aortic intercostal. ANGEIOLOGY. 139 SUBCLAVIAN BRANCHES. Fig. 74 fihows the branches of the right sub- clavian. 1. Innorainata. 2. Right carotid. 3. First portion of the subclavian. 4. Its second portion. 5. Its third portion. 6. Vertebral ar- tery. 7. Inferior thyroid. 8. Thyroid axis. 9. Sup'U'ficialia cervicis. 10. Profunda cervicis. II. Posterior scapula!'. 12. Supra-scapular. 13. Internal mammary. 14. Superior intercostal. 5. Internal mammary ; descends by the side of the sternum to the dia- phragm, where it enters the sheath of the rectus, and inosculates with the epigastric ; it sends off the following branches : Anterior intercostal, to the front intercostal muscles ; mammary, to the breasts ; comes nervi iihrenica, which accompanies the phrenic nerve ; mediastinal and pericardiac, to the mediastinum, pericardium, and thy- mus gland ; and jnusculo-phrenic, to the diaphragm and intercostal spaces. The Axillary Arteries. — The axillaries curve gently through the middle of the armpit, where they become the brachial. Each axillary gives off seven branches : 1. Thoracica acromialis ; distributed to the pectoral muscles and mammary gland, and inosculating with the supra- scapular. 2. Superior thoracic ; disti-ibuted with the preceding, inos- culating with the intercostal and mammaiy. 3. Inferior thoracic ; dis- tributed to the pectoralis minor, serratus magnus, and subscapularis muscles, and axillary and mammary glands, inosculating with the su- perior thoracic, intercostal, and mammary. 4. Thoracica axillaris ; distributed to the plexus of nerves and glands in the armpit. 5. Sub- scapular ; the largest branch ; supplies the muscles on the under sur- face and lower border of the shoulder blade, and the side of the chest. A branch, called dorsalis scapulce, is sent to the upper side of the Bcnpula. 6. Circumjlex ; these wind around the neck of the humenis, and supply the shoulder joint. 7. Posterior circumjlex ; a larger branch disti'ibuted to the joint and deltoid muscle. Brachial Arteries. — Each brachial artery extends down the arm, from the lower border of the latissimus dorsi to the elbow, where it divides into the radial and ulnar. Along the arm it gives off four branches : 1. Superior 'profunda ; winds around the humerus between the triceps and bone and inosculates with the radial recurrent; tsendi? 140 ANATOMY". the j?05^f rfor «?'fzcu?rtr to the elbow johit. 2. Inferior pr of unda ; arisea from the middle of the brachial, descends to the elbow with the ulnar nerve, and inosculates with the posterior ulnar recui'rent. 3. Anasio- niotica inagna ; arises two inches above the elbow, and inosculates with both ulnar recurrents and the inferior profunda. 4. Muscular branches ; distributed to the muscles along its course, viz., coraco-bra- chialis, biceps, deltoid, brachialis anticus, and tricrus ARTERIES OF FORE-ARM. The Radial Arteri . — The radial di- vision of the brachial runs along the radial side of the fore-arm from the elbow to the wrist, -svhere it turns around the base of the thumb beneath its extensor tendons, and passes into the palm of the hand. It then ci'osses the metacarpaj bones to the ulnar side, forming the deej) paZmar arch, and terminates by inosculating with the super- ficial palmar arch. This is the arteiy which, from its superficial position above the WTist and base of the thumb, is select- ed for " examining the pulse." Its branches are : 1. To the fore-arju ; the recurrent ra- dial and muscular. 2. To the wi'ist ; su~ perficialis voice., carpalis anterior, carpalis posterior, metacarpalis, and dorsales polli- ds. 3. To the hand ; yrinceps pollicis, radialis indicis, interossece, and j^erforantes, disti'ibuted as their names import. The arteries of the forearm are sho^vn in Fig. 75. 1. Biceps muscle. 2. Inner condyle of the humerus. 3. Pronator radii teres. 4. Supinator longus. 5. Flexor longus pollicis. 6. Pronator quadratus. 7. Flexor profundus digitorum. 8. Flexor carpi ulnaris. 9. Annular ligament. 10. Brachial artery. 11. Anas- tomotica mngna. 12. Radial. 13. Radial recunent. 14. Superficialis volae. 15. Ulnar. 16. Its superhcial palmar arch. 17. Magna pollicis and radialis. 18. Posterior ulnar recurrent. 19. Anterior interosseous. 20. Posterior interosseous. The Ulnar Artery. — The ulnar division of the brachial crosses the arm obliquely, then runs down the ulnar side to the wrist, crossing the annular ligament, forming the superficial palmar arch, and termi- nating hy inosculating with the superficial volae. Its branches are : I. ANGEIOLOGY. Ul To the fore-arm ; anterioi and posterior recurrent, anterior and poste- rior interosseous, and muscular. 2. To the wrist; carpialis anterior and posterior. 3. To the hand ; digitales, distributed as their names import. The Thoracic Aorta. — In the cavity of the chest the aorta gives off three gi-oups of branches : 1. Bronchial ; four in number, distrib- uted to the bronchial glands and tubes ; they also send branches to the oesophagus, pericardium, and left auricle. They are the nutritive ves- sels of the lungs. 2. (Esophageal ; numerous small branches distrib- uted to the oesophagus, and making a chain of anastomoses along its course. 3. Intercostal ; nine on each side, arising from the posterior part of the aoita, and sent to the nine lower intercostal spaces, where each branch gives off a dorsal branch ; thus dividing into spinal and muscular branches, which supply the spina cord, and muscles and in- teguments of the back. The Abdominal Aorta. — In the abdominal cavity the aorta gives off nine primary branches : 1. Phrenic ; these are given off imme- diately below the diaphragm., and soon divide into an internal branch, which inosculat(^s with its fellow in front of the oesophageal opening, and an external, which is distributed to the circumference of the dia- phragm, and sends branches to the supra-renal capsules. The phrenic arteries inosculate with branches of the internal mammaiy, inferior in- tercostal, epigastric, oesophageal, gastric, hepatic, and supra-renal. 2. The Cceliac axis ; this is a single ti-unk, arising just above the first lumbar vertebrje, about half an inch in length ; it divides into three large brandies, the gastric, hepatic, ard splenic. The Gastric artery is the smallest branch; it ascends between the two layers of the lesser omentum to the cardiac orifice of the stomach, to be distributed to the lower part of the oesophagus and lesser curve of the stomach. It inosculates with branches of the hepatic and splenic. The Hepatic branch ascends along the right border of the lesser omentum to the liver, where it divides into right and left branches these are distributed along the portal canals to the right and left lobes. It sends a pyloric branch to the lesser curve of the stomach and duo- denum ; the gastro-duodenaUs, dividing into the gastro-ejriploi'sa dextra and pancreatico-duodenalis, which are distributed to the greater curve of the stomach, pancreas, and duodenum ; and the cystic, which is dis- tributed to the gall-bladder. The gastric, pyloric, and splen.c branches 142 ANATOMY. inosculate with each other, and with branches of the pancreas, duode- num, jejunum, and mesenteiy. The abdominal aorta is 3ho^vn in Fig- 76. Fig. 76, with its branches. 1. Phre- nic arteries. 2. Coeliac axis. 3. Gastric artery. 4. Hepatic. 5. Fplenic. 6. Right supra-renal. 7. Right renal. 8. Lumbar. 9. Su- perior mesenteric. 10. The two spermatic. 11. Inferior mesenteric. \2. Sacra media. 13. Common lil- acs. 14. Right internal iliac. 15. External iliac. 16. Epigastric. 17 Circumflexa ilii. 18. Femoral. The Splenic artery is the largest branch of the ca-liac axis ; it passes horizontally to the left along the upper border of the pancreas, and enters the spleen by five or six divisions, which are dis- tributed to its structure. In its course it is tortuous and serpentine, fi-equently mak- ing a complete turn upon itself. It is accompanied by the splenic vein, and splenic plexus of nerves. It sends oft' numerous small branch- es, ^awcr6ai?C(^parrer extremity. If y A.1MPHATIC CENTRE. The Ductus Ltmphaticus Dexter. — This is a short trunk which receives the lymphatic vessels from the right side of the head, neck, right arm, right lung, right side of the chest, and some branche» from the liver. Like the thoracic duct, it is prorki&d with valves. ANGEIOLOGY 158 where it discharges its contents into the veins, at the point before mentioned. Lymphatics of the Head and Neck. — The principal superficial glands are the occipital, posterior auricular, parotid, zygomatic, buccal, and submaxillary, situated as their names indicate, and the cervical, extending along the course of the external jngular vein. The deep glands are numerous and large around the internal jugular veins and carotid arteries, extending from the base of the skull to the root of the neck. The superjicicd vessels are disposed in occipital, temporal and facial groups, which converge to the deep cervical, parotid, and submaxillary glands. The deep vessels are the meningeal and cerebral, which pasa through foramina at the base of the skull to terminate in the deep cervical glands. Lymphatics of the Upper Extremity. — The superficial glands are few and small in the arm and fore-arm. The principal chain of deep glands accompanies the brachial artery. The axillary glands are large and numerous ; a small chain of them extends along the lower border of the large pectoral muscle to the mammary gland. They re- ceive the lymphatics of the integuments of the chest and the mam- mary gland. The superfi^cial vessels commence upon the fingers, and course along the fore-arm to the elbow, where they are arranged in two gi-oups, which extend upward to the axillary glands of the armpit. The deep vessels accompany the blood-vessels, communicate occa- sionally with the superficial, and enter the axillary and subclavian glands Lymphatics of the Lower Extremity. — The superficial in- guinal glands are those of the groin; the smallest gi-oup extends along the course of Poupart's ligament, and receives vessels of the walls of the abdomen, gluteal 'egion, perineum, and genital organs; the largest group clusters around the termination of the internal saphenous vein, and receives the vessels of the lower extremities. The deep glands are the anterior tibial, popliteal, deep inguinal, gluteal, and ischiatic, situated in the regions after which they are named. The superfi.cial vessels are divisible into an internal group, commenc- ing on the dorsum of the foot, and ascending the leg along the interna) saphenous vein to the glands oi'the gi'oin, and an external gi'oup, which commences on the outer side of the foot and back part of the ankle, and accompanies the external saphenous vein to the popliteal glands* 160 ANATOMY. The deep vessels follow the deep veins and arteries, and, after joining the deep inguinal glands, communicate with the numerous glands ai'ound the iliac vessels. Most of the efferent lymphatics from the superficial inguinal glands communicate \vith the large gland in the femoral ring, by which a communication is established between the lympliatics of the trunk and those of the lower exti'emity. Lymphatics of the Trunk. — These may be arranged into three groups : 1. Superficial ; the superficial vessels of the upper part of the ti'unk converge to the axillary glands, and to those at the root of the neck. Those of the lower half of the trunk, gluteal region, perineum, and external organs of generation, converge to the upper gi'oup of su- perficial inguinal glands. 2. Deep ; the deep glands are the intercos- tal, situated on each side of the vertebral column, the internal mam- mary, in the intercostal spaces beside the internal mammary ai'teries, and the anterior and posterior mediastiyial, situated about the large vessels at the root of the heart, and extending along the course of the aorta and oesophagus in the mediastinum, communicating with the deep cervical, intercostal, and abdominal glands ; the lumbar, numerously situ- ated around the common iliac vessels, aorta, and vena cava; the external iliac, placed around the external iliac vessels ; the internal iliac, located along the coui-se of the internal iliac vessels, and the sacral, placed on the concave surface of the sacrum. The deep vessels of the thorax are the intercostal, following the course of the intercostal arteries ; the internal mammary, -which commence in the w^lls of the abdo- men, and, communicating with the epigasti'ic, ascend to the root of the neck ; the diaphragmatic, which pui-sue the direction of their cor- responding veins. The deep vessels of the ahdomen are continued up- ward from the thigh, beneath Poupart's hgament, and along the exter- nal iliac vessels to the lumbar glands, receiving in their course the epigasti'ic, circumflexa ilii, and ilio-lumbar vessels. Those fr")m the walls of the pelvis and from the gluteal, ischiatic, and obturator vessels, follow the coui-se of the internal iliac arteries, and unite with the lum- bar lymphatics ; and the lumbal* vessels, after receiving all the lymph- atics from the lower extremities, pelvis, and loins, terminate by several large tiTinks of the receptaculum chyli. 3. Visceral ; the lymphatic vessels of the lungs are of large size, distributed thi-oughout their textures and surfaces, and converge to the numerous glands around the roots of the lungs and bifurcation of the trachea. These bronchial glands in the adult are 3f a variable brownish tint, and in old ago pre' sent a deep blacR v,oIor NEUROLOGY 161 Those of Llie heart follow the course of its blood-vessels to the gknds around the arch of the aorta, and to the bronchial glands. The lymph. - atic vessels of the liver proceed from its different parts to the glands, along the course of the hepatic artery and lesser curve of the stom- ach, mediastinal glands, to those situated around the inferior cava, and to the lumbar glands ; those from the gall-bladder, which are large, n-nd form a remarkable plexus, enter the glands in the right border of the lesser omentum. Those of the spleen and pancreas pass through the splenic glands, and those along the course of the splenic vein, and join the aortic glands before entering the thoracic due'. Those of the stomach proceed variously to the glands along its lesser and gi'eater curves, and to the splenic, pyloric, and aortic glands. The lymphatics of the small intestines are of two kinds : those which run upon the surface and belong to their structure, and those Avhich commence in the substance of the mucous membrane, and are called 'acteals. Both enter the mesenteric glands. Those glands are situ- ated between the layers of the mesentery, in the meshes formed by the superior mesenteric artery. They are most numerous and largest near the duodenum, and near the termination of the ileum. The lacteals commence by tubular mouths, which open into a fine network, situated in the sub-mucous tissue, from whence they proceed to the mesenteric glands, and thence to the thoracic duct. Those of the large intestines proceed in two different directions : the vessels of the cascum, ascending and transverse colon, traverse their own proper glands, and then enter the mesenteric, and those of the descending colon and rectum proceed to the lumbar glands. Those of the kidneys follow the blood-vessels to the lumbar glands, situated around the aorta and inferior cava ; those of the supra-rena! capsules, which are very large and numerous, terminate in the renal. Those of the pelvic viscera terminate in the sacral and lumbar glands. CHAPTER VIIL OF THE NERVES— NEUROLOGY. The nervous system may be divided into two sub-systems — the cerebrospinal and the organic. Ths former comprises th<3 brain, spinal marrow, the nerves of sensation and the nerves of motion; the 162 ANATOMY. latter embraces the nerves and ganglions which preside over the de- rclopraent and functional changes of the body ; this division of the Pi„ g4 nervous sti'ucture has been called the sympathetic, ganglionic, and, more properly, the organic sys- tem. This system is essential tt> animal existence ; the lowest ani • mals are destitute of the cerebro- spinal sti'ucture. The nervous tissue is enclosed in membranes, or sheaths, and consists of two pulpy materials, one of which is of a white color — the medullary substance, and the other gray-colored- — ^the cine- ritious substance. The medul- lary structure is fibrous, the fibres being looped at their termina- tions, and containing a centi'al stripe, called the cylinder axis of Purkinje. The ciiieritious ig more vascular, and composed of kidney-shaped globules, contain- ing a vesicular nucleus with a nucleolus. These globules are soft, and of a yellow or brow^nish color. The ganglions iand nervous centres consist of a mixture of white fibres and gray globules. The sheath of the nerves is call- ed neurilemma, and the enclosed matter neurine. The trunks of nerves frequently interchange ti-unks or fasciculi, forming anastomoses ; and a combination of these anasto- moses into a network forms a plexus. N'jmerous small elliptical bodies, attached to the ulnar and digital nerves, ai'e called Pacinian corpuscles ; these have no terminal loops, being the only exception to the general rule. Microscopic observation makes out the elements of the nervous sys- tem to be, white nerve-fibros; gray nerve-fibres, n^rve-cells, and nerve* granules. NERVOITS SYSTEM. NEUROLOGY. lez Fig. 85 represents the microscopic elements of the nervous structure. 1. Mode of termination of white nerve-fibres in loops ; three ui these loops are simple, the fourth is convoluted. The latter is i'ound in situ- ations where a high degree of sensation exists. 2. A white nerve-fibre from the brain, showing the vari- cose or knotty appearance produced by traction or pressure. 3. A white nerve-fibre enlarged to show its structure, a tubular envelope and a contained sub- stance — neurilemma and neurine. 4. A nerve-cell, showing its composition of a granular-looking cap- sule and granular contents. 5. Its nucleus containing a nucleolus. 6. A nerve-cell, from which several processes are given off; it contains also a nucleated nucleus. 7. Nerve-granules. Fig. 85, MINUTE NEKVOUS STRUCTURE. White nerve-fibres compose most of the brain, spinal cord, and cere- bro-spinal nerves, and enter into the structure of the organic system. They terminate in the various internal organs, at the surface of the body, and in the substance of the cerebro-spinal axis, by forming loops. In size they vaiy from — - to — - of an inch in diameter. '' -^ 2000 1-4000 Gray nerve-fibres are smaller in diameter, and less transparent. They constitute the principal part of the organic system, and are also p'3isent in the cerebro-spinal nerves, most abundantly in those of sensation. The nerve-ceUs vary from —^ to -— of an inch in diameter. They •^ 300 1250 *' are composed of a capsular sheath, containing a reddish-gray gi'anular substance, and one or more nuclei and nucleoli, the nucleus being attached to the sheath. Nerve-cells are found in the gray substance of the brain and spinal cord, in the ganglions of the cerebro-spinal nerves, and in the organic nerves and their ganglia. From the circum- ference of the nerve-cells arise one or more delicate thread-like pro- cesses, from -^ to j^^ of an inch in diameter, which are the origins of the gray nerve-fibres. The nerve-granules exist in the forms of minute homogeneous parti- cles, aggi-egated particles, and nucleated corpuscles, varying in diameter between —^ and ^^^ of an inch. They serve as a bond of connection between the fibres and cells of the brain and spinal cord, and enter into the various ganglia. A nerve is a collection of nerve-fibres into small bundles, or fascicuL each fasciculus being invested by a distinct neurilemma. Several of these fasciculi are again collected into larger bundles, which are also enclosed ni a separate neurilemma ; then again the larger fasciculi are collected into a grand bundle, which is enclosed in a general neurilem- ma, or sheatb- of white fibrous tissue 164 A N' A T M Y. THE BRAi:*f. The braia is the mass of nervous substance contained within the cranium. It is divided into cerebrum, cerehellum, and medulla oblongata. Its investing membranes are called dura mater ^ arachnoid, and pia mater. The brain and its membranes together constitute the cncephalon. Membranes of the Brain. — The external covering is the dura mater, a strong, whitish fibrous membrane which adheres to the inter- nal surface of the cranium, and is prolonged into the spinal column under the name of tlieca vertebralis ; but there it is not adherent to the bones. From its internal surface processes extend inward to support and protect different parts of the brain, and externally other processes for sheaths for the nerves passing out of the skull and spinal column. Its internal processes are the falx cerebri, which extends ver- tically across the median line from the crista galli of the ethmoid bone to the tentorium, dividing the cerebrum into righ* and left hemispheres ; the tentoriwn, which stretches horizontally across the cranium, separat- ing the cerebrum fi"om the cerebellum ; and the falx cerebelli, which divides the cerebellum into t^^o lobes or hemispheres. The arachnoid membrane is the middle covering and the serous membrane of the cerebro-spinal centre. It is very thin and transparent. It surrounds the nerves until their exit fi'om the brain, v\'here it is re- flected back upon the dura mater. It does not enter into the ventricles. The pja mater s the internal covering, vascular, consisting of innu- merable blood-vessels held together by a thin layer of cellular tissue. It invests the whole brain and each of its convolutions by extending thiough all the fissures between them. It contains usually a number of small gi-anulai* bodies, called the glandules Pacchioni ; these are •arger in old persons, and are considered by some anatomists to be of morbid origin. The pia mater is the nutiient membrane of the brain. The Cerebrum. — The cerebral portion of the brain is an oval mass divided superiorly into two hemispheres by the great longitudinal fis- sure. Each hemisphere is divided on its under surface into anterior, middle, and p>ostcrior lobes. The anterior rests upon the roof of the orbit, the middle is received into the middle fossa at the base of the skull, and the posterior is supported by the tentorium. The surface of the cerebrum presents a number of slightly convex elevations, con- stituting the convolutions, called gyri, which are separated from each other by sulci or fissures of various depths. The interior cerebral sub- stance is medullary, and the exterior cineritious to the depth of one of two Imes NEUROLOGY. 165 Fig. 86. THE BRAIX EXPOSED. The externa] surface of the oerebrum is seen in Fig. 86. a a. The scalp turned down, b b. Cut edges of the skull bones. 3. The dura mater suspended by a hook. 4, The left hemisphere. The anatomical distinctions of the cerebnam are the fol- lowing : Crura cerehri ; two thick white coi'ds diverging from the anterior border of the pons va- rolii, their fibres terminating iii the hemispheres. A layer of meduUarj^ matter occupies a triangular space between them, which is called the locus per- foratus. Eminentice mammillarcs ; two white globular bodies, near the size of a pea, between the crura and in front of the locus perforatus. Tuber cinereum; a soft gray mass in front of the eminentise mammil- lares, and behind the chiasm of the optic nerves. Infundihulum ; a hollow, conical, reddish body resting on the tuber cinereum, and attached by its apex to the pituitary gland. Pituitary gland ; a vascular mass, consisting of two lobes, which occupies the sella turcica. Longitudinal fissure; the sulci which separates the hemispheres laterally, and contains the falx cerebri. Corpus calloswn ; a v/hite arched band, forming the great comriiissure between the two hemispheres at the bottom of the longitudinal fissure. It is about an inch broad and three and a half inches long. Its fibres are mostly medullary matter ; a few, however, are cineritious ; these pass longitudinally, and are called the raphe. Septum lucidum ; a vertical partition separating the lateral ventricle?. It is in contact superiorly with the corpus callosum, and below witl the fornix. Fornix ; a ti'iangular arch, the base of which is continuous with the corpus callosum behind ; its apex divides into two crura, which termi- nate in the eminentia mammillares ; its under surface is called Lyra. Under these crura is the foramen of Munro, which communicates be- tween the third and the two lateral ventricles. 166 ANATOMY Felum interpositum ; a triangular process of pia mater under the fornix, containing in its edges a plexus of veins, called plexus choroides. Pineal gland ; a small, reddish- gray, conical body, situated upon the tubercula quadi'igemina, and connected with the optic tubercles by tv\'^o crura. This little thing is mejnorable fi'om having been regarded by the ancients as the seat of the soul. Tubercula quadrigemina ; four prominences over the junction of the pons and crm*a cerebri. Under them is a passage betw^een the third and fourth venti'icles, called the aqueduct of Sylvius, or iter a tertio ad ventriculum quartum. Corpus striatum ; a gray oblong mass medullary within, situated in each lateral ventricle. Thalamus opticus ; an oval body behind the corpus striatum on eacb side. It is a mixed mass of medullary and cineritious matter, and has three prominences, called corpora geniculata. It is connected with it.« fellow by a gray substance, which is called the soft commissure. Tenia striata ; a thin slip of medullaiy matter occupying the groove between the corpus sti'iatum and thalamus opticus. Hippocampus major ; a scroll extending into the inferior cornu of the lateral ventricle ; its extremity resembles a foot, and is called the pes hippocampi. Corpus jimhriatum ; a thin edge of medullary matter on the concave side of the hippocampus major; beneath it is a layer of cineritious substance, having a seiTated ajipearance, called the fascia dentata. Hippocampus minor ; a conical elevation, resembling the spur of a cock, pointing backward into the posterior cornu. Ventricles ; five in number. The lateral exist in each hemisphere, and contain the corpus striatum and thalamus opticus ; the roof is formed by the corpus callosum. In each are three angular depressions, called cornua ; the posterior contains the hippocampus minor, the in- ferior the hippocampus major, the anterior is vacant. They are par- tially separated by the septum lucidum, but communicate with each other and with the third by the foramen of Munro. The third ven^ tricle is the space between the thalami optici. Its roof is formed of the velum interpositum and fornix, and its floor by the locus perforatus and the tuber cinereum. Its front is traversed by the anterior commissure, a medullary cord extending between the corpora sti'iata, and by the posterior commissure, which extends ti-ansversely between the thalami optici. It communicates with the fourth by the aqueduct of Sylvius, and with the lateral by the foramen of Munro. The fourth ventricle is situated between the pons Varolii, cerebellum, and medulla oblongata. Its floor is the calamus scriptorius, and its roof is the valve of the brain NEUROLOGY. 167 tt communicates only with the third Laterally it is limited by the pia mater and arachnoid. T\\g fifth veKiricle is situated between the lara- inas of the septum lucidum, and has no communication with the others. Fig. 87 represents the taesial surface of a longi- tudinal section of the brain. 1. Inner surface of left hemisphere. 2. Divided centre of the cerebellum, showing the arbor vitse. 3. Medulla oblongata. 4. Cor- pus callosum, 5. Fornix. 6. One of the crura of the fornix. 7. One of the cor- pora albicantia, pea-shaped bodies between the crura cerebri. 8. Septum luci- dum. 9. Velum interposi- tum. 10. Section of the middle commissure in the third ventricle. 11. Section of the anterior commissure. 12. Section of the posterior commissure. 13. Corpora quadrigemina. 14. Pineal gland. 15. Aqueduct of Sylvius. 16. Fourth ventricle. 17. Pons Varolii, through which are Been passing the diverging fibres of the corpora pyramidalia. 18. Cnis cerebri of the left side; the third nerve arising from it. 19. Tuber cinereum, from which projects the mfundibulum, having the pituitary gland appended to its extremity. 20. One of the optic nerves. 21. The left olfactory nerve terminating anteriorly in a rounded bulb. MESIAL, SURFACE OF THE BRAIIV The Cerebellum. — The cerebellar portion constitutes one sixth or one seventh of the brain. It is an oblong, flattened body, situated be- tween the occiput and tentorium. Its external substance is cineritious, and the internal medullary. It is divided by a longitudinal fissure into two hemispheres ; in the upper part of this fissm'e is a ridge, called vermis superior ; in front of this is an elevation, called nionticulus ; in the lower part of the fissure is a smaller ridge, called vermis inferior. Two small protuberances are seen at the root of the crura cerebelli, the lower of which is called lohulus amygdaloides, and the upper lo- hulus nervi pneumogastrici. Extending from the lower surface of the cerebellum to the corpora restiformia is a thin gray plate, called the valve of the brain. The substance of the cerebellum, on a section being made in either lobe, presents an arborescent arrangement of medullary matter, called arhor vitce. A gray mass in the trunk of this medullary tree, with sen-ated edges, is called corpus dentatum. The cerebellum is associated with the rest of the encephalon by means of three pairs of rounded cords, called sujjerior, 7niddle, and inferior pe- fivncles. Its two hemispheres are united by the commissure called 163 ANATOMY. pons Varolii ; this consists of transverse fibres, separated into two !ayei-3 by the fosciculi of riie corpora pyramidalia and corpora olivaria. These two layers, the upper and lower on each side, are collected to- gether to form the crura cerebelli. The Medulla Oblongata. — This is the upper enlarged pai't of the spinal cord, about an inch in length, conical in shape, extending from the pons Varolii to the atlas. It is separated anteriorly and pos- teriorly by vertical fissures into two symraeti'ical Literal cords, or col- umns, eac'" column being subdivided by small grooves into tlu-ee smaller cords ; these ai"e the corpora ^''yramidalia, two naiTow tapering cords on either side of the anterior fissure, whose fibres decussate freely about an inch below the pons ; the corpora olivaria, two oblong convex bodies, half an inch in length, behind the corpora pyramidalia, from which they are sepai-ated by a fissure — a section of them exhibits an arrangement of cineritious matter, called corpus fimbriatum ; and the corpora restiformia, which comprehend the posterior half of each late- ral column. That part of the postenor fissm-e between them is ciilled calamus scriptorius, across which pass ti-ansverse fibres of medullary matter. Two slightly convex columns of the medulla oblongata, v/hich enter into the formation of the floor of the fourth venti'icle, are cailc'l funiculi teretes, or posterior pyramids. The fibres composing the columns of the medulla oblongata have a peculiar arrangement on its upper part ; those of the coi-pora pyramid- alia and olivaria enter the pons Varolii, and are prolonged through the crura cerebri, thalarai optici, and corpora sti'iata to the hemispheres of the cerebrum ; while those of the corpora restiformia are reflected backward into the cerebellum, and form its inferior peduncles. These fibres were termed by Gall the diver ffing fibres. They constitute both the cerebrum and cerebellum ; while another set of fibres, called co/i- verging, associate their symmetrical halves and distant parts of the same hemispheres. These converging fibres constitute the commis- sures of the brain already mentioned. The corpus caliosum is the commissure of the hemispheres ; 'he fornix, septum lucidum, the bo- dies called anterior, middle, and {/«Dsterior commissures, and the pe- duncles of the pineal gland, connect different parts of the cerebrmn, while the pons Varolii connects the hemispheres of the cerebellum. The gray matter which is intermixed with the white fibres of the medulla oblongata was regarded by Gall and Spui-zheim as the channels of nutrition : this supposition is strengthened by the gi-eat vasculai'ity of the former substance, which enables it to conve;* a large proportion of the elements of gi-owth and development. NEUROLOGY. 169 In Fig. 88 are seen several sections Df the base of the '-vrain, the distri- bution of the diverging fibres. 1. Medulla oblongata. 2. Half of the pons Varolii. 3. Crus cerebri, cross- ed by the optic nerve (4), and spread- ing out into the hemisphere, where it is called corona radiata. 5. Optic nerve. 6. Olfactory nerve. 7. Cor- pora albicantia. 8. Fibres of the corpus pyramidale passing through the pons. 9, The fibres passing through the thalamus opticus. 10. The fibres passing through the cor- pus striatum. 11. Their distribu- tion to the hemisphere. 12. Fifth nerve. 13. Fibres of the corpus pyramidale, which pass outward with the corpus restiforme into the cerebellum. 14. Section through one of the hemispheres of the cere- bellum, showing a body called cor- pus rhomboideum in the centre of Its white substance, and the arbor VitSB. 15. The opposite hemisphere. Fig. 88. BASE OF THE BRAIN. The Spinal Cord. — The spinal column contains the spinal cord^ medulla spinalis, its membranes., and the roots of the spinal nerves. [ts outer membrane is the tlieca vertebralis, continuous with the dura mater of the skull; the central is the arachnoid, a continuation of the serous membrane of the brain, and the internal is the prolongation of the pia rnater, which is more firm and fibrous, and less vascular, than in the brain. The anterior are separated from the posterior roots of the spinal nerves thi'oughout the entire length of the cord, by their processes of pia mater, called memhrana dentata. A transverse sec- tion of the spinal marrow exhibits an arrangement of gray matter in- ternally and medullary externally. It extends from the pons Varolii to the fir^t or second lumbar vertebra, where it terminates in a rounded point, lis diameter varies in different parts, and exhibits three enlarge- ments, the uppermost being the medulla oblongata, the middle corres- ponding with the origin of the nerves of the upper exti'emities, and the lower corresponding with the origin of nerves that supply the lower extremities. It is divided into lateral halves by anterior and posterior longitudinal fissures, which extend deeply into its substance. Eacxi lateral half is divided by a lateral sulcus, or fissure, into anterior and posterior columns, the anterior giving origin to the nerves of motion, and the posterior to those of sensation. Another slight fissm*e indicates [-15 170 ANATOMY a middle lateral column, which Sir Charles BeB supposed to pertain to the respiratory nerves, though such functional aiTangement has not yet been demonstrated. Ill Fig. 69 ai-e seen the relations of the spinal marrow to the medulla oblongata, pons Varolii, and cerebellum, as well as the sereral c-nlargeuients in its course. The Cranial Nerves. — These are so called from then- emerging through the foramina at the base of the cranium. There are nine pairs of them, all of which are named numerically and functionally. Fig. SO. IS 6 I^TAL CORD. THE XERVES CO.XNECTED WITH THE BRAIN. Fig. 90 ehows the origin of the cranial nerves. The numbers are p'aced against tbs corresponding pairs of nerves. 11 and 12 aif spinal nerves, a a a. Cerebrum, b. Cerebellum, s. Meduiia oblongjtta. d. Medulla spinalis. /. Corpus callosam. i\rst Pair — Olfacl^-y; the nerves of srrelling. Each arises by three roots, which unite in the fissure of Syvius : passing forward it enlarges into a bulbous mass of white and gray substance, which rests on the cribriform plate of the ethmoid bone. From this bulbous olfac- torius the nerves are given off which are distributed upon the mucouj membrane of the nose. NEUROLOGY. 171 Second Pair — Optic; the nerves of seeing. Each is a large cord arising from the thalamus opticus and tubercula quadrigemina, winding around the crus cerebri as a flattened band, under the name of tractus opticus, joining its fellow in front of the tuber cinereum, forming a chiasm called the optic commissure, then proceeding forward it diverges from its fellow, and passes through the optic foramen to the eyeball, pierces the sclerotic and choroid coats, and expands into the nervous membrane called the retina. Third Pair — Motores oculorum ; nerves of motion. They arise from the crus cerebri, pass forward between the posterior cerebral and superior cerebellar artery, and through the sphenoidal foramen to be disti-ibuted to all the muscles of the eyeball except the external rectus and superior oblique. Each sends a branch to the ophthalmic ganglion, from which proceed the ciliary nerves that supply the iris. Fourth Pair — Pathetici; nerves of motion, and the smallest of the cerebral. Each patheticus arises from the valve of the brain (valve of Viessens), winds around the crus cerebri, passes along the cavernous sinus, and entering the orbit at the sphenoidal fissure, is disti'ibuted to the superior oblique muscle. In the sinus it gives off a recurrent branch to the lining membrane. In Fig. 91 is seen the distribution of the fifth pair of nerves. I. Orbit. 2. Antrum of the upper jaw. 3. Tongue. 4. Lower jaw. 5. Root of the fifth pair, forming the ganglion of Casser. 6. Ophthalmic branch. 7. Superior maxillary. 8. Infe- rior maxillary. 9. Frontal branch. 30. Lachrymal. 11. Nasal. 12. Internal nasal. 13. External nasal. 14. External and in- ternal frontal. 15. lufraorbitary. 16. Posterior dentals. 17. Middle dental. 18. Anterior dental. 19. Labial and palpebral branches of the infra-orbital. 20. Orbitar. 21. Pterygoid. 22. Masseter, temporal, pterygoid, and buccal branches. 23. Lin- gual branch, joined at an acute angle by the chorda tympani. 24. Inferior dental, terminating in 25. Mental branckes. 26. Superficial temporal. 2'J. Auricular branches. 28. Mylo-hyoid branch. Fifth Pair — Trifacial; the largest cranial nerves, and the principal nerves of sensation of the head and face, arise, like the spinal nerves, from two roots. Fig. 91. TRIFACIAL NEP-VES. 172 ANATOMY. Each trifticiiil commences in a tract of yellowish matter in front of the floor of the fomth venti'icie, and passing fonvard through an opening in the border of the tentorium, near the exti'emity of the petrous bone, spreads out into a large semilunar ganghon, called Casserian, the an- terior root, which is much the smallest, merely lying against the under surface, but not forming a part, of the ganglion. This ganglion divides into the ophthalmic, superior maxillary, and inferior maxillary branches. The ophthalmic nerve is a short trunk, three fourths of an inch long; it pusses out at the sphenoidal foramen, and divides into thi'ee branches ; the frontal passes through the supra-orbiter foramen to the integument of the forehead, supplying also the conjunctiva and upper eyelid ; it gives off a supra-trachlear branch to the inner angle of the eye and root of the nose. The lachrymal is the smallest branch, and is dis- ti'ibuted to the lachrymal gland, temple, cheek, and inner portions of the orbit. The nasal passes forward between the two heads of the externa] rectus muscle, and enters the nose by the opening at the side of the crista galJi, where it divides into an i?iternal branch, supplying the anterior part of the mucous membrane, and an external, distributed to integuments at the exti'emity of the nose. Within the orbit the nasal nerve gives off a ganglionic branch, which forms the superior long root of the ciliary ganglion, ciliary branches to the iris, and an infra-trochlear to the lachrymal sac, caruncula lachrymalis, conjunc- tiva, and inner angle of the orbit. The superior maxillary nerve passes through the foramen rotundura, crosses the spheno-maxillary fossa, enters the canal in the floor of the orbit, emerges on the face through the infi-a-orbital foramen, whernd facial nerves. Two branches ascend from Meckel's ganglion, and join the orbital nerve as it crosses the spheno-maxillary fossa, called pterygo- palatine. The posterior dental branches pass through small foramina in the back surface of the upper jaw, and nin forward to the base of the alveolus, supplying the back teeth and gums. The middle and an- terior dental branches descend to the corresponding teeth and gums ; previously to their distribution the dental nerves form a plexus in the outer wall of the upper maxj)lary bone, above the alveolus, from which NEUROLOGY. 173 filaments are given off to the pulps of the teeth, gums, mucous mem- brane of the nose, and palate. The Inferior Maxillary Nerve is the largest division of the fifth pair; it emerges at the foramen ovale, and divides into external and internal trunks. The external divides into five branches — the masseteric, two temjJoral, buccal, and internal iJierygoicI, all of which are distributed to the muscles of the temporal and maxillary regions ; the last-named branch is connected by filaments with tlie otic ganglion. The internal trunk divides into three branches ; the gustatory, which is distributed by numerous filaments to the papillae and mucous membrane of the tongue ; the inferior dental, which proceeds to the dental foramen, which it enters, and runs along the canal of the lower javf, supplying the teeth and gums, and terminating in two branches ; incisive, which goes to the front teeth ; and mental, which passes out at the mental foramen, to be distributed to the muscles and integuments of the chin and lower lip ; the inferior dental gives off a mylo-liyoidean branch to the mylo-hyoid and digasti'ic muscles ; and the anterior auricular, which originates by two roots, passes backward behind the articulation of the lower jaw, where it forms a plexus, from which an ascending or tem- poral branch is given off to the temporal region, and a descending branch, which supplies the parotid gland and external parts of the ear, suppl^'ing a few filaments to the tympanum. Sixth Pair — Ahducentes ; nerves of motion ; each arises from the corpus pyramidale, proceeds forward parallel with the basilir artery, and, ascending, passes through the cavernous sinus ; entering the orbit through the sphenoidal fissure to be distributed to the external rectus muscle. A palsy of this nerve produces internal squinting. Seventh Pair — Facial and Auditory ; nerves of motion ; the sev- enth pair consists of two nerves ; the smaller and internal is the facial, or portio dura, arising from the corpus restiforme ; the larger and ex- ternal is the auditory, or j^ortio mollis, arising from the calamus scrip- torius. The facial 7ierve enters the meatus auditorius internus along witn the auditory, passes through the canal called aqueduct of Fallo- pius, and emerges at the stylo-mastoid foramen, then penetrates the parotid gland, and at the ramus of the lower jaw divides into f.ejnporo- facia.l and cervico-facial trunks, Avhich split into numerous branches, forming looped communications, called p)es anserinus, to be distributed upon the side of the fece from the temple to the neck ; in its course it communicates extensively with the neighboring branches of nerves ; it also sends off the following branches : tympanitic, to the stapedius muscle ; chorda tympani, to the tympanum, which it crosses, and, pass- in? trough the fissura Giasseri joins the gustatory nei-ve between the 174 ANATOMY pteiygoid muscles, with which it descends to the submaxillary gm- glion ; the 'posterior auricular, to the muscles of the ear ; the stylo-hy- -'icl and digastric, to those muscles. The auditory nerve divides at the DOttom of the meatus into cochlear and vestibular branches, which are distributed to the internal ear. Eighth Pair ; consists of three nerves; glosso-pharyngeal, pneumo- gasti'ic, and spinal accessory, which some authors reckon as the ninth, tenth, and eleventh paii-s. The glosso-pharyngeal nerve arises from the groove between the corpus olivare and restiforme, emerges at the foramen lacerum poste- rius, and curves forward to be disti-ibuted to the mucous membrane of the base of the tongue and fauces, tonsils, and mucous glands of the mouth. Within the jugular fossa it presents a p-angliouic enlarge- ment, called ganglion jugulare ; near its origin is also a small gan- glion, called petrosal, or Anderschian. Its branches are : Communicat- ing, which proceed from the peti-osal ganglionic plexus, and, in com- mon with those of the facial and sympathetic, form a complicated plexus at the base of the skull; tympanitic (Jacobson's nerve), which proceeds from the petrosal ganglion, and, entering the bony canal in the jugular fossa, divides into six branches, disti'ibuted upon the inner wall of the tympanum, forming a plexiform communication (tympanic plexus) with the sympathetic and fifth pair ; it sends branches of dis- tribution to supply the fenesti'a rotunda, fenestra ovalis, and Eustachian tube, and communicating branches to the carotid plexus, otic ganglion, and petrosal branch of the Vidian nerve ; the muscular, which are sent to the stylo-pharjmgeas, stylo-hyoid, and digastric muscles ; the pha- ryngeal, which are distributed to the pharynx ; the lingual, which go to the base of the tongue, fauces, and epiglottis ; and the tonsillitic, which form a plexus around the base of the tonsils, and supply filaments to the fauces and soft palate. The pneumogastric nerve arises immediately below the former, and emerges from the skull through the same foramen ; soon after passing from the skull it enlarges into a ganglion, plexus gangliformis, nearly an inch in length, surrounded by an irregular plexus of white nerves which communicate with each other, with other divisions of the eighth pair, and with the ti-unk of the pneumogastric below. Descending to the root of the neck, the right pneumogastric passes between the sub- clavian artery and vein to the posterior mediastinum, then behind tha root of the lung to the oesophagus, which it accompanies to the stoit- ach. The left enters the chest parallel with the left subclavian artery, crosses the arch of the aorta, and descends behind the root of the lung, and along the anterior sui'face of the oesophagus to the stomach. N E U R L G y 175 In Fig. 92 is seen a representation of the origin and pj^, gg iistribiition of the eighth pair. 1, 3, 4. Medulla ob- longata. 1 is the corpus pyramidale of one side. '3. / Corpus olivare. 4. Corpus restiforme. 2. Pons Va- ^ rolii. 5. Facial nerve. 6. Origin of the glosso-pha- ryngeal. 7. Ganglion of Andersch. 8. Trunk of the nerve. 9. Spinal accessory nerve. 10. Ganglion of the pneumogastric. 11. Its plexiform ganglion. 12. Its trunk. 13. Its pharyngeal branch forming the pharyngeal plexus (14), assisted by a branch from the glossopharyngeal (8), and one from the superior laryngeal (15). 15. Cardiac branches. 17. Recurrent laryngeal branch. 18. Anterior pulmonary branches. 19. Posterior pulmonary branches. 20. CEsophageal plexus. 21. Gastric branches. 22. Origin of the spinal accessory. 23. Its branches distributed to the BtiJino-mastoid muscle. 24. Its branches to the tra- ''8z'us muscle. The branches of the pneumogastric ai'e : Communicating, which connect with the facial, glosso-pharyngeal, spinal accessory, hypo-glossal, and sympathetic ; auricular^ which passes through a small canal in the petrous portion of the temporal bone to the pinna, sending filaments to the facial ; pha- ryngeal, which assists to form, on the mid- dle constrictor muscle, the pharyngeal plexus, which is distributed to the muscles and mucous membrane of the phaiynx; the superior laryngeal, disti'ibuted to the arj'^tenoideus muscle and mucous membrane of the larynx, communicating behind the cricoid cartilage with the recurrent laryn- geal, and giving off the external laryngeal, which sends a twig to the pharyngeal plex- us, and supplies the inferior consti'ictor and circo -thyroid muscles and thyroid gland ; cardiac, two or three branches which cross the lower part of the common carotid, to communicate with the cardiac branches of the sympathetic, and with the gi-eat cardiac plexus ; recurrent laryn- geal, which passes upward from near the pulmonary branches to the larynx, giving off branches to the heart, lungs, oesophagus, and trachea, and is distributed to all the muscles of the larynx, except the circo- hyroid, communicating with the superior and external laryngeal and EIGHTH PAIR OF NERVES 176 ANATOMY. sympathetic nei-ves ; anteriyr pulmonary, disti'ibiited to the anterior aspect of the root of the lungs, and forming, with the branches of the gi'eat cai'diac plexus, the anterior p)uliionary plexus ; posterior pulmo- nary, which supply the posterior aspect of the root of the lungs, and forming, with branches from the great cardiac plexus, the posterior jmlmonary plexus ; and the gastric, which are the terminal filaments of the two pneumogastric nerves, spread out upon the anterior and posterior surfaces of the stomach, and also distributed to the omentum, spleen, pancreas, liver, and gall-bladde •, communicating with the solar plexus. Note. — The superior ' iryngeal nerve is regarded by some anatomists as the nerve of sensation to the larynx, being distributed mainly to its mucous membrane. The recuiTent is the proper motor nerve of the larynx, being distributed to its muscles. The two pneumogastric nerves divide into numerous branches upon the oesophagus, which communicate with each other, and form the cesophagal plexus. The spinal accessory nerve arises from the spinal cord as low down as the fourth cervical nerve, escapes at the jugular foramen, and divides into two branches, one of which sends filaments to the superior phaiyn- geal nerve, and the other, which is the proper continuation of the nerve, descends obliquely backward, and piercing the sterno-mastoid muscle, is disti'ibuted to the trapezius, communicating with the upper cervical nerves. Ninth Pair — Hypoglossal ; nerves of motion ; each arises fi-om the gi'oove between the corpus pyramidale and corpus olivare, by numerous filaments which unite into two bundles, and emerge from the cranium at the anterior condyloid foramen ; then passing between the internal carotid aitery and internal carotid vein, and curving around the occipital artery, sends branches to the muscles of the tongue, being distributed principally to the genio-hyo-glossus. Its branches ai'e : communicating, which connect with the pneumogastric spinal accessory, cervical and sympathetic ; descendens noni, a long, slender twig which descends upon the sheath of the cai'otid vessels, forming a loop with a long branch from the second and third cen'ical, from the convexity of which branches are sent off to the stei-no-hyoid, sterno-thyroid, and omo- hyoid muscles ; and thyro-hyoidean, disti-ibuted to the thyro-hyoid muscle. The Spinal Nerves. — Of these there are thirty-one pairs, each arising by two roots, an anterior motor and a posterior sensitive ; the posterior are lai'ger, and have moro numerous filaments than the ante- vior. In the intenertebral foram-^j the posterior roots enlarge into a NEUROLOGY. 177 ganglion, after which both roots unite nnd form a spinal nerve, which passes out of the foramen, and then divides into an anterior branch, which supplies the front, portion of the bod/, communicating with the ganglions of the sympathetic, and forming plexuses which give off the principal nerves to the muscles of the trunk and extremities, and a pos- terior, which supplies the muscles of the back. The spinal nerves aro divided into cervical, dorsal, lumbar, and sacrc.l Cervical Nerves. — Eight pairs: the first is called sub-occipital; it passes out of the spinal canal, between the occiput and atlas; and the last passes out between the last cervical and first dorsal vertebra. The anterior branches of the four upper form the cervical jdexus ; the pos- terior branches, posterior cervical plexus. The anterior branches of the fcur lower cervical, with the first dorsal, form the brachial plexus. The cervical plexus sends off the following : superjicialis colli, which divides into a descending branch, distributed to the integument on the side and front of the neck, and an ascending branch, which supplies the integument of the chin and lower parts of the face ; auricularis mag- nus, the largest of the ascending branches, which divides at the parotid gland into an anterior branch, distributed to the gland, adjacent integu- ment, and external ear, and a posterior, which pierces the parotid gland, crosses the mastoid process, and is then divided into branches to supply the integument of the side of the head and back part of the pinna, sending off several fticial branches to the cheek ; occipitalis minor^ which arises from the second cervical, and is distributed to the muscles and integument of the external ear and occipital region ; acromiales and claviculares, two or three large branches distributed to the integu- ment of the upper and front part of the chest ; communicating, fila- ments which comiect with the sympathetic, pneumogastric, and hypo- glossal ; muscular, distributed to the trapezius, levator anguli, scapula?, and rhomboidei muscles ; communicans noni, a long, slender branch forming a loop with the descendens noni over the sheath of the carotid vessels ; and phrenic (the internal respiratory of Charles Bell), which descends to the root of the neck, crosses the subclavian artery, and enters the chest between it and the subclavian vein, passes through the middle mediastinum and in front of the root of the lung to the dia- phragm, to which it is distributed, its filaments communicating with the phrenic, solar, and hepatic plexuses. The posterior cervical plexus gives off musculo-cutaneous branches to the ligamentum nuchas, integument of the back part of the neck, and posterior region of the scalp ; and the occipitalis major, which is diS' liibutod to the mus-'les of the no,ck and integument of the scalp. 178 ANATOMY. The brachial plexus is broad in the neck, naiTOwing as it descends into the axilla, enlai-ging again at its lower part, where it divides into six terminal branches, which are distributed to the upper extremity and chest. From the plexus are sent off superior muscular branches to the subclavius and rhonAoidei muscles, short thoracic to the two pectoral and deltoid muscles, long thoracic (external respiratory of Bell) to the serratus rangnns muscle, supra-scapular to the supra-spinatis and infi-a- spinatis muscles, subscapular to the subscapularis muscle, and inferior muscular to the latissimus dorsi and teres major. The terminal brandies are : the external cutaneous, which, piercing the coraco- brachialis muscle, passes between the biceps and brachialis anticus to the outer side of the elbow, where it perforates the fascia, and divides into two branches ; the external follows the course of the radial vein, communicating with branches of the radial nerve on the back of the hand, and supplying the coraco-brachialis, biceps, brachialis anticus, and integuments on the outer side of the fore-arm; the internal cuta- neous, which passes down the inner side of the arm with the basilic vein, piercing the deep fascia about the middle of the upper arm, and dividiug into two branches ; the anterior descends along the palmarus longus to the wi'ist, supplying the integument in its course ; the poste- rior supplies the integument over the olecranon and inner condyle, and descends the fore-arm along the ulnar vein to the wrist, supplying the integument on the inner side of the fore-arm ; the lesser internal cuta- neous, a long, slender branch which descends on the inner side of the external cutaneous to be distributed to the integument of the elbow ; the median, which arises by two heads, embracing the axillary arteiy, crosses the brachial aitery at its middle, descends to the inner bend of the elbow, runs down the fore-arm between the flexor sublimis and profundus, and beneath the annular ligament into the palm of the hand, where it divides into muscular, anterior interosseous, superficial palmar, and digital branches, to be distributed to the structures of the fore- ai-m, wrist, and fingers : the ulnar, Vf\i\c\i arises with the internal head of the median, runs down the inside of the arm to the gi'oove between the internal condyle and olecranon, where it is superficial and easil}^ compressed — giving rise to the painfully thrilling sensation along the inside of the fore-arm and little finger when a blow is made on it against the inner condyle — after which it descends along the inner side of the fore-arm, crosses the annular ligament, and divides into super- ficial palmar and deep palmar branches, which, with muscular, artic- ular, and anastomotic branches given off along its course, are disti'ibuted to the structures of the arm, fore-arm, wrist, and hand, and communicate with the othe' surrounding branches of nerves: the muscido-spircu NEUROLOGY. 179 nerve, the largest branch of the brachial plexu*?, which descends in front of the tendons of the latissimus dorsi and teres major muscles, winds around the humerus in the spiral groove, and passes to the elbow, where, after sending off muscular branches, and the spiral cuta- neous to the nerves, muscles, and integument in its course, it divides into the posterior interosseous and radial branches ; the radial runs along the radial side of the fore-arm, and about two inches above the wrist penetrates the deep fascia, and divides into external and internal branches, which are distributed to the hands and fingers ; the inter- osseous supplies all the muscles on the posterioA* aspect of the fore-arm, and a descending branch of it forms a large gangliform swelling on the back of the wrist, from which branches an< distributed to the joint; and the circumflex nerve, which arises with t-ie former, winds around the neck of the humerus with the posterior circumflex artery, and terminates in numerous branches, distributed to the deltoid muscle, after sending off muscular and cutaneous branches to the muscles and integuments of the shoulder and arm. 'S)' The Dorsal Nerves. — There are twelve pairs of dorsal nerves. Each nerve, as it emerges from the intervertebral foramen, divides into dorsal and intercostal branches. The dorsal pass backward between the transverse processes of the vertebrae, where each divides into a muscular and a musculo-cutaneous branch, distributed to the muscles and integument of the back ; the intercostal branches, which are the true intercostal nerves, receive filaments from the adjoining ganglia of the sj^mpathetic, and pass forward with the intercostal vessels in the intercostal spaces, supplying the intercostal muscles in their course ; near the sternum they pierce the intercostal and pectoral muscles, sup- l)ly the mammary glands, and are finally distributed to the muscles and integument in front of the chest and abdomen. The Lumbar Nerves. — Of these there are five pairs ; the first passes out between the first and second lumbar vertebrae, and the last between the lower lumbar vertebra and sacrum. At their origin the anterior branches communicate with the lumbar ganglia of the sym- ]nithetic, and pass obliquely outward behind the i)soas magnus muscle, where they intercommunicate and anastomose to form the lumbar j)lexus. The posterior branches divide into internal branches, which are distributed to the adjacent muscles and integuments, and external, which intercommunicate, and, after supplying the deep muscles, are distributed to the integument of the gluteal region. The lumbar plexus gives off the following branches: 1 Mnsculo-cntaneous \ which 180 ANATOMY. divides into a superior biancb, and this, after winding around the crest of the ilium, divides into abdominal and scrotal branches, the former of which is disti'ibuted to the integument of the groin and around the pubis, and the latter accompanies the spermatic cord in the male, and round ligament in the female, to supply the integument of the scrotum and internal labium ; and an inferior branch, which passes along the spermatic cord, to be distributed to the genital organs. 2. External cutaneous ; which passes into the thigh beneath Poupart's ligament, and divides into a posterior branch, which supplies the integument of the thigh, and an anterior bi*anch, which is distributed to the integu- ment on the outer border of the thigh and to the articulation of the knee. 3. Genito-crural ; which runs on the anterior surface of the psoas magnus muscle to near Poupart's ligament, where it divides into a genital branch, which descends along the spermatic canal, to be dis- ti'ibuted to the spermatic cord and cremaster muscle in the male, and the round ligament and external labium in the female, and a crural branch, which enters the sheath of the femoral vessels, and is distrib- uted to the anterior aspect of the thigh. 4. Crural, or femoral ; the •argest division of the lumbar plexus is formed by the union of branches from the second, third, and fourth lumbar nerves, passes into the thigh beneath Poupart's ligament, then spreads out and divides into numerous branches : a. cutaneous, two nerves which perforate the sartorius mus- cle, and are distributed to the integument of the middle and lower part of the thigh and kneo ; b. muscular, round, lai'ge twigs, disti'ibuted to the muscles of the anterior aspect of the thigh, sending filaments to the periosteum and knee joint ; c. aponeurotic, to the sheath of the femoral vessels and adjacent muscles ; d. short saphenous, which divides at the sheath of the fem.oral vessels into a superficial branch, which runs down to the knee joint, and terminates by communicating with the long saphenous nerve, and a deep branch, which divides at the termination of the femoral arteiy into sevend filaments, which communicate with other nerves to form a plexus, some of whose filaments are distributed to the integument on the posterior part of the thigh; e.long sapheyious, which enters the femoral sheath, and descends along the inside of the leg with the internal saphenous vein, crosses in front of the inner ankle, and is disti'ibuted to the integument on the inner side of the foot. In its course it receives a communicafmg branch from the obturator, near the division of the femoral nrteiy, find another at the internal condyle, and gives of^ a femoral cutaneous branch, a tibial cutaneous hronch, and an articular branch, to the integument of the inner and back part of the thigh, the inner aspect of the leg, around the knee joint, the front anc cute?" aspect of the leg, and the ankle joint. 5. Obturator ; formed NEUROLOGY. 181 by a branch from the third and another from the fourth lumbar nerve, passes through the angle of bifurcation of the common iliacs, and along the brim of the pelvis to the obturator foramen, where it joins the obturator artery. After emerging from the pelvis it gives oif twigs to the obturator externus muscle, and divides into four branches ; three anterior, which supply the adductor brevis, pectineus, adductor longus, and gracilis muscles, and a posterior which ramifies in the adduc- tor magnus ; from the anterior branches a communicating filament pro- ceeds to unite with the long saphenous, and a long cutaneous branch descends to the inner side of the knee, where it communicates with the long saphenous ; and from the posterior branch an articular branch is given ofif, which accompanies the popliteal artery, to be distributed to the back part of the synovial membrane of the knee joint. 6. Lumbar sacral ; descends over the base of the sacrum into the pelvis, and forms a part of the sacral plexus. The Sacral Nerves. — There are six pairs of sacral nerves ; the first pass out of the vertebral canal through the first sacral foramina, and the two last between the sacrum and coccyx. The posterior are very small, and are distributed to the integument over the sacrum and coccyx and gluteal region. The anterior diminish in size from above downward ; they are distributed to the muscles and integuments around the coccyx and anus ; many of their branches are connected in the formation of the sacral plexus ; they send communicating branches to the hypogastric plexus, and receive branches from the sacral ganglia of the sympathetic. The Sacral Plexus. — The sacral plexus is formed by the lumbo- sacral and anterior branches of the four upper sacral nerves. It is triangular in form, its base corresponding to the sacrum, and its apex to the lower part of the great ischiatic foramen. Its branches are : 1. Visceral ; three or four branches, which ascend by the rectum and bladder in the male, and in the female upon the side of the rectum, the vagina, and bladder, supplying those viscera, and communicating with the hypogastric plexus. 2. Internal muscular ; given off within the Tjelvis ; an obturator branch to the obturatus internus, a coccygeal branch, and a hemorrhoidal nerve, which descends to the rectum, supplying the spiucter and integument. 3. External muscular ; sev- eral branches, di.stributed to the capsule of the hip joint and suri'ound- mg nmscles. 4. Gluteal ; passes out of the pelvis with the gluteal irtery, and divides into a superior branch, which goes to the gluteus Giedius and minimus, and an inferior, which is distributed v/ith th« 15 182 ANATOxMY. above, and also to the tensor vaginie femoris. 5. Internal jpudic , passes out of the pelvis with the foroer, and divides, beneath the ob- turator fascia, into a superior branch (dorsalis penis), which accom- panies the dorsal artery of the penis to the glans, and is there distrib- uted, supplying filaments to the corpus cavernosum, integument, and prepuce, and an inferior branch (perineal nerve), which supplies the scrotum, and sends branches to the integuments of the under part of the penis, prepuce, sphincter ani, ti-ap<«ve.'6us perinei, and accelerator urina% and terminates by ramifying in the corpus spongiosum. In the female the internal pudic is disti'ibuted to the parts analogous to those of the male ; the superior branch supplies the clitoris, alid the inferior the vulva and parts in the perineum. 6. Lesser isckiatic ; passes out of the pelvis through the gi-eat iscliiatic foramen, and divides into mus- cular branches (inferior gluteal), which are disti'ibuted to the gluteus maximus ; and cutaneous, which send ascending filaments to the gluteal integument; the perineal cutaneous nerve, down the inside of the testis to the scrotum and integument on the under side of the penis ; and the middle posterior cutaneous, which is distributed to the integuments of the thigh and leg at the middle of the calf. 7. Great iscliiatic ; this is the largest nervous cord in the whole body. It is a prolongation of the sacral {ylexus, and measures, at its exit from the gi-eat sacro- ischiatic foramen, three fourths of an inch in breadth. It descends be- t>veen the ti'ochanter major and tuberosity of the ischium, and along the back part of the thigh to its lower thh'd, where it divides into ter- minal branches, called popliteal and p>eroneal. Previous to its division it sends oflf muscular branches to the semi-tendinous, semi-membrano- sus, and adductor magnus, and articular branches, which descend to be distributed to the capsule and synovial membrane of the knee joint. The popliteal nerve passes down externally to the vein and artery, and after sending off muscular branches to the gastrocnemius, soleus, plantaris, and popliteus, an articular to the interior of the knee joint, and a communicating, a large "^erve descending between the heads of the gastrocnemius, and forming Lelow the knee, with a connecting branch from the peroneal nerve, the external saphenous neiTe, it becomes the posterior tibial. The external saphenous peneti-ates the deep fascia below the fleshy part of the gastrocnemius, and passes down the leg along the outer border of the tendo-Achillis, winds around the outer malleolus, and is disti'ibuted to the outer side of the foot and little toe, sending numerous filaments to the integument of the heel and sole of the foot. The posterior tibial nerve continues along the back of the leg from trie lower border of the popliteus ir.uscle to the back of the inner ankle, where it divides into fc:3 interns^ inc external plantar nerve ; in its NEUROLOGY. 183 course it sends nmscular branches to the deep muscles, one or two filaments which entwine around the fibular artery, and then terminate in the integument, and plantar cutaneous branches, which pass down the inner side of the os calcis, to be distributed to the integument of ^he heel. The internal plantar mrve crosses the posterior tibial vessels, to enter the sole of the foot, and is distributed to the toes, integument, and tarsal and metatarsal articulations. The external plantar nerve is smaller than the former, and is dis- ribul.ed to the outer side of the foot, the little toe, and outer side of the second. The peroneal nerve passes dowm by the tendon of the biceps, crosses the head of the gasti'ocnemius to the neck of the fibula, where it divides into the anterior tibial and musculo-cutaneous. The anterior tibial nerve descends the anterior aspect of the leg with the artery to the ankle, where it passes beneath the annular liga- ment, and accompanies the dorsalis pedis artery to supply the adjoining sides of the great and second toes, distribating, in its course, filaments to the muscles and articulations of the tarsus and metatarsus. The inusculo-culaneous nerve passes dow^nward in the direction of the fibula, and at the lower third of the leg, where it pierces the deep fascia, and divides into two peroneal cutaneous branches, which pass in front of the ankle joint, to be distributed to the integument of the foot and toes, after sending filaments to adjacent muscles, and communicat- ing branches to the saphenous and anterior tibial nerves. THE ORGANIC NERVES. The organic nerves, commonly called the sympathetic or ganglionic system, consist of a series of ganglia extending along both sides of the rertebral column, which disti'ibute branches to all the internal organs and viscera, and communicate with all the other nerves of the body. The branches of distribution accompany the arteries which supply the different organs, and form communications around them called j)lexuses, which are named after the arteries, as mesenteric, hepatic, ispienic, etc., plexuses. Cranial Ganglia. — There are five ganglia in the head : 1. Gan- glion of Ribes, situated upon the anterior communicating artery ; it is the superior point of union between the chains of opposite sides of the body. 2. Ciliary ganglion, a small, flattened body within the orbit, between the optic nerve and external rectus muscle ; its branches of distribution supply the coats of the eye. 184 A NATO M Y. CRAjriAL GAXGLIA. Fie. 93. Fig. 93 is a repre- Bentation of cranjal ganglia of tne organ- ic system. 1. Gan- glion of Ki>^«>9 2. A filament by which it commumcates with the carotid plexua (3). 4. Ciliary or lenticular ganglion, giving off ciliary branches to the globe of the era. 5. Part of the inferior division of the third nerve, receiving a short, tliick branch (the short root) from the ganglion. 6. Part of the nasal nerve, receiving a longer branch (the long root) from the gan- glion. 7. A slender filament (the sympa- thetic root), sent directly backward from the ganglion of the carotid plexus. 8. Part of the sixth nerve in the cavernous sinus, receiving two branches from the carotid plexus. 9. Meckel's g;inglion (spheno-palatine). iJ. Its ascending brancnes, communi- cating with the superior maxillary nerve. 11. Its descending, or palatine brancnes. 12. Its internal branches, spheno-palatine, or nasal. 13 The nasopalatine branch. OTie of the nasal branches. 14. Posterior branch of the ganglion, the A'idian nerve. 15. Its carotid branch communicating with the carotid plexus, id. Its petrosal orancn, jommg liia inrumescentia ^'anghformis of the facial nerve. 17. Facial nerve. 18. Ctiorda t)'n:;:ani, ■which descends to join the gustatory. 19. Gustatory nerve. 20. Submaxillary ganglion, receiving the corda tympani and other filaments from the gustatory. 21. Superior cer- vical ganglion of the sympathetic. 3. Spheno-palatine ganglion (Meckel's), the lai'sest of the crania] ganglia, situated in the spheno-maxillary fossa- Its branches of disti-i- bution are : nasal, or splieno-palallne, four or five in number, wli'-'h enter the nasal fossa through the spheno-palatine foramen, and supply the raucous membrane and spongy bones of the nose, and the upper pait of the phaiynx and the Eustachian tube; the naso-palatine to the septum of the nose and palate; the anterior paiotine to the hard palate, bones of the nose, and the anti'um; the middle palatine to the tonsil, soft palate, and uvulva ; and the posterior palatine to the hard palate, gums, tonsil, and soft palate. Its communicating branches join the superior maxillary, abducens, and optic nerves, and the ciliary gHnglion. The posterior branch is the Vidian or pterygoid nerve, which passes to the foramen lacerum. and divides into carotid and petrosal branches to the carotid plexus and the gangliform enlargement of the facial nei've, NEUROLOGY. 185 It also sends a filament to the otic ganglion. 4. Otic ganglion (Arnold's), is u small, oval ganglion, situated on the inferior maxillary nerve, im- mediately below the foramen ovale. It sends off two branches of dis- tribution, one to the tensor palati muscle, and one to the tensor tjan- pani, and branches of communication to the auricular, chorda tympani, nervi molles, facial, and Vidian nerves, and the focial and Casserian ganglions. 5. Suhmaxillary ganglion, a small, triangular ganglion upon the submaxillary gland ; it sends branches of disti'ibution to the gland and Wharton's duct, and communicating branches to the gustatory, facial, and nervi molles. The Carotid Plexus. — The carotid plexus is formed of the divi- sions of the ascending branch of the superior cervical ganglion in the carotid canal, where they form several loops with each other around the artery, together with branches derived from the petrosal branch of the Vidian. The continuation of this plexus onward by the side of the sella turcica is called the cavernous plexus. It is the centime of communication between all the cranial ganglia, and being derived from the superior cervical ganglion, between the cranial ganglia and those of the ti'unk, it also communicates with most of the cerebral nerves, and distributes filaments with each of the branches of the internal caro- tid, Vv'hich accompany those branches in all their ramifications. Cervical Ganglia. — The cervical ganglia are three in number on each side. 1. Superior cervical ; along, grayish-colored ganglion, ex- tending from within an inch of the carotid foramen in the petrous bone to the third cervical vertebra. It sends a superior branch to the carotid canal, whose divisions and intercommunications with each other, and with the petrosal branch of the Vidian, constitute the carotid plexus before described ; an inferior or descending branch to the middle cer- vical ; numerous external branches to the glosso-pharyngeal, pneumo- gastric, hypoglossal, and the first three cervical nerves ; three internal branches, to the pharyngeal plexus, superior laryngeal nerve, and su- perior cardiac nerve ; and anterior branches, called from their softness nervi molles, which accompany the carotid artery with its branches, around which they form intricate plexuses, and occasional^ small gan- glia. 2. Middle cervical (thyroid ganglion) ; of small size, situated opposite the fifth cervical vertebra, and resting on the inferior thyroid artery. It sends a superior branch to the superior cervical ganglion ; infe 'ior branches to the inferior cervical ganglion ; external branches tc the third, fourth, and fifth cervical nerves; and internal branches to the inferior thyroid plexus and artoiy, and middle cardiai: nerve. 188 ANATOMY. Fig. 94. GANGLIONIC SYSTEM. In Fig. 94 is presented a view of the organic or synipathetx sysUm. A AAA. Semilunar gan- glion and solar plex- us. B. Small splanch- nic nerve. C. Great splanchnic nerve. D D D. Thoracic ganglion. E. Internal branches- F. External brancheH. G. Right coronarj' plex- us. H. Left coronary plexus. I. Inferior cer vical ganglion. J. In ferior twigs. K. Exter nal threads. L. Inter* nal twigs. M. Anterior threads. N. Middle cer- vical ganglion. O. In- terior twigs. P. Exter- nal twigs. Q. Superior cervical ganglion. IL Superior branches. S. Inferior branch. T. Ex- ternal branches. U. Submaxillary gland. V. Vidian nerve. \V. Na- so-palatine branch. X. Spheno-palatine gangli- on. Y. Ophthalmic gan- glion. Z. Auditory nerve. 1. Renal plex- uses. 2. Lumbar gan- glia. 3. Internal branch- es. 4. External branch- es. 5. Aortic plexus 3. Inferior cervi- cal ; of a semilunar form, situated upon the base of the transverse process of the seventh cer- vical vertebra, ami hence called ^^ver- tebral ganglion. " It sends superior branches to the midile cervical ganglion ; inferior NEUROLOGY. 187 to the fii-st thoracic ganglion ; external to the dorsal nerves and vertebral plexus ; and internal branches to the inferior cardiac nerve. The Cardiac Nerves. — The superior cardiac arises fi'om the lower ^part of the superior cervical ganglion, and, descending the neck, passes behind the arteria innoiuinata, and joins the cardiac ganglion below the arch of the aorta, receiving in its coui'se branches from the pneurao- gastric, and sending filaments to the thyroid gland and trachea. The middle cardiac proceeds from the middle cardiac ganglion ; it is the largest of the three nerves, and at the root of the neck divides into several branches, and communicates with the superior and inferior car- diac, the pneumogastric, and recurrent nerves, and descends to the great cardiac plexus at the bifurcation of the trachea. The inferior cardiac arises from the inferior cervical ganglion, communicates with the recurrent laryngeal and middle cardiac, and descends to the gi*eat cardiac plexus. The cardiac ganglion is a variable enlargement beneath the arch of the aorta, which receives the superior cardiac nerves and a branch from the pneumogastric, and gives oft' numerous branches to the cardiac plexuses. The great cardiac plexus is situated upon the bifurcation of the trachea, above the right pulmonary arter}^ and behin<1 ^^V^e arch of the aorta ; the anterior cardiac plexus is situated in front of the ascending aorta, near its origin; ihe posterior cardiac plexus rests upon the posterior part of the ascending aorta, near its origin. These plex- uses intimately intercommunicate with each other and with the neigh- boring nerves, and supply the heart. Two sets of branches fi'om the posterior cardiac constitute the posterior coronary plexus ; and the an- terior and posterior 2)uh)ionary plexuses are formed in part by branches from the great cardiac plexus. Thoracic Ganglia. — There are twelve thoracic or dorsal ganglia on each side, resting upon the head of the ribs ; their form is irregu- lar, but they present the peculiar gray color and pearly lustre of the other organic ganglia. They send superior and inferior branches, to f'ommunicute with the ganglia above and below, two or three external branches to the roots of each of the spinal nerves, internal branches to the pulmonary, oesophageal, and cardiac plexuses, and splanchnic, sev- eral large cords from the lower ganglion, which unite to form the sptlanchnic nerve. The great splanchnic nerve arises from the sixth dorsal ganglion, and, receiving branches from the seventh, eighth, ninth, and tenth, de^ Bcends in front of the vertebral column, witliin the preterior mediasti- 188 ANATOMY. num, pierces the diaphragm, and terminates in the semilunar ganglior». The lesser splanchnic (renal) is formed by filaments from the three lower dorsal ganglia, pierces the diaphragm, and deiceuds to join the renal j^lexus. The semilunar ganglion is a large, LTegular body, pierced by numer- * ous openings, and appearing like an aggregation of smaller ganglia with intenening spaces. It is situated by the side of the ccEliac axis, upon the aorta, and communicates with the ganglion of the opposite side, both above and below that trunk, forming a ganglifonn circle, from which branches pass off radiatingly in al'. directions ; hence the entire circle is called the solar plexus. It is undoubtedly the presiding centre^ or great brain of the organic system, and probably the starting point in the development of all organized beings. Various sensations usually refeiTed to the heart liave, no doubt, their source in this ganglion. The solar plexus receives the great splanchnic and pait of the lesser splanchnic nerves, the termination of the right pneumogHsti'ic, branches from the right phrenic, and sometimes filaments from the left, and transmits numerous filaments to accompany, as plexuses, all the branches given off by the abdominal aorta, being the phrenic, gastric, hepatic splenic, supra-renal, renal, superior mesejiteric, spermatic, and inferior mesenteric plexuses, all derived from the solar plexus. LujiBAR Ga>*glia. — There are four lumbal* ganglia on each side, situated upon the anterior part of the bodies of the lumbar vertebrae. Their superior and inferior branches communicate with the ganglia above and below ; their external branches communicate with the lum- bar nerves; and theu' internal branches interlace around the abdominal aorta, constituting the lumbar aortic plexus, and again over the promon- toiy of the sacrum, forming the hypogastric plexus^ which distributes branches to all the viscera of the pelvis. Sacral Ganglia. — The sacral ganglia are four or five in number on each side, situated near the anterior sacral foramina. Their superior and inferior branches communicate with the ganglia above and below ; the external with the sacral nei"ves ; and the internal are disn-ibuted to the pelvic viscera, sending brunches to the hypogasti'ic plexus. The lower sacral ganglia give off branches which join the azygos ganglion on the coccyx, which connects the ganglionic system iofeir^nly, as the ganglion of Ribes does superiorly. ORGANS OF THS EXTERNAL SENSES. 189 CHAPTER IX. . ORGANS OF THE EXTERNAL SENSES. The organs of sense, which bring the animal machine into relation with external objects, ai*e five ; four of them, the apparatus of smell, sight, hearing, and taste, are situated within the head, while the organ of touch, resident in the skin, is disti'ibuted over the entire surface. THE ORGAN OF SMELL. The external parts of the organ of smell are called the nose^ and the internal parts the nasal fosses. The Nose. — The anatomical parts of the noso are : The nostrils, which overhang the mouth, and are so constnicted that the odors of all substances must be received by the nose before they can be introduced within the lips; the columna, or partition between the nosti'ils ; the •cihrisscE, stiff hairs which project across the openings, and guard their entrance ; the fibre -cartilaginous integument, which forms the tip, called lobulus, and wings, called ales; the muscles, already described; the bones — nasal and nasal processes of the superior maxillary ; the mucous membrane, lining its interior; the arteries, from the f.icial and supra coronary; and the nerves, which are the facial, infra-orbital, and nasa branch of the ophthalmic. Fig. 95 shows the fibro-cartilages of the nose. 1. One of Fig. 9.5. the nasal bones. 2. Fihro-cartilage of the septum. 3. Lateral fibro-cartUage. 4. The alar fibro-cartilage. 5. Central por- tions of the alar fibro-cartilages. which constitute the colum- na. 6. Appendix of the alar fibro cartilage. 7. Nostril. Nasal Foss.a:. — The nasal fossas are two ir- regular compressed cavities extending backward from the nose to the pharynx. They are bounded above by the lateral cai'tilage of the nose, and the nasal, sphenoid, and ethmoid bones ; below by the hard palate. On the outer waU of each fossa are three projecting processes, called spongy bones ; the two superior belong to the ethmoid, and the inferior is a separate bone ; they increase the surface upon which the mu- cous membrane is spread out. The spaces be- tween the upper and middle, the middle and lower, and lower and floor of the ncstrils. are the superior, middle, an! inferior meatuses NASAL CARTILAGES. 190 ANATOMY. In the superior meatus are several openings into the nasal fossae of the sphenoidal and posterior ethmoidal cells; in the middle the anterior ethmoidal cells, the frontal sinuses, and the antrum maxillare; and in the inferior the termination of the nasal duct. The mucous membrane of the nasal fossae is called pituitary or Schnciderian ; it is continuous with the lining membrane of the gastro- pulnionary cavities, and extends in^o the sphenoidal and ethmoidal cells, fi'ontal sinus, and antnim, through the nasal duct to the eye, where it is continuous with the conjunctiva; along the Eustachian tubes into the tympanum and mastoid cells, and through the posterior nerves into the pharynx and moutli, thence through the lungs and alimentary canal. Its surfiice is furnished with a delicate columna epithelium, supporting innumerable vibratile cilia. The arteries of the nasal fossae are the anterior and posterior ethmoi- dal branches from the ophthalmic, and the spheno-palatine and pterygo- palatine from the internal maxillary. The nerves are : The olfactory, Y]a 0,6 ^^^® spheno-palatine branches from Meckel's ganglion, and the nasal branch of the ophthalmic. The ultimate filaments of the ol- factory terminate in papillae. Fig. 96 is a vertical section of the mid- dle part of the cavities of the nose. 7. Middle spongy bones. 8. Superior part of the nasal cavities. 10. Inferior spongy bones. 11. Vomer. 12. Upper jaw. 13. Middle meatus. 14. Inferior meatus. 17. Palatine process of the upper jaw. 18. Roof of the mouth, covered by mu- cous membrane. 19. A section of the NASAL CAVITIES. mucous membrane. OF THl- CRGAN OF SIGHT. The Structures of the visual organ may be conveniently divided into three classes : the coats, humors, and appendages of the eye. The eyeball is of a spherical form, about one inch in diameter. The globe of the eye is composed of three coats, or tunics, and three humors. Outer Coat, or First Tunic. — The first coat of the eyeball is foiTned of the sclerotic and cornea. The sclerotic is a dark, fibrous membrane, investing about four fifths of the globe. Its anterior surface is covered with a tendinous layer, called the tunica albuginea, which is derived from the expansion of the tendons of the four recti muscles. A part of the tuni:;a a.:uginea is covered by a mucous membrane ORGANS OF THE EXTERNAL SENSES. 19*. called the conjunctiva, which constitutes the "white of the ej^e." The sclerotic forms a thin, sieve-like plate, called lamina cribrosa, at the enti'ance of the optic nerve ; this lamina is full of openings for the pas- sage of nervous filaments. The largest of these openings in the centi'e is called the porus opticus, through which the arteria centralis retince — central artery of the retina — enters the eyeball. The cornea con- stitutes the anterior fifth of the globe. It is circular, ti'ansparent, and resembles a watch-glass. It is received into the gi'ooved edge of the sclerotic in the manner that a watch-glass is received into its case. It is composed of four layers, the external being the white membrane, or conjunctiva, before mentioned. Fig. 97. Fig. 97 is a longitudinal section of the globe of the eye. 1. The sclerotic, thicker behind than in front. 2. The cornea, re- ceived within the anterior margin of the sclerotic, and connected with it by means of a beveled edge, "j 3. The choroid, connected anteriorly with (4) the cil- iary ligament, and (5) the ciliary processes. 6. The h-is. 7. The pupil. 8. The third layer of the eye, the retina, terminating ante- riorly by an abrupt border at the commencement of SECT,ION OF THE GLOBE, the ciliary processes. 9. The canal of Petit, which encircles the lens (12) ; the thin layep in front of this canal Is the zonula ciliaris, a prolongation of the vascular layer of thw retina to the lens. 10. The anterior chamber of the eye, containing the aqueous humor; the lining membrane by which the humor is secreted is represented in the diagram. 11 The posterior chamber. 12. The lens, more convex behind than before, and enclosed in its proper capsule. 13. The viti-eous humor enclosed in the hyaloid membrane, and in ccJls formed in its interior by that membrane. 14. A tubular sheath of the hyaloid mem- brane, which serves for the passage of the artery of the capsule of the lens. 15. The neurilemma of the optic nerve. 16. The arteria centi-alis retinae, imbedded in the centra of the optic nerve. Middle Coat. — The second tunic is formed of the choroid, ciliary ligament, iris, and ciliary processes. The choroid is a vascular mem- brane, of a rich brown color externally, and of a deep black on its inner surface. Posteriorly it has an opening for the passage of the optic nerve ; it is connected anteriorly with the iris, ciliaiy processes, and with the junction of the sclerotic and cornea, by a dense white structm-e, called the ciliary ligament, which surrounds the circum- *Brence of the iris, like a ring. The choroid membrane is composed 192 ANATOMY. of tjiree layers, the externa\ being principaJy an arrangement of veins called vence vorticosce. The middle layer is formed by the ramification of minute arteries. The internal layer is a delicate cellular structure, containing the pigmentum nigrum^ or coloring matter of its posterior sorface. Fig. 98. Fig. 98 is a dissection of the eye- ball, showing its second tunic, and the mode of the distribution of th? venae vorticosse of the choroid. After Arnold. 1. Part of the scle- rotic coat. 2. The optic nerve. 3 3. The choroid coat. 4. The .«| ciliary ligament. 5. The ii'is. 6 6. The venae vorticosas. 7 7. The trunks of the venae vorticosae at the point where they have pierced the sclerotica. 8 8. The posterior ciliary veins, which enter the ej-e^ ball in company with the posterior ciliary arteries, by piercing the sclerotic at 9. 10. One of the lung ciliary nerves, accompanied by a long ciliary vein. nSSECTION OF THE EYEBAI.L. chambers of the eye the pupil of the eye. Fig:. 99. The ciliary ligament forms a circle round the iris, connecting the cornea and sclerotic at their junction witli the iris and external membrane of the choroid. The iris, or rainbow, is so denominated from its variety of colors in different individuals. It makes a partition between the front and back and has a circular opening near its centre, called The iris is composed of two layers ; the anterior is muscular, consisting of both cu'- cular fibres which surround the pu- pil, and radiating fibres from the centi-e to the circumference ; the combined conti'action of these fibres diminishes the diameter of the pupil. Fig. 99 is the anterior segment of a trans- verse section of the globe of the eye, seen from within. 1. The divided edge of the three tunics ; sclerotic, choroid (the dark lay er), and retina. 2. The pupil. 3. The iris, tlie surface presented to view in this section being the uvea. 4. The ciliary processes. 5. The scalloped anterior border of the retina. ANTERIOR SEGMENT The cilici'y processes consist of li circmB ffitli^ thetiirei rue 62 tniii < cesIRo' istliei layers, of arte withti m\k, thebu ropje Hn ciiaiiiix tliectf h'n theiii ciliaris secrete siidroi Tue oftbi ORGANS OF THE EXTERNAL SENSES 193 triar^gular folds of the middle and internal layers of the choroid. Their circumference connects with the ciliaiy ligament ; they are covered with a thick black pigment. Fig. 100. Fig. 100 is the postt'rior segment of n transverse section of the globe of the eye, seen from within. 1. The divided edge of the three tunica. The membrane covering the vv'hole internal surface is the retina. 2. The entrance of the optic nerve with the arteria centralis retinsa piercing its centre. 3 3. The ramifications of the arteria cen- tralis. 4. Foramen of Soemmering, in the centre of the axis of the eye ; the shade from the side of the section obscures the limbus luteus, which surrounds it. 5. A fold of the retina, which generally obscures the foramen after the eye has been opened. Inner Coat. — The third tunic fs the retina. It is formed of tliree layers. The external is a mere film ; the middle or nervous is the expansion of the optic nerve, en- veloping the vitreous humor, and extending forward to the ciliary pro- cesses; the inner membrane is the vascular, composed of ramifications of arteries and veins. The anterior margin of the retina is connected with the anterior surfiice of the lens by a thin vascular layer, called zonula ciliaris. There is a circular spot in the retina, in the centre of the back part of the globe, called the foramen of Soemmering, sur- rounded by a yellowish halo, called limhus luteus. POSTERIOR SEGBIENT. Humors of the Eye. — The aqueous humor occupies the two ghambers of the eye. The anterior chamher is the space bounded by the cornea in front, and the ms and pupil behind ; the posterior cham- ber is the very small space between the pupil and posterior surface of the iris in front, and the ciliaiy processes, crystalline lens, and zonula ciliaris behind. Both chambers are lined by a thin membrane, which secretes the fluid of tlie aqueous humor, which does not exceed five or six drops in bulk. The vitreous humor makes the greater part of the bulk of the globe of the eye. It is a glassy, transparent fluid, enclosed in a delicate membrane, called the hyaloid. The inner sm*face of the hyaloid is disposed in thin lamellae or plates reflected inward, forming diflerent apartments or cells, like the ti'ansverse section of an orange, for holding the vitreous humor. The crystaLliiu humor, or lens is situated bebind the pupil, -sur- 1—17 194 ANATOMY rounded by the ciliary processes, and embedded in the front part (»f the vitreous, from which it is separated by the hyaloid membrane. The capsule of the lens is an elastic, transparent membrane which sur- rounds it. The lens is formed of concentric la^^ers, the external being soft, the middle firmer, and the interior still firmer. The cajial of Petit is a small triangular channel around the cuTumference of the lens. Uses of the Structures. — The oi ^^ar group of muscles has al- ready been described. The firm sclerotic coat gives shape and form to the eye, and protects its complicated and delicate tissues. The ti-ansparent cornea furnishes a medium for the transmission of the rnjs of light. The choroid sup- ports the nutritive vessels, and by the black pigment of ite posterior surface absorbs the scattered rays of light, that might otherwise con- fuse the image impressed on the retina. The iris regulates the quan- tity of light admitted through the pupil, by conti'acting when the rays are too sti'ong, and expanding when the light is more feeble. The hu- mors refract the rays so as to impress the object on the retina in the most favorable manner for distinct vision APPENDAGES OF THE EYE. These are the eyehroius, eyelids, eyelashes, conjunctiva, caruncula lachrymalis, and the lachrymal apparatus. The eyebrows, called super cilia, are projecting ai'ches of integument covered with short thick hairs, foiming the upper boundary of tha orbit of the eye. The eyelids, called pa(2Jc6?-rt?, are valvular layers in front of the eye. The elliptical space between is divided into the outer and inner canthus. The inner canthus id prolonged into ati'iangular space toward the no8a» which is called the lacus lachrymalis. The lachrymal papilla is a small angular projection at the commencement of the lacus lachiymalis on each side, each of which j)apil]a has a small orifice at its apex, called punctu77i lachrymale, and constituting the commencement of the lach- rymal canal. The thin, firm, fibro-cartilaginous bands supporting the edges of the eyelids are cfJled tie tarsal cartilages ; in their internal surface ai*e embedded a numijer of secretiig tubes or follicles, called tlie Meibomian glands. The eyelashes, called cilia, are triple rows of long tliick hail's, curl ing upward from the upper lid, and downward from the lower ; nu ar- rangement which prevents their interlacing each other. The conjunctiva covers the anterior surface ^f the eye, and is so reflected O!! the lids as to form their inner layer. The duplicates ORGANS OF THE EXTERNAL SENSES. 195 formed between the globe and lids of the eye are called the superior and inferior imlpehral sinuses. The caruncula lachrymalis is a small reddish body occupying the lacus lachrymalis at the inner canthus. It is composed of an assem- blage of mucous follicles, and secretes the whitish matter usually found at the inner angle of the eye. On the outer side of the caruncula is a fold of the conjunctiva, called p^zca semilunaris ; this is the 7nem- brana nictitans in birds, and the rudiment of the third lid in animals. Fig. lOl Is a representation of the appendages Fig. 101. of the eye. 1. The superior tarsal cartilage. 2. The lower border of the cartilage, on which are seen the openings of the Meibomian glands. .3. The inferior tarsal cartilage ; along the upper border of this cartilage the openings of the Mei- bomian glands are likewise seen. 4. The lachry- mal gland — its superior or orbital portion. 5. Its inferior or palpebral portion. 6. The lachrymal ducts. 7. The plica semilunaris. 8. The carun- cula lachrymalis. 9. The puncta lachrymalia of the lachrymal canals. 10. The superior lach- rymal canal. 11. The inferior lachrymal canal. 12. The lachrymal sac. 14. The dilatation of the nasal duct, where it opens into the inferior meat- us of the nose. 15. The nasal duct. APPENDAGES OF THE EYE. The lachrjmial apparatus consists of the lachrymal gland with its excretory duct, the iJuncla lachrymalia, tlie lachrymal canals, the lach- rymal sac, and the nasal duct. The lachrymal gland is situated at the outer and upper part of the orbit. It secretes the tears, which are ordinarily conveyed away by small ducts which run a short distance between the conjunctiva, and then open on ts surface a little above the upper border of the tarsal cartilages. The kichrymal canals commence at the j^uncta lachrymalia and run inward to the lachrymal sac. The superior duct first ascends, then turning suddenly inward, forms an abrupt angle ; the inferior duct, hy descending, and then turning abniptly inward, forms a similar angle. The lachrymal sac is the upper extremity of the nasal duct. It con- sists of a mucous membrane covered by a fibrous expansion of the ten- dons of the orbicularis and tensor tarsi muscles. The nasal duct is a short canal, three fourths of an inch long, running downward, back- ward, and outward to the inferior meatus of the nose, terminating thero in an enlarged orifice. OF THE ORGAN OF HEARING. The auditory apparatus is divided anatomically into the extertud «ar, tympanum, or middle efl,r, and labyrinth ."ir internal ear. 199 ANATOMY. STRUCTURE OF THE EAR. fig 102 le a representation of all parta of the ear. 1. Meatus audltorlus estemus. 2, Drum of the era-, or tympauum. 3, 4, 5. The bones of the ear. 7. Vestibule, the central part of the labyrinth. 8, 9, 10. The semicircular canals. 11, 12. The channels of the cochlea 13. Auditory nerve. 14. Eustachian tube, the channel from the middle ear to the throat. The External Ear. — The external ear consists of the pinna, a tunnel-shaped cartilaginous plate, which collects the vibrations of air, and the meatus, the tube which conveys them to the tympanum. The 2^'fina presents several folds and hollows upon its surface ; a prominent rim, called helix, a curved ridgo within it, called antihelix ; this divides above, and encloses a space called scaphoid fossa ; the pointed process over the opening of the ear is called tragus ; a tubercle opposite anlilragus ; the dependent portion of the pinna is the lohulus; a space between the helix and antihelix is called /055a innominata; and the large central space to which {lU the channels converge is the concha, wliich opens into the meatus. The )n"sclcs of the pinna are the major helicis, minor helicis, tragicus, anlilragicus, and transvcrsus aurlculce ; they are merely rudimentary In the human ear, but in many animals are large and active. The meatus audita rius is about an inch iu length, extending inward and a little forward from the concha to the t}-mpanum, and narrower in the middle than at either extremity. In the substance of its lining Q»en)branf) ore oirv-nUmmt j^kiuds, ^vhich eMdCJrete tlie aar-\Fax. Short. ORGANS OF THE EXTERNAL SENSES. im Btiff hairs stretch across its interior, to prevent tlie ingress of insecta and dust. The pinna derives a plentiful supply of arteries from the anterior auricular branch of the temporal, and the posterior auricular fi"om the carotid. Its nerves are In-anches derived fi'om the anterior auricular of the fifth, the posterior auricular of the facial, and the auricularis magnus o.' the cemcal plexus. Tympa>'um. — The middle ear is an irregular bony cavity within the petrous portion of the tempoial bone. It is bounded externally by the membrana tympani, and filled with air, which entei-s by the Eustacliian cube. Fig. 103 is a diagram exhibiting the principal divisions and parts of the ear. p. Pinna, t. Tympanum. I. Labyrinth. I. Upper part of the helix. 2. Antihclix. 3. Tragus. 4. Antitragus. 5. Lobulue. C>. Concha. 7. Upper part of the fossa innominata. 8. The meatus. 9. Mem- brana tympani, divided by the section. 10. The three small bones of the ear, malleus, incus, and stapes, crossing the area of the tympanum ; the foot of the stapes blocks up the fenestra ovalis upon the inner wall of the tympanum. II. The promontory. 12. Fenestra rotunda; the dark opening above the bones leads into the mastoid cells. 13. Eustachifui tube ; the little canal upon this tube contains the tensor tympani muscle in its passage to the tympanum. 14. Vestibule. 15. The three semicir- cular canals, horizontal, perpendicular, and oblique. 16. The ampuHse upon the perpendicular and horizontal ca- nals. 17. Cochlea. 18. A depression between the convexities of the two tubuli which communicate with the Fig. 103. DIAGRAM OF THE EAR. tympanum and vestibule; one is the scala tympani, terminating at 12; the other the scala vestibuli. The memhrana tympani is a thin, semi-transparent membrane, placed obliquely across the meatus, concave externally and convex toward the tympanum, and composed of an externa) epidermal, a mid- dle muscular, and an internal mucous coat. The proper bones of the ear {ossicula auditUs), viz., malleus, incus^ and stapes, are contained in the tympanum. Tho malleus (hammer- like) consists of a head, neck, and handle called mcnuh^.um, which >* 198 AN.^TOMY. connected with tl e raembrana tympani by its whole length. The incus has au imaghied resemblance to an anvil, from which circumstance its name is derived; it consists of a flattened body and two processes; its body articulates with the head of the malleus. The stapes is shaped like a stirrup ; its head articulates with a process of the incus called OS orhkulare. These bones are connected together and held in their places by various ligaments, and moved upon themselves by four mus- cles, called tens(A tympani, laxator tympani, laxator tympani minor, and stapedius. There ai'e ten foramina, or openings, in the t^-mpanum, five large and five small. The large openings are, meatus auditorius, already described: fenestra oralis, communicating between the tympanum and vestibule ; fenestra rotunda, communicating between the vestibmle and cochlea ; a large, irregular opening by which the mastoid cells commu- nicate with the upper and posterior circumference of the tympanum ; and the Eustachian tube, a communicating canal between the tympa- num and pharynx. The small openings are two for the entrance and exit of the chorda tympani; one situated in a fissure called Glasseri, for the laxator tympani ; one immediately above the opening of the Eustachian tube, for the tensor tymjyani ; and one for the stapedius, at the apex of a conical body called the pyramid. Above the fenestra ovalis is a rounded ridge formed by a projection of the aqucsductus Fallopii. Beneath the feuesti'a ovalis is the jiromontory formed by a projection of the first turn of the cochlea, the surface of which pre- sents three grooves for lodging the tympanic branches of Jacobson's nerve. The arteries of the tympanum are derived fi-om the internal maxil- lary, internal carotid, and posterior auricular. Its nerves ai'e branches from the facial, the chorda tj'mpani, the tj^mpauic branches of Jacob- son's, and a filament from the otic gang'ion. The Internal Ear. — The term lalyrinth is applied to the internal ear on account of the complexity of its communications. It consists of a bony and a membranous portion. The osseous labyiinth presents a series of cavities channeled through the substance of the petrous bone, and is situated between the cavity of the tympanum and meatus audi- torius internus. It is divided into vestibule, semicircular canals, and coclilea. The vestibule is a small, three-cornered cavit}' within the inner wall of the tympanum ; its corners are called cornua, or ventricles. The semicircular canals open into it by five orifices behind, and the cochlea by a single one in front. T::e fenesti'ti ivalis is on its outer wall, and ORGANS OF TEE EXTERNAL SENSES. 199 on its inner several small holes, a cluster of which is called macula cribrosa, for the entrance of a portion of the auditory nerve. The scala vestibuli is the termination of the vestibular canal of the cochlea. The aqucsductus vestibuli is the commencement of the small canal which opens under the osseous scale upon the posterior surface of the petrous bone. The semicircular canals are three bony channels, communicating with the vestibule into which they open by both extremities, each ex- ti'emity being expanded like a fiask, and called ampulla. The cochlea (snail-shell) forms the anterior j)art of the Libj^inth. It is a tapering, osseous canal, one inch and a half in length ; and makes two turns and a half spirally around a central axis, called the modiolus, wliich is a porous mass of bone perforated by numei-ous filaments of the cochlear nerve. The canal of the cochlea is partially divided into two passages {scalce) by a thin, porous plate of bone, called lamina spiralis, which terminates at the apex with a hook-shaped process called hamulus ; this is covered by the ciqwla. The two scake com- municate over the hamulus by an opening called heiicolre.ma. Near the termination of the scala tj^rnpani is the small opening of the cochlear asqueduct. The internal surface of the osseous labyrinth is lined by a fibro-serous membrane, which exteriorly serves as a periosteum, and internally as a serous membrane, secreting a limpid fluid called aqua lalj^rinthi. Fig. 104 shows the cochlea divided pcoral- lel with its axis through the centime of the modiolus. 1. Modiolus. 2. The infundibu- lum. 3, 3. Cochlear nerve, i, 4. The scala tympani of the first turn of the cochlea. 5, 5. Scala vestibuli of the first turn ; the sep- tum between 4 and 5 is the lamina spiralis. 8. Loops formed by filaments of the cochlear nerve on the lamina spinalis. 9, 9. Scala tympani of the second turn of the cochlea. 10, 10. Scala vestibuli of the second turn. 11. Half turn of the scala vestibuli ; the dome over it is the cupola. 14. Ilelicotrema ; a bristle is passed through it, in front of which is the hamulus. '* 'i| ^ THE COCHLEA. The membranous labyrinth is in form a perfect counterpart of the vestibule and semicu'cular canals, but smaller in size. In sti'ucture it is composed of four layers ; an external, or serous, a vascular, a nervous, and an internal, or serous. Its cavity is filled with a limpid fluid, and contains two small ca careous masses, called otoconites ; and it coosista 200 A.N ATOMY of a small sac, sacculus cojiimums, of three semicircular membranous canals, and a small round sac, sacculus jproprius. Fig. 105. THt LABYRINTH. Fig. 105 is the labyrinth of the left enr, laid open to exhibit its cavities and the membranous labyrinth, 1. Cavity of the vestibule. 2. Am- pulla of the superior semicircular canal. 4. The superior cnnol, with its contained membranous canal. 5. Ampulla of the inferior canal. 6. Ter- mination of the membranous canal of the hori- zontal Ecraicircular canal in the sacculus com- munis. Ampulla of the middle semicircular ca.nal. b The same canal with its membranous canal, i. Common canal. 10. Membranous common canal. II. Otoconite of the sacculus communis. 12. Sacculus proprins ; its otoconito is seen through its membranous parieties. 13. Fir.=t turn of the L-'>chlea. 11. Extremity of the scala tympani, corresponding with the fenestra rotunda. 15. Lamina spiralis. 18. Half turn of the cochlea. 19. Lamina spiralis, terminating in its falciform extremity. The dark space included within the falciform curve of the extremity of the lamina spiralis is the helicoti'cma. 20. The infundibulum. The auditory nerve divides, in the meatus auditorius internus, into a vestibular and a cochlear branch. The vestibular nei-ve divides into three branches, which are disti-ibuted to the various parts ; in the sub- stance of the Bacculi and ampullss the nervous filaments radiate in all directions, anastomosing Avith each other, and forming interlacements and loops, finally terminating upon the inner surface of the membrane in minute papillae, resembling those of the retina. The auditory nerve divides into numerous filaments, which enter the foramina in the basi'> of tho cochlea, and are distributed to the tissue of the lamina spiralis The arteries of the labyrinth are derived mainly from the auditory branch of the superior cerebellar aitery. THi: ORGA>' OF TASTE. The tongue is composed of longitudinal, transverse, oblique, and vertical musculai- fibres, between which is a quantity of adipose sub- stance ; it is connected posteriorly with the os hyoides by a muscular attachment; and to the epiglottis by mucous membrane, which fonns tlic three folds called frfpna epiglottidis ; and on each side with the lower jaw by tlio same membrane, which forms a fold in front beneath its under surface, called /rrt?nww, lingKE. The suriaco of tlio tongue is covorcd by a donsi layer, which sup 0EGAN9 OF THE EXTERNAL SENSE8. 2(U ports its pajnllfS, of which there are four kinds. 1. PapillcE circum- vallaUe, or lenticular, are of large size, and fifteen or twenty in number, situated near the root, and arranged in two rows, which meet at the middle line, like the branches of tiie letter A. At their point of meet- ing is a deep mucous follicle, called /pr«77ien ccecum. 2 and 3. Papilla coniccs and i)apillts filiformes, conical and filiform in shape, cover the sur- jli-^-e of the tongue in front of the circumvallatee ; their extremities are ])ierced by a minute aperture, hence they may be regarded as follicles rather than sentient points, the ti'ue sentien*- organs being extremely minute papillae occupying their surface as well as that of the other papillae. 4. Papillectinati are fewer in number than in the right am-icle, and are situated only in the appendix auricula?. The left ventricle, which receives the blood from the left auricle and sends it through the aorta, forms the apex of the heart ; its figure is conical externally and internally. Its openings are, the auriculo- ventricular, between the auricle and ventricle, and the aortic. Its valves are the mitral, attached around the auriculo-veuti'icular commu- nication to prevent the reti^ogi'ade passage of the blood, and, like the tricuspid, are fhrnished with a musculai" apparatus; and the semilunar pkced around the commencement of the aorta. Fig. 110. ANATOMY OF THE HEART Artery and arch of the a«^tft. th« ligbt «Mc of the heart. Fig. 110 is a general view of the inter- nal structure of the heart. 1. Right auricle. 2. Entrance of the superior cava. 3. Enti'ance of the inferior cava. 4. Opening of the coronary vein, half- closed by the valve. 5. Eustachian valve. 6. Fossa ovalis, surrounded by the annulus ovaUs. 7. Tuberculum Lovveri. 8. Musculi pectiuati in tiie appendix auriculse. 9. Auriculo ven- tricular opening. 10. Cavity of right ventricle. 11. Tricuspid valve, attached by the chordae tendinsB to the cameaj columuae (12). 13. The pulmonary ar- tery, guarded at its commencement by three semilunar valves. 14. Right pul- monary artei-y, passing beneath the arch and behind the ascending aorta. 15. Left pulmonary artery, crossing in front of the descending aorta. * Re- mains of the ductus anteriosus, acting as a ligament between the pulmonary The arrows maik the course of the venous blood throuch Ifi. Left acriclo. 17. Openings o/ tbe fwirth pulrannaiv SPLANCHNOLOGY 207 reins. 18. Auriculc-ventricular opening. 19. Left ventricle. 20. Miti-al valve, attached by its chordas tendinae to two large columnae carnese, which project from the walls of the ventricle. -21. Commencement and course of the ascending aorta behind the pul- monary artery, marked by an arrow; the entrance of the vessels is guarded by three semilunar valves. 22. Arch of the aorta. The comparative thickness of the two ventri- cles is shown in the diagram. The course of the blood through the left side of the heart is denoted by arrows. The general structure of the neart is an arrangement of strong muscular fibres, disposed in several layers, so as to form fibrous rings and bands, which afford it tlie greatest possible amount of strength for Its bulk. lis arteries are the anterior and j^osterior coronary ; its veins empty into the right auricle b} the common coronary ; its lymjjhatici terminate in the glands about its root; and its nerves are derived fi'om the cardiac plexus- es, which are form- ed by communica- ting filaments from the ganglionic and pneumogastric. Fig. Ill is an external view of the heart, a. Left ventricle, b. Right ventricle, c, e, f. Aorta arising from the left ven- tricle, ff. Arteria inno- minata. k. Left subcla vian artery, i. Left ca- rotid, k. Pulmonary ar- tery. I, I. Its right and left branches. m, m. Veins of the lungs, n. Right auricle. o. As- cending cava. g. De- scending cava. r. Left auricle, s. Left coronary artery. P. Portal veins, which return the blood from the liver and bow- *^^- THE HEART. ORGANS OF VOICE AND RESPIKATION. The cartilaginous and muscular sti'ucture at the upper part of the windpipe, called the larynx, constitutes the apparatus of voice ; the lungs and trachea are the organs of resph-ation. or THE LAEYKX. The kirynx is a short lulw. of an houT-glass forn\ Fituated at the 208 AN ATOM V. upper and front part of the neck, composed of cartilages, ligaments, muscles, vessels, nerves, and mucous m&inhrane. The cartilages are: 1. Thyroid (shield-like), which consists of two lateral portions (alee) meeting at an angle in front, and forming the pro- jecting part of the throat, called powiwm Adami (Adam's apple). Each ula forms a rounded border posteriorly, which terminates above in a superior cornu, and below in an iiiferior cornu. 2. Cricoid (like a ring), a circular ring, narrow in front and broad behind, where it has two rounded surfaces, which ai'ticulate with the arytenoid cartilages. The cesophngus is attached to a vertica. ridge on its posterior surface. 3. Two arytenoid (pitcher-like) ; ti'iangular in form, and broad ^nd thick below, where they articulate with the upper border of the cricoid; above they are pointed and prolonged by two small pyriform cartilages, "ailed cornicula laryngis, which form part of the lateral wall of the larynx, and afford attachment to the chorda vocalis and several of the articulating muscles. 4. Two cuneiform. ; small cylinders, about seven lines in length, and enlarged at each extremity ; they are attached by the lower end to the arytenoid, and their upper extremity forms a prominence on the border of the aryteno-epiglottidean fold of mem- brane ; they are occasionally wanting. 5. Epiglottis ; shaped like a cordate leaf, and sitiiated immediately in front of the opening of the larynx, which it closes when the larynx is drawn up beneath the base of the tongue, as in the act of swallowing. The laryngeal cartilages ossify more or less in old age, particularly in the male. The ligaments are: 1. Three thyro-hyoidean, which connect the thyroid cartilage with the oa hyoides. 2. Two capsular crico-thyroid, which articulate the thyroid with the cricoid, and with their synovial membranes from the articulation between the inferior cornu and sides of the cricoid. 3. The cricc -thyroidean memhrane, a fan-shaped layer of elastic tissue, attached by its apex to the lower border of the thy- roid, and by its expanded margin to the upper border of the cricoid and base of the aiytenoid ; above it is continuous with the lower margin of the chorda vocalis. 4. Two capsular crico-arytenoid, which connect those cartilages. 5. Two superior thyro-arylenoid, thin bands between the receding angle of the thyroid and the anterior inner border of each arytenoid ; the lower border constituting the upper boundaiy of the venti'iclo of the larynx. G. Two inferior thyro-arytenoid, the chordcc vocales, which are thicker than the superior, and, like their composeJ of clastic tissue. Each ligament, or vocal chord, is attachea in front to the receding angle of the thyroid, and behind to the anterior angle of the base of the arytenoid. The inferior border of the chorda vocalis w continuous with the lateral expansion of the crioo-thyroid ligament SPLANCHNOLOGY. 209 Tlio superior border forms the lower boundary of the venti-icle of the larynx. The space between the two chordae vocales is the glottis, or ' ,ui glottidis. 7. "Three glaso-epi glottic, folds of mucous membrane meeting the anterior surface of the epiglottis with the root of the tongue. 8. The hyo-eji glottic, an elastic band connecting the anterior a-pect of the epiglottis with the hyoid bone. 9. The thy i-o-ejn glottic, a slender elastic slip embracing the apex of the ej)iglottis, and inserted into the thyroid above the chordae vocales. Fig. 112 is a vertical section of the larynx, showing it.- ligaments. 1. Body of the os hyoides. 2. Its great cnruu. 3. Its lesser cornu. 4. The ala of the thyroid. ii. Its superior cornu. 6. Its inferior cornu. 7. Pomum Adami. 8, 8. Thyro-h5'oidean membrane ; the openinnr Rf'ar the posterior numei'al transmits the euperic laryngeal nerve and artery. 9. Thyro-hyoidcan liga- ment, a. Epiglottis, b. Hypo-epiglottic ligament, c. Tliyro-epiglottic. d. Arytenoid cartilage, c. Outer angle of its base. /. Corniculum laryngis. ff. Cuneiform n rtilage. k. Superior thyro-arytenoid ligament, i. riiorda vocalis, or inferior thyroarytenoid ; the ellipti- cal space between the two thyro-arytenoid is the laryn- g-'§itiiei chial tubes, terminating in intercellular passages and air-cells, and the ramifications of the pulmonary artery and vein, bronchial arteries and veins, lymphatics and nerves, the whole held together by cellular tis- sue, and called the parenchyma. The bronchial tubes, on entering the lungs, divide into two branches-, »nd each of these divide and subdivide until lost in intercellular pas- sages, and these, after several bifurcations, ultimately terminate by a caecal extremity, which is the air-cell. The sti'ucture of the bronchial tubes is changed fi-om cartilaginous to membranous afber they have ari'ived within one eighth of an inch of the surface of the lung, and diminished to a diameter between one thhtieth and one fiftieth of an inch. The pulmonary artery, which ti'ansmits the venous blood to tlie lungs, terminates in a minute network of capillary vessels, distributed through the walls of the air-passages and air-cells ; these converge to form the pulmonary veins, which return the arterial blood to the heart. The lymphatics of the substance and surface of the lungs terminate in the bronchial glands. The nerves, derived from the ganglionic and pneumogastinc, form anterior and posterior plexuses upon the front and back of the root of the lungs, from which branches follow the coui-se of the bronchial tubes to supply the intercellulai- passages and air-cells. tki, caue riii t:pa THE PLEURA. Each lung is invested and sustained by the p/cwra, a serous mem brane, which invests it as far as the root, and is then reflected upon the sides of the chest and across the diaphragm. The part enclosing tlie lung is called j^lcura ])ulmonalis, and that in contact v/ith the parietieg of tiie chest, tlie pleura costalis ; the tsvo reflected portions in the middle of the chest form a septum, called mediastinum, which divides the thorax into two pulmonary cavities; this portion is diatingiiisliea "111 K^-tii liere SPLANCHNCLOGY. 21S .nto anterior, jyostsri.ir, and middle portions, the latter containiug the heart and its pericardium, the ascending aorta, the superior vena cava, the bifurcation of the trachea, the pulmonarj ^teries and veins, and the phrenic nerves. THE ABDOMINAL VISCERA. The abdominal cavity \r> bounded above by the diaphi-agm, below by the pelvis, in front and laterally by the lower ribs and abdominal mus- cles, and beliind by the vertebral column and abdominal muscles ; it contains the alimentary canal, liver, pancreas, spleen, and kidneys, with the supra-renal capsules. Abdomi.nal Regions. — For convenience the abdominal cavity is divided into nine regions, by two transverse lines 'around the body, one pai-allel with the inferior convexity of the ribs, and the other with the highest points of the crests of the ilia ; and two perpendicular lines, one at each side, drawn from the cartilage of the eighth rib to the middle of Poupart's ligament ; the central region of the upper zone is called the epigastric^ and its lateral divisions right and left hypochon- driac ; the middle region of the middle zone is the wnhilical, the t^vo lateral the lumbar ; the middle of the lower zone is the hypogastric, and the two lateral the iliac. In the upper zone is found the liver, ex- tending from the right to the left side ; the stomach and spleen on the left, and the pancreas and duodenum behind ; in the middle zone the transverse colon, upper part of the ascending and descending colon, omentum, small intestine, mesenteiy, and, behind, the kidneys and supra-renal capsules. In the lower zone is the inferior portion of the omentum and small intestine, the caecum, ascending and descending colon with the sigmoid flexure, and the ureters. The peritoneum is the serous membrane of the abdominal cavity ; it invests each viscus separately, and is then reflected upon the surround- ing parieties, enclosing the whole in a sac. The diaphi-agm is lined by two layers, which, descending to ihe upper surface of the liver, form its coronary and lateral ligaments ; and, after surrounding the liver and meeting at its under surface, pass to Che stomach, forming the lesser omentum. After surrounding the stomach they descend in front of the intestines, forming the great omentum ; they then surround the traus- * verse colon, and pass backward to the spine, forming the meso-colon^ where the layers separate. The j^osterior ascends in front of the pan- creas and aorta to the diaphragm; the anterior descends, and, after investing all the small intestines, returns to the spine, thus forming the mesentery. Descending into the pelvis, it forms the mesQ-rectum^ and a poaci] called the ruito-vesiccd fold, b^tve^u Uie r^ctoua aiad bladder; 214 ANATOMY It. then ascends ui,on the nock of the bM^^Tlbi^^^ ^. Fig. 115. ABDOAIIIVAL CAVITY Fit.'. 115 exhibits the abdominal cavity, with the i lilf^^n. A. ne«»<'ndm(r a<«^ \- v a -• i aucreas. K. hJdnevfl. aAu, Ascendiog rcna «,vn. R. Eoctum. B. Bladder' SPLANCHNOLOGY. 215 In the female it is reflected on the posterior surface of the vagina and both surfaces of the uterus, forming on each side the 'broad liga- ment of the latter viscus. The great omentum consists of four layers, the two which descend from the stomach again returning upon themselves to the transverse colon ; a quantity of adipose matter is deposited around the vessels which ramify tlii'ough it. Its function is to protect the intestines from cold and friction, and facilitate their movements upon each other in their peristaltic action. The mesentery retains the small intestines in their places, and gives passage to the mesenteric arteries, veins, nerves, and lymphatics. There are small, irregular pouches of the peritoneal membrane, filled with fat, and situated like fringes upon the large intestines, which are called o.ppendkes eiyjAoias. The gastro-phrenic ligament is a du- pFicature extending from the diaphragm to the lesser curve of the stomach and extremity of the oesophagus ; the gastro-splenic omentum is a duplicature connecting the stomach and spleen. In structure a serous membrane consists of an external cellular fibrous layer, which is vascular and adherent to surrounding sti'uctures, and an internal dense and smooth layer, deficient of vessels. In gen- eral character serous membranes resemble a shut sac, and secrete b fluid resembling the serum or wateiy pai't of tne blood. THE ALIMENTARY CANAL. The alimentary canal is a continuous tube from the mouth to the 'anus, musculo-membranous in sti'ucture, and distributed into various ; portions, called mouth, phaiynx, oesophagus, stomach, and intestines; {the intestines are subdivided into the small, which are distinguished into duodenum, jejunum, and ileum; and large intestines, distinguished into caecum, colon, and rectum. The Mouth. — The mouth is an irregular cavity, containing the organs of taste and instruments of mastication. The lips are two fleshy folds attached to tlie surface of the jaws, ind formed externally of common integument, internally of mucous membrane, with layers of miiscles and numerous small glands between. The cheeks (buccae) form the sides of the face, and are constituted .limilarly to the lips; then- glands ai-e called buccal. The hard palate is a dense structure of mucous membrane, fibrous [issue, glands, vessels, and nerves, firmly connected to the palate pro- jesses of the upper maxillary and palate bones. Its middle line ia ^.narked by an elevated raphe, on each side of which are traneRrersd idges and grooves. 1' £16 ANATOMY, The gums are tliick, dense folds of mucous membrane attached to [he periosteum of the alveolar processes, and remarkable for tlieir insensibility. The tongue has been ah'eady described. The soft palate (velum pendulum palati) is a fold of mucous mem- brane, with glands and muscles, at the back part of the moulh, con- tinuous above with the hard palate ; the uvula is a small rounded pro- cess hanijing from the middle of its inferior border. The tonsils (amygdalte) are tvvo glandular almond-shaped bodies oq each side of the fauces, between folds of the mucous membrane of the soft i)alate, which are called the anterior and j^osterior pillars. They are composed of an assemblage of mucous follicles opening on the sur- face of the glands. The isthmus of the fauces is the space included between the soft . palate and root of the tongue ; it is the opening between the mouth and pharynx. The salivary glands communicate with the mouth by their excre- toiy ducts; they are the parotid, submaxillary, and sublingual. The parotid, the lai-gest, is situated immediately in front of the external ear, extending deeply behind the ramus of the lower jaw. Embedded in its substance are the external carotid artery, temporo-maxiilaiy vein, and facial nerve. Its excretory duct opens on the internal surface oft the cheek opposite the second molar tooth of the upper jaw. The submaxillary is situated in the posterior angle of the submaxillary tri- anglo of the neck, and behind the lower jaw. Its excretory duct opens on the papillae under the tongue, by the side of the fra^numi lingurc. The sublingual is a flattened body beneath the mucous mem brano of the floor of the mouth, on each side of the frsenum linguaeJ Its secretion is poured into the mouth by seven or eight small ducts, which oi)eu on each side of the fra?num lingiias. In struGture the salivaiy glands are conglomerate, consisting of lobes made up of small lobules, and these of still smaller lobules, the smallest lobule being com- posed of granules, which are minute cffical pouches, formed by the dilatation of the extreme ramifications of the ducts. TuE Pharynx. — The j^harynx is a musculo-membranous sac be tween the mouth and oesophagus. Its anterior part is incomplete, aod has opening into it the two posterior nares, the two Eustachian tubes, )nouth, larynx, and oesophagus. The CEsophagus. — Tho asophagus is the continuation of the oli- rueatftry ccumlI front tlio pliaryux to the iitoamch. la itti doa^caading SPLANCHNOLOGY. 217 coui'se along the spine it inclines to the left in the neck, to the right in the upper part of the thorax, and to the left again as it passes through the posterior mediastinum. It terminates at the cardiac orifice of the stomach about the tenth dorsal vertebra. The Stomach. — The stomach is an expansion of the alimentary tube, its greater or splenic end being situated in the left hypochondriac region, where it is in contact with the concave surface of the spleen, and its lesser or pyloric end extending into the epigastric region. Above it forms a lesser curvature, and below a greater curvature ; its opening into the oesophagus is the cardiac orifice, and its opening into the duo- denum the pyloric orifice. (See fig. 107.) The Small Intestine. — The small intestine is about twenty-five feet in length, extending from the pylorus to the caecum. Its first division is the duodenum, about twelve fingers' breadth in length. It ascends obliquely backward to the under surface of the liver, then descends perpendicularly in front of the right kidney, and then passes transversely across the third lumbar vertebra. A little below its middle it receives the ductus communis choledochus from the liver, and pan- creatic duct from the pancreas. The second division is called jejunum ; it forms the upper two fifths of the small intestine ; it is thicker to the touch than the other portions, and has a pinkish tinge. The third divi- sion is the ileum ; it is smaller in diameter, and thinner in texture, and paler than the jejunum. It opens into the colon at an obtuse angle, in the right iliac fossa. The Large Intestine. — The large intestine is about five feet in length, sacculated in appearance, and divided into the caecum, colon, and rectum. The ccecum is the most dilated portion of the intestinal tube, forming a blind pouch, or cul-de-sac. Attached to its exti'emity is a w^orm-shaped tube, from one to five or six inches in length, called appendix vermiformis ; it is the rudiment of the long caecum found in all mammiferous animals except man and the higher quadrupeds. The colon is divided into transverse, ascending, and descending, and in the right iliac fossa it makes a remarkable curve upon itself, called the sig- moid flexure. 'Rie rectum is the termination of the large intestine ; it descends in front of the sacrum, and near the exti'emity of the coccyx curves backward, and terminates at the anus, which is situated a little more than an inch in front of the coccyx. The integument around the anus is covered with hairs, and arranged into numerous radiated plates, which are obliterated during the passage of fseces. (See fig 107 .) I— 19 218 ANATOMY. Structure or the Alimentary Canal. — The pharynx has mucous, fibrous, and muscular coats ; the oesophagus has only mucous and muscular coats ; the stomach and intestines have mucous, muscular, and serous coats. The mucous is the internal coat, the muscular the middle, and the serous the external. The mucous coat veiy closely resembles the cutaneous covering of the exterior; it is composed of three layers, an epithelium, a, mucous jyroper, and a fibrous. The epithelium is the epiderraa of the mucous membrane. The proper mucous layer is analogous to the papillary layer of the skin. In the stomach it forms polyhedral cells, into the floor of which the gfistric follicles open ; in the small intestine it pre- sents numerous minute projecting papillae, called villi, which give the surface a velvety appearance ; in the large intestine the surface resem- bles the cellular network of the stomach. The Jibrous layer (formerly called '■'nervous coaV^) is the membrane of support, as the corium is to the papillary layer of the skin. The muscular coat of the pharynx consists of the muscles already described ; that of the rest of the alimentary canal is composed of two planes of muscular fibres, one of which is external and longitudinal, and the other internal and circular. The serous coat is a layer of membrane derived from the peritoneum. In the oesophagus the mucous membrane is disposed in longitudinal plicce ; in the stomach it is formed into plaits, or ruga ; at the pj- lorus it forms a spiral fold, which constitutes a part of the pyloric valve ; in the lower part of the duodenum, the whole length of the jejunum, and upper part of the ilium, it forms valvular folds, called valvula con- niventes ; at the termination of the ilium in the ctecum it forms two projecting folds, ca]led ileo-ccscal valve ; in the caecum and colon it is raised into cresentric folds ; and in the rectum it forms three valvular folds. The glands and follicles of the intestinal structure are situated in the loose cellular or areohr tissue of the mucous coat, connecting the muceus with the fibrous layer. The pharyngeal glands are large and numerous around the posterior nares ; the esophageal glands are small lobulated bodies opening upon its surface by a long, oblique excre- tory duct ; the gastric foLicles are long tubular bodies situated per- pendicularly side by side throughout the mucous membrane of the stomach, and intended probably for the secretion of the gasti'ic juice; the duodenal glands are small flattened granular bodies, resembling in sti'ucture small salivary glands, and opening on the surface by minute excretoiy ducts ; the solitary glands are small saccular cavities in the small intestines, without an excretory duct, and in the Urge intestine* SPLANuHNOLOGY. 219 small circular prominence, with a minute excretory opening in the centre ; the aggregate, or Peyer''s glands, are circular patches sur- rounded by simple follicles, near the lowen- end of the ilium ; and the simple follicles are small pouches of mucous layer, dispersed in immense numbers over the whole mucous membrane. The arteries of the alimentary canal are the pterygo-palatine, ascend- ing pharyngeal, superior thyroid, and inferior thyroid, in the neck ; oesophageal m the thorax ; gastric, hepatic, splenic, superior, and infe- rior mesenteric, in the abdomen ; and inferior mesenteric, iliac, and in- ternal pudic, in the pelvis. The veins from the abdominal portion of the canal unite to form the vena portae. The lymphatics and lacteals open into the thoracic duct. The nerves of the pharynx are derived from the glosso-pharyngeal, pneumogasti-ic, and ganglionic ; those of the stomach are the pneumogastric, and ganglionic branches fi-om the solar plexus ; those of the intestinal canal are the superior and inferior mesenteric and hypogasti'ic plexuses ; the extremity of the rectum is supplied by the inferior sacral nerves from the spinal cord. THE LIVER. The hvei is a large conglomerate gland, and the largest organ in the body, weighing about feur pounds, and measuring about twelve inches through its longest diameter. It occupies the right hypochonai lac re- gion, and extends across the epigastrium into the left hypochondriac, frequently reaching, by its left extremity, the upper end of the spleen. It is marked anteriorly by a deep notch, which divides it into two lobes. Above and behind it is in relation with the diaphragm, below with the stomach and ascending portion of the duodenum, ti'ansverse colon, right supra-renal capsule, and right kidney; its free anterior border corresponds with the lower margin of the ribs. It is held in its place by five ligaments ; the longitudinal, a fold of peritoneum extending through its notch ; two lateral, formed by layers of peritoneum, which connect its lobes with the diaphragm ; the coro- nary, formed by the separation of the two layers of the lateral ; and the round, a fibrous cord resulting from the obliteration of the umbilical vein ; this passes through a fissure in its under surface from the um- bilicus to the inferior cava. Its under surface is marked by five fissures ; the longitudinal, the bwer part of which contains the remains of the ductus venosus ; the transverse, through which the hepatic artery, portal vein, and hepatic ducts enter the liver, the fissure for the gall-hladder, and the fissure for the vena cava. These fissures divide the liver into five lobes; the "igh, five or six 220 ANATOMY times ims^er than the left; the left, the lobus quadratus, on the under surface of the right lobe ; the lobus spigelii, a triangular portion, also on tlie under surface of the right lobe ; and the lobus caudatus, a small appenfliige of the former. The vessels and lymphatics of the liver have been described ; its nerves from the animal system proceed from the right phrenic and pneumogastric ; those from the organic system ai'e derived fi'om the hepatic plexus. Mknute Anatomy of the Liver. — The liver is composed of lobules, a connecting medium called Glisson's capsule., of the ramifica- tions of the portal vein, hepatic duct, hepatic artery, hepatic veins, lymphatics, and nerves, and is enclosed by the peritoneum, and retained in position by its folds. The lobules are small granular bodies, iiTegular in form, about the size of millet seeds, and, when divided longitudinally, have a foliated appearance. Each lobule is composed of a plexus of biliary ducts, of a venous plexus ^ormed by branches of the portal vein, of a hepatic vein, and of minute arteries ; nerves and absorbents are also supposed to enter into their formation, but hare not been ti'aced into them. To microscopic examination a lobule presents numerous minute bodies of a yellowish color and various forms, connected with each other by ves- sels ; these minute bodies are the acini of Malpighi. The branches of the portal vein are disti'ibuted through canals chan- neled in every plirt of the organ. This vein brings the returning blood from the chylopoietic viscera, and also conducts the venous blood fi-om the ultimate ramifications of the hepatic artery ; its branches in the canals are called vaginal, and form a venous vaginal plexus ; these give off interlobular branches, and the latter enter the lobules and form lobular venous plexuses ; from the blood circulating in these plexuses the bile is secreted. The bile in the lobule is received by a network of minute ducts, the lobular biliary plexus ; from the lobule it is conveyed into interlobular ducts ; and these proceed into the biliary vaginal j^lcxus of the portal canals, and thence into the excreting ducts, by which it is carried into the duodenum and gall-bladder, after being mingled in its course with thr mucous secretion from the numberless mucipai'ous follicles in the walls of the ducts. The hepatic artery distributes branches through all the portal canals, gives off vaginal branches, which form a vaginal hepatic plexus, from which the interlobular branches arise, and these latter terminate ulti- mately in the lobular venous plexuses of the portal vein. The artery SPLANCHNOLOGY. 221 ramifies abundantly in the coats of the hepatic ducts, supplying mate- rials for their mucous secretion, and for the nutrient vessels of the entire organ. The hepatic veins commence in the centre of each lobule by minute radicles, which collect the impure blood from the lobular venous plexus, and convey it into the interlobular veins ; these open into veins called suhlobular, and the sublobular unite to form the large hepatic trunks by which the blood is conveyed into the vena cava. • An important physiologica' deduction from the anatomi- cal structure of the liver is, that bile is wholly secreted from venous blood, and not from a mixture of venous and arterial blood, as stated by Muller; and an equally im- portant pathological inference is, that bile is wholly an ex- crementitious fluid, and not "auxiliary to digestion," as many physiologists suppose. Fig. 116 is a horizontal section of three superficial lobules, showing the two principal systems of blood- vessels. Fig. 116. LOBTJIiES OF THE LIVER. The Gall-B ladder. — ^The gall-bladder is a pyriform sac, which serves as a reservoir for the bile. It is situated on the under surface of the right lobe of the liver, and composed of serous, fibrous, and mu- cous coats. Its mucous coat is raised into minute rugae, which form a spiral valve at the neck of the sac. The biliary ducts are three : the ductus communis cJioledocJms, which is the common excretory duct of the liver and gall-bladder, about three inches long, and about the size of a crow-quill, commences at the mid- dle of the duodenum, and before reaching the liver divides into the cystic, which is about an inch in length, and enters the neck of the gall-bladder, and the hepatic, which continues onward to the transverse fissure, where it divides into two branches, which ramify through the portal canals to all parts of the liver. THE PANCREAS. The pancreas (sweet-bread) ia a 'ong, flat, conglomerate gland, in 222 ANATCMY. structure and function analogous to the salivary glands. It is about six inches long, weighs about four ounces, situated transversely across the abdomen behind the stomach, opposite the fii-st and second lumbar vertebrae. Its greater end, or head, is placed toward the right, sur- rounded by the curve of the duodenum ; the lesser end extends to the left as fiir as the spleen. Upon the posterior part of its head is a lobular fold, called the lesser pancreas. In structure the pancreas is composed of reddish-yellow polyhedral lobules, these consisting of smaller lobules, and these again composed of the ramifications of minute ducts, terminating in c3Bcal pouches. The pancreatic duct commences at the papillae on the inner surface of the duodenum by a small dilatation common to it and the ductus communis choledochus, and passes obliquely through the middle of the gland, giving oflf numerous branches to be distributed through its substance. A smaller duct, the ductus pancreaticus minus, receives the secretion of the lesser pancreas ; it generally opens into the principal duct near the duodenum, but sometimes passes into that intestine separately. Its arteries are branches of the splenic, hepatic, and superior mesen- teric ; its veins open into the splenic ; its lymphatics terminate in the lumbar glands; its nerves are filaments of the splenic plexus. THE SPLEEN. The spleen is an oblong flattened viscus, of a dark, bluish-red color, situated in the left hypochondrium. Its size and weight are variable ; its texture is exceedingly spongj', vascular, and fi'iable. Its internal surface is marked with several large irregular openings for the entrance and exit of vessels ; this is the hilus lienis. A second spleen is some- times found appended to one of the branches of the splenic artery, about the size of a hazel nut, and occasionally two and three of these bodies have been found. The spleen is profusely supplied with blood ; the splenic artery is very large in n-oportion to the bulk of the organ, and its branches are distributed to distinct sections, sparingly anastomosing with each other. The veins, by their numerous dilatations, form most of its bulk ; their blood is poured into the splenic vein, which is one of the trunks that form the portal. The lymphatics are remarkable for their number and large size, and terminate in the lymphatic glands. Its nerves are the splenic plexus, derived from the solar. The function of the spleen is unknown. Most physiologists have conjectured that it was in some way auxiliary to digestion; others, with more probability, have regarded it as a sort of brain-appendage to the organic nervous sjsten:, Tliis hypothesis is strengthened by its pecu- SPLANCHNOLOGY. 223 liar structure, which has many points of resemblance both to secernent glands and the cerebro-spinal substance ; and by the absence of an excretory duct. THE SUPRA-RENAL CAPSULES. The supra-renal capsules are two small, yellowish, flattened bodies, surmounting the kidneys, and inclining toward the vertebral column. The right is triangular in shape, the left semilunar; they are connected to the kidneys by the common cellular tissue and a fissure on the an- terior surface divides each capsule into two lobes. Both capsules rest against the curve of the diaphragm on a level with the tenth dorsal vertebra. They are larger in the foetus than in the adult, and are sup- posed to perform some function connected with embryonic life. Their stnicture is composed of cortical and medullary substances. Their arteries, derived from the aorta, renal and phrenic arteries, are remarkable for the innumerable minute twigs into which they divide before entering the capsule. The supra-renal vein, whose large ti'unk in its centre gives the capsule the appearance of a central cavity, col- lects the blood from the medullaiy venous plexus, and receiving several branches which pierce the cortical layer, opens directly into the vena cava on the right side, and into the renal vein oh the left. Their lymphatics are large and numerous, and terminate in lumbar glands. The nerves are derived fi'om the phrenic plexus. THE KIDNEYS. The secreting organs of the urine are situated in the lumbar regions, behind the peritoneum, and on each side of the vertebral column, which their upper extremities approach. Each kidney is between four and five inches long, two and a half broad, about an inch thick, weighing from three to five ounces. The right kidney is somewhat lower than the left, from the position of the liver ; the left is covered in front by the gi-eat end of the stomach and the spleen. The structure of the kidney is dense and fragile, and when divided presents an external, vascular, or cortical, and an internal, tubular, or medullary substance. The tubular portion is formed of pale-reddish conical masses, and the vascular portion of blood-vessels and plexiform convolutions of uriniferous tubuli, which not only constitute the surface, but dip between the cones and surround them nearly to their apices. The cones, or pyramids, ai"e composed of minute straight tubuli uriniferi, of a diameter not exceeding that of a fine hair, which com- mence at the apices of the cones, and bifurcate from point to point toward the circumference of the kidney. 224 ANATOMY SECTION OF THE KIDNEY. Fig. 117. Fig, 117 is a eection of the kidney surmounted by the suprarenal capsule ; the swellings on the surface mark its original constitution in distinct lobes. 1. Supra-renal capsulo. 2. Vascular portion. 3, 3. Tubular portion, consisting of cones. 4, 4. Two of the papillae project- ing into their corresponding calices. 5, 5, 5. The three int'undibula ; the middle 5 is situated in the mouth of a calyx. 6. Pelvis. 7. Ureter. In tlie cortical portion are contained a multitude of very small, jeJ, globular bodies, culled glomeruli, or corpora ATaljjighiana, each of 's^bich is composed of a plexus of capillary vessels, and a coil of uriniferous tu- bule, both enclosed in a thin membranous capsule. The cones of the interior are in- vested by mucous membra "»«, which is con- tinuous at their apices with the uriniferous tubuli, and is reflected fi-ora their sides so as to form around each a cup-like pouch, or calyx. The calices commu- nicate with a common cavity of large size at each exti-emity and in the middle, and three cavities, called the infundibula, unite and form a membranous sac, which occupies the hilus reualis, the pelvis of th% kidney. The excretory duct of the kidney is called ureter ; it is a membranous tube about as large as a goose-quill, and nearly eighteen inches long ; it is situated behind the peritoneum, crossed by the spermatic vessels, and in its course downward crosses the common iliac artery and vein, and then the external iliac vessels ; within the pelvis it crosses the umbilical artery and vas deferens in the male, and the upper part of the vagina in the female, and terminates upon the internal surface of the bladder. Sometimes there are t^vo ureters to one kidney. Mr. Bowman, who has investigated the intimate sti'ucture of the ividneys, thinks there are tv\'-o distinct sj'stems of capillary vessels, through both of which the blood passes in its course from the arteries into the veins, and that certain saline substances and morbid products, as sugar and albumen, which escape from the system through the urine, and also the principal constituents of urine, such as urea, lithic acid, etc., are, Hke the bile in the liver, derived from venous blood. THE PELVIC VISCERA. The cavity of the pelvis is the lower portion of the abdominal cavity; it is included within the bon^s of the pelvis, below the level of the linea-ilio-pectinea and the pre nonto:y of the sacrum. The male pel- SPLANCHNOLOGY 22» Tic viscera are the urinaiy bladder, prostate gland, vesicula seminales, and rectum. The bladder is an ovoid-oblong membranous sac, situated behind the ossa pubis and in front of the rectum. Its middle portion is called the body ; its upper segment tlie fundus ; its broad surface resting on the rectum, the bise ; and the naiTt w constricted portion against the prostate glimd, the neck. It is composed of serous, muscular, and mucous coats ; the muscular coat is composed of longitudinal fibres externally, and an internal layer of transverse and oblique fibres, so arranged as to diminish the diame- ter of the viscus in all directions in the expulsion of its contents ; a ring of elastic tissue surrounds the urethra within the prostate gland, to which the longitudinal fibres are attached, whose contraction en- larges the passage from the bladder into the urethra. Upon the inter* nal surface of its base is a pale triangular plane, called trigonum vest- cale, the most sensitive portion of the bladder, and occasioning great suffering when pressed upon by calculi. At the enti'ance of the urethra there is a slight elevation of the mucous membrane, called vvula vesiccE. It is retained in its place by seven true ligaments ; two anterior, formed by the pelvic fascia; two lateral, formed by a reflec- tion of the pelvic fascia and jevatores ani muscles upon the sides of its base ; two umbilical, the fibrous cords resulting fi'om the obliteration of the umbilical arteries of the fcetus ; the urachus, a small fibrous cord, formed by the obliteration of a tubular canal existing in embryo, at- tache! I to the apex of the bladder, and thence ascending to the umbili- cus; and four false ligaments, v.diich are folds of peritoneum, the two lateral corresponding with the passage of the vasa deferentia from the sides of the bladder to the internal abdominal rings, and the two poste- rior with the course of the umbilical arteries to its fundus. The external surface of the bladder corresponding with the trigonum is triangular, and separated from the rectum merely by a thin layer of fibrous membrane, the recto-vesical fascia. It is through this space, bounded behind by the recto-vesical fold of peritoneum, and on each side by the vas deferens and vesicula sejninalis, which converge al- most to a point at the base of the prostate gland, that the opening is made in the recto-vesical operation for puncturing the bladder. The prostate gland is situated in front ol the neck, of the bladder, and upon the rectum, through which it may be felt with the finger, fcraiu takes cognizance ; yet they have an impressibility or a feeling of their own. To illusti'ate : the brain does not feel food in the stomach, nor blood in the heart, nor air in the lungs, nor bile in the liver, yet their presence is recognized or felt by the organic nerves. These nerves, too, have their little brains, or special centres, which serve to supply the nervo-electric influence to particular parts and organs, and connect the whole together in close sympathetic functional relations. The semilunar ganglion may be considered as the pi'esiding centi'e, or great brain, and the other ganglia the central points, or lilfle brains of the nutritive S3'stem. In the lowest orders of animals the nutritive or organic system is concentered in a single straight nervous cord, which performs all tho functions of those animals, as the brain, which belongs to a higher gi-ado of being, does not exist. It is stated as a remarkable circumstance, that those animals which have no brain are also destitute of a spleen or melt. This fact s,trongly favors the hypothesis that the principal func- tion of the spleen is to supply the organic nerves with an additional laboratory of their peculiar electrical or other power or influence. The organic nerves evidently derive 'their nourishment and support, as well as the principle or element by which they operate to control and regulate the organic functions, in a great measure directly from the arteries, for which purpose their filaments penetrate the arterial coats, and spread out on their internal surfaces. The superaddition of a brain in the higher animals seems to demand an additional source or organic nervous power, for the special purpose of its development and support. And for this purpose the spleen, by its large provision of arterial bloo ^ , and absence of an excretory duct, seems well adapted. The organic nerves are connected with the cerebral by frequent anastomoses, which circumstance accounts for the reciprocal influence between mental impressions and bodily affections. The Motort Nervous System. — AH the nerves of voluntary motion originate from the brain and spinal marrow. In a perfectly healthy state of the whole organism, they are completely under the con- trol of the will. In various spasmodic and convulsive diseases, this rela- tion is for a time nearly or quite destroyed. The motor nerres are 1—21 242 PHYSIOLOGY distributed to every muscular fibre in the body, and fire the instruments through which the mcnta. impulse is communicated to the muscles. All voluntary action is the motion produced by the conti'aclion of the muscular fibres in obedience to the volition or decision of the miu I, conveyed to the muscles by the motory system of nerves. The Sentiknt Nervous System. — The nerves of sensation like those of voluntary motion, are said to originate from the brain and spinal maiTow. They are the instiuments of communication from the external world to the brain, being the media of the external senses — seeing, hearing, tasting, smelling, and feeling. Thus the optic nerve conveys to the brain impressions of light ; the auditory, of sound ; the gustatory, of savors ; the olfactory, of o l«vs ; and the nerves, of touch, distributed to all parts of the body whic i are endowed with sensibility, convey impressions of the chemical or mechanical properties of bodies, as heat, cold, form, size, density, pressure, etc. Each nerve of a special sense is endowed with a modification of the general sense of feeling peculiar to and inherent in itself; for under no circumstances can the ear feel the impression of light, the eye of sound, or the skin of odors. The Reflex Nervous System. — The spinsri cord is regarded as a conveyer of nei*vous influence to and fi-om the brain, and also as a* originator of nervous influence. When the spinal cord is divided c severely injured, the motor nerves' given off hetow the injured point d not resjjond to the volition ti'ansmitted from the brain, while all th*» nerves a-bove that point are under the influence of the brain. The im^ pressions on the sensitive nerves are not propagated to the sensoriu»i from below, but are from above the injured poijit. The sj)inal cord is divided into t^vo lateral halves, and each of these mto an anterior, middle, and posterior column, coiresponding probably to the sensory, motor, and organic nerves. The anterior root of the spinal nerves is the motor or efferent root, which conveys impressions from the brain ; the posterior is the sensory or afferent root, which con- veys impressions to the brain. A part of the fibres of both roots are unconnected with the brain, having their origui in the gi-ay matter of the spinal cord. These fibres are supposed to form a distinct nei'vous circle, and they constitute the system to which those actions are due, called rejicx. All spasmodic or con^'ulsive movements of the body are considered examples of exti'eme reflex action : the producing causes of them may be seated in the spiual cord itself, then called centric irri- tation, or at a distance, the irritntion of which is transmitted to the THE TISSUES. 243 cord, called concentric irritation. Reflex motions are those muscular actions or contractions which take place in consequence of impressions conveyed to the spinal cord by the afferent nerves, and reflected from them by the efferent nerves. A spinal nerve contains a bundle of sensory fibres passing upward to the brain ; a motor set, conveying the influence of volition from the brain ; an excitor set, or centripetal fibres, terminating in the true spinal cord, or ganglion, and conveying impressions to it ; and a motor set, or centi-ifugal fibres, arising from the true spinal cord, and convey- ing the motor influence reflected from it to the muscles. The last two named sets of fibres, with the gi'ay matter in the centime of tKe cord, constitute the reflex system. Fig. 125 is a diagram of the origins and terminations of the different groups of nervous fibres, a, a. Vesicular substance of the spinal cord, b, b. Vesicular sub- stance of the brain, e. Vesicular substance at' the commencement of the afferent, which consists of c 1, the sensory nerve passing to the brain, and s 1, ice spinal division, or excitor nerve, which termi- nates in the vesicular substance of the spinal cord. On the other side is the efferent or motor nerve, consisting of two divisions, c 2, the cerebral portion convey- ing voluntary motion, and s 2, the spinal division conveying reflex motion. The medulla oblongata has the GROUPS OF NERVOUS FIBRES. general properties of the spinal cord, and associates the cord and brain in functiona. qualities. Its power of reflexion is considered higher than that of any other part of the nervous system, irritation of it exciting convulsions in the whole trunk of the body. Respiration, deglutition, and those rhythmical actions of the respiratory system, laughing, yawning, sighing, etc., de- pend upon it. It is supposed also to be the seat, in whole or in part, of the power of voluntary motion. The Mental Nervous System. — The surface of the brain is arranged in various convolutions, which constitute the phrenological organs of the prevailing system of mental philosophy. These convolu- tions bear a close relation to the general mental capacity, being more numerous and prominent in persons whose minds have been well- developed by exercise, while in those whose brains have been exer- cised but little they are much less complex, and in idiots exceedingly lU PHYSIOLOGY. limited. The object of these convolutions is to afford an extensive surface for the gray or vesicuhir matter which generates the nervous power, and a more free communication between the blood-vessels on one side, which supply the materials of nei'vous influence, and the numerous fibres on the other side, which propagate their influence to the muscles. The brain and spinal cord are divided by a mesial line into equal right and left halves or hemispheres ; hence all the mental organs are double, as are also the sentient and motor nerves, which convey impres- sions to and from them. AU pliysiologists agi'ee that the cerebrum is the seat of intelligence This part of the brain composes about six sevenths of the whole ence- phalon, and usually weighs from thhty-six to forty-six ounces. Phre- nologians regard it as the seat of all the mental powers, except ama- tiveness, whose organ is the cerebellum, which constitutes about one seventh part of the brain. It has been objected to the cerebellum being the organ of sexual impulse, that its development in the scale of animals bears no relation to the energy of the sexual propensity. But animals ai'e created with reference to the ch'cumstances in which they are to be placed ; and, although size is a measure of power, other things being equal, there is, doubtless, as much in quality as in bulk of organization ; and in those cases whei-e the passion of amativeness has existed in connection with a partial or total absence of the organ — the force of habit, the exercise of the organ, or transmitted organic sus- ceptibility, may explain the apparent exceptions to general experience. That the cerebellum is also a generator of nei'vous influence to the muscles of locomotion, seems to be established fi-om experiments on animals. When the organ was removed, although sensibility in any part was never desti'oyed, the animals lost the power of standing, walking, springing, flying, etc. The whole brain, though the seat of sensibility, is itself wholly in- sensible. Any part of it may be cut, pricked, torn, or removed, with- out exciting pain. Animals from whom the cerebrum was removed always lost the senses of sight, hearing, taste, and smell, and appeared as if in a deep sleep, without the power of dreaming ; they could, however, be aroused to unconscious motions by irritations operating through the sense of feeling. These facts prove that it is not only the seat of most of the mental functions, but possesses the power of directing the mind to particular sensorial impressions. PiiiLOSOPiii cr Mind. — The brain is the presiding centre of senaa- THE TISSUES. 24S tion, voluntary motion, the inte'Jectua faculties, and the passions or propensities. The mind is the aggregate of all the functions of the brain. A mental power is the function of a particular organ or portion of the brain. All the mental power? may be distinguished into facul- ties and propensities. The faculties together constitute the intellect. They are the pow- ers concerned in thought the fi;imation of ideas, the acquisition of knowledge, the thinking and knowing part of the mind. The faculties are divided into perceptive and reflective. The perceptives take cog- nizance of individual things and their mechanical properties. The reflectives arrange, compare, and analyze subjects, and ti'ace out their relations of cause and effect. The perceptive faculties are the func- tions of the observing organs ; the reflectiye faculties are the powers if the reasoning organs. The propensities are the feeling organs; they are the impulses, emotions, or passions which impel to action. To gratify these feel- ings or propensities the intellectual faculties devise means, seek*out ob- jects, study methods. The external or special senses, seeing, hearing, smelling, tasting, and feeling, are the media through which the faculties operate in their natural or normal condition. But they are capable of acting independently of the external senses in certain abnormal states, as in somnambulism, dreaming, mesmerism, and claii-voyance. When the faculties have discerned the object, or ascertained the manner of satisfying the impulse or propensity, the will determines its instra- mentalities — the bodily structures, to act in relation to its possession or enjoyment. The propensities which relate merely to individual pres- ervation are called selfish, or self-relative ; those which pertain to the family chcle, domestic ; those which connect us in mutual interests and sympathetic relations with our fellow-creatures, social ; the higher plane of propensities, which relate to rules of action, conscience, and a Supreme Being, are termed moral qualities or sentiments; and those propensities most nearly allied in location and association with the fac- ulties are called semi-intellectual. Mind then appears to us as " duality in unity," consisting essentially of faculties and feelings — in other woids, affections and thoughts. It is not difficult to imagine that the affectuous mind is the primitive mental property ; first in order, highest oi most interior in existence, and, to extend the idea poetically, more nearly " allied To angels on our better side." All true happimss consists in ri'rht feeling ; (hindng is but a means 246 PHYSIOLOGY. to it. Tlie healthful exercise of all the mental powers is the perfect coDclition of right feeling ; and the normal play of all the bodily func- tions is indispensable to this healthful exercise of the mental powers. It is, therefore, literally true that health of body and health of mind is happiness. The mind, however, must not be confounded with the soul. Mind may be defined as the manifestation of the soul or spirit through the material organism. The Nervous Influence. — The essential natui'e of that power, principle, or influence, wdiich endows the nervous tissue with its pecu- liai- properties has always been a theme of interesting speculation. The most ancient doctrine was that of the circulation of a fluid through the tubes of the nervous fibres ; but at length the tubes were found not to be hollow. The next theory was that of vibration : it was sup- posed that the nerves conveyed impressions from one extremity to the other by a vibratory motion analogous to a stringed insti'ument ; but this doctrine was abandoned on discovering that the nerves, instead of being attached firmly at their exti'emities, are diflTused into a soft, pulpy mass. The prevalent opinion now is, that the source of nervous power is some modification of electi'icity. The identity, however, of the nervous influence wnth electi'icity, galvanism, or magnetism, as manifested by any sti-ucture or material other than the nervous tissue, is positively disproved. It has been ascertained that if a ligature be placed upon a nerve, its power of conducting the true nervous or func- tional influence is lost, while its ability to transmit electrical cm'rents remains. In the present state of physiological science, therefore, we can only say that the nervous influence, the sensibilit}'' of the nervous tissue, the contractility of the muscular, and the elasticity of the areolar, are each vited properties peculiar to, and developed in, the organization of the Bti-uctures to which they appertain ; and there is not much proba- bility that we shall ever arrive at any better explanation. What they are exactly and essentially we can no more demonstrate than we can the essential nature of oxygen, electricity, magnetism, or any other ele- mentary substance or principle ; nor would we be benefited if we could. Rationale of Muscular Action. — The voluntary muscles are disposed in sets, which are said to antagonize each other ; these sets are called flexors, extensors, adductors, abductors, etc., as they draw the part to which they are attached forward, backward, inward, out- ward, etc. Thus, where the flexors contract they close the fingers, THE TISSUES. 247 draw up the arms, bend the legs, stc. ; and the extensors, by contract- ing, open the fingers, extend the arm, straighten the leg, etc. The common opinion has long been, that when the "nervous energy, or mfluence of the brain, is transmitted to one set of muscular fibres — the flexors, for example — they contract, while the other, or antag- onizing muscles, remain passive, by which flexion is produced ; and that when the nervous influence is directed to the opposing, or exten- sor muscles, these contract, and the flexors remain passive, by which means the contrary motion, extension, results. But such cannot be the correct theory of muscular motion. Experi- ments seem to have demonstiuted that when the nerves which supply either the flexor or extensor muscles are divided, neither will act or contract at all. From this it appears that neither set can act independ- ently, and that the antagonizing muscles, as they are called, do really act in correspondence ; the same neiTous influence which produces contraction in one set, producing relaxation or expansion in the other. We must, then, regard muscular action, which is performed by the alternate conti-action and expansion of the muscular fibres — analogous to electi'ical atti'action and repulsion in inorganic matter — not as de- pending on two principles of influence, or on one principle alternately bestowed and withdi'awn, but as resulting from two properties of one principle operating simultaneously. The same law of motions appears to prevail with regard to the in- voluntary muscles ; but theh* stracture and arrangement are so difierent that its operation is more difficultly ti'aced. Instead of ruiming in straight lines, their fibres extend in parallel, transverse, diagonal, and circular directions, thereby embracing the part, organ, or vessel, so as to produce a complicated series of motions at the same time, as in the stomach bowels, bladder, and uterus, where a kind of universal compression on the contents of their cavities results from the varied directions and motions of their fibres. The strength and rapidity of muscular action are well illustrated in the feats performed by tumblers, jugglers, and dancers, and the articu- lations of spoken language. Some persons can pronounce 1500 letters in a minute, each requiring a separate contraction of muscular fibres, followed by a relaxation of equal length ; so that each contraction must have occurred in one tenth of a second. Mesmeric Phenomena. — Those manifestations of peculiar abnormal states and operations 3f the mental nervous system, known as dreams, somnambulism, second sight, mesmerism, clairvoyance, etc., deserve a passing notice. The sum total of these phenomena has been called 248 PHYSI0L0G7 mesmerism, pathetism, electrical psychology, or electi-o-biology, etc. The fact that the mind can and does take coguizance of things — some- times real and sometimes imaginary — while io the state or condition termed mesmeric, which it cannot and does not in its ordinary state or condition, is unquestionable. The explanation is not so apparent. It is a self-evident proposition that the human mind is created with constitutional relations to all objects in external nature — in the universe. All surrounding objects, without regard to direction or distance, may and do hold a specific relation to the mind, in other words, act upon, or impress, or hold communication with it. The special senses — seeing, hearing, tasting, smelling, and feeling — are the media of the correspond- ence between mind and surrounding objects, in the usual, ordinary, or normal state. But if the brain and nervous system are functionally exalted, rendered peculiarly impressible, while the special senses aro in the ordiuaiy functional condition, the mind will have a larger field of perceptions, a gi'eater capacity to form ideas, whether correctly or incorrectly. If the bi-ain and nervous system maintain, by any unusual internal or external exciting cause, the normally active condition, while the external or special senses ai'e at rest — inactive or insusceptible — the same increased mental capacity to feel the impressions of distant objects, form ideas, etc., results. And if the brain and nervous system ai*e under the abnormal influence which preternaturally augments their functions, while the external senses ai'e not merely in a state of normal repose, but of profound and preternatural rest — abnormally insuscepti- ble — then the objects at a very gi'eat distance, or in a direction which could not be seen, feJt, heaixi, etc., in the normal state, or through the external senses, impress the mind, and are distinctly recognized. In this state, too, the mind takes greater or less cognizance of the thoughts of other minds with which it is brought into close sympathetic relations, and echoes very accurately the thoughts or opinions of such minds. In this way clairvoyants answer with surprising correctness many questions, their answers ^eing simply the reflection of the minds, thoughts, or opinions of the operator, or manipulator, or of the person placed in communication. But many times the attention of the mesmerize e or clairvoj-ant is directed to places, objects, and persons at great distances, hundreds or thousands of miles, wheir they discover and describe many things as they really exist, and others which have no reality at all. These phe- nomena prove that the mental field of vision may be vastly extended, but that its abnormal or preternatural state does not render its impres- sions reliable as exclusive sources of information; the ever-varying states of the nervous susceptibility n:iy render the cognizance of THE TISSUES. 249 objects in the abnormal state just as variable in regard to reality or fantasy. Some persons have an organization peculiarly favorable to the mani testation of the phenomena in question, and others are capable of ac quii'ing a great degree of mesmeric susceptibility, so much so as to pass into the clau'voyant state at will, and then survey with interior vision many things in heaven and earth as they really exist, or revel in dream- land, as imagination leads off in the mental operations. The phenomena more strictly physiological, and tho?e effects on the nervous influence which have been made available as remedial pro- cesses in disease, may all be accounted fov on the principles of mental sympathy and electrical or magnetic innervation. A strongly magnetic, powerfully electric, or in other words, vigorously healthy person, may rapidly manufacture nervous influence, and readily impart it to another of more susceptible temperament, or in feeble health. The hand and fingers are exquisitely organized for receiving and transmitting a large amount of nervous influence, and gentle manipulations are the best ways of imparting it. The exercise of weak, torpid, and rigid muscles, .»y rubbing, kneading, thumping, etc., is remedial, or innervating, or magnetically medicinal, very much in the ratio of the capacity of the vital organism, and the development of the organic or nutritive nerves and ganglia of the operator. Order of Structural Development. — From minute vesicles or cells, having as a nucleus a small round body of matter, surrounded by a granular fluid, and enclosed in a thin membrane, all the structures are developed. The ovum and the embryo are originally composed of such nucleated cells. Some cells are independent of and isolated from each other, as the corpuscles of the blood, chyle, and lymph ; others cohere by their surfaces and borders, as in the epidermis, or scai'f-skin; others are connected by an intermediate substance, as bone and cartilage ; and others are united in rows, forming hollow tubes, capillary vessels, and the tubuli of nerves and muscles. The first distinct sti'ucture developed in the human body is that of the nerves of organic life. The necessity of this is apparent, as they constitute the presiding centre and conti'oUing instruments over all the functions of nutrition and gi'owth. They form not only a general centre to the whole organic system, but by means of their ganglia supply each particular part organ, and function with a special presiding centre. These ganglia appear like mere enlargements of the nervous cord, and ai'e numerously distributed throughout the body, according to the importa.nce and complexit;^' of the functions to which they specially 250 PHYSIOLOGY, appertain. They serve undoubtedly to collect, dii-ect, n odify, regulate, and aiJapt the nervous influence to the functional condition of the various organs, and constitute, in one sense, so many points of polarity to its attractive and repellent properties. Next in order, as second in functional importance, the heart and muscular system are produced, followed by blood-vessels gradually ex- tending and enlai-ging till the vascular system is completed. The nutritive or organic nerves intimately accompany the arteries from their ganglia, and send off branches to aid in the development and preside over the nourishment of particuhu* organs, to which they hold Lhe same relation that the brain does to the voluntary muscles. The ganglia which form the subordinate centimes to the alimentary canal are the first ones produced from the increasing development of the organic nerves. Soon on each side of the central mass of the nutri- tive nervous substance numerous ganglia, or little hrains, arise, in the shape of two connected nervous cords, and eventually form, on each side of the spinal column, a series of ganglia extending the whole length of the spine. These ganglia send out branches of nerves to the several special centres, to unite them in associated action ; to the muscles, and to those branches of the other ganglia which are sent to the viscera, and contribute to the development of the spine, trunk, and extremities. The gi'eat centime of the organic system, the semilunar ganglion, con- sists of the two semicircular bodies behind the pit of the stomach; they are closely connected by branches passing fi-om one to the other, w4iich fonn the solar plexus. To this general centre the numerous special centres are united by nervous cords and plexuses. Death takes place vf the functions of this system of nerves be suspended but for a moment. With the increasing formation of the ganglionic centime the alimentary organs are developed ; the stomach, intestines, pancreas, etc., follow^ed by the excretory organs, the liver, kidneys, and skin. Lastly are de- veloped the lungs, spleen, brain, and spinal maiTow, the membranes, bones, ligaments, and cartilages, terminating in the hair, nails, and ppiderrais. CHAPTER II. OF THE SPECIAL SENSES. Sensation is the recjgnition by the mind of. an impression. That part of the brain, oj- rather quality', which perceives impressions is often THE SPECIAL SENSES. 251 calUid the sensorium. Sensations are distinguished into external and internal. External sensations arise from impressions made upon the outer surface of the body, as the eye, nose, mouth, ear, and skin, which are the organs of the external or special senses. Internal sensations have their causes within the body, and arise from functional conditions, as hunger, thirst, suffocation. An active capillary circulation is essential to the normal sensibility of a part. If the blood is excluded from the capillary vessels by severe co.d, the sensibility is deadened ; and if the vessels are over-distended, as in inflammation, the sensibility becomes painful. General sensibility is distributed over the entire body, enabling us to feel those impressions of surrounding objects which produce the various modifications of pain and pleasure. Special sensibility pertains to those organs which connect the mind with the physical world, and by which the mind is educated. The nerves of special sensation have no general sensibility except what is derived from nerves of general sensibility distributed to them. Sense of Touch. — The nerves of feeling ai-e the posterior roots of the spinal nerves, and some fibres of the fifth and eighth pairs r cerebral nerves. They are distributed to the pjcr. 12(5. papillae of the skin, which are small eleva- tions enclosing loops of blood-vessels and branches of sensory nerves, situated on the external surface of the cutis vera. , Fig. 126 is a representation of the papillge of the palm ^-^-^-c^c^— — T^.,"-''*- of the hand, the cuticle bein"; removed. CUTANEOUS PAPILLA. When a body to be touched comes in contact with the sensory sur- face, the only idea communicated to the mind is that of resistance. The degree of resistance affords a knowledge of the hardness or soft- ness of the body. When the body touched and the sensory surface are moved upon each other, a motion is conceived of extension or space, roughness, smoothness, and other mechanical properties. The knowledge of form and weight some late physiologists have been unable to account for by the ordinary sense of touch, and have got out of the difficulty by supposing a sixth sense, which they call the muscular sense, to exist for that particular purpose. The sense of tem- perature has also been atti'ibuted to a distinct set of nerves, because the recognition of it occurred without the actual contact of the hot or cold body with the sensory surface. I do not see that either supposition makes the matter any clearer. Form and w^eight are but degrees of extension and resistance, and temperature, whether its essential nature 252 P I Y S 1 L «. G r. is caloric, light, or electricity, is but the perception of rays or particles coming in contact with the sensory surface, and expanding or conti-act- ing, that is to say, moving the conli-actile tissues so as to imjiress the nervous papillfe. The sense of touch is developed in different parts in proportion to the supply of sensory nerves. In man the acuteness of the sense varies in different regions of the body. The lips, tip of the tongue, and inside of the last joints of the fingers are exquisitely sensitive, in consequence of the nerves being very numerous and superficially dis- ti'ibuted. The epidermis is also very thin in tliose paits, and the innumerable lines and furrows afford the papilla3 a greater degi'ee of isolation. The development of the sense corresponds with the number and extent of these lines and furrows. The sense of touch, like nil the special senses, may be educated to a surprising degi-ee of acuteness and accuracy, as with the Wind, who have been taught to read and even distinguish colors by it. Sense of Taste. — The various papillae on the surface of the tongue, when excited by contact with savory substances become turgid and erect, so as to produce considerable roughness of the organ. Some of the papillae, the filiform particularly, ai'e supposed to be concerned in the common s-ensibility or feeling of the tongue, and the remainder are regai'ded as exclusively pertaining to the sense of taste. Solubility of the matter brought in contact with the tongue is a necessary condition of taste. The sense may also be excited by me- chanical or chemical irritation of the nerves. A smart blow by the finger, or a galvanic shock, ^vill often excite the taste, which is then sometimes acid and sometimes alkaline. As sapid substances impress the olfactory as well as the gustatory nerves, the sense of taste is gen- erally materially diminished when the nose is obstructed. Taste, like all the special senses, is highly educable, but in civilized life is generally deeply depraved and perverted. Its object in the ani- mal economy is to dire ft us in the selection of aliment;uy substances, ind assists us in judging of their adaptation to the wants of the nutritive apparatus. The ability to ai)preciate and enjoy the gustatory jH'operty of natural and hcaWiful food is exactly proportioned to the integrity of the sense ; and those pei-sons who cannot realize any agreeable savor in any article of nutriment until the papillae of the tongue are stung into action by salt, pe])per, mustard, vinegar, or other pungents, know but little of the bountiful and luxurious repast nature hns pro- vided for her unsophisticated children, or of the real pleasures of eat- ing. Like the drunkard, who svnpHows the burning poison of alcohol THE SPECIAL SEXSJIS. 258 not for the mere pleasure of drinking, but tt drown or appease a mad- dening and insatiable craving, the epicure or riotous liver eats not to enjoy or live, so much as to silence the goadings of a morbid appetite. Sense of Smell. — Olfaction enables us to distinguish flavor, and thereby judge of the odorous particles floating in the atmosphere. Its use is to co-operate with taste in determining the qualities of food, and protect the respiratory passages by detecting injurious effluvia or other deleterious matters. Its seat is the mucous membrane of the nose, though the whole of the raucous surface is not endowed with the sense of smell. The upper portion of the membrane, expanded over the superior and part of the middle spongy bones, is the olfactoiy region, to which the olfactory nerve is distributed. Sneezing, which is called a reflex action, is sujoposed to depend on the fifth pair of nerves, from which is derived the general sensibility of the mucous membrane. The conditions requisite for the perfect exercise of this sen?e are, integrity of the nervous apparatus, and a normal degree of special sensibility. The odorous particles must also be soluble. Colds, in- flammation of the mucous surface, strong irritants and narcotics, as cephalic or tobacco snuff", always weaken or paralyze, and sometimes utterly destroy all perception of odors. Smelling-bottles of ammonia and camphor, and all sti'ong and pungent perfumery, not only injure the sense, but injuriously affect the whole brain through the medium of this sense. Sense of Hearing. — No part of the human organization exhibits a greater complexity of structure than the hearing apparatus. Nor will it excite wonder that it is so, when we consider how extensively hu- man beings ai'e related to the external world and to each other, in their duties, their interests, and their pleasures, by this function. The ex- ternal ear is fashioned into various elevations, depressions, and curva- tures, peculiarly fitted to catch the sonorous waves fi-om all directions. The external ineafus conveys them, strengthened by reflection from the walls of the canal, and modified by the resonance of the mass it encloses, to the memhrana tynvpani. This membrane is not essential to sound, for its perforation or desti'uction is not followed by a loss of the sense ; but it serves to modify the sonorous vibrations which are to be commu- nicated to the chain of bones, in such a manner as to be thrown into reciprocal vibration, though it cannot reciprocate any sound lower than its own fundamental note. The chain of hones, moved by their muscles, conducts the vibrations across the tympanum to the internal ear. The tensor tympani, in the 22 254 PHYSIOLOGY function of hearing, performs an office analogous to that of the his in seeing. Its contraction draws down the handle of the malleus, render- ing the membrana tympani tense. When very tense it cannot recipro- cate low sounds, and by veri/ loud sounds it may be excited to reflection, IH which state the membrane is too tense to reciprocate them. Its natural condition is rather lax, the slate in which it c single vision with two eyes as a result of the rays of light from a luminous object falling upon parts of the retinfe accustomed to Fig. 129. act together. OPTIC CHIASM. Fig. 129 is a representation ot the course of the fibres of the optic nerve in the chiasm, a. Anterior fibres, commisural be- tween the t^To retinse. p. Pos- terior fibres, commisural between the thalami, or origin of the optic nerves, a.' p.' Diagram of the preceding. The essential pai'ts of the eye are, the expansion of the optic nerve, called retina, which feels the impressions of light, and the transparent refracting media, or humors of the eye, which transmit the light so as to bring it to a focus upon the retina. The sclerotic forms a firm sun- port to the globe, and is opake, except in front, where it becon s transparent for the admission of the rays of light, and is called cornt i. The dark pigment called choroid, between the sclerotic and retina, ab- sorbs the raj-s of light after they have impressed the retina. I'lie choroid becomes gradually hghter in many people as they advance in life, and in the Albino it is entirely wanting. The iris is a vertical curtain-like process of the choroid, hanging across the cavity of the aqueous humor, and its centi'al perforation is the pupil. The conti-ac- tion and relaxation of the circular fibres surrounding the orifice of the pupil, as the rays of light are sti'onger or weaker, regulate the impres- sion on the nei-vous expansion. When the iris becomes insensible or weakened, the pupil remains permanently dilated and vision dull, as VOICE AND SPEECH. 25i in affections of tlie optic nerve, compression of the brain, etc. The iria is also weakened and the pupil dilated by being continued too long in dark or deeply shaded situations. The pure narcotics, belladona, hen- bane, etc., cause a dilatation of the pupil by paralyzing the nervous in- fluence. Under exposure to very strong light, and in acute inflamma- tory affections of the brain the pupil is i-eix^n-kably contracted; and also during the stage of excitement, v/hen the brain is jaboring under the influence of the stimulating nju'cotics, as opium, camphor, and alcohol. The adaptation of the eye to distances is a phenomenon not yet very well explained. Some physiologists consider it as entirely the result of habit or education, while others s'ippose the perception of a distinct image, whether the object be lar or near, is owing to an altered posi- tion of the crystalline lens by muscular agency — an opinion strength- ened by the fact, that the adjusting power of the eye is impaired or lost by the extraction of the lens, or by paralyzing the muscles of the ciliary processes and iris with belladona. The question has been much discussed, why objects appear erect to us, when it is known that the rays of light fi'om the opposite points of a luminous object cross one another by the successive refi-actions they experience, and thus make the image on the retina actually inverted ? But no satisfactory solution has yet been offered, and many regard the phenomenon as the result of education and experience. CHAPTER III. OF VOICE AND SPEECH. Voice is formed in the larynx, and is produced by the simple expul- sion of air from the lungs, when the vocal ligaments or cords are held in a certain degree of tension. Nearly all animals possess the power of making voice-sounds. Singing, crying, and yelling are examples. Speech is the modification of voice-sounds in the cavity of the mouth, constituting articulation. The articulating organs are the tongue, palate, lips, and teeth. The fauces and cavities of the nose modify and intensify both voice and articulate sounds by affording a resonant surface. Speech in perfection is a faculty peculiarly human, although many animals — the parrot and jackdaw, for examples-^are cspable of uttering words and sentences very distinctly. 258 PHYSIOLOGY All the vowels are voice-sounds, being made without any change in the shape or pi^sitiou of the vocal organs during their continuance. iS//07-^ vowel soi.nds are distinguished from those termed long, hroad, grave, and close, by the impossibility of prolonging them for any appre- ciable length of time. The others can be prolonged as long as expira- tion can be maintained. The consonants are articulate sounds, formed by interruptions in the vowel sounds produced by changes in the posi- tion of the vocal organs. The English Language may be reduced by analysis to forty-four nidi- meutal sounds, or elements, sixteen of which are vowels and t^venty- eight consonants. The vowel elements are : the long, short, broad, and grave sounds of a, as in ail, at, all, aJi ; the long and short sounds of e, as in ease, end ; the long and short sounds of i, as in isle, ill ; the long, short, and close sounds of o, as in old, on, move ; the long, short, and broad sounds of u, as in turn, tub, full ; and the double vowel sounds of oi or oy, in oil, coy, and ou or otv, in our, how. Diphthongs are two vowel sounds in one syllable ; the only ones in our language are long i, as in mile, and long u, as in lure, and the sounds of oi or oy, and ou or ow. Triphthongs have no existence. They are said to be the union of three vowel sounds in one syllable ; but though these vowels are often written in one syllable, one or more of them is always silent in the pronunciation, as in adieu, which is pro- nounced as if ^^a•itt€n adw. The consonant elements are : the name sound of b, as in bite ; the soft or hissing sound of c, or name sound of s, as in cent ; the hard sound of c, or name sound of k, as in cayne ; the name sound of z, as in sufjice; the sound of sh, as in ocean; the name sound of d, as in dust ; the name sound of t, as in correct ; the name sound of f, as in brief; the name sound of v, as in of; the soft sound of g, or name sound of j, as in ger7n ; the hard or guttural sound of g, as in gull ; the sound of g represented by zh, as in rouge ; the aspirate or name sound of h, as in hale ; the name sound of I, as in late ; the name Bound of m, as in 7nan ; the na?ne sound of n, as in nun ; the sound of 71 represented by ng, as in link; the name sound of jp, as in page; the smooth sound of r, as in far ; the trilled sound of r, as in rough ; the name sound of v;, as in wool; the sound of .r, represented by ks, as in Jlax; the sound of a:, represented by ^r, as in exist; the sound of y, represented by ye, as in youth ; the aspirate sound of th, as in thin ; the vocal sound of th, as in this; the sound of wh, as in whale; and the sound of ch, as ki church. In a strictly philosophically written language, each distinct element- ary sound should be represented by a distinct character, making as many VOICE AND SPEECH 25& letters as there are vocal and articulate elements. But in the English language there ai"e only twenty-six letters to nearly twice as many sounds ; and while some of the letters represent but one elementary sound, others, as a and c, represent four. The phonographic reform, therefore, is clearly founded in nature and in physiology. The vocal apparatus has been compared to various musical instm- ments, in wliich strings, tubes, and reeds are the agencies in the pro- duction of sound, as the violin, flute, and clarionet. The analogy is not very close in relation to either separately, but the vocal machinery combines many properties of them all. The lower vocal cords are mainly concerned in the production of sound; if the upper cords are removed voice continues, but is rendered feeble ; if the lower are destroyed, it is entirely lost. The tones of voice depend on the varying tension of the vocal cords. In the production of tones, the ligaments of opposite sides are brought into approaching parallelism with each other by the approximation of the points of the arytenoid cartilages ; in the intervals they are again separated, and the opening between them, rhna glottidis, assumes the form of the letter V. Fig, 130 exhibits the vocal ligaments Fig. 130. as seen superiov-ly. G, E, H. Thyroid cartilage. N, F. Arytenoid cartilages. 3, V, S, V. Vocal cords or ligaments. N, X. Crico-arytenoideus lateralis. V. k, f. Right thyro-arytenoideus. N, 1, N, 1. Crico-arytenoldei postici. B. B. Crico- arytenoid ligament. The muscles which stretch or relax the vocal ligaments are alone concerned in the voice. The muscles which open and close the glottis regulate the amount of the air inspired and expired, and belong to respha- tion. These muscles are the larynx from above. seat of spasmodic affections producing suffocation. The pitch of the tones is regulated by the tension of the vocal cords. Its volume or intensiiy depends on the capacity of the lungs, length of the trachea, and the force with which the air is expelled, and the flex- ibility of the vocal cords. In the male the vocal cords ai'e longer than in the female, in the proportion of three to two, which renders the male voice usually an octave lower 260 PHYSIOLOGY The natural compass of voice in most persoiis is two octaves, or twenty-four semitones. Singers are capable of producing ten distinct intervals between each semitone, making in all 240 intervals, requiring as many different states of tension of tne vocal cords, all of which are producible at pleasure, and without a gi-eater variation of the length of the cords than one fifth of an inch. One of the most w'onderful phenomena of vitality is the facilit} with which the will determines the exact degree of tension necessary to produce a given note, when the mind has formed a distinct conception of the tone required. A musical note is a prolonged vowel sound, and may be regarded as the natural language of emotion, or the expression of the affectuous mind. Speech is the natural expression of ideas or thoughts. These two kinds of natural language are intimately associated in the human being, so that there is music in well-spoken thoughts. Ventriloquism is simply the power of imitating the voices of others, the cries of animals, and the sounds of inanimate matter so closely as to produce a coanplete vocal illusion, making them seem to come from any distance or direction, or through any kind of media. Those who have this imitative power well developed, must possess an exti-aordinary flexibility of the whole vocal apparatus. CHAPTER IV. OF THE INDIVIDUAL FUNCTIONS. Those functions which relate exclusively to the growth, develop- ment, and preservation of the individual organism are, digestion, circu- lation, respiration, absorption, nuti-ition, secretion, and calorification. Some phj'siologists regard imiervatioyi, or the production of nervous influence, and that propeity of the tissues called endosmose and exos- mose, by which fluids and gases are interchanged through th/? structures, as distinct functions. I think, however, the term function is not properly applied to those properties or processes of the organism. Innervation literally means the existence of nervous power; its production must depend on the f)ther functions. Endosmosis and exosmosis -ire rather mechanical than vital processes, as they take place in unorganized as well as organized stmctures. THE INDIVIDU.^L FUNCTIONS. 261 Fi- 131. Fig^l31 is an ideal repi'esent- ation of the organs of digestion, opened nearly the whole length. 1. Upper jaw. 2. Lower jaw. .3. Tongue. 4. Roof of the mouth. 5. CEsophagus. G. Trachea. 7 and 8. The paro- tid and sublinguinal glands- two of the salivary glands, 9. Stomach. 10, 10. Liver. 11. Gall-cyst. 12. The duct cor veyingf the bile to the duode uum (13, 13). 14. Pancreas. 15, 15, 15, 15. Small intestine. It). Opening of the small intu the large intestine. 17, 18, 19, 20. Large intestine. 21. Spleen, 22. Upper part of the spinal column. Digestion. — The first of the organic functions is the conversion of aU- iiientaiy matter into chyle, which in its turn is converted into blood. Tiie first process of the digestive function is mas- tication, by which the food is divided into fine particles by the cutting and gi'inding action of the teeth. The presence of aliment and the act ">f mastication , excite the function of the salivary glands to secrete the sol- vent fluid called saliva, which is intimately min- gled with the particles of alimentary matter, completing the process of insalivation. The alimentary substances, comminuted and softened are then conveyed into the stomach by the act of swallowing, called deglutition. The presence of food in the stomach excites the flow of gastric juice, which is secreted from its mucous membrane. The vessels of the stomach then rec-eive a gi'eater supply of blood, and there is a slight increase of temperature. The solvent property of the gastitc juice was generaUy conjee* ired, but sometimes denied, until THE DIGESTIVE SYSTEM. 262 PHYSIOLOGY. clearly demonstrated by the experiments of Dr. Beaumont, in 1833. In consequence of a gun-shot wound in the person of Alexis St. Martin healing in such a manner as to leave an artificial opening into the stom- ach, Dr. Beaumont was enabled to inti'oduce various aliments directly into the stomach, and ascertain the chemical or solvent property of the gastric juice. The gastric juice usually manifests an acid reaction to chemical tests, but chemists do not agi-ee very well as to its actual chemical properties. According to the analysis of Professor Dunglison, it contains free muri- atic and acetic acids, phosphates and muriates of potassa, soda, magnesia^ and lime. Blondlot imputes its acidity to super-phosphate of lime, while Professor Thornton and MM. Bernard and Barseswil attribute it to the presence of lactic acid ; an acid w^hich Liebig positively denies the existence of in a healthy stomach. These diversities in the results of analyses are probably due, in some measure, to the different methods of conducting them, in part to the different proportions or kinds of saHne, alkaline, and earthy matters taken into the system with the food and drink, and in some degree to differences in the qualities or kinds of the aliments themselves. The active principle of the gasti'ic juice is called 'pepsine ; its action is analogous to tliat of a ferment, which has the power of exciting chemical changes in the particles of other substances without under- going decomposition itself. The quantity of gastric juice secreted is regulated by the wants of the system, and not by the quantity of food taken. Hence all excess of ingestion is a source of injurious imtation. Chymification is that part of the digestive process in w^hich the nuti'i- tious portion of the aliment is reduced to a pultaceous, homogeneous mass, called chyme. In addition to the solvent action of the gastric juice, chymification is aided materially by the contraction of the mus- cular coat of the stomach, whose fibres are so arranged as to diminish its diameter in all directions, and keep the food in constant motion until it is thoroughly permeated by the gastric juice, the pyloric orifice of the stomach being closed at the same time by the circular fibres acting there as a sphincter. As fast as the alimentary mass becomes chymified, it is passed along into the duodenum. The most innulritious particles of the ingesta are not rendered chymous, but are reduced to a condition enabling them to pass through the alimentary canal with facilit}', to be expelled as excrementitious matter. Hence the fallacy of the doctrine lately advanced by Dr. Edward Johnson in his works on Hydropathy, and by some other European authors, tliLt the focccs were wholly a secre- tion, an error which must have originated from observations made on THE INDIVIDUA.L FUNCTIONS. 263 persons whose diet consisted almost wholly of animal and concentrated vegetable food. In the duodenum the alimentary substance receives the pancreatic juice from the pancreas., and is there also mixed with the bile fi-om the liver. The pancreatic juice is analogous in qualities to the saliva, and assists further to attenuate and resolve the particles of chyme into the condition best adapted for conversion into chyle. Various opinions are entertained concerning the natm'e and uses of the bile. Some physiologists regard it as in part a vital secretion, and in some waj auxiliaiy to digestion. The common notion that it is found in the stomach in a healthy state is erroneous. The stomach cannot en- dure and will not tolerate it. When accidentally forced there by reversed peristaltic action, the operation of emetics, or other morbid conditions, it produces violent tremblings, spasms, and vomitings, and sometimes convulsions. Others regard the bile as a mere chemical agent in sep- arating the chyle, or nutritious part of the aliment, from the general mass of chyme ; and others still look upon it as wholly an effete or excrementitious matter. The fact that the bile is secreted from venous or impure blood, with which the liver is supplied, unlike any other organ in the body, seems to indicate that the office of the liver is to filter some of the accumu- lated impurities from the blood, before it returns to the heart, and the analyses of the bile pretty conclusively show that the liver is the depurating organ for certain combinations of effete carbon and hydrogen. Foreign substances have actually been found in the liver very soon after their reception into the stomach ; substances which can never be found in the general circulation ; a ciixumstance strongly corroborative of the opinion that the bile is, at least primarily, an excrementitious fluid. It may be, however, secondarily subservient to the economy of the di- gestive function, by mixing with the innuti'itious portion of the aliment, and lucubrating its passage, and by mingling with the oily matters, and favoring their solution by resolving them into a saponaceous mass ; and also by its alkaline properties, neutralizing any surplus acid matter. Fluids taken into the stomach are mostly absorbed fi"om it without pass- ing into the intestinal tube. When digestible solid and liquid aliments are taken into the stomach together, the aqueous portion is absorbed before the digestion of the solid matter commences ; but indigestible substances must either be violently expelled by vomiting or purging, or more quietly thrown off by the excretories. When, therefore, their impression on the stomach is not strong enough to produce violent resistance, or the organic instincts are palsied in a measure by habit, they must necessarily be abso]-bed, and pass unchanged into the circu- 2t>4 PHYSIOLOGY lation. This is the case with metallic, mineral, and many earthy, alka line, and saline matters, with all medical drugs, with alcohol iu all its forms, tobacco, and with many aiticles employed as seasonings or con- diments. Chylijication does not take place in the duodenum, for chyle itself is never found there. A still further process is required to elaborate a fluid which is to replenish the blood and supply all the structures. Another change is thersf jre effected by the lacteal absorbent vessels. The lacteals, or chyle-ducts, do not take up or absorb chyle from the alimentary tube, but form or manufacture it from the chymous m;iss ; nor does the functional action of these vessels perfect or complete the process of chylification. The finishing elaboration takes place in the viesenteric glcw.ds, numerously distributed along the course of the lacteals, and formed by their enlai'gement and convolutions. On receiving the final action of the mesenteric glands, the chyle, fitted for nutrition, passes into the thoracic duct, and thence into the general mass of blood. The innutritious portion of the food, mingled with and lucubrated by excrementitious matters in the form of bile, and such fcecal matters as are secreted by the mucous surface of the intestinal canal, are carried off by the peristaltic action of the bowels. The peristaltic motion of tne whole alimentary canal is produced by the regular, gradual con- traction of the circular muscular fibres from above downward, which motion is assisted and invigorated by the general compression on the whole surface of the abdomen produced by the free and energetic action of the external abdominal muscles. Vomiting is eftected by the reversed action of the Tiiuscular fibres, aided by the sympathetic and powerful conti-action of the abdominal muscles. Hunger and thirst., the sensations of which are refeired to the stom- ach and throat, are indications of the wants of the general system. The rather ancient doctrines that hunger was produced by gastric juice in the stomach, and thirst by a dry condition of the mucous surface of the fauces, are clearly erroneous. Both sensations are organic instincts which communicate the need of the body for solid and liquid aliment to the common sensorium. Circulation. — The circulating system -"-omprises the heart as its grand central organ; the arteries, which convey the ijlood to all parts of the body ; the capillaries, which connect the arteries and veins ; and the veins^ which return the blood to the heart. Commencing at the cenh-al point, the blood is received from all pai'ts of the venous system into the right at ride of the heart: tlie auri- THE INDIVIDUAL FUNCTIONS. 265 cle contracts, and the blood is forced into the right ventricle ; the right ventricle, contracting, sends it into the ijulmonary artery ; this artery divides into branches, which are i-araified through the substance of the lungs, and bring the blood in contact with their innumerable air cells, where it throws off its surplus cai'bon, and probably receives oxygen or electricity, becomes changed from dark or venous to fluid or arterial, and is returned through the pulmonary veins to the left auricle of the Iieart ; fi'om the left auricle it passes into the left ventricle, and from thence it passes through the arteries to all parts of the body; the valves of the veins and of the different cavities of tlie heart preventing the cur- reut from receding. The whole quantity of blood is estimated at about one fifth of the entire w^eight of the body, which is thirty pounds in a person weighing 150 pounds. The cavities of the heart hold about two ounces, three fourths of which is discharged at each contraction, and, counting sev- enty pulsations in each minute, a little more than six pounds of blood will pass through it in this time, or nearly 10,000 pounds in twenty-four hours. The whole quantity of blood probably passes through the heart once in four or five minutes. The frequency of the heart's contractions — in other words, the beats of the pulse — gi-adually diminish from the commencement to the end of life. Immediately after birth the pulsations are 100 to 130 ; in mid- dle life, 65 to 75 ; and in old age, 65 to 50. The two auricles of the heart contract simultaneously, as also do the two ventricles, the auricles and ventricles alternating with each other. The contraction of each cavity is called its systole ; the relaxation which follows, its diastole. The systole of the venti'icles corresponds with the projection of blood into the arteries, causing the imlse. The apex of the heart, being near the walls of the chest, in the neighbor- liood of the fifth and sixth ribs of the left side, communicates, by the motions of the organ, a decided shock or jarring sensation, which is called the impulse of the heart. The sounds produced by the heart's action can be readily detected^ By placing the ear on the front part of the chest, two sounds will be distinctly heard, following each other in rapid succession at each beat of the heart. These sounds are alternated with short intervals of re- pose. The first sound is the longest, and corresponds with the systole of the ventricles, the pulse in the arteries, and the impulse against the walls of the chest ; the second, which is but half as long, corresponds with the diastole of the ventricles. The first sound is dull and pro- longed •, the second is short and sharp. The first sound is produced by the rush of blood through the comparatively narrow ?.':;'J«ts of the I~23 266 PHYSIOLOGY. aorta and pulmonary artery, and its passage over the rough internal surface of the heart, aided by the muscular contraction of the ventri- cles and the heart's impulse. The second sound is evidently occa- sioned by the sudden shutting down of the semilunar valves at the orifices of the aorta and pulmonaiy ai'tery. The capillary vessels are a network of extremely minute vesselt* intermediate between the arteries and veins. This structure exists ii all organic textures. The size of the capillaries is proportioned to that of the red particles of the blood, their diameters varying from ^55^ to g^ of an inch. They are not a distinct system terminating in open mouths, but merely fine tubes by which the arteries are continued into the veins. "^ Fig. 132. Fig. 132 represents the anastomoses of the blood-vessels, which form the capinaries, as seen in the web of a frog's foot by the aid of the microscope. 1, 1. The veins. 2, 2, 2. The arteries. In the capillary vessels all the organic flinctions take place. Their oJrculation is to a great degree independent of the heart's action, and is, no doubt, influenced and regulated by the organic nerves, which preside over the functional process, and distribute the blood to the va- rious parts and organs, according to the necessities of the vital economy. The sum of th<.* diameters of all the capillary vessels greatly exveed:3 THE INDIVIDUAL FUNCTIONS. 26? that of the arteries and veins, which enables the blood in them to move elowly, and even sometimes take a retrogi'ade direction to some ex- tent, circumstances favorable to the perfect nutrition of the structures, the separation of worn-out material, and the consolidation of new. In its passage through the capillary vessels the blood loses the vivify- ing properties and fluid color it received in the lungs, and becomes dark, impure, and charged with efiete matter, resulting from the disin- tegration of the tissues. All the excrementitious or waste matters not collected into the excretory apparatuses of the several depurating or- gans, are carried along by the capillaries into the veins, to be purified in passing through the liver and lungs. Respiration. — Respiration is the function by which the blood is aerated or purified. It consists of the alternate inspiration and expiration of atmospheric air. The process of breathing has a two-fold relation to the animal economy. 1. The lungs, as depurating organs, eliminate from the blood a large proportion of the impurities and waste matters which it acquires in the capillaries, particularly its excess of carbon. 2. The lungs, as auxiliary nutritive organs, digest the inspired air, and separate, or rather form from it a principle convertible into the sub- stance of the blood. Doubtless, too, they receive and transmit to the nervous system, through the medium of the blood, a constan^ly replen- ishing stream of that electric, magnetic, or other vital property on which the nervous influence depends. The air which we ordinarily breathe, uniformly consists of about twenty-two parts of oxygen, seventy-seven of nitrogen, and one of carbonic acid gas, in one hundred. Other gaseous matters frequently exist, to a greater or less extent, in the atmosphere, from local causes, not as constituents, but as accidental admixtures, if we except ammonia, a compound of nitrogen and carbon, which appears to be ordinarily present in the proportion of one fourth of a gi-ain to about 20,800 cubic feet. The constituent proportions of the atmosphere are found not to vary perceptibly in different latitudes, nor in low or mountainous regions. The air expired fi-om the lungs is found to have lost about sixteen parts of its oxygen, and gained about fourteen per cent, of carbon. As carbonic acid contains precisely its own volume of oxygen, fourteen of the sixteen parts of oxygen lost in the lungs may he employed in converting the effete carbon into carbonic acid gas, in which state it is expelled, and the remaining two parts of oxygen may serve as nutrient material. But as carbonic acid fs found to exist already formed in the veins, and as animals placed in hydrogen or nitrogen still contin">.e iibb ^:iYsiOLOG\ to evolve carbouic acid, it appears cleai' enough that (he greater part, if not all, of the carbonic acid gas expelled from the lungs is formed in the tissues, thus leaving the gi-eater part or all of the oxygen absorbed from the inspired air to be used for other purposes than "burning up the carbon" in the lungs. This decai'bonization and oxygenation of the blood changes it from a dark purple to a bright florid color. The oxygenation of the blood does not consist of the circulation of oxygen a the blood as oxygen, but is rather a process of aeriform digestion, by which oxygen is converted into electricit)% analogous to the process of alinientaiy digestion, by which food is converted into chyle. The nitrogen, which forms so large a propoition of the air wo breathe, is sometimes increased, sometimes diminished, and at other times unchanged in quantity by respiration, which seems to prove that its absorption in or expulsion from the lungs depends on the wants of the (•rganic economy, and probably is regulated by the sufficient, excessive, ( chemistry regards as a simple element mto another. The processes by which the various changes of matter take place in the capillary system have been the subject of much chemical research and speculation in modern times. But here, as in all cases where the operations of a living principle are approached, chemistry is and must of necessity be at fault. Chemistry may reduce and refine, divide and subdivide all the forms of organic matt ">i- to their ultimate elements, or (o a certa'n set of ultimate results oi substances, by a process of de- structive nalysis. It may readily destroy the evidence of the life prin- ciple, but the chemist's skill can never recombine the elements so as to restore or reproduce the manifestation of vitality. All attempts, therefore, to explain the phenomena of life by the demonstration of chemical problems, are to be regarded only in the sense of analogies. Experiments have shown that saline ingi-edients, dissolved in water may be decomposed by an electric sti'eam. If a solution of salts be placed in a glass tube having a membranous covering at its extremities, an electric current will not only separate their constituent elements, but deposit some of them on the outside of the membrane. Reasoning analogically, we may suppose that the organic nerves transmit the electric principle, which, like the continuous operation of a galvanic battery, separates the materials of the blood into their simplest form-s, enabling the play of organic affinities to attach each particle of matter to a congenial particle, and thus replenish or augment the structures. Each atom of matter is evidently j^olarized, that is, possessed of points or properties of attraction and repulsion toward all surrounding atoms, which enable it to assume determinate relations of aggregation or separation toward all other atoms of the same or of different matter. To this view, that the organic nerves are necessary to the nutritive process, it may be objected that nutrition is just as perfect in vegetables, which have nothing analogous to a nervous system. But animal ni>- trition, unlike vegetable, requires sensation, locomotion, and mind to appreciate, move after, and judge of the materials of nutrition ; and the office of a distinct nutritive nervous structure is to associate the operations of mind and the special senses with the voluntary muscles, fls well as to energize the involuntary muscles, in the performance o this function. WeiH3 animals, like vegetables, "fixed to one peculiar spot," and thf :r snly fuv.ctional economj' -'to draw nutrition, propagate, 276 PHYSIOLOGY. and rot," there would be no necessity for either a motory, or sensory, or mental nervous system. Mere increase of bulk is not nutrition. Morbid depositions of matter which is not assimilated may take place, as in tubercles, wens, encysted dropsy, etc., and the emhonpoinl of persons who are called "high livers," though indicative of excessive alimentation, denotes defective rather than excessive nutrition When the whole body is loaded with fktty accumulations, assimilation is never as perfect, nor the structures as firm, round, nnd elastic, nor the body as powerful and enduring, nor as capable of sustaining depletion and j)rolonged fasting, as in a moder- ately lean condition of the system. In those abnoj-mal growths called hypertrophy^ there is an actual in- crease of substance identical with the hyperti'ophed tissue or organ ; while in the opposite state, atrophy, there is an absolute deficiency of assimilated matter. In the former case the nourishment of the stnic- ture is gi-eater than the waste ; in the latter the waste is gi-eater than the replacement. Cancerous and fungous growths proceed by a similar process of ceU- development to that of the original structures, but fijom some disturbing cause, the nuti'ient particles are arranged according to a new and ab- normal scale of chemical affinities. Many speculations have been indulged respecting the time in which the whole body is renewed, the extremes of the calculations having generally been four and seven years. The period must vary greatly, according to habits of life, amount of exertion, kind of food, etc. Probably many bodies are renewed in a much less time than four years. The coagulation of blood out of the body affords a good illusti'ation of the law by which the primary atoms are arranged in the building up of the tissues, as represented in the ^ut. In Fig. 133, A represents the blood- corpuscles as seen on their flat sur- °' face and edge. B. Congeries of blood- j^ ^1 corpuscles in columns. In coagulat- (jr)W_J >J5\B ^^' ^^^ corpuscles apply themselves _ ./^ // /^^^^BWl ^° each other, so as to resemble piles If of money. Though the blood is the im- mediate source of all nutrition, many stractures, as the ten- compuacuLEs of the BLoor ^^^ a^^ ligaments, do not re- ceive red blood. The coloring THE INDIVIDUAL FUNCTIONS. 277 matter which surrounds the corpuscles, therefore, is not essential to the nuti-itive quality of blood. Many fishes, reptiles, and insects have no red blood. Dr. Carpenter has made the following convenient table, showing the distribution of the constituents of haman blood in living and in dead bodies. Living Blood. Dead Blood. Fibrin, ■\ Albumen, v Ii solution, forming Liquoi Sanguinis. Salts, S Corpuscles, — Suspended in Liquor Sanguima. Fibrin, ? Corpuscles, \ Crassamentum, or clot. Albumen, > t i ^- /• ^ , > In solution, torramg serum. Salts, S Secretion. — Secretion literally means sej^^araiiow ; but the process by which a new substance is produced by a re-arrangement of the elementary matters contained in the blood is one oi formation. Seci-e- tion, therefore, is not the separation but the production of a proximate element from the blood. Each organ or sti'ucture secretes or forms its own peculiar fluid, serving some special purpose in the animal economy. The mucus and serous fluids poured out on the surfocea of mucous and serous membranes, are regarded as exhalations, mere exudations by the process of exosmose, rather than secretions. All the cavities of the body which open externally, as those of the nose, mouth, alimentary canal, trachea, bladder, and uterus, are lined with a mucous membrane, which secretes or exhalo-s a bland, slimy fluid, called mucus. This mucus serves to moisten and lubricate their surfaces, facilitate the passage of crude matters, and protect them p jainst the. action of acrid and instating agents. All the internal surfaces of cavities not opening externally, as those of the abdomen, chest, heart, brain, and joints, are lined with a serous membrane, fi-om which secretes or exhales a thin watery fluid, called serum, whose office is to facilitate the motions of their surfaces. Some of the secretions are wholly recrementitious, being for the use of the animal economy, as the saliva, chyle, gastric juice, and synovia; others are wholly exc ementitious, being mere waste material, as sweat, urine, bile, and foeces. Some of the excrementitious secretions are made subservient to organic purposes, as the bile and ear-wax ; and Bome of the organs secrete a nutrient and expel an effete material at Ihe same time, as the 'iings and skin. 278 PHYSIOLOGY. Fig. 139. GLAINDULAR SECRETION. There are tln-ee forms of secreting organs. The simplest form is that of the animal membrane, which is abundantly supplied wjth blood-vessels, and cov- ered with an epithelium, as the serous and synovial membranes ; the next form is the inversion or de- pression of the membrane, constituting the follicle ; and the last is the gland, an aggregation of fol licles. Fig. 139 represents the follicles, multiplied and clustered to- gether upon efierent ducts common to several of them, the duct converging to form the main excretory duct, the whole constitut- ing a secreting gland. The important agents in secretion, as well as in nutrition, are cells, which are developed upon the lining membrane of the follicles and tubes, and which elaborate the matter of secretion from the blood, and pour it into the excretorj'' duct. The cells, as in the case of uuti'ition, are constantly being cast off and reproduced. The follicular secretions are divided into the mucous and cutaneous. Of the former character are the ordinary follicles of mucous mem- branes, and the numerous glandulae of the intestinal canal ; the simple and the compound gastric follicles of the stomach, which secrete the gastric juice ; the glands of Brunner in the duodenum; the glands of Peyer in the jejunum and ilium, which are supposed to secrete the puti-escent elements of the fceces ; the follicles of LieberJciihn, distrib- uted through the whole intestines, but especially numerous in the small intestines, and which secrete a thick, tenacious mucus ; the large fol- licles in the cacum and rectum, producing slight elevations on their surfaces; the glands of Duvergny and Nabothi, in the vagina and cervix of the utei-us in the female ; and the glands of Ccnvper and the prostate, in the male, The tonsils also are considered as a collection of lubricating mucous folliclea- The cutaneous division includes the meibomian follicles, which are seated in the tarsal cartilages, and secretes the gummy fluid that lubri- cates the edges of the eyelids ; the ccruniinous, which secretes the thick resinous substance called ear-wax ; the sebaceous, which pour out an adipose matter upon the skin ; and the sudoriferous, which se- crete the propor 2>crs]nr able matter. The sweat glands have been estimated by Mr. E. Wilson at about siven millions. As theii' secretion is usually evaporated as fast as fbrmed, most of the perspirable matter passes off in the form of in- sensible persj)iration. Perspimtion is scnsiblt \u\y when excessive, or THE INDIVIDUAL FUNCTIONS. 279 when it accumulates upon the skin by a moist state of the atmosphere. In the armpit is a peculiar description of glandules, called odoiiferous or miliary^ which secrete an odor-ous matter characteristic of that part of the body. This odorous principle is said to differ in animals suf- ficiently to afford a test by which their blood can be distinguished. A few months ago I had a patient under .treatment in whom the odor from the axiUary glands was so strong and fetid as to make his presence disagreeable, especially in a warm room. It has been alleged that the blood of the female can be distinguished from that of the male by the peculiar odor from this source ; an opinion which I am inclined to think 1ms more fancy than fact about it. The glandular secretions are the lachrymal, or tears, fi-om the lach- rymal gland, which lubricates and cleanses the conjunctiva; the sali- vary, formed by the jJci/'otid, submaxillary, sublingual, and jjancrealic glands ; the bile, found in the liver ; the urine, found in the kidneys ; the spermatic secretion of the testes, and the inammary secretion of the breasts. The milk is more affected by the food and drink of the mother than any other secretion, and also by strong passions or emo- tions of the mind. Instances have been known in which a single violent fit of passion, or other paroxysm of excitement, has so changed the quality of the milk as to destroy the life of the nursing child in an hour. The spleen, svpra-renal capsules, thymus and thyroid glands, have been called vascular glands, or glandiform ganglia, although they form or secrete no peculiar fluid, and have no excretory duct. Phys- iologists generally regard them as reservoirs for an excess of blood in neighboring organs, the spleen being the diverticulum for the stomach and liver, or the portal circulation ; the thymus to the lungs in fcetai life, the thyroid to the brain, and the supra-renal capsules to the kidneys. The Excretory Organs. — Those organs which perform the ex- cretory part of the secretory function are the lungs, skin, liver, bowels, and kidneys. All the excretory organs are capable of vicarious func- tion, doing the work of each other to a gi*eat extent, though the lungs and liver, skin and kidneys, most intimately reciprocate in fiinctionai duty. The lungs and liver are the special de]rarating organs for the surplus carbon and hydrogen ; the skin and kidneys foi- the niti-ogenous products of decomposition ; and the bowels throw off the more complex proximate elements of waste matters and foecal secretions. The depurating as well as nuti'ient function of the lungs has already been considered. The skin is not only a cleansing organ, but, like the lungs, a brenthing 280 PHYSIOLOGY. organ ; for it really absorbs oxygen, and throws off cai-bonic acid gas. Next to the lungs the skin is the most extensive as well as important detergent sh-ncture of the body. The amount of solid matter eliminated from the body through this cmunctory is, on the average, about 100 grains per day. The amount of fluid thrown off is more vai'iable, de- pending on external temperature, quantity of drink, activity of the kidneys, etc. The estimates of the ti-anspiration from the cutaneous and pulmonary surface in twenty-four hours are from 1| lb. to 5 lbs., nearly three fourtlis of this amount passing fi-om the skin. The lirer secretes the matter of bile from the venous blood. The object of the biliary secretion evidently is to eliminate certain impurities from the body in the form of compounds of carbon, hydrogen, and ni- trogen, and also to deterge the blood of a portion of any excess of alkali that may be absorbed by the venous exti*emities. Liebig has fabricated a singularly inconsistent hypothesis, which has satisfied himself and all others who are satisfie^^. to echo his arguments without taking the trouble to examine th ^m, that the bile is a nuti'itive product, and that, consequently, whatever will tend to the formation of bile, or any of the proximate elements usually found in bile, is a useful and nuti'itive substance. Liebig reasons in this wise. The bile is composed of several certain proximate elements. One of these is called taurine. This taurine is the only compound or proximate ele- ment found in the bile which contains nitrogen. Now theine and caffeine, the active principles of tea and coffee, are found, on chemical analysis, also to contain a very small quantity of nitrogen ; ergo, tea and coffee, though injurious stimulants to the nerves, may be useful to the liver by furnishing the niti-ogenous element of the taurine of the bile ! Such reasoning is exti'emely absurd, and the error is a most palpable one. It consists in mistaking a waste material for an aliment ; a depurating process for a nuti'itive one. As well might one mistake putrid flesh for wholesome food, because it contains cai'buretted hydro- gen, which is also found in the foeces, or excrementitious matters of the bowels. The kidneys eliminate from the system a large proportion of effete saline, alkaline, and earthy pai'ticles, and ihc gi*eatest portion of the surplus niti'Ogen. The average amount of urine excreted in twenty- four hours has been estimated at from thirty to forty ounces. CY course it depends gi'eatly on the activity of the skin, amount of fluid taken into the stomach, moist or dry, hot or cold state of the atmosphere, etc. The amount of solid organic matter expelled daily by this emunctory has a close relation to the activity and corresponding waste of the mus- cular tissue, and this is determined wi-h considei-able accuracy by th» THE INDIVIDUAL FUNCTIONS. 281 amount of urea in the urine ; a test, however, of no jtractical vahie in treating diseases. The "brick dust" sediment, "challl, is an ox*:raneous, useless, exhausting labor, which wears out the machinery of life with inordinate rapidity. If the excessive quantity of carbon is constantly supplied in the diet, the organisrai must prematurely wear out, or break down with disordered action. If fatty matters are only occasionally eaten, the temporary in- crease of temperature will be followed by depression and debility, precisely as with alcohol, though much less in degree. The lungs, however, do not "burn up" — oxidate — all the surplus carbon of grease, oils, gravies, etc., for we see in most persons addicted to their free use, pimples, blotches, eruptions, swellings, boils, and cancero4is ulcerations, with evidences of bad blood, torpid brains, and glandular obstiiictions, clearly traceable to this habit, and curable by its discontinuance. I^he principal injurious effect, therefore, of animal oils and fVits is not from their large quantity of carbon, but from their intrinsically impure char- acter. In all pure, Healthful, and natui^ alimentary substances, the system can appropriate what carbon it requires, and dispose of the remainder without injury, obstruction, or excitement, be the quantity contained in the alimentary article more or less. All the grains, escu- lent roots, and fruits, as well as the flesh-meat of animals, contain exactly the right proportions of carbon in their composition for perfect nutrition, respiration, and animal heat, however much theu' respective quantities of carbon may vary. They are also universally allowed to be " easily digestible," and innocuous to the stomach in all normal con- ditions of the digestive powers. Not so with greasy matters. Pereira himself says, directly in the face of his argument in favor of the use of grease for the benefit of the lungs : '"^ Fixed oil or fat is more difficult of digestion, and more obnoxious to the stomach, than any other alimentary principle." Can any body tell why an alimentary article which is so necessary to the Jungs should be so obnoxious to the stomach, unless nature has made a very great blunder ? The whole theory of a respiratoiy alimentary principle seems to me preposterous in the extreme. It is further urged, in favor of this wild conclusion from a false start- mg point, that people in very cold climates, the Esquimaux, for example, consume immense quantities of blubber oil, tallow candles when they can get them, fatty matters of all kinds that they arc able to procure, as 286 PHYSIOLOGY. well as enormous quantities of flesh or fish, as they can catch it; and si'nply because they do these things, and live in a cold climate where they can get little else, the inference is drawn that it is necessary they should so eat to get carbon in the body, to be " burned in the lungs" to support the animal temperature. It is veiy true that a cold, rigorous climate enables the digestive organs to bear what would de- stroy life very soon in a warm climate. It is also true that these blubber-oil eaters, and all the ti'ibes of men whose dietetic habits are similar, are a very inferior race, and in them nothing is developed Bcai'cely, save the mere animal nature ; hence theu* stomachs have all the nervous power almost of their whole constitutions. More than this, their animal nature is itself actually inferior in muscular power to that of those tribes and races of men whose general regimen is comparatively free from fats and animal oils. From all the arguments and facts I am able to gather, the conclusion is unavoidable, that this notion of pouring carbon into the stomach to support respiration and manufacture animal heat, is just as absurd as the common fallacy of heating, peppering, and stimulating the stomach with spices, pills, and spirits, to aid digestion. Moreover, the tlieory of the combustion of carbon in the lungs sufficiently to heat up the body is positively disproved by the fact that most of the carbonic acid expelled from the lungs is really formed in the tissues distant from the lungs. There 's no doubt that the oxygenation of the tissues throughout the system, and the combination of oxygen with carbon, are sources of animal heat, in common with all the organic functions and chemical changes which take place in the body. All the conditions requisite to the due regulation of the animal temperature ai*e good digestion, free respiration, vigorous cumulation, proper assimilation, and perfect depu- ration, in two words — good health. The ordinary temperatm'e of the human body ranges from 98** to 100° Fahr., varying but very few degi-ees above or below when the suiTounding atmosphere is greatly elevated or depressed, nor under the most violent fevers or extreme states of debility and emaciation. That cutaneous respiration is subservient to the maintenance of the equal temperature of the body, is evident from the fact that if the hair of animals be shaved off, and the bare skin covered with varnish, the temperature instantly faUs. Endosmose and Exosmose. — Dutrochet dfscovered and Liebig has demonstrated certain facts in relation to the interchange of dissim- ilar fluids in dirtei-ont parts of tl'f anima. struct-n*? which facts to- TEMPERAMENTS. 287 gether have been called the laws of endosmosis and exosriosis. Accord- ing to a principle of these laws, whenever any animal membrane has one of its sm-faces in contact with a different fluid, an interchanire takes place ; a part of the fluid on the outside passes to the inner sur- face, while a portion of the fluid on the inside passes through and mixes with that on the outer surface, the interchange continuing until both fluids become similar. The term endosmose means imhihiiion, and is applied to the cuirent passing from without to within ; exosmose means transudation, and is applied to the passage of the fluid from within to without. If a solution of any salt, or of sugar, is poured into a glass tube closed below by a piece of bladder, the particles of the solution per- meate the pores of the bladder, but do not pass through it. If the tube thus filled is placed in a vessel containing distilled water, the fluid gradually rises within the tube, and sometimes to the extent of several inches, while at the same time it is found that a portion of the solution has passed from the interior of the tube to the water external to it. It is said that in order to have these phenomena manifest, the fluids must be of different deyisities, and that there must also be an affinity betl^veen the membrane and the fluid, or no current will take place. Gases, as well as fluids, are diffused among each other, even through the compound textures. These properties of the tissues, which are also possessed by some in- organic substances, as thin- plates of slate or of baked clay, are ex- tremely important in relation X) the treatment of diseases, especially in cleansing the body from di'ug-medicines and other impurities, circum- stances which wiU be noticed more particularly in the therapeutic department of this \Vork. Note. — The reproductive function will be considered in Part VIII. CHAPTER V. OF TEMPERA>MENTS. Temperaments are peculiarities of organization. Marked differ- ences in individuals, occasioned by the disproportionate development of some one or more of the systems or tissues, have been noticed since the earliest times. Galen distinguished these differences into the sanguine, phlegmatic, lymphatic, and melancholic temperaments, a dis- section based on the supposed prepcvaderance of some one of the fcur 288 PHYSIOLOGY elements — air, water, fire, and earth. Vari<*is divisions of the temper- aments have been proposed by modern physiologists. Dr. Caldwell oases the three principal temperaments on the three principal cavities of the body; the cerebral ov mental temperament, existing when the cranium is most capacious, the sanguine whe'^ the chest is large, and the hjmphat'ic when the ahdomcn predominates. The temperaments usually recognized, and which are as satisfactory as any other classification for practical purposes, are the nervous, san- guine, bilious, and lymphatic. The nervous and sanguine are the irri- table or aclive temperaments ; the bilious and lymphatic are tlie inirr^^ tabic or torpid temperaments. The former dispose to more rapid motion and greater activity, with less power of endurance ; the litter are less easily excited to action, but more powerful and enduring. The former enjoy or suffer with the gi'eatest intensity ; the latter are inca- pable of the same extremes of feeling. When all the systems and parts of the body are equally developed, the temperament is called balanced. Fig. 140. Fie. 141. NERVOUS TEMPERAMENT SANGUINE TEMPERAMENT. The Nervous Temperament. — This temperament is dependent on a large development of the brain and nervous system, and when strong or pure, is marked by angular points in the body and sharpness of features, large head, small bones an3 muscles, and generally delicate features, as represented in fig. 140. The Sanguine Temperament. — The sanguine, or arterial tern- T E M P E Ft A M E N T IS. 289 perament of some authors, depends on a large development of the cir- culating system, more especially the lungs and arteries. Its signs are broad shoulders, an animated, lively countenance, florid complexion. blue eyes, sandy, yellowish, or brown hair, and a smooth, harmonious combination of the general form and features, as seen in fig. 141. "Fig. 142. BILIOUS TKMPERAMENT. LYMPHATIC TEMPERAMENT. Bilious Temperament. — The bilious, sometimes called nervous temperament, is produced by the structural preponderance of the bones, muscles, and veins. It is known by large, full muscles, promi- nent, swelling veins, dark hair and eyes, dark, brown, or yellow com- plexion, as in fig. 142. Lymphatic Temperament. — The lymphatic, or digestive tem- perament, is occasioned by the large development of the abdominal viscera, particularly the digestive organs. It is denoted by a general rotundity or fullness of the body, dull, pale appearance of the skin, and a disposition somewhat inclining to indolence. It is represented in fig. 143. The several temperaments are combined in all conceivable propor- tions, but are seldom so perfectly balanced that one or two will not prevail over the others, and give a manifest direction to the individual character. Black hair and eyes, red cheeks, and a ye.lowish neck, in- dicate an equal combination of the sanguine and bilious; sharp features* I — 2.5 290 PHYSIOLOGY. rod (jbeeks, thin flesh, light hair, and blue eyes, ind.iate a balance be- tween the sanguine and nervous ; sharp features, with a lean body and a dark complexion, indicate a balance between the nervous and bilious ; and heavy, round form and features, with a dtn-k complexion, denote a combination nearly equal between the bilious and lymphatic. CHAPTER VI. RACES OF MEN. The division of the human ftimily into races or classes, each dis- tinguished by certain striking peculiarities in the shape of the head, and in the structure, color, and arrangement of the skin, hair, and eyes, though strictly belonging to the science of ethnology, is a subject constantly becoming more interesting to the physiologist, from its inti- mate connection with the developmer t of men, and the improvement and advancement of humanity. A cliissification of mankind into lead'ng classes must of course involve distinctions purely arbitrary ; for the races may be distinguished into two or twenty, or any number between, as the marks of difference aro more or less prominent. The division of Blumenbach, who makes five principsd races, is as useful and satisfactory as any other can be. These are named the Caucasian, Mongolian, Etkicjnc, American, and Malay. Fig. 144. CAUCA8IAJS RACE The Caucasian Race. — The Caucasian race is remarkable for the highest ])hysiologicaI develop- ment, personal symmetry and beau- ty, and intellectual attainments. The ■jhief families of this race are the Caucasians proper, and the German- ic, Celtic, Arabian, Libyan, Nilotic, and Hindostanic branches. In this race tlie skin is generally fair, the hair fine and long, and of various colors, tlie skull large, round- ed, and oval, and the forehead broad or prominent, lai'ge and elevated. RACES OF MEN, 291 The face is relatively smaE and well-proportioned, the nose arched, the chin full, and the teeth vertical. In this variety or race of men we find the farthest remove from the animal in brain, features, and hau% with a superiority of intellectual and moral power, love of the arts, science, and peltry. The progi'esa of the human family seems to be made wholly through this race. The Mongolian Race. — The Mongolian Fig. 145. * variety includes the Mongol Tartars, Turks, and the Chinese and Po^flr tribes, which in- habit a vast extent of the eaith's surface, and constitute about half of the population of the globe. In physiological characteristics the Mongolians manifest considerable variety. The hair is black, long, and straight, the beard scanty, the skin commonly of an olive tint, the eyes black, the nose broad and short, the cheek-bones broadband flat, the skull ob- long, but flattened so as to give it a square appeai'ance, and the forehead low. In moral development this race is decidedly inferior; their intellectual powers are more imitative than inventive, and they possess but little strength and originality of mind. The Ethiopic Race, — The Negroes of Central Africa, the Caffres and Hottentots of South Africa, the Natives of Australia, and tho Islanders of the Indian Archipelago and the Pacific Ocean, constitute the principal families of the Ethiopic or black race. MONGOLIAN RACE. The black variety of mankind have complexions of jetty hue, black, woolly hair, eyes large, black, and prominent, nose broad and flat, thick lips, and wide mouth. The head is long from the ears back, and narrow; the forehead is low, narrow, and retreating; the cheek-bones prominent, the jaws and teeth projecting, and the chin small. A long, protruding heel, and a flat shin-bone, often distinguish this variety. In disposition they are easy, indo- lent, cheerful, fond of sensual pleasure, and lovers of children, fond of gaudy Fig. 146. ETHIOPIC OR BLACK RACE. 292 PnTSIOLOGY. Fig. 147. show, biit vei-y improvident. In intellect the race varies much, but the majority of its tribes are low in this respect. There are, however, many instances in which individuals of tliis race have exhibited respect able talont. The American Race. — The Indian tribes, or ''Red 7?2en," who once occupied origiu.dly nearly the whole of North and South America, south of the s«tietli degree of north latitude, constitute this variety. The people of this race vary consider- ably in complexion, but are mostly of a reddish-brown color. The hair is long, straight, and black, the beard deficient, the eyes black and deep set, brows prominent, forehead receding, promi- nent aquiline nose, high cheek-bones, small skull, rising high at the crown, and the back part flat, large mouth, hard, rough features, with fine, straight, symmeti-ical frames. They ai'e averse to cultivation, and slow in acquiring knowledge, sedate, proud, restless, sly. AMERICAN RACE. revengeful, fond of war, and wholly destitute of mai'itime adventure, and are rapidly disappearing from the earth before the all-conquering march of the Caucasian. Fig. 148. $-.% The Malay Race. — This variety of the human family inhabit Borneo, Java, the Phillipine Islands, New Zealand, the Polynesian Islands, and a part of Madagascar. The Malays have tawny or dai'k brovvn skins, coarse, black hair, large mouth, broad, short noses, seeming as if broken at the root, projecting upper jaws, and protmding teeth. The forehead is broad and low, the crown of the head high. The moral character of the Malays is of an in- ferior order. They are active, ingenious, and fond of maritime pursuits, and exhibit considerable intellectual capacity. Yet this race is constantly giving way before Euro- pean civilization, and has already disap- peared from New Holland and Van Dio- MAi.AV RACF men's Land RACES OF MEN. 293 If the opinion is correct that the sti'onger race continually overgrows all the rest, and gradually obliterates them from the earth, the Cauca- sians are surely destined eventually to "possess the land." The his- tory of the whole human race thus far indicates that such is the onier of nature, Origin of the Races. — Whether ^je various races of men hav each had separate origins, or whether they are descendants of a com- mon pair, modified by habits of life, climate, and external conditions, my limits will not permit me to discuss. Dr. Pritchard, after a labored investigation, came to the conclusion of the original unity of the races of the human family. Other authors have examined the subject appa- rently as critically, ana settled down upon the opinion of the original diversity of the races. Dr. Carpenter remarks : "It is a question of great scientific interest, as well as one that considerably affects the mode in which we treat the races that differ from our own, whether they are all of one species, that is, descended from the same or from similar parentage, or whether they are to be regarded as distinct species, the first parents of the sev- eral races having had the same differences among themselves as those now exhibited by their descendants." No doubt the question of the natural inferiority of a race or tribe of the family of mankind really does affect the manner in which (hey are dealt with by their superiors, and materially modifies the state of their consciences in relation to the use or abuse of the weaker by the stronger, still this might makes no right, nor does this question furnish any reason why the more powerful race should malti'eat the more feeble. I admit that the process of extennination is going on, accord- ing to the irreversible laws of nature, from the highest human being to the lowest animal. I believe that the stronger animals will exterminate the weaker, that man will eventually run out of existence the stronger animals, and that the superior tribe of the human family will fina.ly oblit- erate all traces of the existence of all the others; still I cannot see in the operations of this law any reason for oppressing, or even for not sti-iving for the development of all men, yes, of all animals, according to their capacities and conditions. So long as inferior men do exist, our duty to them is plain enough. No one pretends that we, the stronger, have any right to rid the earth of their presence by violence, or in any other way except that " ordained by Heaven." So far as Nature is concerned, she will see that her laws on the subject are fiiithfully executed, without our special interference. As far as the feebler races are capable of development ara improvement, they are entitlec 294 PHYSIOLOGY. to the same consideratjon as those who are more ?;ighly endowed in organization. Theory of Populatio>-. — Philosophers have not yet been able to agree upon any satisfactory theory of population. Mr. Malthus has contended that population has a tendency to increase faster than the means of subsistence, unless some exti'aordinary counteracting causes be interposed. On this assumption, "war, pestilence, and famine," may be hailed as special Godsends to keep the race down to the level of the means of subsistence ; but it places the Creator in an attitude from which our reason revolts. Mr. Doubleday, on the other hand, has lately met the positions of Mr. INIalthus with an opposite theory. He has undertaken to show that poverty is the principal cause of a rapid increase, and that a good degree of the comforts of life "deadens the principle of increase." He sustains the fii-st clause of his proposi- tion by adverting to the fact that poor folks have the most children, and th^ latter part by quoting the well-known historical data, that wealthy and luxurious famiMes frequently run out, as have done wealthy and luxurious nations. The doch'ines of both of these gentlemen are too narrow and superficial. Great wealth and extreme poverty are equally in violation of the "natural constitution of man." That God who fashioned the earth, made it capable of yielding sustenance enough for all the beings created in His own image. If men have got at variance with themselves, and wan-ed upon each other; if some have usurped too much of the domain of our common mother, Earth, and others have not where to lay their heads ; if men have deranged their proper social relations, perverted the laws of their own organization, and entailed upon themselves and society innumerable j^^rryiitted evils, let us pause long before w^e charge all these results to special providences or natural tendencies. The actual productiveness of the earth is incredible to those who have never examined the subject. Under the best systems of agricul- ture and dietetics, Ireland, where now eight millions of human beings starve, could healthfully sustain one hundred millions, and the soil of the U lited States is capable of producing inore than food enough for E.H tha inhabitants now existing on the globe. 4 PART III. HYGIENE. The hygienic agencies — absurdly called "non-naturals" in medical books — comprise the whole and ample materia medica of the true hydropath. They are air, light, water, food, temperaiure, exercise, sleep, clothing, and the passions. These agencies, variously modified and intensified, I believe, are capable of producing all the really reme- dial effects in all diseases which the whole pharmacopoeia of allopathy, with its thousand drugs and destructives, can produce, and without any of the evil or injurious results always attendant upon the operation of the latter ; while to sustain the vital machinery in its most vigorous and enduring condition, in other words, to preserve health, we have but to employ or apply them according to established and invariable laws. In claiming for those agencies by which every part and organ of every living animal and vegetable in existence is nourished, built up, sustained, and finally changed and decomposed, by which the integrity of every sti'ucture and function is maintained during life, and resolved into its primitive elements and (onditions on the cessation of the life- principle, a complete and perfect materia medica, I mean as far as regards functional dei-angcment, which, indeed, constitutes ninety-nine- hundredths of the diseases of society. Mechanical injuries, displace- ments of parts, organic lesions, etc., coming appropriately under the management of the surgeon, may and often do require mechanical agencies of some sort. I am aware that few practicing hydropaths take this ultra ground. Some of them administer anodynes occasionally; some bleed now and then ; some call in the aid of blue pill and cathartic potions under par- ticular circumstances ; others give a little brandy on emergencies, oc the absurd notion of "keeping up the vital powers till nature has time to rally;'' and others deal out "a little homeopathy" ever and anon. I am most thoroughly convinced ^.hat all of these "auxiliaries" are un- necessaiy; most of them much worse than useless. Their apparent 296 HYGIENE. necessity, I contend, has its source in the igtwrance of the practitioner. He does not fully understand the philosophy of vitalitj-, the intrinsic character of disease, nor the scope and pnwer of these hygienic agen- cies, if he regards them as at f^iult or insufficient. I grant that occa- sional dosing may be the best some hydropaths can do. I consider him justifiable in acting according to his understanding. It may hapi)en, too, that he has not all the appliances of hydropathy at command, or the patient will not submit to them. Under such circumstances I do not say that it is not expedient to give drugs. But I do maintain that a full knowledge of all the remedial resources of hygiene, with the possession of all the means afforded by such knowledge, enables the hydropath to dispense with drug medication entirely. I have known and carefully noted the particulars of many cases where the professed hydropath has resorted to drugging, or bleeding, or external irritants, and in every such case there w^as manifest igno- rance or error in the management of water, diet, exercise, sleep, tem- perature, or of the voluntary habits, or in relation to some other hygienic agent or condition. I have known some patients, while under judicious water-treatment, in their impatience to force nature a little faster than she was willing to go of her own accord, dose themselves now and then with stimulants, bitters, herb teas, nervines, or laxatives, and whatever seeming advantage immediately resulted, I have alwaj's found, as far as I have been able to "compare notes," that those who did nothing of the kind, other circumstances being equal, would get the best health in the end. CHAPTER I. OF AIR. Vital Property of Air. — The physiology of the respiratory fuuction explains the relation of an abundant supply of pure fresh air to the maintenance of health and the attainment of longevity. Fresh air in the lungs is so immediately essential to life that most animals, in less than one minute, when deprived of it, suffocate, become uncon- scious, and appear to be dead, rea death occurring in a few minutes if air is not supplied. Oxygen, which has been called "vital air," is undoubtedly the vivify- ing princijjle of the atmosphere. Ca-'ion. niti'ogen, and hydrogen are AIR. 297 generally considered poisonous in relation to the lungs, but they are rather negative than positive agents, being merely incapable of support- ing respiration. When persons or animals are confined in a close room, they continue to breathe until the oxygen of the enclosed air is ex- hausted, \."hen death inevitably results. The flame of a lamp or candle will also expire when the oxygen is consumed, this gas being as essen- tial to combustion as to respiratior*. In dry wells, deep vaults, and other situations where carbonic acia gas, or other irrespirable airs, are liable to accumulate, the introductioL of a lighted taper is an important orecaution. If the flame be extinguished, it would be dangerous to lifo ^o enter, for breathing cannot take place where combustion ceases. Carbonic acid gas, being heavier than common atmospheric air, settles to the bottom of a pit or room, while nitrogen and hydrogen, being lighter, ascend to the top; therefore in a room vitiated by a large col- lection of persons, or from want of ventilation, the purest air is foimd in the middle of the apartment. A dog has been suffocated by carbonic acid gas in a room where a man, standing erect, felt no inconvenience. Quantity of Respired Air. — Physiologists reckon that an ade- quate supply of air for an ordinary man to breathe each minute is from seven to ten cubic feet. A hundred persons confined in a room thu'ty feet in length, breadth, and height, containing nearly 30,000 cubic feet, would render the whole air unfit for respiration in about five hours. Imperfect ventilation, therefore, in crowded assemblies, churches, school-rooms, theatres, factories, and workshops, especially in the evening, when many ^amps or gas-burners are employed, is a common source of debility and disease. An ordinary gas-burner consumes as much oxygen as four adult persons ; but the loss of oxygen is not alone the cause of injury resulting from large gatherings of people in ill- ventilated places, for the irrespira.'le air thrown out from the lungs is rendered still more noxious by the exhalations from the skin. The artificial habit of lessening the breathing capacity by means of stays, corsets, and tight dresses, is now happily passing away, although the wasp-like waists which deform so many of the gentler sex still adorn the "fashion plates" of the magazines, and caricature the female form in most of the fashionable shop-windows. Could the women of America — ^I say nothing of ladies — fully appreciate the importance of dress as connnected with respiration, and the relation of this function to their own health and happiness and the welfore of their offspring, the monthly importation of Parisian cuts, tui-ns, twists, fits and misfits, would soon je substituted by " short dresses./' loose as well as short, or ?u!ri{'t]iing V the way of clothing that wil er.iiancipate the lungs 298 HYGIENE. Fig. 149 KATURAL WAIST. Fi-. 150. from oppression "most foul, strange, and unnat- ural." A reform in female dress would not only set free the breathing appamtus, but would confer an incalculable benefit on the huma«i race in another respect. It would enable the wealthy classes to devote more attention to more useful subjects, and think less of the frivolities of ever-changing and never satisfying fashions ; and diminish the demand upon the kind of work — sewing by day and by night — which is now ruining the constitutions of thousands of poor and industi'ious females, and sending them rapidly to premature gi'aves. Fig. 149 is a representation of the female chest in the natural state, unconstrained in the least by the clothing. The person who fails to discover the efise, grace, beauty, and symmetry of the figure as contrasted with that of a modern belle, must have a taste as artificial as any man- tua-maker could desire. It is perfectly certain that, just to the extent that any female diminishes the cu'cumference of the body around the lungs, just in that ratio will she lessen the number of her days, ])rovided she does not die of violence or disease, which is a hazai'd she must also encounter. Observe the stiff, constrained, uncom- fortable, and uncomely appearance of a fashionable lady (fig. 150). It is really painful to look upon such a self-constituted burlesque on humanity. UNNATURAL WAIST. If there are any young ladies whose excess of approbativeness in- duces them to strain, and labor, and suffer, to produce " small tapering waists," so as to look "delicately fashionable," or "fashionably deli- cate," for the purpose of attracting the admiration of the other sex, let me assure them that they are destined to a sad failure. Notice they may, indeed, obtain, but admiration in that way, never. I have never heard a young man speak of the habit except in terms of ridi- cule ; and I have never heard any man speak of it except in language of reprobation for its manifestly injurious consequences, and contempt fur its ridicuVuF appoarnnco. AIE. 298 Fig. 151. VENUS DE MEDICIS. The contrast appears still sti'onger when the diminutive circle of the waist which beautifies the belle is placed by the side of the broad, expanded chest, which renders the woman vigorous and healthy, and conse- quently a help meet for man — fig. 151. Suc> was the model of female beauty ere sacre ligious hands had marred its fair proportions, and wherever, among the inhabitants of all parts of the earth, we find long-lived mothers and grandmothers, we are sure to find full, round chests and capacious lungs. Purity of Respired Air. — Equal in importance with the quantity of the air wo breathe is its purity. It is melancholy to reflect on the hard necessity which compels multitudes to live, or rather stay, in the sweltering garrets and infec- tious cellars of cities, or on the cupidity of landlords who provide such tenements, or on that dereliction of duty in municipal authorities which permits their existence. Much of the evil, however, rnay have its source in ignorance. Few sanatory circumstances are less regarded tiian those nuisances which fill the air with noxious effluvia. I know of no reason whj*- Boston and Philadelphia should be more healthy than New York unless it is because the air of Boston is not continually filled with the poison of tobacco smoke, and the Philadelphians have little or no under- ground population. In every hygienic aspect. New York is the favored locality. It is true New York suffers a large influx of foreigners, the fatality among whom considerably swells its bill of mortality. But this alone, viewed in connection with its superior advantage in position,' does not account for the difference, for according to the statistics of the present year, the mortality of New York is twenty-five per cent, greater than that of Philadelphia, and twelve and a half per cent, greater than that of Boston ; equal, in fact, to New Orleans and other uouthern cities usually regarded as sickly. Nearly all cities— New York especially— are full of air-infecting nuisances, not as generally diffused as tobacco smoke, but as intensely poisonous in certain localities, as distilleries, cow stables, swill-milk factories, hog-pens, soap factories, slaughter-houses, bone-boiling estab- lishments, tallow-melt' ng pkces, graveyards, etc., fi'om which are con- stantly emanating s(:^ams of cor.^agioi an^ death. I do not believe 300 II Y G 1 E N E. there is a single city on earth, certainly not in the United States, where the people would endure or tolerate these pestilences, were they fully enlightened on the subject. It is utterly iniijossible for the lungs to be fully expanded in a very impure atmosphere, because the air passages, i]-»-itated by the extra- neous particles, spcismodically contract to keep them out. The conse- quence of this is, those pei-sons who reside permanently in an atmos- phere charged with foreign ingi-edie Jts or miasms, find their lungs contiimally contracting, unless this tendency is counteracted by a con- stant vocal or muscular exercise calculated to invig -nte the whole respiratory apparatus and expand the chest. Chance of Air. — The remarkable benefits frequently experienced when the inhabitants of crowded, dusty cities rusticate in the country for a few days, or wdien invalids exercise themselves in traveling, and amuse themselves with a variety of new scenery, has caused some physiologists, who have a reputation for considerable intelligence, to imagine that the advantage w^as in the change itself more than in the better quality of the countiy air. It is quite a prevalent notion that human beings require changes of food, drink, and air, merely as changes. Such notions have no foundation in philosophy. If the food, or drink, or air, or all, is physiologically the hest^ it can never be improved by any change during the whole period of life ; but if in any respect it is imperfect, a change to a better quality would be beneficial. Dr. Dunglison, who is a standard author in the profession on hygienic mattei-s, thinks there is so much virtue in " modifitdtions of different atmospheric influences," that a change from a hetter to a worse air ^ better than no change at all. His language is (Elements of Hygiene, page 125) : "The change from a better to a worse air has even been found serviceable. In Edinburgh, the inhabitants of the most airy parts of the New Town frequently send theh children, when laboring under hooping-cough, to the Cowgate, a filtliy street, which runs at right angles under one of the mrgest thoroughfares in the Old Town, and in which, at a certain hour of the night, the inhabitants eject al the offensive accumulations from their houses, to be washed away bj the water of the reservoirs, let on for the purpose." It is passing strange that any medical man of the present day, of high rank and acknowledged authority in his profession, should be so blinded by false theories as to commend a custom so abominable, simply because some ignorant persons \7ere foolish onougl. to pmctii e it ! Positions am Habii i affectin Respikation. — Sedentary AIR. 301 habits, unless frequently alternated with vigorous and prolonged exer- cise, weaken the abdominal muscles, and thereby lessen the activity of the breathing process. Intense mental application, if long-continued, powerfully diminishes the respiratory function. No person in deep thought, with the brain laboring at its utmost capacity, breathes deep and free ; hence editors, particularly those who are closely conjfined to their sanctums, are jn-overbially short-lived. Many of them are worked to death in five or six years, who, had they attended properly to their respiratory functions, both pulmonary and cutaneous, could have held out, under the same amount of labor, three or four times as long. All veiy stu- dious persons, especially those given to abstruse investigations — the exercise of the reflective intellect — should never fail to exercise the whole body daily, and the arms, shoulders, and abdominal musclatj several times a day. Riding on horseback, climbing mountains, run- ning up and down stairs, dancing the tight rope, swinging on the hand ladder, throwing the dumb bells or grace hoops, playing ball, bowling, sawing wood, planing boards, etc., are examples of appropriate exercises. Rotary motions, with both arms extended, making the hands simulta- neously describe as large a circle as possible, striking the elbows or backs of the hands together behind the back, or attempting so to do, are excellent exercises when the person is stoop-shouldered, and the chest contracted from malformation or by artificial means. All crooked or constrained bodily positions affect respiration injurious- ly. Reading, writing, sitting, standing, speaking, or laboring, with the ti'unk of the body bent forwai'd, is extremely hurtful, by overstretch- ing *he muscles of the back, compressing the lungs, and pushing downward and backward the stomach, bowels, and abdominal muscles. In all mechanical or manual labor occupations, the body should always be bent, or lean, on the hip joints ; the trunk should always be kept "as straight as an Indian." Catching Cold. — The general misapprehension in regard to the theory of "catching cold," frequently produces the very evil that is most feared. More colds are taken in overheated than in too cold pkces, and still more are owing to vitiated air. "Backwoodsmen," who sleep all winter long in shanties through which the snow-flakes pass freely, are seldom troubled with what are called "colds and coughs." Too close confinement to hot air in ill-ventilated rooms renders the body preternaturally susceptible to atmospheric changes. Infants and young children are generally badly managed in this respect in this country. They are often made sickly, puny, peevisli, and effeminate, 26 802 HYGIENE. by keeping the doors and windows too close, and the sufferer too much in doors, as though the breath of heaven was unfriendly to human life. Purifying tke Air. — There is one method of pm-ifying the air which is accessible to all persons in all pkces. In sleeping and other apartments, where thorough ventilation is impossible, the air may be rapidly changed and materially freshened by opening all the doors and windows, and then swinging one door violently forward and backward. It is a good, indeed a necessary practice in the cases of invalids who occupy close and secluded rooms, ana who are una-ble to walk out. Sleeping Rooms. — Sleeping rooms are generally miserably venti- lated. Air of a pure quality, and abundant in quautitj^ is much more important during our sleeping than in om* waking hours; but the com- mon habits of the people are to provide large, spacious eating and sitting rooms, and small, close sleeping apartments. No one should sleep in a room, in summer or in winter, with all the windows and doors tightly closed. Windows can at all times be opened more or less at the bottom or top, or the door placed a little ajai', so as to permit the ingress of fresh air, without admitting any injurious current. I have known invalids with bronchitis, consumption, and other diseases, in this city of a thou- sand intelligent physicians, suffer horribly, by being confined in a close, sultry room, in a hot July day, per advice of the doctor! Bed-curtains are rather worse than a useless appendage. If used at all, they should never be drawn tightly around the bed. The head should never be raised very high during sleep, as that position oppresses the lungs; nor should the sleeper incline toward the face, with the shoulders thrown forward. A late supper, by filling the stomach, pre- vents, in the horizontal posture, the descent of the diaphragm, hinders free breathing, and induces congestion of the brain, dreaming, night- mare, etc. Stoves and Fireplaces. — Grates and fireplaces secure a much better ventilation than stoves of any description. Stoves are regarded by some as constituting "the gi-eat nuisance of America;" and there is no question that, as usually managed, they do actually vitiate all the air of tho room. Air-tight stoves require the most careful attention to ventilation, and indeed no stove should be used in any place where there is not resource or provision for the free admission of external air. Lamps, Candles, Gas-Burners, etc. — As all the means by which a room is lighted in tho ei ening are so many methods of consuming AIR. 303 the oxygen, and rendering the ah* h'respirable, it is well to bear in mind that the amount of ventilation must have a due relation to the number of hghts employed. In small rooms, and in sleeping rooms where a lamp is kept burning through the night, and in rooms occu- pied by invalids, attention to this circumstance is especially important. In this connection I will allude to another very common source of vitiated air — smoky lamps. It may astonish those who have never seen this evil, to be told that persons can have their organs of sense so dulled and torpified as to sit a whole evening in a room with two or three oil lamps, each sending up a column of black smoke, and filling the room with a rank, suffocating odor, and yet not appear to be the least offended or incommoded. Yet such things are not uncommon in our cities ; and many who work evenings by the light of smoky lamps, often get weak eyes as well as impure blood as the result. Public Conveyances. — It may be traveling a little out of tho record, for me to speak of the bad air of steamboats, railroad cars, stages, omnibuses, and other conveyances ; but being a constant suf- ferer from this source, I may perhaps be justifiable in glancing at it. especially as it is a public evil as well as a private grievance. It would seem at first thought that any method of passing through the air at the rate of fifteen or twenty miles an hour, ought to secure the passenger fresh air in abundance. The theory is beautiful, but it fails in practice. Wherever we go, the tobacco-nuisance follows us. We feel its nar- cotic miasm rank in every sti-eet of the city, and if we go into the countiy it goes with us. To be sure, "No smoking abaft the wheels," is conspicuously displayed on the Sound and River steamers; "No smoking inside the cars," is said or intended on the cars ; while on the numerous ferry-boats conveying constant streams of people to and ft'om the gi'eat emporium, it is gently intimated, '■'■Gentlemen are par- ticularly requested not to smoke on this side of the boat;" still it fdways happens that the evidence of smoking pervades every part of the boat or car. Those who stand outside of the not-to-be-smoked-in apart- ment, around the gangways, on the platform, and at either end, con- trive in some way or other to make the whole company smell the weed, whether they will or no. And in the stages and omnibuses no one thinks of smoking inside without permission, but the driver, and one or two puffers on his seat, can easily give the passengers a "comfortable smoke," particularly uncomfortable to some if the wind be against them. There is yet another evil which ought to be remedied. There is usually in omnibuses, stages, and railroad ears, a few persons who cs;>' 304 II Y a I £ N E. not, or think they CHiniot, bear fresh ah-, when *.he weather is cool or damp. To suit their whim, all the windows are closed, and the com- pany perhaps for an hour or two sit inhaling over and over again the confined air, all the while becoming more vitiated. The rules of venti- 'fltion apply to all rooms and apartments alike, whether in dwelling- houses or ti'aveling vehicles CHAPTER TI OF LIGHT. Relation of Light to Organization — The hygienic import- ance of light is not sufficiently undei*stood by the people, nor its reme- dial influence sufficiently regarded by physicians. Whether it be a distinct imponderable entity, a property of electi'icity, or something else, it would be idle here to speculate ; but it is certain that the light which this eaith derives from the sun and the fixed stai's, has a power- fully modifying influence on all the functions of its animal and vege- table kingdoms. Some plants thrive best when exposed to sti'ong sunlight, others in a moderate light, and others when considerably shaded, yet all of them, without exception, require a good degree of the influence of light to become hardy, firm, and vigorous. Those which grow in deeply- shaded situations or dark cellars ai'e comparatively colorless, slender, and friable. Light is the cause of color in all bodies ; it is entirely re- flected by white surfaces, and completely absorbed by black. Many insects and fishes while living are constantly lumhious, in con- sequence of the rays of light being constantly emitted from various points of their bodies ; the fire-fly emits its sparks from two oval spots at the side of the thorax ; in the glow-worm a })hosphoresoent bril- liancy issues from its abdominal rings ; luminous insects are supposed to absorb light during the day, like the Bononian stone, and impart it in the evening. Physiological Influences of Light. — Plants absorb carbon, and give out oxygen or vital air in the light; bvt during the night this process is reversed, so that they absorb oxygen, and give out carbon; hence it is injurious and even dangerous to sleep at night in a situation \vhich is closely surrounded with dense foliage, and not well ventilated. LIGHT 30o The nutritive process is materially checked in all vegetables and animals when deprived of light for a considerable time ; in this case vegetables are said to become etiolated, a condition analogous to that called ancemiay or hypcemia, in man — a state of debility, bloodlessness, and inanition. In some of the lower animals the process of metamorphosis is arrested by deprivation of the solar iniluence. The tadpole, for example, in- stead of developing into the frog, either continues to gi'ow as a tadpole, or degenerates into some kind of monstrosity; and the specimens of human monstrosities, developed abnormally, in consequence of the absence of a due degree of "Heaven's first-born," are neither few nor far between in the underground tenements of large cities. The operation of light on the animal organism has always been recognized as urging to exercise, and increasing the activity of both the bodily and mental powers; while its absence or privation disposes to indolence and obesity. Animals are more readily fattened when kept in obscurity, because the diminished activity of the depurating functions favors the accumulation of adipose matter. Poultry are often confined in dark places to augment their store of oil ; and the heads of geese and turkeys are sometimes covered by a hood, or their eyes put out, in order to procure from them fat and greasy livers, as choice morsels for depraved epicures. Almost the entire population of our large cities, who occupy back- I'ooms and rear buildings where the sun never shines, and cellars ana vaults below the level of the ground on the shaded side of narrow streets, is more or less diseased. Of those who do not die of acute diseases, a majority exhibit unmistakable marks of imperfect develop- ment and deficient vitality ; and, in fact, as w^ith animals and vegetables in like circumstances, often run into deformities and monstrosities, noi more reproachful, however, to those parents who propagate under such disadvantages, than disgi*aceful to that city, state, or national gov- ernment which either compels or permits any class of its citizens to live in such abodes. These facts show us that ligl t, and an abundant supply of it, is ii: • dispensable to a due development of all organized bodies. Therapeutic Considerations. — Medical men have always no- ticed that diseases of all kinds, from the most trifling toothache, quinsy, or rheumatism, to the severest attack of fever, scrofiila, or consumption, are much less manageable in low, dark apartments. A.nd it is notorious that, during the prevalence of epidemics, as the cholera, the shaded side :^f a nan 5W sti-e >t invariably exhibits the greatest ratio of fatal cases. 306 HYGIENE. " The observations of Dr. Edwards, on the influence of light in pro- mo^ing the perfect development of animals, led him to conclude that m climates where nudity is not incompatible with health, exposure of the whole surface of the body to light is favorable to the regular con- formation of the body; and he, therefore, has suggested insolation in the open Jiir as a means calculated to restore healthy conformation to children affected with scrofula, whose deviations of form do not appear CO be incurable." Pereira says ; " As in bright solar light we feel more active, cheer- ful, and happy, while obscurity and darkness give rise to a gloomy and depressed condition of mind, so we employ isolation in the open air as a mentnl stimulus in melancholy, lowness of spirits, and despondency " Sanatory Ikferences. — The inferences deducible from the fore- going considerations ai'e sufficiently obvious. All persons, in order to acquire and maintain the best condition of health and strength, should te frequently exposed to the light of the sun, except when oppressively hot. Children are generally maltreated, more especially in cities, in being kept almost entirely excluded from sunshine. Many good moth- ers are more fond of the delicate faces and pale complexions of their little ones, than intelligent in relation to their physiological welfare. A little sun-browning occasionally of their faces, necks, hands, and feet, and, finally, of their whole bodies, would not only render their devel- opment more perfect and enduring, but tend to the production of the gi'eatest symmetry and beauty in manhood and womanhood. Parents should not be too careful in putting umbrella-hats and bonnet-sun- shades on the heads of their children every time they run out of doors. Almost all persons, young or old, who live in cities, can invigorate the skin and improve the genera' health, by fi-equent exposures of the whole body to the air of a well-lighted room, applying moderate fric- tion to the surface at the same time. Light as well as air is generally excluded from the sm'face by too much or too tight clothing, which evil Buch exposures in some degree would counteract. Dwelling-houses ought to be constructed with esprcial reference to ight. Those rooms which are most occupied should be the best light- ed, as the kitchen and sitting-room. The sun should be allowed free access to the yard and out-grounds. Shade-trees and shrubbery, use- ful to some extent around the dwelling, should never be so thick as to shut the direct rays of the sun out entirely. The influence of light in dissipating and decomposing noxious vapors and deleterious gases, whicb collect in and around low grounds and dark pla:es, is very great. DRINK, 307 The sudden exliilaration and invigoration experienced by the pent- up denizens of our large towns, when they go from their dim count mg-rooms, gloomy offices, and basement workshops, to rusticate a few days in mountainous regions, is due nearly as much to the greater stt-ength of tho oatural light as to the greater purity of the air. CHAPTER III. OF DRINK. Nature's Beverage. — Nature has provided no other dnnk for man, nor for animals, nor for vegetables, than pure water ; and no animal but man seeks any other either as a beverage or as medicine Its value as a beverage is in all cases in proportion to its purity. In plants water is employed as a vehicle to convey the nutrient element* absorbed by the roots throughout their various sti'uctures. In animals provided with a stomach for receiving aliment, it is the medium by which the materials of nuti'ition are conveyed to all parts of the body, and the waste matters carried away. Milk, which constitutes the prin- cipal food of the young mammal until the teeth are developed, contains about ninety parts of water in a hundred, and though often employed as a leverage by adults, is properly regarded as food. All the diluent preparations, which fill so large a space among medical prescriptions, owe their whole powers of dilution to the water alone. Is Man a Drinking Animal ? — The question whether man is by nature a drinking animal, or whether the water required for his organ- ism is sufficiently supplied in his natural food, has been raised within the kst half century. Dr. Lambe, of England, has very ably argued the negative of the first position named ; but the majority of dietetic wi-iters hold the opposite opinion. It is, however, perfectly certain — and the fact has been proved by the direct experiments of Dr. Alcott and others — that those who adopt a regimen exclusively vegetable, and make a large proportion of their food to consist of succulent fruits and watery vegetables, c^n be healthfully sustained and nourished without water-drinking. It is also certain that those who eat much animal food, use salt, spices, and greasy dishes freely, and who have to employ a large proportion of concentrated farinaceous substances — which is indeed, the genei-al plan of the dietarj^ sj^s'em of civilized society — 508 YGIENE. requii'e a large amount of water to carry off the saline particles ai J other impurities, and allay the artificial fever which they produce. \a either case the thirst is the safe rule of practice. Quantity a>d Times of Water-Drinking. — Writers are re- markably discordant in their notions as to the quantity of water a per- son should take into the stomach, and also as to the times for taking ii. Some think we should drink as little as possible ; others are of opinion that we should swallow all we can ; one class of writers recommends all drinking to be done between meals, and another class advises us to drink abundantly at meals. It is easy to discover the sources of these discrepancies. Writei's are too apt to deduce general inferences fi'om individual peculiarities. What is precisely right for one person may be exactly wi'ong for anotlier. If the dietetic and other voluntary habits of all people were strictly physiological, we could give tliem all a rule without exceptions, and the same rule. But the quantity' of water useful or necessary depends on all the habits of life, amount of exercise, quality of food, the employment of stimulants, condiments, etc. The kind of occupation also affects the question ; for example, a person laboring in a dry, warm atmosphere will require more drink than one working in a cool, moist air. The amount of water contained in the various alimentary substances in common use, shows the relation which the quantity of the water necessaiy to employ as drink bears to the kind of food. Thus, in one hundred parts (rejecting fractions) water constitutes, of gum arable 17 sugar-candy 10, aiTOw-root ] 8, wheat 14, lye 16, oats 20, barley 13 maize 13, peas 16, beans 14, lentils 15, potatoes 75, turnips 92, carrots 87, beets 87, artichoke 79, white cabbage 92, black bread 32, beef tea 98, blood 80, fi-esh lean meat of beef, mutton, veal, pork, deer, chicken, and pigeon 74 to 78, cod, hadi^ock, sole, cai'p, and ti'out 79 to 82, ox's liver 68, calf's sweet-bread 70, white of egg 68, yolk of egg 85, cow's milk 87, human do. 87, goat's do. 86, ass's do. 91, ewe's do. 85. The quantity of water contained in aliments, however, does not de- termine their nutritive power, for some substances, as butter and hog's lard, contain scarcely any water, yet are capable of supplying the body with much less nourishment than milk, which is about seven eighths water. As to the best times for drinking, it is not difficult to give a general rule; but people who live variously must vary it accordingly. Un- questionably the best time for water-drinking, as a habit, is when the stomach is entirely empty — on first rie'mg in the morning, and half an hour or an hour before meals Persons who take habitually a tumbler DRINK. 309 of puro water at those times, and eat plain food, will seldom expe- rience much thirst ; but those who employ thirst-provoking aliments or seasonings should assuage that thirst by water-drinking, even at meals. Th^lj^ are many morbid conditions of the system in which it is advisable to drink freely, even at meals, and without regard to thirst, Jnut these will be more appropriately considered hereafter. One rale, however, of almost universal application for dietetic or remedial pur- poses is, never to drink, either at meals or at other times, to the extent ol producing any decidedly uncomfortable heaviness, distention, or op- pression of the stomach. Those who have weakened their digestive powers, and rendered the sensibility of the nervous system morbidly acute by the use of tea, coffee, etc., should accustom the stomach to the impression of cold water gradually, beginning with only a part of a tumbler, and increasing the quantity as the tone of the digestive organs improves. Temperature of Drink —Cool, but not very cold water appeal's to be most perfectly adapted to all the purposes of the animal economy. Without doubt the human system possesses a wide range of adaptabil- ity, and can, provided the general habits are reasonably correct, be very well sustained on water rather warm or veiy cold. It is well known that in the hot season, particularly in our cities, many laborers die very soon after drinking freely of iced-water. This matter ought to be well understood, for there is surely no necessity for any one to die in this ^vay. It is not the iced-water alone that destroys them, but this proves an exciting cause when the system has been brought into an unfavorable state of vital resistance. I never knew or heard of any person dying or being seriously injured by the free use of iced- water — ^as free as the thirst demanded — who was temperate and sim- ple in all his eating and drinking habits. All who are fatally injured by ilrinking iced-water, as fiir as I have been able to observe, or can learn from others, are among those who use some kinds or combinations of dietetic articles which provoke a great degi-ee of factitious thirst; for example, baker's bread, and butter, stale salted meat, as ham or cod- fish, old cheese, plum-pudding, etc. Of course such persons feei a necessity for drinking freely, and as iced-w^ater seems a grateful anti- dote to the feverishness artificially produced in the stomach, they are apt to indulge injuriously. There is no safety for such persons, except in either eating wholesome food, which does not provoke thirst, or in drinking water of a moderate temperature. But the great danger is with those who, in addition to the bad diet just mentioned, add the poison of intoxicating drinks. In fact, very few die in consequence oi 810 HYGIENE. irinkiug cold water in hot weather, except those more or less addicted to alcoholic stimulants — probably not more than one in ten. The tend- ency of all forms of alcoholized beverages — from soft wines and ales to small beers and porters, and from hai'd ciders and rough brandies to harsh rums ancj strong gins — is to weaken and paialj'ze the nerves of the stomach ; and when these exhausted nerves are suddenly chilled by a large draught of cold water, it is not wond i^nul that reaction does not take place, nor that death ensues. Artificial Drinks. — Under this head I purpose to speak briefly of a variety of made-up drinks, some of which are intended as luxu- ries, others as medicines. " Ardent spirits, malt liquors, wine and cider," specially anathematized by name and nature, and deservedly excommunicated fi*om use and fellowship by the total abstinence soci- eties, I need not dweU upon. They ai'e poisons, in every sense inim- ical to the human constitution ; in fact, deleterious to every organizea thing in existence, and are produced only fi-om the decay, destniction, and decomposition of the products of organized matters. They d« serve commemoration only for the mischiefs they have done, and ex ecration only for the miseries they are now inflicting on human society I cannot, however, refrain from uttering a word of lamentation in this place, and expressing my regret and astonishment that there should be any found in this enlightened day and countiy, and among tlie leaders of mankind, especially among medical gentlemen and Chi'istian minis- ters, who profess to guide the body to health and the soul to heaven — w^ho profess to take true science and the Bible as their guides, yet who not only indulge in the intoxicating bowl themselves, but even com- mend it to their fellow-creatures ! Surely the number of clergymen who have fallen from their pulpits in consequence of misinterpreting Paul's advice to Timothy, and the number of physicians who have filled drunkard's graves, ought to admonish them that "wine is a mocker, and strong drink is raging." Tea possesses sti'ong nervine and moderate narcotic properties, and considerable astringency, due to the presence of tannin. All the properties of tea are subject to much vai'iation. Usually the green teas possess more astringency than the black ; they are also, as found in our markets, to a great extent adulterated with coloring matter, commonly Prussian blue. The less injurious effects of blacK teas evidently depend on their pui-er quality and weaker strengtn, as a concentrated exti'act of either is powerfully and equally poisonous. It is amusing to read the conflictijig testimonies of medical authors re- si>pcting the perative effects of f ?a as a beverage, ar \ wc sometimes DRINK. 311 find conflicting opinions expressed by the sam5 author. Thus says Pereira : " Strong green tea produces on some constitutions, usually those popularly known as nervous, very severe effects. It gives rise to ti-emor, anxiety, sleeplessness, and most distressing feelings. On others, however, none of these symptoms ai-e manifested. Part of the ill eflects sometimes ascribed to tea may be owing to the use of so much aqueous liquid, to the temperature of the liquid, to milk and sugar used with it, or to the action of tannin on the digestive liquid. But, independently of these, tea possesses a specific and marked in- fluence over the functions of the brain, not referable to any of the circumstances just alluded to. The influence of tea, especially the green variety, over the nervous system, is analogous in some respects to that of foxglove, for both green tea and foxglove occasion watchful- ness, and act as sedatives on the heart and blood-vessels." This appears to read plain enough, but in the next preceding para- graph the same author has told us . " Notwithstanding the extensive employment of tea in this country, it is no easy matter to ascertain its precise eflect on the constitution." Professor C. A. Lee, of this city, says: "A very strong decoction of green tea, or the extract, speedily destroys Hfe in the inferior ani- mals, even when given in very small doses. The strongly-marked effects of tea upon persons of a highly nervous temperament, in caus- ing wakefulness, ti'emors, palpitations, and other distressing feelings, prove also that it is an agent of considerable power, and should not be used to any great extent by persons of such a habit. It not unfre- quently occasions vertigo and sick headache, together with a sinking sensation at the pit of the stomach shortly after eating. It is also op- posed to an active nutrition, and should, therefore, be used with great moderation by tliose who are very thin in flesh." These facts are usefuito us, but the medical prescription can be greatly improved upon. If the extreme effects of tea are manifested by the susceptihle constitutions, the principle is clear enough that all constitutions suffer from it, though in a less ""egree. Instead of recom- mending "nervous" and "thin" persons to use it with moderation, the true physician, who values truth too highly to compromise it with false customs, will advise its total disuse. Schwaan found by experiment that tannin, wlien mixed with arti- ficial digestive liquids, threw down a precipitate, and rendered the fluids inert. The effect of the tannin upon the gastric juice may ac- count in part for its influence in promoting indigestion. It is certain that females, on account of their in-door occupations nir>re sedentary habits, suffer incom[)arabIy more from this, rlieir 312 HYGIENE. favorite beverage, than males do ; and I am inclined to think that the hot water is nearly or quite as deleterious as the herb, as the infusion is usually drank. From a pretty close observation, too, I am fully sat- isfied that the general prevalence of "female weaknesses" — a phrase including an extensive and formidable class of ailments — are in a great measure atti'ibutable to warm teas. Almost every kind of herb that grows, except those which are really nutritious, or are violently poisonous to the stomach and bowels, preternaturally excites the action of the kidneys and urinary oigans ; or, to speak more physiologically, the kidneys are the excretory oriiaus mtended to throw off a great part of such foreign or ^vaste material as is contained in infusions and decoctions of herbs. Very warm drinks are in themselves debilitating to the stotnach, but the addition of tlio pro}>erties of the tea or other herb burdens tlie kidneys and urinary apparatus with an unnatural amount of labor continually. These or- gans, kept constantly over-excited, must become debilitated, and j)re- ternaturally irritable ; and this condition of debilit}' and irritability ex- tends sympathetically to all the surrounding viscera; finally, the abominid muscles themselves become relaxed, and, with the general nervous exhaustion produced by the active nervine and narcotic j)rop- erties of the tea throughout tlie system, a foundation is laid fur tiuj whole train of maladies, displacements of organs, and disordered func- tions, which are so general among females of the present day. The history of these complaints, and the history of artificial bever- Hges, paiticulai'ly the employment of hot tea and coffee, show that ihere has been an intimate connection between the origin, progress, and prevalence of those diseases and these beverages. Fifty or an liundred years ago these complaints were comparatively rare. IMoth- ers in those days did not commence tea- drinking in childhood; their bodies were nearly developed and their constitutions well forioe I before their mothers allowed them to indulge in enervating slops. But now tea-drinking commences sometimes before the period of childhood — in babyhood. I have seen a regular tea-toper in a baby under two years of age. It is very common in these days for chil- dren of five and six years of age, little girls especially, to drink their two cups of tea or coflfee morning and evening. Is it wonderful that in early youth they are precocious in infirmities, and become chlorotic or cachectic, and complain of spinal irritation, mismensti-uation, ner- vous debility, and a train of local affections wholly unknown in simple or in savage life ? Coffee possesses the same nervine and narcotic properties as tea, without its nstringency. It nsnally acts as a laNarive to the bowels for DRINK. 313 awhile in those unaccustomed to its use ; ;)ut its long-continued em- I^loyment always results in constipation. Its operative effects ai-e, in most persons, rather more exciting and disturbing to the meiital and orgfmic functions *han those of tea. Most persons who accurately no- tice their feelings under its influence, find a greater derangement of the digestive functions and the secretion of the liver, than results from the use of tea. From all the testimony I can gather from medical and dietetical writers, coupled with some degree of personal observa- tion, I should judge it to be more directly injurious to the digestive process, and more exhausting to the general nervous energy, than tea, fmd less injurious to the kidneys and pelvic viscera. Medical authorities are as self-conti-adictory in regard to coffee aa they are about tea. Pereira says : " Employed moderately, I believe it to be a wholesome and slightly nutritive beverage." But in the same paragi-aph Pereira continues : "The immoderate, use of coffee is said to produce various nervous disorders, such as anxiety, tremor, disordered vision, palpitation, and feverishness." Professor Lee speaks like a man who loves a good cup of the exhilarating decoction. He says : " We should consider that cordials and stimulants are, at least occasionally, useful, and that, whether useful or not, mankind always have, and probably always will, make use of theni. But of all those which have hitherto been inti'oduced, none, perhaps, combine so many excellent with so few evil qualities as that of coffee. To moderately nutritive properties it adds those of a mild and cordial stimulant, with- out producing those peculiar narcotic effects which so often accompany the use of strong green tea." The eulogy of Dr. Lee is out-eulogied by Abd-al-Kadir Anasari Djezeri Hanbali, son of Mahomniet : " O cofi'ee ! thou dispellest the cares of the gi-eat ; thou bringest back those who wandei* from the paths of knowledge. Coffee is the beverage of the people of God, and the cordial of His servants who thirst for wisdom. When cofffeo is infiised into the bowl, it exhales the odor ofinusk, and is of the color of ink. The truth is not known except to the wise, who drink it from the foaming coffee-cup. God has deprived fools of coffee, who, with invincible obstinacy, condemn it as injurious." Chocolate, though destitute of the nervine properties of tea and coff"ee, contains a large proportion of fat or oil, called butter of cacao, wliich is difficult of digestion, and particularly injurious to dyspeptic stomaclis. Chocolate is prepared from the seeds of the thcohroma cacao, a native plant of the West Indies and Central America. The kernels of the roasted seeds are ground in a mill, whose sole rests on a heated iron plate, by which they are made into a brown pasty mass, 1—27 B14 HYGIENE. then sweetened with sugar or honey, mixed more or less with sago, flour, or starch, and generally flavored with vanilla or cinnamon. Chickory, or suckory, is a preparation of the roasted roots of a plant called wild succory, or u-ild cndine, which is cultivated in HoUcnd, Belgium, and Germany. It is used to adulterate coffee, and a spu- rious article is sold for chickory, made of roasted peas and beans, dam- aged corn, and coffee husks, and colored with Venetian red or Arme- nian bole. Cocoa is another preparation of the seeds of the theobroma cacao ; it is somewhat less greasv than chocolate, but has no other advantage. There are a great variety of acidulous drinks in popular use. Most of them are prepared juices of fruits and sugar, as lemonade, apple-tea. Bottle soda-water, as generally prepared, is merely a mixture of car- bonic acid gas in sweetened water. These beverages, in a hygienic point of view, ppssess but little importance. The only reason that the appetite demands them is, because the sense of tciste is so torpified by stimulating food and seasonings, that it cannot relish simple water ; still, they cannot be considered quite as healthful as pure water. Ef- fervescivg preparations of soda and tartai'ic acid, and of seidlit'z pow- ders, are decidedly injurious as common beverages, because they inti'odui e into the system a large quantity of debilitating nrutral salts. Ginger and root beers have had an extensive employment among pop- ulai' beverages. The latter is rendered pungent by yeast fermenta- tion, which develops from two to four per cent, of alcohol ; this, of course, is against its healthfulness ; but as such preparations will not keep but a very few days without becoming sour, the manufacturer often linds it profitable to add an additional quantity of alcohol. These drinks are trash at best, and worse than useless in their tendency to keep up artificial appetences, requiring strong, pungent, or gross bev- erages to satisfj'. In relation to the nilder kinds of malt liquors, small beer, or table heer, as it is called, j^orter, pale ale, and brown stout, Pereira talks pre- cisely like an " old-fashioned English gentleman." I quote Pereim mostly, because he is the latest and most approved author on dietetics as well as materia medica in the allopathic school. He says: "The practice of taking a moderate quantity of mild malt liquor, of sound quality, at dinner, is in general net only unobjectionable, but benefi- cicd. Considered dietetically, beer possesses a tln*ee-fold property* : it quenches thirst; it stimulates, cheers, and, if taken in sufliicieut quan- tity, intoxicates; and, lastly, it noui'isbes or sti'engthens." Surely his admiration of the virtues of grog was not excelled by that of the toper, who found it amply suflficient for food, drink, and lodging. Who can DRINK. 315 wonder that druLkenness is the distinctive v:ce of Christendom, when the professors of the healing art teach such ridiculously false doc- trines ? But let us quote also Pereira's reasoning : " Its power of appeasing thirst depends on the aqueous ingredient (water) which it contains, assisted somewhat by its acidulous constituent. Its stimulat- ing, cheering, ov intoxicating power is derived either wholly or prin- cipally from the alcohol which it contains. Lastly, its nutritive or strengthening quality is derived from the sugar, dexti-ine, and other substances contained in the extract. Moreover, the bitter principle of hops confers on beer tonic properties." If the reader can discover in such reasoning any thing but the veriest nonsense, I confess he has the advantage of me. Different Kinds of Natural Waters. — The natural waters of the globe have been classed into common waters, comprising rain, spring, river, well or pump, lake, and marsh waters ; sea ivaters, including the ocean and the salt lakes or inland seas ; and mineral waters, to which class belong all the springs, sti'eams, or pools usually regarded as medicinal. Rain water is the purest of all natural waters. When collected in cities, it is more or less impure at the commencement of the shower, from admixture with foreign matters suspended in the atmosphere, and is often loaded with the particles washed from the roofs of the buildings. After several hours of continuous rain in cities, and a much shorter time in country places, it -jomes down almost perfectly pure. Air is a constant constituent of or admixture with rain water, and it contains a slight trace of carbonate of ammonia, which is probably a product of animal decomposition, and the cause of rain water so read- ily running into the putrefactive process. Snow water does not differ materially from rain water, except in not containing air. That it is injurious to health has long been a vulgar error; eating snow, how- ever, does not quench thirst ; but melted snow is as efficacious for this pm'pose as rain water. Spring ivater only differs from rain water in having percolated through the earth, and ha.ving, during its passage, either imparted some of the particles it held in solution to the soil, or taken up soluble matters from the soil, or both. Its properties will therefore depend entirely upon the nature of the soil. A majority of the springs in the United States are hard, owing to earthy and saline matters, the most common of which are sulphate and carbonate of lime. There are, however, many sojl water springs ; enough, in fact, to answer all the drinking purposes of as dense a population as the country can sustain, Sl« HYGIENE. if it were conveyed to and distributed among the dwellings. The people in the country are generally singularly inattentive to the im- portant njatter of providing themselves with pure soft w^ater. They are very apt to get their supply from the most convenient spring, in- stead of the best. If they fully appreciated the importance of good water, they would not locate the dwelling-house until they had located the spring or well. River water is an admixture of rain and spring water ; it always holds in suspension a greater or less amount of exti'aneous matter, and in and ai'ound cities is strongly contaminated with decomposing animal and vegetable mattei-s. Much of the river water in this countiy, as it runs through the spai-ely-populated districts, is compai'atively quite pure and healthful. The \^ ^iter of the Thames, and in the vicinity of London, contains, as impurities, about 20 grains of solid matter to the gallon. Of this, carbonate of lime constitutes about 16 gi'ains, and sulphate of lime and common salt about 3;^ grains. The Croton water of New York contains but a ti-ifle over four grains of solid matter to the gallon, only a grain and a half of this being carbonate of lime ; sulphate of lime, the chlorides of calcium and magnesium, and the carbonate of magnesia constitute a little over two grains. The Cochituate water of Boston is equally as pure, and the Schuylkill of Philadelphia nearly as pure. Previous to the inti'oduction of the Croton river, the Manhattan water supplied to our citizens contained, in Chambers and Reade streets 125 grains of impurities to each gallon ; in Bleecker-sti'eet 20 grains ; and in Thiiteenth-street 14 grains. Some of the weUs in the lower part of the city contained 58 grains. The water in the wells of Bos- ton and Philadelphia were in no better condition. The usual results of drinking very hard waters, and those strongly impregnated with the exuviae of animal and vegetable substances, are sevoe dysenteries or protracted dian'heas, and chronic aftections of the kidneys. Weil water is generally more impregnated with earthy salts, espe- ! cially bicarbonate and sulphate of lime, than river water, or even t spring water. Its hardness is shown by its curdling and decomposing ': soap, instead of mixing with it readily and forming a suds, as will soft water. Sulphate of lime (gypsum, plaster of Pai'is) is a frequent cause of diarrhea. I Horses manifest su:li an instinctive repugnance to hard water, that they will drink out of a ti'^iid and muddy pool, provided its water is DRINK. 81'! soft^ in preference to partaking of the clearest and most transparent water, if it be hard. Lake water is generally very impure, being a collection of rain, river, and spring water, contaminated with puti-efying animal and veg- etable matters. Marsh water is similar to lake water, but still more loaded with offensive and putrescent organic matters. The stench arising from marshy and swampy grounds, which are occasionally inundated from the sea, is owing to the decomposition of the sulphates of the sea wa- ter by the puti-efying vegetable matters, which process evolves the intolerable sulphureted hydrogen gas. Sea water contains on the average 3i per cent, of solid matter. The amount varies considerably in different seas, and in different parts of the same sea. Its composition also varies in different localities. An analysis of 1000 grains of the water of the Mediterranean gave the following result : Water 959.26, chloride of sodium (common salt) 27.22, chloride of potassium 0.01, chloride of magnesium 6.14, sul phate of magnesia 7.02, sulphate of lime 0.15, carbonate of lime 0.20. Iodine, and bromide of magnesium have been found in some sea waters. Taken into the stomach, sea water excites thirst, nausea, and, in large doses, vomiting and purging. Mineral waters are classed according to the character of their pre- vailing impurities. Those whose predominating active principle is iron are called chalybeate or ferruginous. Sulphurous or hepatic waters are strongly impregnated vnXh sulphureted hydrogen, which gives them an odor like rotten eggs. Carbonated or acidulous waters contain car- bonic acid, which renders them sparkling and pungent. Of the saline mineral waters there are many sub-varieties, as the calcareous, alka- line, silicious, etc. The medicinal fame of the "Congress water" at Saratoga is derived from the great amount of its deleterious ingi-edients. One gallon con- tains the following impurities : Chloride of sodium (common salt) 385.0 gi'ains, hydriodate of soda 3.5 do., bi-carbonate of soda 8.982 do., bi- carbonate of magnesia 95.778 do., carbonate of iron 5.075 do., silex 1.5 do., hydro-bromate of potash, a trace ; in all, 597.943 grains. Each gallon also contains 311 cubic inches of carbonic acid gas, and 7 of atmospheric air. Dr. Steel, of Saratoga, very judiciously advises those who wish to experience the full benefit of this water to drink it only once a day — about three pints earij in tiie morning ; and he remarks very sensibly ; "It would be much better for those whose complaints render them fit subjects for its administra^ior., if the fountain thould be locked up, and 818 HYGIENE no one suffered to approach it after the hours of nine and ten in the morning." If it should be locked up at all houi's of the day and night, and a sti'eam of pure soft water substituted, the advantage to the in- valid portion of tlie guests would be still gi'eater. The Iodine Spring, at that place, differs from the former mainly m containing 3i gi'ains of iodine to the gallon, with a httle more than half the quantity of the other ingi-edients. The Sans Souci Spritig, at Ballston Spa, differs from the Congress principally in containing carbon- ate of lime, instead of bi-carbonate of magnesia, and possessing alto- gether a little less than half the amount of impurities. Tests of Ordinary Impurities. — The following are the tests (copied from Pereira's " Food and Diet"), by which the presence of the usual impurities of common waters may be ascertained : 1. Ehullition. — By boiling, au' and carbonic acid gas are expelled, while carbonate of lime, held in solution by the carbonic acid, is de- posited; this deposit is the fm* or crust which lines tea-kettles and boilers. 2. Protosulphate of Iron. — If a crystal of this salt be introduced into a phial filled with the water to be examined, and the phial be well corked, a yellowish-brown precipitate (sesquioxide of iron) will be de- posited in a few days, if oxygen gas be contained in the water. 3. Litmus. — Infusion of litmus, or syrup of violet, is reddened by a free acid. 4. Lime-water. — This is a test for carbonic acid, with which it causes a white precipitate (carbonate of lime), if employed before the water is boiled. 5. Oiloride of Barium. — A solution of this salt usually yields, with hard Jvater, a white precipitate, insoluble in nitiic acid ; this indicates the presence of sulphuric acid, which, in common water, is combined with lime. 6. Oxalate of Ammonia. — If this sdt yield a white precipitate, it indicates the presence of lime, carbonate and sulphate. 7. Nitrate of Silver. — If this occasion a precipitate insoluble in nitric acid, the presence of chlorine is inferred. 8. Phosphate of Soda. — If the lime contained in common water be removed by ebullition and oxalic acid, and to the sti'ained and ti'ans- parent water ammonia and phos})hate of soda be added, any magnesia present will, in the course of a few hours, be precipitated in the form of the white ammoniacal phosphate of magnesia. 9. Tincture of Galls. — This is used as a test for iron, with solutions of which it forms an inky liquof ^tannate and gallate of iron). If the DRINK. ' 31» test produce this effect on the water before, but not after boiling, the iron is in the state of carbonate ; if after as well as before, in that of sulphate. Tea may be substituted for galls, to which its effects and indications are similar. Ferrocyanidc of potassium yields, with solu- tions of the sesquisalts of iron, a blue precipitate, and, with the proto- saltSf a white precipitate, which becomes blue by exposure to the air. 10. Hydrosulphuric Acid (sulphureted hydrogen). — This yields a dark (brown or black) precipitate (a m.etnllic sulphuret), with water containing iron or lead in solution. 11. Evaporation and Ignition. — If the water be evaporated to dry- ness, and ignited in a glass tube, the presence of organic matter may be inferred by the odor and smoke evolved, as well as by the chaiTJng. Another mode of detecting organic matter is by adding nitrate or ace- tate of lead to the suspected water, and collecting and igniting the precipitate, when globules of melted lead are obtained, if organic mat- ter be present. The putrefaction of water is another proof of the presence of organic matter. Nitrate of silver is also a test, as before mentioned. Purification of Common Waters. — Filtration removes all in- sects, living beings, and all suspended impurities, but it does not deprive water of the substances it holds in solution. Boiling destroys the vitality of any animals or vegetables it may contain, expels air or car- bonic acid, and causes the precipitation of carbonate of lime. Some- times it may be advantageous to boil water first, and filter it afterward. Distillation purifies water from every thing except traces of organic matter; it is, however, a process too ti'oublesome and expensive for general employment. Chemical agents are sometimes made use of to free water from particular ingredients. Alum, two or three gi'ains to a quart, will cleanse muddy water ; the alum decomposes the carbon- ate of lime ; sulphate of lime is found in solution, and the alumina is precipitated in flocks, carrying with it mechanical impurities. Though this process renders the water clear, it adds nothing to its healthfulness, but renders it even harder, by converting the carbonate into sulphate of lime. Alkaline carbonates soften water by decomposing all the earthy salts, and precipitating the earthy matters ; the carbonates of soda and potash are much used in washing on this account ; they do not render the water any purer, nor fit for drinking or culinary pur- poses Adulterations or Common "Water. — The purest water is liable to become impregnated with poisonous properties when conveyed 320 HYGIENE. through some kinds of metallic pipes, particularly leaden ones. The air contained in very pure water rapidly corrodes lead ; distilled water, from which the air is excluded, has no action on it until air is again ad- mitted, when a thin white crust of carbonate and hydi'ate of the oxide of lead is speedily formed. Rain water is often impregnated from the lead of roofs, guttei-s, cisterns, anc pipes. (' ombinations of lead, iron, and zinc, and other mixed metals, as in cases where iron bars are used to support leaden cisterns, the introdu ion of iron pumps into leaden cisterns, etc., often produce a galvanic action which dissolves a portion of the lead. The leaden covere of leaden cisterns are also a source of contamination ; the water evaporates from the cistern in the form of pure or distilled water, and condenses upon the lid, w^hich it corrodes, and then falls back into the cistern impregnated with the metal. Su.^h cisterns should have wooden covers. Various saline matters impair the corrosive action of water and air, and exercise a protecting influence. The carbonates and sulphates afford the best security against lead poisoninir, because they fonn a protecting cnist upon the surface of the metal. Dr. Lee declai-es that "Palsy is often met with in the city of New York among grocei*3 and porter-house keepers, and is doubtless occasioned by their drink- ing beer in the morning which has stood in the lead pipes over night." Chemists do not agree respecting the action of our Croton water on its leaden conduits ; but experience settles the question affirmatively. It becomes our citizens, therefore, to exercise a constant watchfulness in its employment, wliich is, to let as much water run as the leaden pipes contain to their junction with the iron pipes in the sti'eets, be- fore drinking it- With this precaution, and the fi'equent emptying of the leaden pipes through the day, it is not probable that any appreci- able injur}'^ will be experienced from the lead. But these facts prove that the principle of conveying water thi'ough our dwellings by leaden pipes is wrong, and a substitute should engage the attention of inge- nious men and philantlnopists. CHAPTER IV, OF FOOD. Chemical Elements of Food. — In the present state of chemical •cience all known bodies, mineral and organized, are regarded as con- stituted of fifty-five simple substai ces, wl ].. a^'c- called chemical ele FOOD. 321 ments. Of these fifty-five elements nineteen have been found in organized bodies, animal and vegetable. Of these nineteen elements thirteen are regarded as essential constituents of the human body, viz., carbon, hydrogen, oxygen, nitrogen, p}ios])lwrous, sulphur, iron, chlo- rine, sodium, calcium, potassium, magnesium, and Jluorine. Pereira lays down the following postulate : " A living body has no power of forming elements, or of converting one elementary sub- stance into another ; and it therefore follows that the elements of which an animal is composed must be the elements of its food." If this position is correct, any alimentary substance capable of sus- taining the structures of the human body, must possess all of the chemical elements above-named among its constituents. We do not, however, find such to be the fact. Milk affords complete nutrition to the young mammal, and occasionally to the adult; wheat and apples are capable of perfectly nourishing the body ; yet neither of these articles, nor all together, yield to chemical analysis all of the elements above-named. It is, moreover, probable, and I think demonstrable, that, to a cer- tain extent, the vital functions of a living organism have the power of transmuting substances supposed to be elementary. This is proved by the fact, that the lime found in the bones of the chick when it quits its shell did not pre-exist in the recent egg. It could not be derived from the shell, because the membrane which lines its interior is not vascular; hence its only source is the transmutation of some other substance. The accuracy of Pereira's proposition may be admitted, or, rather, it cannot be controverted, with a qualification he has after- ward expressed, viz., that many substances now regarded as element- ary may be in reality compounds, which the body, though not able to create, may compose and decompose. Liebig, and most of the recent writers on physiology and organic chemistry, have distinguished foods into nitrogenized and non-nitrogen- ized — a distinction based on the presence or absence of nitrogen when the articles are subjected to chejnical analyses. It is assumed that the former only are capable of transformation into blood, and of form- ing the substance of the tissues ; hence Liebig has called them the plastic elements of nutrition. The non-nitrogenized foods he denomi- nates elements of respiration ; their use in the animal economy being, according to his notion, to keep up the ani'mal heat, by yielding carbon and hydrogen to be oxidated in the lungs. The following '^;:' ilar ar- rangement, copied from Pereira, sliDws *.lie absurdities ' > which mnn of the most extensive learcing becom»- nvolved, in the . 337 is by no means well understood." Liebig says : " Fresh flesh, over which salt has been strewed, is found, after twenty-four hcurs, swim- ming in brine, although not a drop of water has been added. The water has been yielded by muscular fibre itself, and having dissolved the salt in immediate contact with it, and thereby lost the power of penetrating animal substances, it has on this account separated from the flesh. The water still retained by the flesh contains a proportion- ally small quantity of salt, having that degree of dilution at which a saline fluid is capable of penetrating animal substances. This property of animal tissues is taken advantage of in domestic economy for the purpose of removing so much water from meat that a suflicient quantity is not left to enable it to enter into puti'efaction." If Liebig's explanation be true — and I believe it is tixie, and it is corroborated by the experiments and opinions of other distinguished chemists — that the antiseptic property of salt is owing to its abstract- ing from the animal fibre its aqueous particles, thus rendering it less capable of solution and decomposition, it proves also that salt is anti- dietetic in the exact ratio that it is antiseptic, for digestion implies the decomposition and ti'ansformation of the elements of the alimentary substance. But some authors, among whom are Paris and M. Eller, have expressed the opinion, and proved it by experiments, that salt actually combines chemically with the animal tissues, thus effecting to some extent their destruction ; hence a large quantity of it, or what is usually called the " free use of salt," cannot be otherwise than seriously injurious. The following awfully convincing argument in favor of salted food is frequently quoted by " old schoor' writers on hygiene : " Lord Somer- vilie, in an address to the English Board of Agriculture, refers to a punishment that formerly existed in Holland. The ancient laws of the country ordained men to be kept on bread alone, unmixed with salt, as the severest punishment that could be inflicted upon them in their moist climate. The eft'ect was horrible ; these wi'etched crim- inals are said to have been devoured by worms engendered in their own stomachs." Whether this story is fact or fiction, the principle applicable to its explanation is obvious enough. It is true that salt will kill many kinds of worms ; and if the bread fed to the Hollander con- victs was really a bad, rotten, wormy article, there can be no doubt that the addition of salt enough to destroy the vermin was a decided advantage. The fondness of domesticated animals for salt is often referred to as evidence that the desire for salt is a necessary and natural instinct in all animals ; and the fact that the deer of our forests seek the licks of 1—29 888 hyg:e>e. salt water, is adduced in evidence of the same nat;>ral instinct. But it should be remembered that domesticated animals have domesticated tastes, and that civilized horses, sheep, cattle, and hogs, are just as liable to acquire depraved appetites as civilized men. I have known co\AS to break into the "sap-bush" in maple-sugar districts, and drink themselves almost to death on syi-up, yet no one would pretend that sugar, molasses, or ti'eucle, was a natural food for cattle, except as it exists in the juices of vegetables. It should be obseiTed, too, that the wild animals who frequent the salt water pools, only do so habitually in the warm season, when insects and worms are troublesome. The scurvy, which is owing principally to a diet consisting of a large proportion of salted provisions, is a disease whose symptoms indicate an exceedingly impoverished state of the blood, and a putrescent con- dition of all the fluids and solids of the body. The antiseptic property of salt does not therefore render it wholesome. The ti'uth is, the term antiseptic has no applicability' to a living body or its aliment. It is a property which preserves dead organic matter in a fixed, un- changeable state ; and so far as it affects any living tissue, it must deaden its vitality. The dietetical rule for the employment of salt is veiy simple — tht less the better. I do not suppose a vei-y moderate quantity is harmful to any appreciable extent, i very little may be so diluted by the fluids of the stomach, and so readny washed out of the system as to occasion no important inconvenience. But if used habitually to the extent of provoking unnatural appetite and exciting thirst, it cannot be other- wise than prejudicial to the whole organic domain, occasioning glandu- lar obstructions, rlaidity of the muscles, producing genei-al irritation of the mucous membrane of the alimentaiy canal, and loading the circu- iting fluids with a foreign ingredient, which the excretory organs must labor inordinately to get rid of. So far as common salt and its elements (sodium and hydrochloric acid) exist in esculent fruits and vegetables, so far I admit they are alimentary. But it seems ^o me quite clear that nature has put the saline as well as the acid aud alkaline elements of our food together in exactly the right proportions, so that the wants of the organic economy do not require us to make any extraneous additions. Probably those who have never tried the experiment would be sur prised to learn how easily the appetite for very salt food is overcome. Many persons, on restricting themselves to less than one fourth the usual quantity for one month, have found the palate as well satisfied as it was previously on four times the quantity. The diminution of quan- tity can then be carried still further without sacrificing much gustatory FOOD. 339 pleasure, for, as the unnatural irritant is withdrawn, the sense of taste becomes proportionally keen, so that food, before unpalatable without high seasoning, is relished with little or none. The remarks in relation to common salt are equally applicable to the dietetical nature of all other saline ingredients found in alimentary sub- stances, although none of them are in use as condiments. The plios- jyhate of lime, which is tlie basis of the bony structure, is found more generally in vegetables than any other salt. The earthy phosphates are found in one hundred parts of wheat 0'36 to 0-9, rye 0*06 to 4*18, barley 0*1 to 0-6, oats 0*16 to 0*6, rice 0*4, garlic I'l, casein 6*0, milk 0-1975, blood 0-03, bones 45 to 56, muscular ilesh of ox a trace, do. of calf 0-1, do. of pig a trace, do. of roe 0-4, do. of chicken 0-6, do. of trout 2*2, corn, potatoes, milk, and many other foods contain the earthy phosphates. Minute quantities of the salts of potash are found in most vegetable foods, and in the blood, solids, and secretions of animals. The state in which the compounds of irx)n ex^st in the system, and the manner in which they are introduced, ai'e entirely unknown ; and it is question- able whether they are in any degree natural constituents of alimentary substances. A.LIMENTS, OR FooDS Proper. — Having treated of the ultimate or chemical elements of food, and the proximate elements compounded of the ultimate, we come now to the consideration of aliments, or foods proper, which are compounds of the proximate elements. Pereira terms the proper foods " comjyound alijnentSj," a name predicated on the mistaken notion that the alimentary principles were really simjjle aliments. He might as well call the oxygen and the hydrogen of the water we drink aqueous principles, and their combination in the form of water compound drink! Whatever may be the natural dietetic character of man — a question to be discussed in the succeeding division of this work — both the ani- mal and vegetable kingdoms are n.«de subservient to his nutrition. Hence the obvious propriety of treating this branch of our subject under the general divisions of animal and vegetable food. §. Animal Food. — Animal substances yield the Alimentary princi- ples called proleinaceous, gelatinous, and oleaginous, to which may be added the sugar of milk. They are derived from flesh, blood, bones, cai'tilages, ligaments, cellular tissue, viscera, milk, and eggs. All the species of animals which human power and ingenuity have been able to grasp — beasts, birds, fishes, reptiles, and insei^te, and every viscus or structure of each animal — brain, lung, heart stomach; in 840 HYGIENE. testine, kidneys, skin, etc., has been more or less employed as human aliment. In the more civilized counti'ies the mammals — neat cattle, sheep, and hogs, aflbrd the principal supply of food ; the deer, ra'buit, hare, elk, moose, buffalo, and bear, belong to this class, and are used to some ex- tent in many counti'ies. Even the horse, dog,, cat, rat, and mouse, are common food among the Kalmuck Tartars and some other tribes of the human family. Of birds those principally eaten are the common fowl, turkey, goose, duck, parti'idge, woodcock, and pigeon, though a gi-eat variety of other game birds are common at the refectories. The only reptiles which are much sought after in the United States are the various kinds of turtles, the most common of which are the salt ivater terrapin, painted tortoise, broad terrapin, red-bellied terrapin, geo- graphic tortoise, snapping turtle, soft-shelled turtle, and the green tur- tle. The common water-frog and the bull-frog are occasionally eaten, and the ■fle-'^h of vipers was once in repute as an analeptic or restorative diet for invalids. O^ fishes oui* brooks, rivei-s, lakes, and oceans furnish an endless variety, from the ichale of a hundi'ed tons to the shrimp of a tenth part of an ounce. The shell-fish employed as food are the lobster, crawfish, crab, prawn, shrimp, etc. — the crustaceousj and the oyster, mussel, cockle, whelk, scallop, limpit, p)^nwinkle, etc. — the raollusks. The best animal food is, beyond all peradventure, that derived from the herbivora — beef, mutton, etc- Those animals which derive their nourishment directly fi-om the vegetable kingdom will certainly afford a purer and more wholesome aliment tlian animals who subsist on other animfils — the carnivora. Omnivorous animals, that eat indiscrim- inately vegetables or other animals, are far inferior to the purely herb- ivorous as food for human beings. Of the hog, whose filthy carcass is converted into a mass of disease by the ordinary fattening process, I need only express my abhorrence. Although swine flesh and gi'ease, under the names of pork and lard, are staple and favorite articles of food throughout Christendom, common observation has long since traced the prevalence of scrofula, erysipelas, and a variety of glandular and ei-uptive diseases resulting from impure blood, to their general em- ployment. If there are any animals which should be exterminated from earth, mad dogs and fattened hogs are among vhem. If, as Dr. Adam Clarke suggested at a dinner where a smoking roaster of a pig graced the table, the animal was " cursed under the law," how can it be blessed under the gospel ? The flesh of animals that subsist ex- clusively on vegetable food contains a greater portion of nutritive mat- ter, according to chemical analysis, than the flesh of any other animals. FOOD 841 But thd quality of the food derived from herbivorous animals may be gi'eatly varied by circumstances. Very young or very old animals are less healthf il than young, nearly full-grown, or middle-aged. Ani- mals which have been excessively fattened, ov stall-fed, and those which have been hard worked, are deteriorated as food ; and animals tiiat have been " slopped" with liquid preparations, the refuse matters of the kitchen, c^r the filthy excrements of distilleries, are very un- clean and unhealihful. There is also a choice in the different parts or structures of all ani- mals when we come to the matter of converting them into the actual substance of the organs and structures of our own bodies. The veiy best part of any animal for any human being to eat is the lean flesh or muscular fibre ; and that flesh is unquestionably the most wholesome which is found in animals neither fattened nor emaciated. But some allowance must be made for the masticatory ability of human teeth, "as society is now constituted." Flesh-meat requires thorough mas- tication. Human beings have not the tearing teeth of the tiger and the wolf, nor the cutting motion of the jaw which belongs to the car- nivora. Moreover, the teeth, jaws, and gums of most people who live in the ordinary way are preternaturally sensitive and tender ; and in addition to all this, a large portion of people, even young people, ii civilized society, wear artificial teeth. They cannot, therefore, well masticate tough meat, as is often demonstrated in the cases of choking in the attempt to swallow half-chewed flesh. For this reason the ani- mal had better be in good condition, and only the most tender fibres selected as food. Epicures generally have their flesh kept until it becomes tender from age ; but such tenderness is the condition of in cipient putrefaction, and although the article may be very easily dis- posed of by the teeth, and very quickly dissolved in the stomach, it can never be well digested, nor can it ever be converted into pure blood and sound tissues. It is advantageous to break up the fibres of tough meat by thoroughly pounding before cooking. Tiie process of decomposition commences in a dead animal the mo- ment that life is extinct, although it may not be offensively apparent to our senses for some hours or days after death And as living animals can derive no nittriment fi-om any solid food exuept it be in its organized state, it follows that the flesh of animals as food deteriorates continually after the animal is killed ; and hence the sooner butcher's meat is em- ployed after being_ killed, the more wholesome. It may, however, be immediately frozen, and kept a long time without injury. The manner of slaughtering the animals also affects the quality of their flesh. They should ahvays be JcilU i aUojMtki call]/— begging pardon of my "old- ,^2 HYGIENE. school friends," if I have any — that is, hied in such a manner as to empty the vessels as cleanly as possihleviand never executed by stunning, pounding, Av^inging the neck, etc. The blood not only contains the nutrient elements of the food, but the waste matters to be expelled from the body, and also such accidental impurities as may have obtained admission into the body; and the more bloody any kind of animal food is, the more unclean, uutresccut, and unwholesome. Dr. Dunglison Utters the following flat conti'adictions on the same page o| his late work on Human Health. In speaking of the Roman custom of killing ani- mals by running a red-hot spit through the body, he says: "This mode of slaughtering was replete with objections, if regarded in an aliment- aiy point of view. The flesh of animals thus killed is dark colored, owing to the retention of blood in the vessels, and hence it becomes speedily putrid. ^^ Per contra, says Dr. Dunglison : "When an animal is killed accidentally, without bleeding, its flesh is not unwholesome, al- though it may not be palatable, in consequence of the blood remaining in the vessels.'^ And yet again says Dr. Dunglison, as if to render confusion as confounded as possible : " The blood i« the most putresci- ble of all fluids, and consequently animals, under such circumstances, do not keep sound so long as when they are bled to death." And yet once more says Dr. Dunglison: "Caution should always be observed in eating animals that have died from, or been killed dm'ing disease. Although the meat may often be innoxious, at other times it would seem to be capable of producing disease, and even death." The body of an animal dying from disease 7nay he healthful food, says Dr. Dungli- son. Of such thoughtless and senseless gabble is the gi'eat mass of medical and dietetical books afloat made up. The bloody drippings from broiled flesh which are so eagerly "spooned out" by many per- sons to season their potatoes, or "sop" their bread with, are always more or less charged with animal excrement, and never fit to be taken into the stomach, albeit some medical books prate about that stufi" being the "juice" and "strength" of the meat! The Mosaic law, which forbade the Jews to eat the blood of any beast or bird, or to partake of their flesh, unless the throat had been cut, in order to drain ofi* the blood, was founded on coiTect physiolog- ical principles. As a further precaution against eating blood, they were required, previously to boiling meat, to let it soak half an hour in water, and then lie an hour in salt ; the object of tWs proceeding was to draw out any remaining portion of blood the flesh might contain In regard to the philosophy of dietetics, Moses was far in advance of the majority of tiie Christian teachers of the present day. The sausages sold in the shops under the nanie of black pudding FOOD. 343 are made of pig's blood mixed with fat, seasoned with aromatics, end inclosed in the prepared intestines. Brande and Schlossberger give the following proximate composition of muscular flesh: Albumen, Nutritive 100 Parts. Water. or Fibrin. Gelatin. Matter, Beef, 74 20 6 26 Veal, 75 19 6 25 Mutton, 71 22 7 29 Pork, 76 19 5 24 Chicken, 73 20 7 27 Cod, 73 14 7 21 Haddock, 82 13 5 18 Sole, 79 15 6 21 The comparative healthfulness of other parts of animals can be read- ily determine''; nj a reference to the physiological principles already adverted to. The fatty matters, next to the blood, are the worst ali- mentary substances ; and, notwithstanding artificially depraved appe- tites generally crave unnatural aliment with an intensity proportioned to its impurity, such fact does not alter the truth, nor sliould qualify our manner of expressing it. The kidney, whose function is to elim- inate from the body a large proportion of its most puti-escent materials, though often considered a "dainty dish" by epicures, is certainly unfit to eat. A cooked kidney always exhales a urinous odor. The liver stands in the same relation to the human stomach. Next in the order of their unfitness are the brains, lungs, stomach, and intestines, skin, cartilages, tendons, etc. All these viscera and structures are made into a variety of fashionable dishes, and all have their admirers ; but just as far as we depart from lean flesh i-n selecting aliments from the animal kingdom, just so far does their value depreciate. The dietetic character of animal food is also aflected by the manner of cooking. It is to be prefeiTed lightly or but moderately cooked, providing a due degree of tenderness of fibre is secured. In broiled steaks this may be accomplished by pounding; but large, thick, roasting pieces are apt to be tough if not w^ell cooked. Broiling, on all accounts, is the best method of cooking all flesh-meat. Boiling, taking care to skim oft" any floa*c3!g particles of oil, is better than roasting; and this again is better \h?in frying, which is a method never to be recommended. Another argument may here be stated in favor of the position that muscular flesh is the best form of animal food, which is, the §t)solute identity of the chemical elements of pure flesh and pure blood. Th© analyses of Playfair and Boeckmann give the following results : 544 HYG lENE. Roasted Elements. Ox Blood. Dry Beef Roasted Tieef. pLoasted Veal. Deer. Carbon, 51-95 51-83 52-590 52-52 52-60 Hydrogen, 7-17 7-57 7-886 7-87 7-45 Nitrogen, 15-07 15-01 15-214 14-70 15-23 Oxygen, Ashes, 21-39 4-42 21-37 f 4-23 S 24-310 24-91 24-72 100-00 100-00 iOO-000 100-00 100-00 The milk of the mammals, though an animal secretion, can hardly be called {mimul food, in sti'ict language. It contains, on the average nearly ninety per cent, of water, and about ten per cent, of solid mat- ter, consisting of butter, casein, sugar, and various salts. The cream of cow's milk, according to Berzelius, consists of butter 4-5, casein, or curd 3-5, whey 92-0=100-0. By agitation, as in churniyig, tlie gjobules of fatty matter unite, and form butter; the residue is callecl huttcrmilk ; it consists of casein, serum, or whey, and a very smal^ quantity of butter. SJcimmed mill: very soon becomes acid and curdy. The admixture of an acid or rennet (which is the infusion of tho fourth, or true stomach of the calf), immediately coagulates it, separ- ating the casein, or curd, from the whey. The* addition of acetic acid will cause a still further sepai-ation of coagula, which has been called zieger, hracotte, etc. After the separation of casein and zieger, the whey left yields lactic acid^ salts., and some nitrogenous sub- stances, one of which is supposed to be osmazome. Osmazome, how- ever, does not appear to be a tangible reality, but a flavor or effluvia developed by the chemical changes which take place in several animal substances during the process of cooking — heating, roasting, boiling, etc. Good milk is a homogeneous but not viscid liquid, not coagulable by heat. When examined by the microscope it appears to consist only of transparent spherical globules. The cream j'ielded varies from five to twenty per cent., as tested by the lactometer, which, by the way seems to be a very unsatisfactory instrument for the purpose. No secretion is so readily aflected by the ingesta, or the general health of the animal producing it, as the milk. The taste, color, and odor of cow's milk are readily modified by the food. Children are easily salivated, narcotised, catharticised, and poieoned and disordered in many ways, through the mother's milk. The organic instincts, true to the first principle of self-preservation, determine the accidental im- purities of the body to this channel as the most ready way of expelling them from the body Nursing mothers have little idea how much disease nain, and nii«er " they inflict on their little ones, nor how fre- F 3 D. 346 quentl)^ they commit infanticide^ by taking irritating aliments and drinks, and injm'ious drags into their own stomachs. If I could pre- sent this subject to them in all its force, and in all its bearings on their happiness, and' on the well-being of the hun^n race, as I hope to at- tempt in a future publication, I am certain there would be a sudden and very radical revolution in the way of dieting mothers and doctoring children. The milk produced by cows fed on distillery slops, which, to the disgrace of municipal authorities, rich men are permitted to sell to the poor in nearly all our large cities, is not only very iunutritious, but abso- lutely poisonous. In New York, Brooklyn, and Williamsburgh, several thousand cows are kept in close and horribly filthy stables, fed on warm slops, and other refuse matters of the distilleries, which rot their teeth, weaken their limbs, and render their whole bodies masses of disease ; and their milk is furnished to our citizens as a principal article of diet for their children ! Although milk cannot be considered a necessary or strictly natural food for mammals, except during the period of infancy, when the teeth are undeveloped — and no animals of the class mammalia, save man, em- ploy it otherwise — it is nevertheless, when pure, the best form of ali- ment out of the strict order of natural foods. It contains all the elements requisite for prolonged nuti-ition, and except in certain abnormal states of the digestive organs, its moderate employment is attended with no inconvenience. Some invalids cannot enjoy, and some dyspeptics can- not tolerate it ; but exception^ cases from morbid conditions are not rules for healthy persons. Butter^ as prepared for the table, js a different article dietetically from its fatty particles as they exist in milk. The former must rank with all animal oils, in being difficult of digestion, but slightly nuti'itive, and liable to generate rancid acids in the stomach. There is, however, a great difference between fresh-made and slightly salted butter, and that which is old and highly salted. Compared with the latter the former is almost innocuous. Me'..ed and cooked butter is, wherever found, a very deleterious aliment. Siveet cream, from its solubility in water, and greater miscibility with the saliva, is far preferable to but- ter. Indeed, I am not aware that experience assigns to it any injurious or even unpleasant effects as an aliment. ^ The fresh curd of milk is perfectly wholesome, and pot-cheese, when made of i?iilk as soon as it becomes sour, and before it gets bit- ter, is also a harmless article. Green cheese is not very objectionable, but old, strong cheese is one of the most injurious and indigestible tliiiigrs in existence. It is also one of the most constipating articles to ft4fl HZGIENE. the bowels thnt can be found . It is a common fancy among med- ical men, and a common whim among the people, that old, sti'ong, rank cheese, though itself very indigestible, stimulatt^s the stomach to digest other things ; hence almost all the medico-dietetical works quote the old adage : " Cheese is a mity elf, Ingesting all things but itself." There is more poetry than truth in the doggerel distich. Old cheese occasionnlJy undergoes spontaneous dejj-omposition, during which pro- cess acrid and poisonous elements are developed, as is frequently the case with bacon and sausages. Next to the flesh of the herbivora, or rather the graminivorous ani- mals, the jiesli of birds affords the most wholesome form of animal food. All of the species of the feathered tribes in conmion use, how- ever, are not equally wholesome. Their alimentary value depends in a great degree on their food and manner of life. Pereira says: "Ra- pacious birds, as tlie hawk and owU are not eaten, partly, perhaps, from prejudice, and partly because those which touch carrion acquire a cadaverous smell." I should think the stench alluded to was a suffi ciently strong reason for refusing to eat them, without imputing any thing to the score of prejudice. The white-jleshed bu'ds — chicken, turkey, partridge, quail, etc. — ai'e very nearly as nutritious and digestible as beef. Chicken flesh is called the " least stimulating of animal foods" by medical writers, but I think the assertion is wholly gi-atuitous. The dark-fleshed birds, as game birds, grouse, robin, woodcock, snij^e, etc., are less nuti-itive and less digestible, but more greasy and savory to epicures. Pereira says of the flesh of these birds: "It is richer in ozmazome, and when suffi- ciently kept it acquires a peculiar odor, called funiet, and an aromatic^ bitter taste, most sensible in the back. In this condition it is said to be npe, or high, and is much esteemed as a luxuiy." This "fumet," so highly prized, is the stench of putreftiction, as is the " cadaverous smell" of carnivorous birds. Prof Dunglison eulogizes this fumet still more exti-avagantly : "The solubility of game, grouse, etc., is amazingly increased, as weii as the luxury of the repast, by keeping it until it has attained the requisite /wmc<; which indicates that incipient putrefaction is diminishing its cohesion." The luxury of putrefying animal flesh sounds sti-angely to those who do not go to epicures and "riotous livers" to learn their dietetic rudiments. It is unfortunate for the cause of human health and longevity, that phys ologists do not consult nature and common-sense more, and cooks a .d refectOKes less, in seeking for the facts and principle > of hygiene. FOOD. 347 The aquatic birds, geese and ducks, sre strong, rancid, and oily, and extremely unwholesome. The canvas-sack is considered one of the gi-eatest of luxuries ; but here, as in a majority of cases, the luxury consists in the pampering of an exceedingly depraved appetite. The manner in which fowls are fattened for the markets of many large towns, though it commends them to the tastes of epicures, detracts very much from their purity as food. They are confined in dark places, sometimes their eyes are put out or stitched up, and crammed with a paste made of barley -meal, mutton suet, molasses, and milk ; this ripens them in a fortnight, when if they are not innnediately killed, a fever or general inflammation comes on, which frequently desti'oys them. Particular parts of certain birds have long been celebrated as "deli- cate morsels" by epicures ; as the brains oi the ostrich and peacock, the tongues of the nightingale and flamingo, the trail, or intestine of the woodcock, the enlarged liver of the goose, etc. This last article is a diseased condition of the liver, called by physiologists fatty degen- eration, and is produced by confining the goose in a dark, warm place, and stuffing it with food and chaixoal. Sometimes in this way the liver swells enormously, weighing two pounds. The body of the goose also becomes very fat, and in the language of Pereira, "excellent for the table." Pereira says of this morbid liver: "It is obvious, therefore, that these diseased livers must be difficult of digestion, and unfit for persons with delicate stomachs." Why should any persons, be their stomachs delicate or indelicate, eat "diseased" livers? The eggs of oviparous animals, when fresh and rare-boUed, are moderately nutritious and easy of digestion. They are not particularly objectionable as a part of a dietary selection, yet their virtue is rather negative than positive. Poached eggs are extremely pernicious ; and eggs are very indigestible when hard-boiled or fried. One w^riter, Mr. Pearson, states that there are "instances of laboring ])eople, and persons who use violent exercise, with whom eggs, hardened by boiling or frying, agree better than in the soft or liquid state." It is not un- common for laboring men to suppose that hiu-d water agrees better with their stomachs than soft water ; but no intelligent physiologist will think so. The flesh of turtles is prepared at the refectories in the forms of steak and soup. It is unwholesome aliment in all ways, though Sir Hans Sloane, who appeai-s to be as high authority among flesh-eaters as Hoyle is among chess-players, says, "the livers are counted delica- cies." Sii* Hans also tells us that the callepce, or under part of the breast or belly, baked -s veckoned the best piece. Moreover, «48 II Y G I E N E. Sir Hans remarks : " Persons who feed much on turtles sweat out a yellow serum, especially under the armpits." And again says our author: "The lard, ur fat of the green turtle, when melted out, is of a warm yellow color, and communicates a yellow tinge to those who feed on it; whence theii- shirts are yellow, and their skin and face of the same color;" from all of which testimony we conclude that these rep- tiles are not fit for human beings to eat. The eggs of these animals are sometimes eaten. In a general sense, fish aliment is far inferior to flesl The pis- civorous ti'ibes of the human family are universally in a state of exti'eme mental and bodily abjection. The explanation of this fact is found in the food upon which the animals which they errf: subsist — smaller fishes, worms, and insects, and the impurities of the element in which they reside — so far as salt-water fishes are concerned, which penetrate their structures, and mingle in all their fluids and secretions. Fish is not as nutritious as flesh, and is usually considered as less stimulating. The feverishness so generally noticed after a meal of fish may be imputed to the impurity of the aliment, though some regard it as evidence of stimulation. As a general rule the least oily fishes are the most wholesome, as the cod^ halibut, trout, u'hitefish, bass, blackjish, had- dock, whiting, sole, turbot, etc. Salmon, eels, herrings, pilchards, sprats, viackerel, shad, etc., are among the oily varieties. Dr. Dekay, in a late work, enumerates 440 species of fishes belonging to the State of New York, hence the varieties distributed over the aqueous portions of the globe must be innumerable. The objectionable nature of fish aliment is generally made still more objectionable by the usual method of cooking — frying, and the indi- gestible additions of melted butter, lobster-sauce, egg-sauce, etc. The idea has been extensively entertained that fish diet gr*eatly in- tensifies the procreative powers, and Tourtelle refers to the numerous children found in seaports as proof. But there is no evidence that ichthyophagous people propagate faster than others. Were the opin- ion currecf, it woulu afford another argument against the sanatory na- ture of the food ; for it appears to be a law of the animal kingdom that tl^e rapidity of propagation increfises with the increase of the cause? which destroy the animal. The Egyptian priests were forbidden to eat fish, and among the aquatic animals which Moses prohibited to the Hebrews were, "Wlrat- soevcr hath no fins nor scales." A law similar to that of Moses was made by Numa Pompilius for the Romans. In tropical climates many Bpecies of fish are absolutely poisonous, especially at particular seasons, producing, when eaten, violent itching, colic, burning heat in the tliroat. FOOD. 54& nausea, giddiness, blindness, cold sweats, often terminating in death. Dr. Burrows enumerates twenty kinds of poisonous fish. The nature of this poison is wholly unknown. The fishes found in the clear water of lakes, rivers, and rivulets are greatly superior to those which inhabit muddy or foul waters. Some kinds of fish are eaten whole, as the white bait. Nearly all the parts and viscera of these animals are eaten more or less, not excepting the milt or testicle of the male, and the roe or ovary of the female. The former, called the soft roe, and the latter, called the hard roe, are "among the " esteemed luxuries" of sensuous epicures. The caviare, which Dr. Dunglison calls " an article of national food," is the pre- served roe of the sturgeon and various other fishes, salted, peppered, and further flavored with minced onions. The milt of the herring has been recommended by several distinguished physicians — Ritter, Neumann, Frank, Siemerling, and Hufeland — as a remedy for various diseases ; and, what is specially amusing, its effiacy was ascribed to the common salt it contained ! Of the crustaceans, lobsters, crabs, shrimjjs, and praiuns, are those most genera y eaten. They are all exceedingly indigestible, and a frequent cause of disordered digestive organs. The peculiar odor and taste of these animals are due to a resinous substance of the membrane enclosing the shell, and which becomes red by boiling. Pereira says : " Both the crab and the lobster excite, in some constitutions, urticaria^ or nettle-rash, and even colic." Of the class mollusca, the oyster is the greatest favorite with the lovers of sea-food. They are not very nutritive, containing only about 12^ per cent, of solid matter. When eaten raw they are more digest- ible and wholesome than when cooked in any manner. Oysters have had the reputation among medical men of being a specific for dyspep- sia, scrofula, and consumption, but the more intelligent physicians of the present day specially prohibit them in those diseases, except when they deem it policy to compromise with the appetites or prejudices of their patients. Mussels, clams, scallops, cockles, and even snails, are oaten to a considerable extent by people on the sea-coasts. The for- mer are frequently poisonous. Dr. Lee states : " It is a very common thing for persons to be poisoned in this city (New York) by eating mussels produced from our adjacent waters." Eruptive and paralytic afiections are said to be the results of being poisoned by these animals. The vineyard or great snail, has been, and still is, in England, not only a -popular but a regular remedy for consumption. Fulvius Hir- pinus, of Roman celebrity, had several snail parks in his garden, where he kept and flUtened the " most famous and excellent" snails, 30 350 HYGIENE. each variety liiiving a park to itself. He fed them upon a pap mad© of sweet wine, honey, and flour; "and under this diet," says Dr Dunglison, " they, becairie so wholesome and delicate, and were so much esteemed, that they were sold for eighty quadrants the dishful." I am of opinion that the wholesomeness of an aliment is not to be de- termined by the tastes of epicures, or its price in the market ! But few insects are employed as food among civilized people at the present day. The gruh-ivorm was in repute as a " delicacy" in the day.- of Pliny. Locusts, grasshoppers, and some species of spiders, have been eaten. In South America centipedes ai-e eaten. The Bra- zilian Indians are fond of the ichite ant; and the West Indian negroes relish a species of caterpillar. On the dietetic value of these insects I need not dwell. §. Vegetable Foods. — The vegetable kingdom affords the purest aliments, as well as the greatest variety of alimentaiy principles. Vegetable foods are found in the form of the seeds, fruits, roots, huds, and young shoots, leaves, flowers, and stems, of flowering plants, and lichens, ferns, sea-weeds, and mushrooms, of flowerless plants. The seeds and fruits are the most important and most usefiil of hu- man aliments ; yet it would be difficult to decide which of these is most necessary, for the perfection of nuti-ition requires both. The seeds commonly employed are the cereal grains — wheat, oats, barley, rye, rice, maize or Indian corn, and millet; the leguminous seeds — peas, beans, and lentils ; the cupuliferous seeds — chestnuts, etc. ; and the oily seeds or nuts — almonds, walnuts, hazel-nuts, butter- ^Mts, filberts, cashew-nuts, cocoa-nuts, etc. The most common alimentary fruits are the diiipaceous or stone fruits — peaches, nectarines, apricots, cherries, etc. ; the pomaceous fruits — ajyples, pears, quinces, etc. ; the baccate or bemed fruity — currants, gooseberries, whortleberries, cranberries, grapes, elderberries, etc.; the aurantiaceous fruits — oranges, lemons, limes, citrons, shaddocks, etc. ; the curcubitaceous fniits, pepones, or gourds — cucumbers, melons, squashes, i^umpldns, etc. ; leguminous fruits, legumes, or pods — of the tatJiarind, bean, etc. ; the synochus fruits — figs, tomatoes, etc. ; the Borosis fniits — mulberries, pine-apples, etc. ; the etgeno fruits — strawber- ries, raspberries, blackberries, etc. In the order of roots, tubers, and subterranean stems, we have the potato, turnip, carrot, beet, parsnip, artichoke, etc. Among buds and young shoots we find onions, leeks, garlics, shaU yQts, asparagus, etc. Leaves anc* 'eaf-stalks furnish us cabbage, spinach, cauliflower, broc coli, con^slips, milkweed, turrv^v tops, potato tops, dandelion tops, let-' FOOD. 351 tuce, mustard tops, endive, water-cress, common cress, celery, rhubarb, sorrel, plantain, etc. Of the receptacles and bracts, the flower-heads of the garden arti- choke are the best known. The stems of several palms yield a fiirinaceous food, as sago. The pulpous stems of 3. fern-tree in New Zealand are eaten, and esteemed an excellent vegetable. The tuberous rhizomes of ferns, in Polynesia and other parts of the world, yield a fai'inaceous matter, which is occasionally employed as food. Many lichens, of which Iceland moss is the most familiar example, are used dietetically and medicinally. Several species of algae or sea-weeds — Irish moss, Ceylon or Jafna moss, etc., are also employed both as food and medicine. Several species of the fungi or mushrooms are considered edible. The best known among them are the Jield mushroom, boletus, morel, truffle, pepper dulse, and tangle. Of the cereal grains wheat and rice ai'e the most extensively culti- vated. Although they possess about an equal amount of alimentary properties, the wheat is far superior as a single article of diet. Those who employ a diet mostly of rice require a larger proportion of succu- lent fi'uits, or watery vegetables, or ligneous matter, as leaves, roots, etc., than those who subsist principally on the whole gi-aki of wheat, for the reason that the latter contains in the bran a much larger pro- portion of lignin. But even wheat is too nutritious and concentrated of itself, and requires the admixture of a due proportion of fruits, or other succulent and, comparatively, innuti'itious vegetables. It appears to be a confirmed habit among dietetical writers and med- ical practitioners to ^\Tite and speak of animal food, as compared with bread and other preparations of the grains, as being more " nourish- ing," more "substantial," etc., in the face of all human experience and all chemical investigation, which prove the latter to contain at least three times as much nutriment in a pound as can be obtained from the best flesh-meat. Those tribes of men, laborers, hunters, etc., who subsist almost wholly on flesh, fish, or fowl, devour on the avei'age about seven pounds per day ; while those persons in similar ch'cum- stances and occupations who subsist almost exclusively on farinaceous vegetable food, eat but little more than one pound. In fact, the quan- tities of animal food consumed by some human beings, who are car- nivorous in practice, seem almost incredible. Captain Parry relates the case of an Esquimaux lad, who, at a meal which lasted tueniy hours, consumed 4 lbs. raw sea-hoirse flesh, 4 lbs. broiled ditto, I4 pint 862 HYGIENE. gravy, besides 1| lbs.4)read, 3 wine glasses raw spirits, 1 tumbler stiong gi"og, and 9 pints of water. Captain Cochrane states, in a " Narrative of Travels through Siberian Tartary," that he has re'peatedly seen a Yakut or Largouse eat forty pounds of meat in a day ! It is stated that the men in the service of the Hudson's Bay Company ai'e al- lowed the daily rations of seven or eight pounds of ordinaiy flesh- meat. The world is full of examples of laboring individuals, even in cold climates, subsisting on coarse bread, not exceeding the average amount of one pound of wheat, rye, or corn daily ; and the millions of China and India subsist on much less than that quantity of rice, with only animal or other food enough to amount to a condiment or seasoning. For the purpose of making raised or fermented bread, wheat is su- perior to all other grains, on account of its large proportion of gluten. The wlieat of hot climates, as a general rule, contains more gluten than tliat of cool climates. The Southern or red wheat of this countiy is more glutinous than the Western or white wheat ; hence the Southern flour is called stronger by the bakers, and is capable of being puffed up into the largest, and, for the manufacturers, the most profitable loaf. Wheat also proves more palatable to a majority of people in its various forms of preparation than any other grain. Boussingault gives the following analysis of wheat, rye, and oats, which makes them almost identical in chemical constituents. The other gi'ains cannot diifer essentially from these : Ultimate Elements. \Mieat. Rye. Oat3. Carbon, 46-1 " 46-2 50-7 Hydrogen, 5-8 5-6 6-4 Oxygen, 43-4 44-2 36-7 Niti-ogen, 2-3 1-7 2-2 Ashes, 2-4 2-3 4-0 Total, 100-0 100-0 100-0 The proximate constituents of the grains are : Starch, albumen, Jihrin, gluten, mucin, sugar, gum, cil, lignin, earthy phosphates, and tcater. The methods by which wheat is prepared for the table are very numerous. The very best is unquestionably the unleavened wheat- meal bread. The yeast brown bread ranks next in wholesomeness. Fine bread, made of flour, with the addition of a quantity of rye-meal, or coarse-gi'ound Indian meal, or both, is an excellent article. The common superfine bread, especially as preu^'ed for the market by th» F C D 863 bakers, is the lowest order of bread-kind in the scale of healthfulness. All the bakers' bread with which I am acquainted — and I have ex- amined it very extensively — is over-fermented, by wliich much of the starch as well as the sugar is destroyed, and more or less of the gluten decomposed, and converted into acetic acid, which acid is neutralized by ammonia, or otliov alkaline matters. Thi«i is the reason that stale }jakei"s' bread is so l. ipalatable after it is fairly cold, while good domes- tic bread preserves its sweetness and flavor for a week or two. Uni- versal experience as well as physiological science pronounced all fresh fermented bread unwholesome. Fermented bread is never fit for the stomach until it has been twelve liDurs from the oven, and is not in its best condition under twenty-four hours. There are two reasons why new bread, when fermented, is prejudicial to the digestive organs. Its texture being soft, spongy, and adhesive, it is not well masticated and insalivated; and again, the process of fermentation not only devel- ops the carbonic acid gas which raises the dough, but also converts a small portion of the elements of the saccharine matter into alcohol ; this alcohol is probably not perfectly dissipated by the heat of the oven, nor until the bread has *been many hours from it. To make the best bread it is essential to have a good article of flour — if fresh-ground the better — fine, fresh, sweet yeast ; the dough must be well kneaded, so as to diffuse the yeast equally through the mass ; the loaf must be placed in the oven the precise moment when it k sufficiently light, or it will be heavy from deficient, or sour from excessive fermentation, and baked in a brick oven from an hour to an hour and a half, accord- ing to the size of the loaf. Very good yeast bread may be baked in a stove or kitchen-range by observing carefully all the above conditions. Wheaten grits (cracked wheat), an article rapidly getting into popular favor through hydropathic auspices, simply boiled, make an excellent dish, seasoned w^ith a little sugar or milk. For children there is nothing in the world superior, from the very moment they are able to take any food except the mother's milk. I know it will almost horrify some good mothers and kind nurses to be told that cracked wheat, " bran and all," is proper aliment for the delicate, susceptible stomachs of little infants; while many a college-bred M.D. is ready to declare that such coarse, rough, scratchy food is enough to tear its tender bowels all to pieces ; and I know, too, tliat the great " standard authors" of the medical professirn, and all their little echoes throughout the country, proclaim the br^in part a "mechanical irritant;" and yet I know the assertion I make to be true. Let those who oppose this kind of diet for children, if the;/ can, give some rational reason why thiity children l)er wee'f in the city of New York die of the disease called convulsions^ 364: HYGIENE. a disease whose almost exi lusive cause is obstruction, or constipation, and this condition being almost universally produced in them by the vai'ious preparations of fine flour. Farina, formerly called pearl wheat, contains more of the ligneous, or branny property, and is hence far preferable to fine flour for mush or pudding. Semolina, soujee, and mam^acroup, ai'e also granular preparations of wheat similar to farina, considerably emploj^ed in England. Maccaroni, vermicelli, and caglivari paste, are pasty prepai-ations of wheaton flour. Hot rolls are rendered tender and brittle by excessive fermentation, but are, for the same reason, very indigestible and unhealthful. Rusks, tops, bottoms, buns, etc., are fermented, and for the same reason unhealthful when fresh ; they are also less digestible from the additions of butter, sugar, and milk. Gingerbread is made exti'emely hght by means of carbonic acid gas, but the combination of flour, treacle, butter, alum, and potash is a serious objection to its wholesomeness. The common sea-biscuit^ or ship-bread, is made of either wheat-meal, or flour containing a con- siderable proportion of bran, simply mixed with water, and baked. It is hard and compact, and very wholesome. Wlieat-meal crackers (Graham crackers) when made without shortening, and not over-fer- mented, are a good article for exercising the teeth, and promoting the salivarj^ secretion. Cakes, in almost endless variety, are made of superfine floisr, butter, lard, sugar, eggs, with spices, essences, fi-uits, or alcoholic liquors, for seasonings. Of course they are pernicious, as a general i^ile, according to their complexity. Plum-cake is a fair specimen of the average character of the cakes of cook-books and popular recipes. All dietetic writers of any respectability agi*ee as to its unfitness, while the common fruit-cake and wedding-cake are as univei'sally regarded as exceedingly indigestible ti'ash. Pancakes, or fritters, are fried in hog's lard. Griddle-cakes, made of wheat-meal, or of flour and Indian meal, or of rice or buckwheat, are a tolerable article, provided they are cooked on soapstone gi'iddles without grease. A very palatable and compara- tively wholesome cake may be made of wheat-meal, sugar, and sweet- cream, or good rich milk in place of the cream. Those who become accustomed to unbolted farinaceous food, will generally prefer this kind of cake to that made of fine flour, even as a matter of taste. Puddings are sometimes made of wheaten flour; but no form of boiled flour can be very digestible or wholesome. Bread puddings are the best of these preparations; hasty and batter puddings next in the descending scale. The ^;Zj/??i or suet p^udding is one of the most pernicious compounds ever invented ; it is generally made of bread crumbs^, currants, raisins beef suot, salt, citi'on, eggs, sugar, mace, and FOOD. 355 nutmeg, and eaten with butter, sugar, and wine for sauce. Dumplings are another form of boiled flour and fruit ; they can be made so as to be tolerably light and digestible, but as usually served up at refectories they tax the digestive powers very severely. Considerable attention has of late years been given by bread -makers to various methods of manufacturing raised bread without yeast ; em- ploying m its stead acids and alkalies, usually hydrochloric acid and sesqui-carbonate of soda. If the proportions of these articles are exactly balanced, and their admixture with the dough carefully managed, the acid, uniting with the alkali, forms common salt, while carbonic acid gas, without leaving any free acid or alkali, is set free to raise the dough. A variety of other experiments have been tried in this country and in England, but I believe they have never succeeded in realizing quite as good an article as can be made with the best of yeast, skill- fully managed. Two years ago one of our city bakers commenced tlie manufacture of bread raised with an acid and alkali. The baker conscientiously supposed his article to be more wholesome than the ordinary fermented bread, but wishing to be well assured of the fact, ho submitted specimen loaves to the medical gentlemen of the New York Academy of Medicine, requesting a professional o.pinion concern- ing its hygienic chai'acter. The Academy referred the matter to a special committee, but there it rested ; and notwithstanding the urgent importunities of the manufacturer, the Academy has not even yet seen fit to express any opinion. Oats have been extensively used as food by the people of Scotland and the northern parts of England, and to some extent in this and other countries. The entire seeds of oats contain, in 100 parts, about 66 of meal to 34 of husk. 100 parts of dried oatmeal yielded, according to Dr. Christison's analysis : Starch 72-8, sugar and mucilage 5-8, albumen 3-2, oily-resinous matter 0-3, lignin, or bran 11-3, and water 6-6. Oat- meal is prepared by grinding the kiln-dried seeds, deprived of their husk and outer skin. Groats are the grains deprived of their integu- ments. Oatmeal is usually employed in the form of mush, porridge, or stir- ahout, prepared by simply boiling in water, and oat-bread, or oat-cakes, made by rolling the dough into very thin cakes, and baking it before the fire, or in a stove or oven. These preparations are more whole- some than those of fine whoaten flour, because they contain a larger proportion of lignin, or bran, and are hence more laxative, or rather less constipating. Persons unaccustomed to oatmeal sometimes com- plain of acidity after eating it; but such a result may occur on first eating any kind of grain to which the stomach has not been habituated* 866 HYGIENE. it is, however, more frequently noticed with respect to rye and corn than the other gi-ains. Barley is but little used as human food in modern days, the breweries converting neai'ly the whole crop of the world into the poisons callec^ malt liquors. It is, however, far from being the most inferior of gi-ains, either in chemical constituents or physiological properties. The seeds of barley contain, in 100 parts: Meal 70-05, husk 18-75, water 11*20. 100 parts of harley-meal yield: Starch 67-18, fibrous matter 7-29, ginn 4-6'2, sugar 5-21, gluten 3-52, albumen 1*15, phosphate of lime with albujnen 0-24, water 9-37. Various preparations of barley are in repute for the sick-room. Pereira considers barley-water as a ^^ light, mila, emollient, demulcent liquid, slightly nutritive, and very easy of digestion ;^^ a rai'e combina- tion of medicinal virtues, ti'uly, for steeped seeds of grain to possess ! Less learning would be displayed, but more intelligence communicated, by calling the water in which a little barley-meal had been boiled diluent and nutritive, the former being the property of the water, and the latter the property of the gi-ain. Scotch, hulled, or j^ot barley, is the seeds deprived of their husks ; and when these seeds are rounded and polished they constitute pearZ barley. Patent barley is the farina obtained by grinding the pearl barley to powder. Barley contains too small a quantity of gluten to make good bread by panary fermentation. Rye is considerably employed as food among the inhabitants of northern Europe, and in New England, In Germany and Sweden it is the principal ingi-edient in bread. The enth'e seeds of i*ye yield, in 100 parts : Meal 65-6, husJc 24-2, wnter 10-2. Rye-meal contains, in 100 parts : Starch 61-07, gum 11-09, gluten' ^-AS, albumen 3-28, sac- charine matter 3-28, husk 6-38. Rye-meal mush is somewhat more laxative to persons unaccustomed to it than wheat-meal mush, and is a valuable food in constipation and torpid bowels. Buckwheat is sometimes employed in bread-making. In Germany and France it is in common use for pottage and puddings ; and in the United States it is extensively cultivated, and eaten in the form of griddle- cakes. It is not in itself objectionable ; but the melted butter and sugar with which buckwheat cakes are seasoned, and the burned grease used in cooking them render them exceedingly noxious. The itching and skin diseases generally atti'ibuted to buckwheat, are really chargeable to its accompaniments — pork gi'av^-, sausages, butter^ sugar, etc. Rice is the principal grain of India, Cliina, and most Eastern coun- h'ies. It is also extensively cultivated in the West Indies, Central America, the southern countries of Europe, and the southern paits ot FOOD. 367 the United States. The coir position of Carolina rice is, according to Braconnot, in 100 parts : Starch 85-07, woody fibre 4*80, glutinous mat- ter 3-60, oily matter 0"13, sugar 0*29, gum 0*71, phosphate of lime 0*40, water 5*00, with traces of acetic c. id, phosphate of i^otash, chloride of potassium, and vegetable salts of potash and lime. In nutritive properties rice does not differ materially from wheat, although it is much lefes adapted to prolonged nutrition as an exclusive article of diet, because of its small proportion of lignin or bran. From the fact that the cholera first appeared in a rice-gTowing country, and has prevailed extensively in counti'ies where this grain is the principal food of the inhabitants, a suspicion has arisen that a rice diet was among the causes of cholera. Although a rice diet alone would be incapable of producing such a disease, there can, I think, be hardly a question that a diet almost exclusively of rice would produce a predis- position, enabling other sources of impurity and debility readily to de- velop the disease. In fact, this principle is fully illustrated by the phenomena of cholera and bowel complaints as they appear in this country. The ordinary employment of concenti'ated farinaceous foods with us (food containing too small a proportion of what is called in- nutritious matter, to keep the excretories free and unobstructed) abso- lutely produces a general predisposition to bowel complaints, only requiring some disturbing agent of the nature of an exciting cause, to induce diarrhea, dysentery, cholera morbus, cholera infantum, inflam- mation of the bowels, or Asiatic cholera, according to the combination of all the predisposing and exciting influences. Obstruction, constipa- tion, irritation, and inflammation always result, unless due relations betAveen bulk and nutrin ent are maintained in our aliments; and hence the more concentrated or nutritive the gi'ain or flour we em- ploy, the greater should be the proporti n of the less nutritious vege- tables and succulent fruits. An immense amount of disease^ suffering, decrepitude, and premature death result from a misunderstanding of, or inattention to, this simple and obvious principle ; and the advice emanating from medical men, boards of health, medical ccrmcils, etc., in cholera seasons, recommending the people to abstain from fi'uits and vegetables, and eat principally rice, superfine flour, dried beef, smoked herring, etc., has destroyed many lives and saved none. The best preparation of rice is that of simple boiling ; it should nofc be stirred sufficiently when cooking to break up or mash the seeds. Mice, milk, and sugar make one of the best plain puddings. Rice griddle-cakes, which contain eggs and sugar, are somewhat offensive to nil stomachs, and especially so to dyspeptics. The various remarks which medico-dietetical wiiters have perpeti'ated »68 HYGIENE. concerning the nature of rice as an aliment, afford some amusing ex- amples of the loose and thoughtless manner in which men m.ay reason when they have no settled principles to reason from or upon. Thus says Dr. Dunglison, in allusion to the constipating effects of rice upon the bowels : " Perhaps the cause of its having astringent properties assigned to it is its long retention in the stomach when that organ is debilitated. This is probably owing to its possessing but little stimu- lating jjoz^'cr." Was ever greater nonsense uttered ! Again, says Dr. Dunglison : " Formerly the idea prevailed that rice, ivhen habitu- ally eaten, is possessed of poisonous properties" — as though its nature depended on whether we eat it constantly or occasionally ! Bontius thought that the use of rice tended to the production of blindness. Probably he was not aware that disordered vision, giddiness, etc., is a very common effect of too concentrated food and of excessive aliment- ation in all countries. Maize or Indian corn is extensively employed as food in America, Asia, and some parts of Europe. Its proximate composition in 100 parts, as analj-zed by Dr. Gorham, is : Starch 77-0, ze'in (a substance somewhat resembling gluten) 3-0, albumen 2-5, gum 1*75, sugai 1*45, extractive matter 0*8, cuticle and ligneous fibre 3*0, phosphate, carbonate, and sulphate of lime, nearly 1*5, water 9-0. In nuti-i- tive power and wholesomeness maize is but little inferior to wheat. It has not enough of the glutinous property to make light loaf bread alone, but ma^es an excellent bread with the addition of a portion of wheat-meal or wheaten-flour. The coarse-ground meal is incomparably superior to the fine-ground for all cooking purposes. Samp is made by boiling the broken grains until soft ; hominy is a preparation of the gi-ain between samp and meal; and Indian mush is the boiled meal. These are all excellent dishes as a part of a dietetic course. Corn, Indian, or Johnny cakes are made by wetting the meal with water, or milk, or both, and baking in a stove, oven, or before the fire. The In- dian method of baking under hot ashes is, for healthfulness, still better. Sometimes these cakes are sweetened and raised with sour milk and hi-carbonate of soda. This preparation is not as wholesome as the former, but far superior to most of the sweet-cakes made of fine wheaten flour. Saleratus is very generally employed in this countiy in nearly all kinds of Indian or wheaten cakes, but it is a most perni- cious article. Yor plain puddings the coarse Indian meal, or hontiny, is the best article, excepting, perhaps, wheaten grits and rice. Milk and sugar are aV the seasonings wanted to make as rich a pudding as human appetites ought to desire. Our New England mothers and grandmothers had a raetliod of FC DD 869 making a most delicious and salutary bread, without raising or fer- mentation, in which Indian meal was the chief ingredient. Due por- tions of the meals of corn, rye, and wheat were kneaded into a rather soft dough with water or milk, and baked all night in an iron bake- kettle, which was well covered with coals and hot ashes. In the morning an article " fit for a king" and all other " lords of creation," was brought forth from the baker. Such mothers would be godsends to the puny children of this degenerate age. Dr. Lee says : "A pound of corn, when cooked, makes from two and a half to tlii'ee and a half pounds of food, and this will suffice for the daily support of a laboring man. If an individual could be sup- ported on this alone, his annual expense for food would be but $3 65, or say $15 to a family of five. The average cost of potatoes may be put at about half a cent a pound, and allowing five pbunds per day to an adult individual, the expense wiE be about $9 a year. "When we consider that it is not unusual for land to yield one hundred bushels of corn to the acre, or thirty tons of potatoes, we may form some esti- mate of the population which this country is capable of supporting from the produce of the soil." We may see the munificence of the Creator, in making provision for all our natural v^ants, in a sti'onger light by vaiying the calcula- tion. Let us suppose an acre of land planted with corn, half an acre with potatoes, and good apple-trees surrounding the whole — all to be in the best state of cultivation. We would then have a combination of foods capable of fully sustaining the organism in its highest integ- rity ; and nutrition enough from an acre and a half to sustain at least thirty human beings. Millet or kirse is less employed than any other cereal grain. It is cultivated in some places as a garden plant, and used in cooking pud dings, seasoning porridge, etc. Peas, beans, and lentils possess nearly the same proportions of ulti- mate chemical constituents as the cereal grains. In proximate com- position they are more oily and amylaceous. They are most digestible when green and fresh. When dried and old they produce more or less flatulence, and sometimes colic in persons accustomed to a concen- trated or stimulating diet. This objection, hov/ever, is generally soon overcome in those who adopt a plain and correct dietary system. Not a little of the indigestibility charged upon the lugirainous seeds is justly due to the gi-ease, butter, and seasonings with which they are usually cooked and served. The nuts or kernels are generally oily, and, tv- most stomachs, indi- 8;estible. The chestnut, however, contains no oi. and when cooked is S60 HYGIENE pleasant and considerably nutritive ; it is employed as a staple article of food in some counti'ies. It is at least probable that all, or nearly all, of the nuts are in themselves natural and wholesome food; their indi- gestibility resulting from the abnormal state of the digestive organs we have produced by our artificial and enervating habits of life. Bitter almonds^ though extensively used by cooks and confectioners, contain poisonous properties ; the volatile oil obtained from them is a more potent poison than Prussic acid. At the head of the fruit kingdom stand the apple-ti'ee and the grape-vine. Many other fruits are as w^Lolesome in their season, and some are more nutritive, but none are so hardy and enduring, nor capable of such extensive cultivation. The varieties of the apple that can be produced are almost innumerable. The sweet, subacid, and mealy kinds are the most nutritious. If well grown and fully ripe they may be eaten in the raw state, roasted, or baked, with nearly equal advantage as a part of the meal, or they may be stewed and sweetened. They can also be preserved by drying, or in their own inspissated juices, the year round. Unfortunately, grapes are cultivated much more for the pui'pose of manufacturing intoxicating wine, than for human sustenance. An ar- gument in favor of this use, or rather abuse, of the fruit of the vine, has been predicated on the opinion somewhat prevalent, that wine- gi-owing countries were the most temperate ones. But Dr. Bell, 31. Villerme, M. Perier, Mr. Buhver, and other standard writei^s, have shown this opinion to be an error. In France nearly one thousand millions of gallons of alcoholic drinks were consumed in 1830, of which wine constituted more than half. Several Americans who have resided in Paris testify that " drunkenness is the prevailing curse of the labor* iug classes of France." Of the different varieties of grapes the Isabella and catawha are oore generally cultivated in this country ; the former of these is most common in our markets, and most highly esteemed. Dried gi*apes ai'e called raisins. The muscatels and blooms are sun-dried. Sometimes the grapes are dipped in a mixture of water, ashes, and oil, and after- ward sun-dried, by which treatment the juice exudes and candies on the fniit. The small or Corinthian raisin is the hlack currant sold at our groceries. There is an old adage which says, " Fruit is gold in the morning, silver at noon, and lead at night." The proverb is founded more in our artificial habits than in nature. Those who are accustomed to a plain vegetable diet can take fruit with equal pleasure and profit at either meal. B\i stomachs weakened by enervating drinks or con- FOOD B61 centrated aliments can tolerate fruits much better in the fore part of the day. The opinion is common that the fruits produced in different climates or localities are most suitable for the inhabitants residing there. Un- questionably this is true so far as quality and maturity are concerned ; for most kinds of fruit being exceedingly perishable, are of neces- sity gathered before fully ripe, when they are to be transported on long voyages. For this reason many of the peaches and strs-W- berries brought to the New York market are far inferior, both in flavor and dietetical vhtues, to those picked and eaten where they are raised. Almost all persons can use nearly all sorts of fniits in our markets, excepting, perhaps, the very acid kinds, with freedom and advantage, providing they are well grown, perfectly ripe, and are eaten only at meals. Those persons with whom they seem to disagi-ee should grad- ually accustom themselves to their employment — eat a very little at first, and increase the quantity as the stomach will bear. We have many varieties of pumpkins and squashes, which are not only excel- lent for pies, but make a delicious sauce. The only cooking they re- quire is to be well boiled. As a general rule, those of the firmest, heaviest texture are the best flavored and most nutritious. Of the edible roots the potato holds the first rank. It is nearly or quite as nutritious as the best flesh-meat, and in ultimate chemical composition is almost identical with the cereal grains, containing, iu 100 parts : Carbon 44-0, lujdrogen 5-8, oxygen 44-7, nitrogen 1'5, ashes 4-0. Its proportion of solid matter is 24-1 to 74-9 of water. The potato alone is capable of sustaining the prolonged nutrition ol human beings, as has been verified by repeated experiments. Potato starch is extensively sold under the names of 2^otato flour, English ar- roio-root, corn starch, etc. A mixture of potato starch and chocolate has been sold in England under the name of BrighVs universal sana- tive breakfast beverage. Two or three years ago Professor Mulder entered into a profound philosophical contemplation of the nature and properties of the potato, and came to the conclusion that its use, " as an article of food, was the principal cause of the physical and mental degeneracy of the people of those nations who employed it." The learned professor had un- doubtedly mistaken the effects of intoxicating liquors, tobacco, and many other noxious agents, for those of the innocent potato. The Carolina or siveet potaio contains considerable saccharine mat- ter, and is equally digestible and wholesome as the common or Irish potato, making due allowance for habit. When boiied until sofl. but T— 3] 562 HYGIENE without destroying their shape, potatoes are probably more nutritive and wholesome than when prepared in any other manner. Potatoes have long been celebrated as a preservative against the scurvy ; and it has puzzled physicians exceedingly to determine m what particular part or element this antiscorbutic property resided. Some have ascribed it to citiic acid. I am of opinion that this virtue resides equally in every part of the tuber, and that its preventive power in this disease is due to its healthfulness as an article of food, and not to any particular medical property. In fact, all good fresh fruits and vegetables are antiscorbutic. With regard to the other esculent roots, turnips, parsnips, heels, carrots, etc., they are of but little value in an alimentary point of view, yet useful in preserving the due relations of bulk and nutriment with those who partake of a large proportion of fjirinaceous food. To most stomachs they prove more or less flatulent, but th>s depends very- much on the vigor of the digestive powers, and the other dietetical habits. A perfectly healthy stomach can manage them without any difficulty. Of the cruder vegetable products the cabbage is the most nutritive. It contains considerable nitrogen as well as sulphur. An Edinburgh physiologist — Dr. Johnson, I believe — has lately " discovered" that it possesses more muscle-making property' than wheat ; but his inference is drawn from the mistaken opinion that foods are nuti'itive to muscular tissue in proportion to the nitrogen they contain. As cabbage contains more than ninet}^ per cent, of water, its nutritive power must l^e less than ten per cent., while we know wheat possesses from eighty to ninety per cent, of nutriment. Pot-kerbs, including cabbage, spinach, asparagus, and a variety of leaves, leafstalks, stems, young roots and shoots, receptacles, bracts, flowers, etc., are generally grateful and wholesome ; always so to healthy stomachs. If they ever prove injurious, it is from the melted butter, oil, vinegar, etc., with which they are too often cooked and eaten. These aliments, too, prove flatulent to many stomachs; and the rule already mentioned is applicable to these and all other crude and watery vegetables. Delicate stomachs must get gi-adually accustomed to their use, if they would avoid unpleasant effects. Salads are usually eaten with mustard, vinegar, pepper, salt, and oil, and are objectionable mainly on account of the seasonings. Lettuce contains the narcotic principle of opium, and is injurious on that account. Most of the fruits herein mertioned, and some of the vegetables, are employed in making pies and pastry. As usually prepared by the baker, tliev are of course exceedingly pernicious, for however delicious TEMPERATURE 363 and wholesome the fniit of itself may be, the crust is far otherwise. But excellent, and delicious, and even healthful pies can be made of the mild-flavored or sweet fruits, simply sweetened, with a crust of wheat-meal or fine flour, shortened with potatoes, and seasoned Avith new milk or sweet cream. Condiments^ or seasonings^ though not in any sense alimentary sub- stances, are so commonly employed with almost all articles of food, that they deserve a moment's notice in this connection. Those in general use, in addition to salt and vinegar, already discussed, are mus- tard, cayenne, black pe-pper, allspice, cinnamon, cloves, mace, Jiutmeg, horse-radishes, ginger, etc. ; various other pungent and spicy substances are frequently employed. They all tend to blunt the organic sensibili- ties, and the more acrid are extremely irritating to the whole mucous surface. Though the majority of dietetical writers commend them, and nearly all medical writei-s declare them to be indispensable, I know of but one physiological rule in relation to them — the less the better. It is ti-ue that an appetite partially palsied by their use, cannot appre- ciate the flavor of aliments without them; and stomachs accustomed to digest under their irritation, will not at first work as satisfactorily in theii absence, but the same rule obtains with regard to liquor, tobacco, or any other artificial habit. Hunger is the only natural sauce ; and those persons who can summon moral and animal courage sufficient to abstain from acrid seasonings of all kinds, will find, in a short time, that the God of nature has made all the foods He has intended we should eat extreme- ly palatable, without endowing them with any properties to provoke our appetites to the injury of the vital domain. He made the food savory enough for us to "eat to live;" if we over-season it, we may Boon find ourselves too closely allied with those who " live to eat," to have pure appetites or sound health. CHAPTER V. OF TEMPERATURE. Vicissitudes of Weather. — The wonderful power of the living organism to develop, maintain, and regulate its own heat, enables hu- man beings to exist in great extremes of climate, and exposed to nu- merous and sadden vicissitudes of weather. Franklin, Parry, Ross, Back, and other northern navigators, have been exposed for mont*»a £504 HYGIENE. together to a temperature varying from 50° to 70° below zero, while ie the oasis of Mourzouk, and many parts of the tropical zone, the ther- mometer often ascends to 130°. The maximum of heat noticed by travelei-s in various places is : Equator 101°, Cape of Good Hope 111°, Bassora 114°, Cairo 104°, Madras 104°, Pendicherry 112°, Saris 3 01°, Guadaloupe 101°, Surinam 90°, Martinique 95°, Vera Cniz 96°, Vienna f^6°, Warsaw 93°, Copenhagen 92°, Petersburgh 87°, Iceland 69°. In Sew York city the thermometer has a range of about 100°, rarely, however, rising to 100°, and seldom sinking below 0. The changes of temperature in this climate frequently amount to 40° or 50° in twenty- four hours. Generation of Animal Heat. — The more energetically the or- ganic functions are performed, the more rapid is the generation of ani- mal heat ; hence the animals of cold climates, whose actions are vigor- ous, manifest a higher bodily temperature than those of hot climates, whose motions are more sluggish. The quadrupeds of the frigid '/oue are said to have a higher temperature than those of any other region of the globe ; an arctic fox, killed in an atmosphere of 14°, was found by Capt. Lyon to have a temperature of 106|. Capacity to Endure External Heat. — The human body is capable of enduring for a considerable time a highly-heated atmosphere, when the air is dry. Mechanics whose occupations require it, often endure, without perceptible inconvenience, an elevation of SSO'' to 280 ". Some workmen have entered the furnaces of iron-foundries while the floor was red-hot, and the thermometer stood at 350°. Chabert, the "Fire-king," was in the habit of entering an oven heated from 400" to 600°. Artificial Heat. — As the human body is a self-regulating machine, within certain limits, as respects its tempei-ature, it follows that all arti- ficial means of supplying heat to the body can only be regarded as necessary evils. Fire relaxes and debilitates the skin and the whole -system ; yet in cold climates and seasons we have no better way of maintaining the requisite temperature of our rooms. These should always be warmed equally throughout every part, and the temperature kept as low as possible, consistently with comfort. The comfortable point of out-door air depends very much on the temperature we have previously been accustomed to ; it also varies in different climates and seasons. In this country it ranges from 65° to 75°; but when the thermometer has been for some days between 90'' and 100°, a depres- TEMPEEATURE. 365 eion of fifteen or twenty degrees imparts an uncomfortable sensation of cold; and in spring a sudden elevation from 30° or 40° to 75" imparts an oppressive sensation of heat. A room permanently heated above 55° to 60° can hardly be consistent v/ith health, and a few degi'ees less is still better for most persons. Those who occupy rooms warmed by grates should never sit directly before the fire. Many persons have a habit of sitting with then- faces close to a hot fire, but such habits are not only very weakening to the whole skin, but particularly inju- rious to the brain and nervous systevn. Healthfulness of Climate. — It has been proved by ample experi- ment that the aeration of the blood is more rapid in cool or cold than in warm or hot air, owing to the circumstance that rarefied air contains less oxygen in the same bulk than cold air. But I cannot subscribe to tha doctrine generally advanced in medical books that all warm climates, or even hot climates, are necessarily unhealthful. It is well known that bilious attacks, diseases of the liver, fluxes (as diarrhea, dysentery, and cholera), and some forms of fevers, are mor<| prevalent in hot climates, especially among those who go from a northern to a southern latitude. But I think a better explanation can be found in another way. It is as well known that persons can endure, with appai'ent impunity, in a cold, bracing air, riotous living, excessive alimentation, constipating food, and many other erroneous habits, which will inevitably produce disease, and frequently death, in a hot, enervating atmosphere. The travelers who visit pestiferous Africa, the Englishmen who remove to the scorching suns of British India, and the Northerners who go to the sickly South, may find the true explanation of their liability to disease in their own dietetic errors. Undoubtedly the more mild and uniform climates are most con ducive to permanent health and longevity. Examples, however, are not wanting of individuals attaining the age of 165 in Plussia, and of 200 in Arabia. Variable climates, like England and the United States, are more favorable to activity of mind and body — a rapid development of all the physiological and mental powers ; yet that excess of action must sooner exhaust their vitality. Various parts of the United States have furnished numerous examples of centenarians, but I believe Joice Heath, who reached the age of 162, was the oldest person this countiy ever produced. Rev. Mr. Harvey delivered a temperance lecture in the Broadway Tabernacle in this city, in 1846, at the age of 114. Common Colds. — " Catching co.d" is usually attributed to a sudden transition from a warn, to a cold atmosphere ; but I believe more 866 HYGIENE colds result from the contrary change — fr jm a cold to a highly-heated atmosphere, especially the sudden change from a cold, out-door atmos- phere, to the confined air of a hot room. I need not say that the body, when excessively cold, should be warmed very gradually. When very hot, however, the body is better enabled to resist extreme cold, and may be suddenly exposed to it with impunity, provided it has not been warmed by any debilitating process or agency, as hot, confined air, severe and exhausrtng exercise, etc. Colds are more frequently pro- duced by unequal temperature than by extremes of either heat or cokl. Thus, when a part of the body usually covered wuth clothing is exposed to a sti-ong draught of air, w4ien the rest of the body is protected with clothing or bedding, a cold is very easily caught. Again, a person ac- customed to wear boots in the winter season, will often "take cold" by weai'ing shoes a few hours, even though he remain within doors, and his feet feel perfectly comfortable. Young ladies, at balls and parties, often make such changes in their clothing as to expose some parts of the body usually covered, as the neck, or cover some parts usually un- dressed, as the hands and head, or dress some parts thinly which have been accustomed to thicker clothing, the feet and arms, for example, by which the usual temperature of the body is unbalanced, and severe colds produced. A very common way in which a severe cold, or a gi-eat disturbance of the body which is usually denominated a cold, is produced, is eating a very full evening meal after fasting all day, and then retiring soon after to rest, and sleeping in a warm room, or a room heated by hot air. The temperature of the apartment, aided perhaps by bad ventilation, relaxes the body, so that the stomach cannot relieve itself of its burden, and in the morning the sufferer awakes, if indeed he has slept, fever- ish, sore, and inflammatory, and with all the manifestations of a hard or confined cold. It is also to a crowded state of the stomach, as much perhaps as to the relaxing temperature and bad air, that the colds so generally follow- ing balls and dancing assemblies are to be attributed. The viands at these parties are all so prepared as to tempt the appetite to excessive indulgence, when the state of exhaustion requires exactly the opposite — fasting, so that the muscular system may have its due sui)ply of nervous energy for the restoration of the motive powers. Those who are exposed to cold, pure, out-door au% may eat very in- temperately, as respects both quality and qunntit}', and suffer but very little, compared with those who commit the same error in the enerwit- ing atmosphere of a crowded assembly, when the body is in a state of exhaustion, the vsrhole musculai system relaxed, and the digestivo powers proportionately enfeebled. EXERCISE. 367 Mean Temperatures. — The following table of mean temperatures has been compiled from meteorological registers : a; I. C -^ ttj Mean Temferature of different Seasons. Mean Tempera- ture ol' Places. Win- ter. Spring Sum- mer. Au tumK. Warrn- e.'it Month. Cold- est Month. New York O 1 40.40 39 56 38.53 39.06 32.47 31.34 29.48 19.11 23.10 13.10 10.27 46.47 44.54 57.08 4L30 48.12 48.50 43.46 41.53 .32.37 36.48 51.30 30. 38.46 o / 53.78 53.42 5.?..56 53 78 60.18 64.76 72.23 77.72 78.(8 79 03 81.86 41.74 42.44 26.42 51.02 49.28 51.08 59.00 60.40 64.56 59.98 50.36 69.01 ■55.86 80.06 15 / 29.84 32.18 36.80 32.^0 51.09 48.56 59.29 71.96 71.24 76.07 80.24 14.18 23 44 0.60 33.82 34.70 38.66 44.30 45.86 59.50 61.52 5L26 51.44 53.83 54.14 66.73 65.48 71.47 77.90 78.98 79.00 83.C6 38.84 38.58 23.90 46 87 47.66 49.28 56.00 57.74 62.20 65.66 o / 79.16 73.94 75 90 72.86 80.89 79.16 82.73 81.50 83.31) 81.00 82.04 68 00 60.54 48 38 68.70 64.94 64.58 74.00 75.20 69 33 80-24 o y 54.50 56.48 56.59 54.86 67.55 66.02 75. ] 5 78 62 78 98 80.00 80.24 46.04 45.43 33.44 53.83 50.00 51.44 60.70 62.78 67.23 72.50 <5 1 80.78 77.00 79.13 74.30 82.81 79.70 83 94 81.86 S3.84 91.00 84 38 73.40 63.52 51.80 71.46 66,56 65.30 77.00 82 76 O 1 25.34 Philadelphia 32.72 Washington, D. C 34.66 30.20 Charleston, S.C Natchez Miss 49.43 46 94 St. Augustine, Fl Vera Cruz 56.60 71.06 • Hav ana 69.93 Barbadoes 65.0 Cumana 7<).16 Quebec, L. C Eastport, Me 13.81 20.91 Nain, Labrador 11.20 Newport, R. I Geneva 32.14 3416 Paris 36.14 Florence Home 42.26 Madeira Algiers GO.03 London New Orleans St. Louis, Mo Jamaica CHAPTER VI. OF EXERCISE. Necessity for Exerise. — To secure the full and pei'fect develop- ment of the body, nature has implanted among the mental propensities a special organ of motion. The phrenological organ of " mirthfulness," or " playfulness," seems to be intended to secure this end, by prompt- ing to frequent, free, active, and vigorous exercise. Young animals, especially of the mammiferous class, manifest this disposition very early; and young children must have theu* frequent "play-spells," or be sick — there is no alternative. I am disposed to believe that it is im- possible for a healthy adult to be otherwise than active in body or mind, or both, and that laziness is actually a disease, dependent on some ab- normal condition of the organism. 368 HYGIENE. It is true that a variet)' of social circunistaucfrs may operate to pro- duce an indolent dispositior of mind and inactive habit of body, as ex- treme poverty, excessive wealth, gi'inding servitude, tyrannical govern- ment, etc. ; but all these also produce a primary condition of ill health. So of personal habits, dissipation, gluttony, dietetic errors, or unhealth- ful voluntary habits in other respects; they all conduce to the production of a morbid condition. Nothing is more discouraging to the future prospects of a young child than a disposition to sit still, be quiet, keep out of mischief, etc. Such children may give the n»jrse and schoolmaster but little trouble in keeping them "out of the way;" but in after life their parents may find it somewhat ti-oublesome and expensive to provide them attendants and doctors. Physiology of Exercise. — The function of respiration, by which the blood is vitalized, and the nutrition of the muscular structure, on which depends all the motive power or strength of the system, are in- timately connected with the circulation of the blood, and this with active exercise. This principle is well illusti'ated in the effects of gymnastics and training, by which the muscles of any part of the body are remarkably invigorated by regular, systematic exercises. People of all trades and occupations find those j)arts of the muscular system wdiich are habitually the most exercised to be the most powerful Thus farmers have the whole muscular system nearly equally devel- oped ; blacksmiths, joiners, carpenters, sailors, etc., have sti'ong arms and chests; travelers, dancers, etc., are disproportionately developed in the muscles of the lower exti'emities ; shoemakers, tailors, etc., have a tolerable development of the arms and chest, but suffer in the lower extremities and abdomen; merchants, clerks, and others who pursue an easy, in-door occupation, have slender muscles generally; and pro- fessional men, whose exercise is more intellectual than bodily, exhibit large brains, with slender muscles. V^ARiETiES OF ExERCiSE. — For hygienic purposes there are many exercises equally advantageous. All that is necessary is that nil parts of the body be actively and frequently exercised, within the bounds of not producing fatigue amounting to exhaustion ; that is to sny, a degi-ee of fatigue which >s not readily recovered from on resting. All exercises, however, to secure their full benefit, should be coupled with an object of either utility or a.nusement, otherwise the mind is apt to labor adversely to the body. Occupation — some useful business pursuit, which I'oouires and h^ncf secures nlteution atid hibor during severn/ EXERCISE. 369 hours of each day — is absolutely essential to the highest sanatory con- dition of the body, for nothing else will insure so constant, regular, and equally divided exercise for both body and mind. Amusements and plays could be advantageously alternated to vary the monotony of the exercises ; and indeed social and family recreations would constitute prominent fea ures of aU physiologically regulated neighborhoods. Among the active exercises which may be beneficially ii'sorted to as pastime, are walking, running, leajnng, dancing. Box- ing and fencing are physiologicnlly adapted to expand the chest, and, in fact, strengthen the whole muscular system, but they are too closely associated with pugilism, and barbarism, and brutalism to be recom- mended, especially as many other exercises are equally beneficial. Wrestling is a dangerous method of developing the muscular power. Ten-pins, billiards, etc., are excellent exercises physiologically, but no better than sawing wood, planing boards, digging j^otatoes, hoeing corn, raking hay, etc., etc. Singing, declaiming, reading aloud, are admirable methods of cultivating the vocal powers, and increasing the capacity of the respiratory apparatus. Riding on horseback is one of the best exercises in cases of weak digestive powers, as is also riding in a carriage without springs over a rough road, or street paved with cobble stones. Hunting Rud fishing are highly recommended by some hygienic writers, but the ideas of gormandizing, and the exhibitions of cnielty with which they are associated, are hardly becoming a re- fined, enlightened, and Christian people. Such amusements are more appropriate to savage than to civilized life. Of the passive kinds of exercise, riding in easy carriages, sailing, swinging, etc., they are rather to he regarded as mere amusements, or as expedients for the invalid. They are highly serviceable, and, in- deed, indispensable to such valetudinarians as have not strength to get a sufficiency of the out-door air without them. Exercises of Children. — Our social organization is very defective in its provisions for the appropriate exercises of infants and young children. The cradle is a most unphysiological method of exercising a child to sleep; its primary object was to save the nurse trouble, but a child accustomed to be rocked to sleep will give the nurse more ti'ouble in the end than one accustomed to sleep without such assist- ance. The motion of the cradle, too, is "njurious to the brain and nervous system. The modern "baby-jumper" is a better conti-ivance. but even this can be advantageously superseded by giving the child *• the largest liberty" to exercise in its own way. Plenty of r«om, a siuocftlc floor, and a pl&ntif il suppl" of any kind of "plaything?^ ' wliicli 870 IrYGIENE. are not da/igerous — India-rubber balls, baskets, brooms, rattle-boxes, etc. — afford the opportunities which a child will always improve to the best possible advantage. Unfortunately, among the poorer classes of our cities young children are kept in stupid inactivity, simply because they have no room to stir; and this confinement makes them sickly, puny, peevish, and finally indolent. Times for Exercisog. — In regard to the times for exercising, the common instincts of mankind have generally guided them cor- rectly. The most severe and active exertions should never be per- formed on a full stomach, nor immediately before or after a meal. The best hygienic regulation for a laboring or business man, who takes three meals a day, and is regular in his habits of retiring at night and rising in the morning, is to exercise moderately an hour or so before breakfast, perform the severest labor between breakfiist and dinner, and work moderately again between dinner and supper. Much evening work is a violation of "the natural order." Persons of sedentary occu- pations should choose such exercises as they can habitually and regu- larly attend to, all of which should be as much out-door as possible. Their most active exercises should take place on first rising in the morning, and at other times of day when the stomach is pai'tially empty. Vigorous evening exercises ai'e also suitable for them. " Nature lives by toil ; Beasts, birds, air, fire, the heavens and rolling worlds, All live by action ; nothing lies at rest But death and ruin." CHAPTER VII. OF SLEEP. General Observations. — Sleep may be defined — the periodical suspension of all the functions of external relation. The constitutional relation of man to the changes of the seasons and the successions of days and nights, implies the necessity of sleep. All animals sleep, buj no animal, save man, sleeps on his back, " with face upturned to heaven." The time of sleep required by different individuals varies greatly, according to temperament, mann^" of life, dietetic habits, etc. John AVesIej', with an active nervous lompcrainout, and a rigilly-plain vegetable diet, could perform mental and bodily labors almost Herculean, SLEEP. 371 and slet p but four or five of the twenty-four hours ; while Daniel Webster, with a more powerful, but less active organization, and the ordinary mixed diet, "has a talent for sleeping" eight or nine hours. As a general rule, in the animal kingdom, herbivorous animals sleep less than carnivorous ; and the universal experience of the human race proves that vegetarians require much less sleep than the human omnivora, or those who subsist on both animal and vegetable foods. This fact must be accounted for on the principle of the greater purity, blandness, and adaptedness of vegeia'">le food, requu'ing less vital ex- penditure to appropriate it, and exhausting the organic economy less in disposing of its waste or innutritions particles. Phenomena of Sleep. — Profound or quiet sleep is the complete cessation of the functions of the cerebral hemispheres and the sensory ganglia, and is attended with entire unconsciousness. Dreaming im- plies imperfect rest — some disturbing cause, usually gasti'ic irritation, exciting the brain to feeble and disordered functional action. Individ- uals of very studious habits, and those whose laHors are disproportion- ately intellectual, require more sleep than those whose duties or pur- suits require more manual and less mental exertion. But no avocation or habit affects this question so much as the quality of the ingesta. Natural Term of Sleep. — Physiologists are not well agreed re- specting the natural duration of sleep. Historical data seem to indi- cate that a great majority of those who attained gi'eat longevity were long sleepers, averaging probably at least eight hours. The statute of nature appears to read : Retire soon 'after dark, and arise Avith the first rays of morning light ; and this is equally applicable to all climates and all seasons, at least in all parts of the globe proper for human habita- tions, for in the cold season, v/hen the nights are longer, more sleep is required. A general rule, and an invariable rule for all whose voluntary habits are correct, and who retire to rest early in the evening, is, to sleep as long as the slumber is quiet, be the time six, seven, eight, or nine hours. Dreamy, restless dozing in the morning is generally mucli more debilita'.ing than refreshing. Those persons who indulge largely in animal food, or eat gluttonously of any thing, and especially those who are addicted to spirituous liquors and tobacco in connection with high-seasoned animal food, are in danger cf over-sleeping, even to tlio extent of very considerably increasing the stupidity and imbecility'' of mind, and indolence and debKty of body, naturally and necessarily consequent upon those habits. 372 H Y G I E N E. Sleeping after Meals .-r-Some persons are partial to tie siesLa, or " dinner nap," and physicians are divided in opinion whether the habit is useful or injurious. Dr. Dunglison, who appears to be in some doubt on the subject, but rather inclines to regard a short sleep after dinner favorably, remarks: '-It is certain that after a full meal both man and animals feel a propensitj^ to sleep." I regard it as perfectly certain that there is no such propensity in man, except when his full meal has been an imjn'oper one. If he has slept too little the niirht previous, he may feel a propensity to sleep at any time during the next day, but not more after a meal than at any other time, unless his meal were fuller than the wants of his system demanded, or of too stim- ulating or concentrated a character to be healthful ; nor is the assertion correct as respects the animals, excepting the carnivorous and gor- mandizing varieties. Sleeping after meals is always pernicious ; and for an adult to sleep at all during the day can be regarded no better tlian the least of two evils when sufficient sleep is not had at niglit. All persons who can should do all their sleeping at once, and not eat such quantities or qualities of food as will produce the unnatural pro- pensity to sleep after meals. Sleep for Different Pfhsons. — It has long been a popular ivliim that females require more sleep than males, and many physio- logical reasons, as whimsical as the whim itself, have been oftered in support of the notion. I know of no sound ai-gument that proves any difference so far as sex is concerned ; and I think a safe rule for male and female, young and old, is, for children to sleep all they are inclined to, without the a-id of ^extra-nervine agencies, rocking in the cradle, or paregoric drops ; and for the middle-aged and old, of both sexes, to sleep all they can at one effort, between sunset and sunrise. Of coui-se* those whose business or pleasure obliges them to reth'e at late or ir- r-egular hours should govern themselves accordingly. Bodily Position during Sleep. — The position of the body in bed is worth a moment's reflection. It should be perfectly flat or hor- izontal, with the head a little raised ; one common-sized hair pillow is generally sufficient. A majority of people sleep with the head too high, often elevated on two thick pillows, with a heavy bolster for the shoulders This is certainly a very bad habit. The neck is bent, the chest is compressed, and the whole body unnaturally crooked. Chil- dren often become stoop-shouldered, or otherwise crooked, from their heads being placed on high pillows. Some physiologists object to sleeping on the bad . and assig-i as a reasoH that the stomach and other SLEEP. 873 abdominal viscera press upon the large blood-vessels below the heart, and thereby produce a tendency to cerebral disturbances, nightmare, apoplexy, etc. This argument only has weight with those who take late or heavy suppers, or suffer from enlarged livers or other abnormal conditions. Healthy persons, of correct dietetic habits, may sleep at pleasure on the back, or gently reclining to one side. All, however, should carefully avoid reclining nearly on the face, or crossing the arms over the chest, as that would approximate the shoulders, contract the chest, and materially affect the respiration. Sir Charles Bell thinks the incontinence of urine, which so frequently troubles children, arises from their lying on their backs. A more rational explanation of this difficulty may be found in the paregorics, anlimonial wines, herb teas, and other weakening drugs and debilitating slops with which they are so generally stuffed by kind mothers, as per advice of sage doctors. Beds and Bedding. — The nature of the beds ana bed-clothing are of importance to those who would preserve or attain health. Feath- ers can only be mentioned in reprobation. Straw, corn husks, hair, and various palms and gi-asses, make comfortable and healthful beds. In cold weather those who are tender may use over either of them a hght, thin, cotton mattress. No bed should be soft enough for tlio body to sink into it ; and few persons who have thoroughly tried the experiment of sleeping on feathers and on straw will willingly ex- change the latter for the former. Children and infants are cruelly though unwittingly abused, when compelled to sleep on feathers. I can hardly imagine that any person would be willing to have a pillow of feathers under his head, after once getting accustomed to one of hair, chaff, or even straw. Cotton is much better for pillows than feathers. The bed-clothes should be as light as possible consistently with comfort. Linen or cotton sheets are better than flannel, and for outside bedding thin quilts are beat in summer, and light flannel blank- ets in addition in winter. Sleejnng apartments always ought to be large and well ventilated ; but generally they are neither. Especial attention is therefore, as intimated in a preceding chapter, due to these circumstances. The windows or doors should be so arranged as to allow a free circula- tion of air ; even night air, which many people and some medical writers appear to think is really poisonous, should have free ingress. If the sleeping-room is dark or damp, it should be occasionally eiried and aired, by a fire if necessary, which may be put out before the sleeping hour. Whether fires in sleeping-rooms are to be advised or rliscouFtsnanced, medical men agree as little among themselves as ^hey 32 374 If 1 GIENE. do in relation to aliiost every other hygienic influence that can be named. While their expediency for some invalids is unquestioned, but little reflection seems necessary to convince any mind unprepos sessed with vague theories that, as a habit, they cannot be otherwisft than pernicious. When fires are employed during the daytime in the sleeping-room, they shoiJd be extinguished and the room well aired before going to bed. In houses heated with warm air, particular at- tention should be paid to ventilating the lodging-room. CHAPTER VIII. OF CLOTHING. Physiological Nature of Clothing. — It is an obvious physio- logical fact, that the more the whole surface of the body is exposed to the external air, within certain limits, the more vigorous is its func- tional action performed, and the better is it enabled to preserve its own proper temperature, as well as to resist all morbific impressions from vicissitudes of weather, or the extremes of heat and cold. Clothing, therefore, which the usages of society and the severity of climates render indispensable, should, as an invariable rule, be as light and loose as possible without bodily discomfort. We must, however, recollect that comfort is veiy much a matter of habit, and make a due discrim- ination between the natural sensation of health and the morbid sensi- tiveness produced by false customs. Some persons wrap their whole bodies in flannel under-garments, and yet are ready to go into a "shiv- ering lit" at every unusual breath of cold air: while others eschew those garments entirely, and endure the coldest weather of this cli- mate with much less discomfort. Materials of CLOTnmG. — The substances principally employed in the manufacture of clothing in civilized countries are, linen, cotton, silk, wool, and hair or down. Those materials which are bad con- ductors of caloric, afford the greatest immediate protection from cold, ns woolens or flannels ; but, for the same reason, they are more de- bilitating to the cutaneous function; they are only to be preferred in cases of temporary exposure, or in very cold climates, or as a " neces- sary evil" in persons whose external surface is debilitated by bad habits of dress, until its vigor can be restored by bathing and other hygienic CLOTHING. 376 processes. Cotton and linen are better adapted to temperate climates, especially dm'ing the warm season ; and linen for under-clothes is the best of the two in hot vv^eather. Flannel next the skin, I am per- suaded, is invariably hurtful as a habit. When woolen clothing is worn, it should be the outside garments ; these may be of any quantity or thickness necessary to keep the body comfortable, while cotton or linen only comes in contact with the skin. The discrepancies among medical authors on this subject are almost ludicrous; some advocating the use of flannel next the skin, at all times and in all seasons ; others condemning it as a fruitful source of colds, coughs, pulmonic and rheu- matic affections, etc. "As regards the chest," says Sir George Le- fcvre, " a veiy light kind of woolen waistcoat should not be dispensed with even in the dog-days." I would much rather prohibit it in winter than prescribe it in summer. In the last cholera season (1849) the N'ew York Board of Health, by authority of their Medical Council, recommended, as among the preventive measures, "the wearing of flannel next the skin," during the hot weather of June, July, and Au- gust. And on this hint a medical adventurer has since invented med- icated aprons and bandages to keep the bowels ivarm, or, as the proprietor says, " retain the animal heat," and thus prevent bowel complaints. These notions are too absurd for serious refutation. Silk is a bad conductor, and for this reason females find silk dresses very un- comfortable in very wai'm weather. Furs are worn in this country more for ornament than use. They are the warmest clothing materials known, and by overheating the part of the body to which they are ap- plied, render it exti'emely susceptible to cold. Fur neckcloths, caps, etc., are very pernicious. Color of Clothing. — In a strictly hygienic regulation of dress, color cannot be wholly disregarded. White colors reflect the rays of caloric ; black absorbs them. Light-colored clothing is therefore more comfortable and sanatory in warm weather than dark-colored, because the former repels the heat, and the latter readily receives and retains it. Various experiments have shown that the heat-reflecting or heat- retaining property of diflerent fabrics varies exactly with their lighter or darker shades of color. This difference is, however, much greater in the luminous rays of light than in the non-luminous. When, there- fore, we are not exposed to the sun, the subject of color is of less im- portance. The absorbing power of dark surfaces renders the skins of dark-colored animals, as well as of the darker persons or races of the human family, less liable to be scorched or bliste; ad by the direct raya of the sun, than ai"e those of a lighter color. 376 HYGIENE. Particular Garments. — Fashion seldom consults hygiene in the matter of dress. The hat is generally too stiff, heavy, and hot. It ought to be as ligbt and soft as possible, and as thoroughly ventilated as a bed-chamber. This could easily be accomplished without marring its beauty. The common neck-stock or cravat is one of the worst articles known ; by confining and heating the throat it predisposes to colds, rheumatism, quinsy, bronchitis, etc. I have known several per- sons in Xew York city, who were habitually the subjects of two or thi'ee sevei-e attacks of quinsy a year, entirely cured by continually exposing the neck in all weathers, and bathing it^ daily in cold water. That the natural clothing of an unshaveL beard is a protection against affections of the throat and lungs, T have no doubt. But if we will render ourselves preternaturally susceptible by shaving, we should not aggravate the susceptibility by binding up the neck with tight clothing. Females are generally debilitated by too heavy an amount of clothing about the back and hips. The custom with some females of oiling the hair, then combing it very smooth, and fastening it in a bunch on the top of the head, is very injurious to the scalp and brain ; in fact, a com- mon source of headache and neiTOUsness. Stockings of cotton and linen are better than flannel, except when the feet are exposed to both extreme cold and moisture. Garters are a common cause of varicose veins in the lower extremities. Fur gloves are a bad article ; so arc India-rubber shoes, except as over-shoes to slip on temporarily. Straps for fastening the pantaloons tightly to the boot or shoe, I believe are almost or quite out of fashion ; it is well they are so, for they render all the motions of the body stiff and awkward, and cause an injuriou-s pressure to be exerted on the knee-pan and shouldei's. Several cases of synovitis, attended with extreme weakness of the muscles around the knee-joint, have lately come under my notice, produced, without any doubt, by wearing pantaloon straps. Suspenders, when the trow- sere are loose and easy, are not objectionable ; although the sailor, whose vocation requires the utmost freedom from all restraint in tiie muscles of the chest and upper exti'emities, finds it more conver.ient to support the ti*oivsers by the tightened waistband. Custom has dealt more cnielly with infants than with adults in the style of clothing. Swathing, bandaging from head to foot with the view of getting the body in shape, and bandaging the abdomen to prevent the child from becoming " pot-bellied," are fashions happily fast going into disrepute, under the teachings of hydropathic and physiologica! writers. The new-born infant wants no bracing or supporting fro!)i the clothes. All the clothing required in infancy and childhood is easy, loose^ flov^iijg garments., sufficient to preserve the requisite temperature* BATHING. 377 Bed and Body Linen. — It is always of importance that the bed and body linen be well aired daily, and frequently changed. Strict at- tention to the depurating function of the skin requires that the under- garment or shirt worn during the day should never be slept in during the night. The sheets, too, which collect more or less of the matters of perspiration, should be well exposed to the air every day. How often the shirts worn in the daytime require changing, depends some- thing on the amount of exercise, perspiration, etc. ; generally tv/o or three times a week are advisable. General Rules. — The first physiological rule of dress is, to have all garments as light in texture and as loose in fashion as is consistent with bodily comfort, and as will admit of the most perfect freedom in the exercise of every muscle of the body. The second is, to observe regularity and uniformity. Boots, shoes, hats, caps, thin and thick stockings, gloves, mittens, neck-dresses, head-dresses, etc., when worn ut all, should be always worn under similar circumstances — not indis- criminately changed or alternated. As intimated in a preceding chap- ter, inequality of clothing is a far more frequent cause of " colds" than deficient clothing. If a person exposes a part of the body usually protected by clothing to a strong current of cold air, he will take cold sooner than by an equal exposure of the whole body. CHAPTER IX. OF BATHING. Keasons for Bathing. — Were human beings in all other respects to adapt themselves to the laws of theix* organization, and were they in all their voluntary habits in relation to eating, drinking, clothing, exer- cise, and temperature, to conform strictly to the laws of hygiene, I do not know that there would be any physiological necessity or utility in bathing at all. But in civic society the laws of life and health are transgi-essed in a thousand ways; and the sura total of all the un- physiological habits of civilized life is, a condition cf body characterized by deficient external circulation, capillary obstruction, and internal con- gestion or engorgement. To counteract this morbid condition no single agent or y rocess s more effectus^ than bathing the whole surface of HYGIENE. the body daily with cool or cold water. As a general rule, therefore, a daily bath should be as regularly atteuded to as are the daily meals. Methods of Bathing. — For hygienic purposes there are various methods of bathing equally advantageous ; the particulai* process is merely a matter of convenience. The towel or sponge bath, plunge, or shower, are, in ordinary cases, equally useful. The first-named is iccessible to all persons, at all times, where a coarse towel and a quart of water exist. The others require less time and are more agreeable to persons accustomed to bathing. A portable apparatus for ti'avelers has lately been consti'ucted, which may be conveniently packed in a trunk or carpet-bag, and used in t'ne bedroom of the hotel, or state- room of a steamboat. After the ablution, in whatever manner per formed, the whole body should be riio'-'^uglily rubbed with a crash towel Time a>'d Temperature of Baths. — The best time for a genera bath is unquestionably on first rising frlm bed in the morning. Bath ing at any time of day, when the stomach is partially or completel} empty, is better than no bath. In warm w^eather an additional evening ablution is refreshing and invigorating. The temperature of the water must be vai'ied to suit diflferent circumstances of constitutional health and vigor. The general rule is, that cool or cold water, short of pro- ducing any permanently disagreeable chill, is the best. Of course, persons of deficient blood and low vitality should use tepid water ; and extremely feeble individuals should commence with warm water, gi-ad- ually reducing the temperature as "reaction" improves. The cold bath may, for general purposes, include all temperatures below 60° Fahr. ; the cool, from 60" to 72° ; the tepid, from 72° to 85° ; the warm, from 85° to 100°; and the liot, above 100°. Infants ought to be bathed daily from birth. The water should be at the temperature of about 72° for the first three months, and reduced about five degrees every three months for a year, after which time, if the child has been well managed in other respects, it may be bathed in water of any medium temperature — say between 50° and 65°. Precautions in Bathing. — No person should bathe in very cold water when the body is chilly from cold, nor when exhausted or over- fatigued from violent exercise, nor when, fi-om any cause, the respira- tion is materially disturbed, nor soon after eating. Heat and perspira- tion are no objections to going into cold air or cold water, provided the body is not in a state of relaxation from confined or bad air, or debility from over-exertion, and the broatli aa is easy and natural. EXCRETIONS 879 CHAPTER X. OF THE EXCRETIONS Relation of Excretion to Nutrition. — From the physiology of the nutritive and the depurative functions we learn that an exact equilibrium must exist between the deposition of new material and the removal of old, in order to sustain the vital machinery in its perfect integrity of health and 'strength. If the nutritive functions be defi- cient, debility and inanition result ; if the excretory functions are im- perfectly performed, obstruction, congestion, inflammation, and fever prevail. The Involuntary Evacuatiovs. — As ah-eady explained, the lungs, liver, and skin are constantly eliminating from the body the gi'eater portion of its waste, worn-out, useless, effete, and putrescent particles, their office being quite independent of the action of the will and voluntary muscles. If the food and drink is rightly apportioned in quantity and quality, and all other hygienic circumstances are duly re- garded, their functional office will only cease when the body consoli- dates to a state of motionless density in a natural death. But when the voluntary habits are unhealthful, or when, from any morbific agen- cies, the mvoluntary excretions are checked or suppressed, we see a variety of phenomena indicative of disease. If the lungs fail in func- tional power, the whole surface is leaden and bloodless, the eye is dull, the face is wan and blue, the complexion is inanimate, and the extrem- ities are cold. If the liver does not duly eliminate the bile, the blood is thick and viscid, the skin is dingy and cadaverous, the head is op- pressed, the mind is confused, the nerves are weak and irritable,- and the eyes yellowish or livid. If the skin fails to throw off the mattera of perspiration, the lungs arc oppressed, the head is giddy and painful, the mouth is parched and feverish, the heart is troubled with pal})ita- tion, the kidneys are irritated by excess of duty, and the bowels arc liable to gi-ipings, spasms, exhausting diarrheas, or inflammatory attacks. The Voluntary Evacuations. — The bowels and kidneys cleanse the body of the grosser fecal matters, and most of the surplus or ex- traneous saline and earthy particles If the bowels are torpid, the ind' 39C HYGIENE rkloal b troubled with fetid breath, bad taste in the mouth, cojiMhI tongue, gnawing or other uneasy sensations at the stomach, dry and : J. colic, sick headache, acrid en * hemorrhoids or piles. If the secretion is deficient, dropsical accumulations take place, the head is ^ even ; • .jcutaneo - . _ a urinous odor, and a low, irritatire, and exhausting fever evhices jn of the whole bcdr. The imp w . ... ^ ... . -^as of nature, so far as these evi.c..- are i bv volition, cannot be overrated. Many persons have beeu serwusly injured by retaining the urinarj* secretion for some time after its sertsible accumulation. Few persons who live in the ordinary niauiicr a5'j>ear to have any mteDigible idea of what constitutes a health- ful and natural action of the boweb. Many imagine that periodical - - -hat b desired. Bc *""■■ • •^ny have a movement of irly every day, and y at a particular time of day, and still be very constipated. The alimentary canal may still regularly, and uoiformly, but that each discharge be free, easy, and c"T>!Ous, but not watery, and without pain, straining, or :' 1 have seen many persons who assured me, on a professior. ., .na- tion, that their evacuations from the boweb were always *' perfectly regular,** when the furred tongue, foul breath, and turgid abdomen, :iS5ured me tliat thb depurating function was very imperfectly per- formed. Hardly a disease can be named but may have its origin in constipated }.- —- ' ' -- . r .1 . _ . . artificia! ' -- ^ . pfy c . ilogue o cu- liar to females, a large proportion of the fatal maladies of children, end a vast riiajority of the cases of dyspepsia -^ ' ' among a Jults of b'jth sexes, have one of :. .: , , condition. I need hardly add that no one can permanently enjoy good heahb. v. ^ habits, in to diet and exercise, do not tecure x -f thb f^' ' ...ty. It b a sad commentary on the V- _• art of ;. practice, that its professors doc- tor, physic, force, and purge the torpid boweb of their patients, year aftfr year, and leave them •••-•'■- - - - »' _ .. i —11^ they permit each and aU of the cat - to ope- rate cootinoaDy, uncontrolled, unattended to, and almost nnthought of. PASSIONS .^1 CHAPTER XT. OF THE PASSIONS. Mental Hygie.xe. — We may religiously observe ail the laws oi' hygiene in relation to air, light, drink, food, temperature, exercise, fcleep, clothing, bathing, and the excretions, and yet " lack one thing." If the passions are our masters, and not our slaves, they will rule and ruin, instead of obeying and serving us. There is no single hjgienic influence more conducive to health, happiness, and long life, than a cheerful, equable temper of mind ; and there is nothing that will more surely disorder the bodily functions, exhaust the vital energies, and stamp premature infirmities on the constitution, and hurry us on to an early grave, than an uneven, irritable, fretful, or passionate mental habit. Different Passions as Affecting Health. — There is, in the vigorous exercise of the higher mental powers — the moral affections and the intellectual faculties — an elevating, sustaining, self-supporting influence ; while the violent indulgence of the lower order of passions — the animal propensities — rapidly w^eais out the mental machinery, and enervates all the physiological powers. Who that has ever felt the holy inspiration of love, and the depressing influence of hatred, can fail to appreciate the importance of mental hygiene ? Contrast the emotion of benevolence, or gratitude, or veneration, or conscientious- ness, or mirthfulness, or faith, or hope, with that of envy, revenge, jeal- ousy, fear, grief remorse, or despair! One energizes the mind and reanimates the body — the other sinks, chills, and enfeebles both ; one manufactures, creates, as it were, vital powder — the other wastes and destroys it. Healthful Exercise of the Pas<5"^t«' . — ^It is vrue that all the propensities with which we are endowea were intended to be exer- cised actively and vigorously, but always in relation to the uses or pur- poses for which they were given — never with violence, or in mere wantonness. Wlien they are all exercised Imrmoniously with each other, their combined influence is to invigorate, ennoble, r\nd exalt the whole being ; but if one or several " grow mutinous and rave," the whole physiological and psychological nature experiences a deteriora- 882 HYGIENE. tion proportioned to the time and degree in -which ungoverned passion is in the ascendant. Those who would maintain permanent and uniform health and attain longevity, should cultivate the " better passions" with the same sedu- lous and unremitting care that they would cultivate the best fruits and vegetables. That anger which " dwells only m the bosom of fools," should be a rare or unknown visitant, and the " evils of hfe" should be met with courage, fortitude, and resolution, instead of wailing, com- plaining, and lamentation. That unhappy disposition which treats all the little or great perplexities, crosses, trials, disappointments, or troubles, which are incidental to existence, and which more ot less beset the earthly pilgi-image of every individual, with fretting, scold- ing, and fault-finding, not only aggi'avates all the "necessai-y evils" of life, but gi-eatly multiplies them ; and, w^hat is worse, dissipates fool- ishly those talents and energies which should be devoted to overcom- ing obstacles, and, by profiting from the lessons of experience, "bring ing good out of evil." The Passions as Coj^nected with Longevity. — In all ages of the world philosophers, divines, naturalists, statesmen, and other men whose studies and avocations w^ere especially calculated to develop and maintain the supremacy of the moral and intellectual powers, have been proverbially long-lived. In this connection we may name among the ancients. Homer, Hippocrates, Pythagoras, Plutai'ch, Plato, Thales, Xenophon, Carneades, Sophocles, Zeno, Galen, Democritus ; and among the moderns, Locke, Newton, Galileo, Boyle, Liebnitz, Buf- fon, Olbers, Blumenbach, Hahnemann, Swedenborg, Sir Edward Coke Fontanelle ; and in our own country, Marshall, Jeiferson, Franklin, Adams, Jay, and Madison. All of the persons above quoted were dis- tinguished for active and laborious habits, and some of them were in- tense if not intemperate workers. The experience of a host of men renowned for great attainments in inorali-, theology, and various de- partments of science, proves thht an immense amount of mental labor can be accomplished by an individual of ordinary natural capacity, when the propensities are harmoniously balanced, and an even, cheerful, hopeful spirit constantly cherished and maintained. The Passions as Affecting the Secretions. — It is well known to medical men that violent fits of passion will arrest, alter, or modify the various organic secretions as suddenly as will an electric shock. They may be depraved or vitiated as readily by excessive mental emo- tion as by a drug-poison taken into the stomach. A paroxysm of anger LONGEVITY. 38S will render tiie bile as acrid and imtating as a full dose of calomel : excessive fear will relax the bowels equal to a strong infusion of to- bacco ; intense gi'ief will arrest the secretion of gastric juice as effect- ually as belladona ; and violent rage will make the saliva as poisonous as will a mercurial salivation. Many a nursing mother has sent her babe to the grave by indulging a furious emotion, which changed the character of her milk from a bland nutriment tc a deadly poison. These facts, which could be multiplied to a great extent, demonstrate the law, that a sound body cannot exist unless connected with a well- balanced mind. Phtsiological Law or the Passions. — The grand essential of a cheerful mind is self-control. This is the great law of mental hygiene. Those who cannot govern the lower range of propensities — the corpo- real and social groups — by the moral sentiments and intellectual facul- ties, should study to acquire self-government as "the one thing need- ful" in the mental operations. It may require long, patient^ and thorough discipline ; it may cost much self-denial, ar.d appear to de- mand great temporary sacrifices, but it is worth all it costs. Occasion- ally it is acquired through long years of bitter experience ; and some- times the greater part of a life is spent in suffering, disappointments, troubles, and crosses, ere the mind is found at peace with itself, and in right relations to all suiTOunding nature. Happy are they who can, even in such expensive schools, learn the art of adapting themselves to i.ne invariable laws of the universe, which they cannot successfully o*p- pose, or in any respect alter ! Without self-control, let it be well un- derstood, no one is competent to govern others. To mothers this principle appeals with more momentous interest than to any or aH other persons ; for it is their influence and example which infuse or- der or disorder into the infant mind, to " grow with its gi'owth, and strengthen with its strength." CHAPTER XIL OF LONGEVITY, Natural Duration of Life. — The Scriptures inform us that at one particular age of the world and state of society, "three score and ten" years were allotted to man ; that at a preceding period, sur- 384 HYGIENE. rounded by difterent circumstances, it was ordained that '*liis days should be an hundred and twenty years ;" and that soon after the creation, when the air was free from infection, the soil exempt fi-om pollution, the food of man plain, simple, and natural, and the ways of debauchery and dissipation almost unknown, individuals lived on the average four or five hundred years, the maximum point of longevity recorded being nine hundred and sixt}"-nine years. Without speculating upon the problem, whether the years of the early historians included tne same period of time as the years of our present almanacs, it is suflicient for all practica. purposes to know the general law, that human lives may be lengthened to one or tAvo hun- dred years or more, or "dwindled to the shortest span,' by our own voluuLaiy individual and social habits. I can discover no physiological or natural law why man should not live some centuries, when placed under every possible favorable condition of constitution, climate, food, occupation, etc. It is obvious that, at the present day, a large propor- tion of our population is born with organizations incafable of manifest- ing the phenomena of life for a longer period than sixty or seventy years ; many, indeed, have not original vitality sufficient to reach the age of manhood, and others are born too feeble to survive the days of childhood ; but, on the other hand, all ages of the world, and nearly all countries, give us many examples of individuals, even under many unfavorable influences, reaching various periods of life over a hundred years ; some of them nearly completing the second century, and some few, if we may credit the records, enduring into the third century. If it can be proved that one man may live two or three hundred yeai-s under the most favorable hygienic circumstances, we want no farther evidence of the existence of a physiological kw that all may, under precisely similar circumstances. The learned Lichtenberg, who col- lected many statistics on the subject of longevity, declared, " Facts answer that man, in general, can live fi-om one hundred and fifty to one hundred and seventy, and even tsyo hunJred yoars." Examples of Longevity. — Haller collec'ed most of the cases of longevity known in Europe in his time. Among them were over a thousand who attained to ages between 100 and 110 years; sixty from 110 to 120; twenty-nine from 120 to 130; fifteen from 130 to 140; Bix from 140 to 150; one reached 169 years. The Russian statistics of 1830 give examples of two hundred and fifty-five individuals between the ages of 100 and 160. In England and Wales, during a period of eighteen years preceding 1830, over seven hundred persons were buried each of whose age^exeepded 100 years. Baker's "Curse of LONGEVITY. 386 Britain" gives a list of about one hundred individuals whose ages ranged from 95 to 370 ! Twenty-one of them reached the age of 150 and upward, and about thirty exceeded 120 years. Pliny copied from the records of the census in the time of Vespasian, the cases of one hun- dred and twenty-four men, living between the Po and the Apennines, who had attained ages from 100 to 140 years. At the same time there were living in Parma five men of ages from 120 to 130 ; in Placentia one of 130 ; at Facentia a woman of 132 ; and in Vellagacian ten persons, six of whom were 110 and four 120 yeai*s of age. Hero- dotus informs us that the average life of the Macrobians was 120 years. The Circassians, according to the traveler, Mr. Spencer, attain a very advanced age. Modern statistics exhibit numerous examples of persons, in vainous parts of the United States, in Norway, Sweden, Denmark, Scotland, Ireland, Poland, Greece, and among the vegetarian Bramins of India, attaining more than one hundred yeai's of age. France, Spain, and Germany afford a few examples. Many places on Long Island, in the state of New York, will compare advantageously with almost any equal number of places on the globe, as regards the longevity of their inhabitants, and the number who have attained 100 years of age. The American Indians, previous to the inti'o- duction of the white man's " fire-water," frequently lived to the age of 100 years. The following catalogue of names and ages of persons distinguished for length of years has been collected by Baker, Horsell, and others. There is a discrepancy of a few years in relation to four or five of the individujils between the ages here stated and those given by other authors. The difference, however, is not mate- rml, and can in no way affect our argument or inferences. William Dwpe 95, William Dupe's father 102, his grandfather 108, Michell Vivian 100, John Crossley 100, Lewis Cornaro 100, Admiral H. Rol- venden 100, Jane Milner 102, Eleanor Aymer 103, Eleanor Pritchard 103, her sisters 104 and 108, William Pepman 103, William Marmon 103, wife of Cicero 103, Stender 103, Susan Edmonds 104, St. John the Silent 104, James the Hermit 104, Hippocrates 104, Bar Decapel- lias 104, Mrs. Hudson 105, Helen Gray 105, Mrs. Alexander 105, St. Theodosius 105, Mazarella 105, John Pinklam 105, St. Anthonj 105, Mary Nally 106, Thomas Davies 106, his wife 105, Ann Parker 108, Gorgies 108, Simon Stylites 109, Coobah Lord 109, Democrates 109, De Longueville 110, Ant. Senish 111, Ann Wall 111, Luceja 112, Mittelstedt 112, J. Walker 112, W. Kauper 112, W. Cowman 112, E. M. Gross 112, Paul the Hermit 113, F. Lupatsoli 113, M. Mahon 114, John Weeks 114, R. Glen 114, St. Epiphamus 115, George Wharton 115, Louis Wholeham 118, Bamberg 120. Arsenius 120, t~33 386 HYGIENE Roraualdus 120, John Bailes leO, Margaret Darley 130, Fi-ancis Peat 130, William Ellis 130, Bamberger 130. Peter Gorden 132, John Garden 1S2, Richard Lloyd 132, John Taylor 133, Catharine Lopez 134, Margaret Forster 136, John Mount 136, Margaret Patten 137, Juan Marroygota 138, Rebecca Perry 140, Galen 140, Dumitor Radaloy 140, Laurence 140, Countess of Desmond 140, Mr. Ecleston 143, Solomel Nibel 143, William Evans 145, Joseph Bam 146, Colonel Thomas Winsloe 14 G, Llywark Ken 150, Judith Crawford 150, Catharine Hyatt 150, Thomas Garrick 151, Francis Consist 152, James Bowels 152, Thomas Parr 152, Thomas Damma 154, Epi- menides 157, Robert Lynch 160, Letitia Cox 160, Joice Heth 162, Sarah Rovin 164, William Edwards 168, Heniy Jenkins 169, John Rovin 172, Peter Porton 185, Mongate 185, Petratsch Czarten 185, Thomas Cam 207, Numes de Cugna 370. Zeao, the founder of the stoical sect, lived 100 years; Titian, the painter, nearly 100 ; Francis Secardia Hongo died a.d. 1702, aged 114 ; in 1757, J. Eflingham died at Cornwall, aged 144 ; Alexander Macintosh, of Marseilles, lived 112 years; James le Measurer, of Navai're, 118 years ; Valentine Cateby, of Preston, England, 118 years; Henry Grosvenor, of Wexford, Ireland, 115 years; John de la Somet, of Virginia, 130 years ; Elizabeth Macpherson, of Caithness, Scotland, 117 years; Owen Carollan, of Ireland, 127 years; Ann Day, an English gipsy, 108 years; Cardinal de Salis, of Seville, 110 years. Natural Dp:ath. — Diseases which produce violent or accidental death, destroy the whole human race, with few exceptions. Probably not one in a thousand dies a natural death. Even of those whose names have been held forth in the preceding paragrapli as examples of extraordinary longevity, several were cut off prematurely by disease. Thomas Parr, at the age of 152, was desti'oyed by plethora, resulting fi-om high living at court. Mrs. Hudson died of an acute disease re- sulting from taking cold at the age of 105. Richard Lloyd was in full health and strength at 132 years of age ; out being persuaded to eat flesh-meat and drink malt liquors, to which he had not been accus- tomed, he soon sickened and died. Natural death results from a gradual consolidation of the structures. In inf^mcy, the proportion of the fluids of the body to the solids is much greater than in adult age, but this relation is constantly changing; the fluidity, flexibility, and elasticity' of youth, as the structures harden and condense, is succeeded by the firmness, stiff'ness, and immobility of age; yet this change is not necessarily attended with infirmity or decrepitude. If the life h:is been very nearly in conformity' with LONGEVITX". 387 the laws of life, the vital energies, so powerfully expended upon the muscular system during the period of growth and development, are, after the maturity of the body, mainly concentrated in the region of intellect. There is less activity, and vivacity, and impulse, but more serenity, and thoughtfulness, and meditation. The mora! and intellect- ual nature seems not to reach its full development until actual decHne has commenced in the functions of organic life. We are accustomed to notice, as the earliest marks of senility, the decay of the teeth, and the disproportionate destruction of the functions of the external senses, especially seeing and hearing. But such is not the natural decline of life. In a perfectly normal condition of the organism, all the functions, powers, and senses decline in the same harmonious relation in which they were developed. As the process of condensation goes on equally and imperceptibly throughout the organic domain, the motive powers grow torpid, the nuti'itive functions are enfeebled, the sensibility be- comes dull, the external senses are obtunded, and, lastly, the nienta^ manifestations disappear — death occurs without a struggle or a groan. Advantages of Longevity. — Some speculative wTiters, w"hose minds have been more directed to the narrow" science of " political economy" than to an enlarged view of the economy of the universe, have lately found a perplexing problem in the relation of the means of subsistence to the facilities for propagation. While population, say they, increases geoiftetrically, the alimentary productions of the earth only increase arithmetically. On this bare proposition longevity seems to be one of the greatest evils that can befall the human family. Some scheme of death appears to be indispensable, to "kill off" the surplus population, to clear the ground of existing human beings as fast as the "coming generations" demand their places. But such a theory places us in an awkward dilemma, and is not very well calculated to "vindi- cate the ways of God to man," nor give us the most exalted views of what constitutes " man's humanity to man." But the whole puzzle comes from mistaking the present social disorder for natural order. It is very true that in some parts of the world there is a dense population in a state of starvation ; but it is equally true that the earth has capacity even there, to produce food enough for all, and to spare. Undei existing governments and social aiTangements, more than three fourths of all the land and all the labor, as far as the production of the means of human sustenance is concerned, is waited, or worse than wasted. A large extent of the earth's surface has never yet been brought under cultivation, and that part of it which is cultivated the best admits of vast improvement. There i? als: an immense waste in raising domestic 588 HYGIENE. animals for food, for it requires not less than twenty times more extent of soil to nourish animuls enough to furnish our ^ood, than is necessary to supply us with food directly from the soil itself. And again, miHiona of acres of excellent land are worse than wasted in raising the filthy tobacco, and fi"uits and gi-ains to convert into alcoholic poisons. But there is a much more cogent argument derived from the phys- iological principles we have been considering, against the position that " creation is a failure ;" for the idea I am controverting amounts to nothing less. It is a philosophical maxim that " intensive life cannot be extensive." The present races of human beings have a hurried, stimulated, forced, disorderly existence. Population is as much more numerous, as a general rule, as it is more depraved ; the causes of multiplying the species increase with the causes of their destniction. Males and females mai'ry at twenty, become the fathers and mothers of a " numerous offspring" at forty, find themselves old at fifty, and ai-e compelled to die at sixty ; in this way, supposing the majoiity of the children to arrive at maturity, and "do likewise," the world will surely fill up pretty fast, and there will be a perpetual demand for " new countries," for the surplus population, or for those other less pleasant resources, "war, pestilence, and famine." But philosophers ought always to discriminate between the existing state of affairs, and a state of aflairs that may, can, or should exist. There are many forcible reasons for believing that the earth now has, and always will have, room enough for all the po))ulatiou that can be produced by human beings who live according to the laws of their being, and till the gi'ound according to the best lights of science and experience. If the human body develops slowly and healthfully, the periods of infanc}', childhood, and adolescence will be greatly pro- longed ; the period of j^outh may extend to what we now call old age, while vigorous manhood may reach onward to some point between one and two hundred years, or even beyond ; and under such chcum- Btances it is probable that the number of offspring in each family would be less instead of greater than the average of the present day ; at least such was the fact with the early inhabitants of the earth with whose histories we are familiar. Again, we have many evidences tliat the surface of the earth actually enlarges continually. The proportion of the land is gi-adually gaining upon the water. Not only are the lakes, and seas, and oceans filling up, and the wild, frozen wastes of the polar regions destined to become, in due process of time, luxuriant harvest fields and flowery gardens, but it is even probable that the entire magnitude or bulk of the earth enlarges by constant accessions of matter, absorbed and condensed from LONGEVITY. 88& the gaseous elemeii!:s floating in what we call space. If these views are correct, and they are certainly not wholly speculative, they afford a complete solution of the problem of population and subsistence, and furnish politicians with a key to a system of legislation that shall not be limited to acts, enactments, and amendments of acts, almost exclu- sively relating to the "rights of property," but which shall, in its higher, broade^r, nobler grasp, comprehend also the progress of humanity. But the chief use and purpose of a long life are yet to be named. As society is now constituted, the principal force of the mental energies of the world is expended in contriving a thousand ways and providing a thousand means to gratify the corporeal and animal passions, ren- dered insatiate by morbid cravings and disorders of all kinds, and in repairing, or rather attempting to repair, the mischiefs and miseries induced by bad habits. The intellectual and moral mind, the spiritual nature, has but little opportunity for cultivation and development until the later periods of life, and then the body is worn out, and the mind has nothing to sustain it. Even the rich stores of knowledge accumu- lated by those who are placed in circumstances peculiarly fortunate for moral research and scientific investigation are mostly lost to others, because their voluntary habits have so disordered the body, that the lamp of life goes out before they have time to arrange, compare, prove, and demonsti'ate the results of their study and experience, and communicate them to the world. The "uncertainty^ of life," which hangs like a depressing incubus upon the majority of minds, has a blighting effect on human intellect, and a demoralizing influence on human affec- tions. As most people live, they feel an assurance of a special liability to some " mysterious providence," which may at any moment termi- nate their existence, and that entirely independent of any natural cause or law which they can either understand or control. The state of mind induced by such confused fears and apprehensions must be exceedingly superstitious, and nothing is more stupefying to all the powers of intel- lect than superstition. Such persons cannot reason well because their reflective powers are spell-bound by an absurd fantasy, and they dare not attempt to reason much for fear they will reason wrong. Imagin- ing their safety to consist in he passive instead of the active state of mind, they make " discretion Jie better part of valor," and try harden* to believe than to understand. But, moreover, this blinded and bigoted state of mind renders its possessor eminently short-sighted and selfish. He is unwilling to trust God, man, or nature, and aims to make sure of eveiy thing, and enjoy as he goes along. Hence he is always pur- suing petty expedients for momentary pleasure, instead of seeking per- manent and substantinl happiness ii following out the laws of his 390 HYGIENE organization. He becomes in society one who seeks to appropriate as much as possible, and impart as little as possible. He is always pre-eminently conservative, uniformly goes for keeping all things as they are, and invariably opjjoses all new creeds, or innovations upon established usages. So fai* as society, or the world, or the human family is concerned, he is useless, or rather worse than useless. But let the same person be w^ell insti'ucted in the philosophy of life, let him feel competent to preserve his own health, and have a full assur- ance that, casualties excepted, his days may be long in the land, and he will sti'aightw^ay look forward to a better and higher destiny, forego many present temporary gratifications, discipline his mind for the more important future, and become a more useful as well as more happy member of the social compact. Instead of finding his pleasure in abstracting all he can from the enjoyments of others, he wiU seek and find his highest happiness in some pursuit which wiU be conducive to the general good. Special Means Conducive to Longevity. — In strict ti-uth there are no special means for promoting health and attaining longevitj-, ex- cept in the negative sens* — the avoidance of special en*ors. The gen- eral adaptation of all the hygienic agencies to the particular circum- stances in which we are placed, constitutes our proper rule of action. But there is one principle involved in this subject more important than any other, and as it is more disregarded, and probably less under- stood, by people generally than any other, it may be well to notice it specifically in this place. We have seen that,^from the cradle to the gi*ave, the proportions of the solid particles of the body are constantly gaining upon the fluids; natural death resulting when, provided no disease intervener, the con- solidation of the structures has progressed so far that the fluids cannot permeate the capillaries sufficiently to maintain the functions of assim- ilation and depuration. As the fluids and solids are both formed mninly from the materials taken into the stomach as food and drink, it follow^s that the character of the aliment has a controlling influence, beyond that of any other hygienic circumstance, in determining the period when nat- ural death shall take place. Gross, concentrated, obsti'ucting food, and all extraneous earthy or saline ingredients accidentally mingled with our food and drink, or employed as condiments, must necessarily abridge tlie term of our existence. All the early historians agree that the primitive inhabitants of the earth were frugivonus, subsisting maluly, if not wholly, on fruits. But if the primitive inhabitants eniployed as food roots, and teuier leavof- and plants as well as fruits, they still had a LONGEVITT. 3^ kind of aliment remarkably fluid and unconcenti-ated as compared with the dishes generally eaten at the present day. And if, fm-ther, they employed any of the cereal grains — ai flonring-mills were then un- known, and no method had been devised for separating the bran from flour — they were used in their most perfect condition, both as respects quality and preparation. The flesh of animals, it is conceded on all hands, was not then even thought of as food for human beings. So far, then, as the dietetic habits of the immediate descendants of the first pair were concerned, they united all the conditions requisite to prolong life to the utmost limit of the laws of life. The principle, therefore, seems established, that the kind -of food which contains a large proportion of fluid, as compared with its solid matter, and a large proportion of bulk, as compared with its nuti'iment, is best adapted to sustain permanently the integrity of the organism, provided it contain also the requisite elements for prolonged nuti-ition. Those who employ a diet lai-gely farinaceous — tliose who make bread " the staff of life" in their dietetic system, reqMhe a large proportion of cruder vegetables, less nutritious roots, or succulent fruits. True, an individual might do very well on ^' bread alone," if he were rigidly abstemious, but the tendency would be, if the habit were extended through several generations, to hasten the consolidation of the struc- tures, and bring on premature old age. Nearly all the arts of commerce and of cookery are, and have been for many centm-ies, directly calculated to disorder the human body, and shorten the duration of its existence. Concentration, stimulati-on, and complication, with many extraneous additions, have generally been the aim of the cook, and the prescription of the physician ; and the result is, that disease is the general rule of society, and health the ex- ception, while the average period of time between birth and death has been fearfully diminished. Anotlier advantage in employing a large proportion of watery fruits and vegetables is, in supplying the system in this wa}' with the water It requires, in its purest state. Most of the water used as a beverage and for cooking purposes is more or less impregnated with deleterious particles, while that found in the juices of fruits and vegetables is nearly free of every thing of the kind. We know that the organic economy requires a due supply of certain earthy mattei-s, as phosphate and carbonate of lime, for the sustenance of the osseous system ; but it is obvious that an undue supply must obstruct the minute rami-fica- tions of vessels, and render the fibres rigid and friable. The depurat- ing organs have the £:nctional ability to secrete and expel fi-om the Vody the surp'"' saline «ind earthy matters to a certain exteiit; but if 192 HYGIENE. they are taken into the sjstem beyond that ability, they must neces sarily accumulate constantly, and exercise a very important influence in bringing the functions of life to an early termination. I admit thai"- a stimulating, concentrated, and even constipating and obstnicting regimen, may produce a rapid development of the body it may produce extraordinaiy precocity in mind or body, or both But it is a kind of development uufortrinate for its possessor and for society. It is a jn'ocess which makes the c!ii. 1 a giant and the man j>. dwarf. It may produce manifestations of matui'ity at twelve, and symptoms of deofjy at twenty. Besides, it always and invariably die- orders the individual ; and if, haplessl}', the forced production of a man propagate his kind, the offspring will inherit a malformed and imperfect organization. It has been urged, with reason, too, that the difficulties and pains of child-bearing are closely connected with the quality of food, as regards concentration. There is httle doubt, 1 think, that the structures of both mother and child are more inflexible, inelastic, and unyielding, when the food has been too stimulating, too concentrated, or in anj respect obstructing — a condition which obviously complicates the dan gers and aggravates the sufferings of parturition. In fact, this subjec'; has been amply and practically illustrated during the last seven or eigh): years in the city of New York, where nearly all the mothers and in- fants treated on the ordinary or allopathic system have experiencec* great suffering, and been " doctored through" many diseases; whilf' all, as far as I have any knowledge, treated hy-dropathically, have es- caped a great degree of the usual suffering, and all of the diseases usually incident to the lying-in period. A late author, who has perpetrated the very common mistake of taking a fact for a principle, and a principle for a theorj', and a theory for a system, and then turning the system into a hobby, has undertaken to show that all kinds of foo^s and drinks are conducive to or detractive from longevity, exactly in the ratio that their constituents contain less or more of saline or other earthy ingredients. According to his nx»tion wheat is the very icorst article of food known ; the other grains are highly deleterious, while all kinds of " fish, flesh, and fowl," and even ardent sjnrits and tobacco, are healthful, because they cor.tnin scarcely any phosphate of liyne or other earthy matters ! As a spocimen of his reasoning, or, rather, misapplication of facts, I make the following ex- tract from his work, especially as it is a fair sample of the manner in which facts are generall}^ misapprehended or misapplied by the medi- cal profession : "Tlie peasantry of those parts of Ireland where wheaten-bi £ad. on LONGEVITY. 393 any kind of grain food is scarcely ever tasted, but where potatoes, fish, turnips, gi-eens, and fresh vegetables, generally form their principal diet, all of which things contain a moderate amount of earthy matter are proverbial for health, activity, and a tolerable longevity. The En- glish peasantry consume one half more solid grain food, as bread and pastry, than the Irish, and are greatly inferior both in health, activity, duration of life, and in temper and disposition. Although the samp external conditions, fresh air and exercise, and much better clothing and lodging, are enjoyed by the English, thej* are more bony, rigid ctumsy, and stupid than the Irish." I think the fine Jlour, with the gi'eater portion of beer, beef, and plum-pudding, accessible to the English peasantiy, explain these phe- nomena perfectly. OccurATioN x\s Affecting Longevity. — The industrial relations of individuals, though important, are less so than domestic conditions and circumstances, as influencing the duration of life. The acknowl- edged theories and the collected statistics of physiologists exhibit some discrepancies, with regard to the connection between occupation and ongevity ; and medical men have been utterly unable to explain or reconcile these discrepancies. Thus, while agriculture is universally allowed to be the most healthful occupation known, the average lives of farmers, though comparing favorabl}^ with mechanics, tradesmen, laborers, factory operatives, etc., is lower in the scale of longevity than that of several other classes. In some parts of England, where this subject has been investigated, particularly in Manchester and Rut- landshire, the "upper classes," or "gentry" were found to be nearly twice as long-lived as the " lower classes," or " workers." These facts require a thorough analysis, or we shall be led into the monstrous absurdity that idleness and dissipation are more conducive to health than industry and temperance. With regard to a farmer's life, it must be remarlced that, although accompanied with good air, early rising, out-door exercise, and regular habits, these advantages are in a great measure counterbalanced by bad water and bad food. It is true that farmers ought to be the healthiest people in the world ; but, unfortunately, they are very igno- rant or negligent of the means of health which are so abundantly at their disposal. With ample facilities for enjoying the best possible diet, they generally employ the very worst. Hard water is usually drank, and, in this country particularly, stale salted meats, superfine fiour, greasy compounds of all kinds, and butter and cheese, constitace tljc essentials of their dietary sj-sten •, fruits and the more watery 894 HYGIENE vegetables being regarded almost entirely in the light of luxuries or seasonings, which may be dispensed with or sent to market, or, if em- ployed at all, are so saturated with sugar, butter, vinegar, salt, pepper etc., as to be really worse than none. Cities are universally reputed to be unhealthful residences; and this fact puts the inhabitants on their guard — compels them to study, in some degree, the laws of life and health. Their greater exposure tf danger becomes the means of rendering them more intelligent ; and the caution they exercise in the selection of the articles and qualities of their foods, very nearly balances the natui'al advantages of the rural districts. The difference between fresh meat and salted, as an article of diet, is very great ; and in this respect the inhabitant of the city has a vast advantage, because in cities fresh meat is the staple article of animal food, and salted the exception ; the reverse being true in the countiy. It is not easy to convince the farmer that he can labor with- out old pork, bacon, or salted beef; but these articles are nevertheless among the principal causes of his rigid muscles, stiff gait, numerous infirmities, and premature old age. The "upper classes" have the advantages of selected locations for their dwellings, plenty of room, clean yards, well-ventilated sleeping apartments, and favorable external circumstances generally. The poorer classes generally occupy the insalubrious localities because they are cheaper, real* buildings, gaiTets, cellars, etc., circumstances which will always very materially abridge the period of existence. It is ti'ue that laborers are not generally fairly dealt with by capitalists, but it Is equally true that laborers have all the means requisite to improve their condition, and become completely independent. Their misfortune is, they know not how to use those means. Their great error, and the grand source of their slavery from generation to generation, is in their dietetic habits. Three or four times as much money is expended on articles of food which give them imperfect nourishment, and render them liable to diseases, with loss of time, and doctors', nui-ses", and apothecaries' bills accumulating, as is necessary to afford them healthful sustenance, if rightly applied. The money saved by a correct regimen would procure them better residences, and admit of an annual deposit in some savings' bank, in view of a future homestead. It is a flict that, in the United States, and indeed in almost any other country, perhaps in all, wages are suflficient to emancipate the laborers from the thralldom of capital in a very few j^ears, if the " toiling millions" would but mako a judicious application of their earnings. There are some occupations necessarily unwholesome, and requiring special j'vecautions on the pnit of those who pursue them. Millers, LONGEVITY. 895 cotton-spinners, tea and coffee-roasters, paper and machine-makers, iron and brass-filers, glue and size-boilers, tallow chandlers, etc., are exposed to an atmosphere loaded with powders or gases which exert a deleterious influence on the lungs. Thorough ventilation, and a posi- tion "to windward" of the current of floating particles, are indispensa- ble considerations. Plumbing, painting, and the arts of the operative chemist, potter, and coppersmith, are deleterious, to some extent, from the substances which are volatilized by various processes being inhaled. Experiments in relation to lead-poisoning, however, have shown that workmen in smelting establishments, house-painters, etc., are injured far more from the metallic particles which adhere to their hands and clothes, thence finding their way into the stomach, than from absorption through the skin, or inhalation into the lungs. The proper precautions consist in changing the clothes before going to meals, and thoroughly washing the hands, carefully removing eveiy particle of paint or metallic matter from under the finger-nails. Gold-finders ai"e exposed to sulphureted hydrogen gas, which is exceedingly poisonous. Severe mental exercise, or close application to study, has usually been considered as unfavorable to long life. This is undoubtedly ti'ue as relates to childhood and early youth. The bodily powers are often stunted, the mental functions blunted, and the whole constitution ruined by too early confinement to study. But there is another evil of immense magnitude connected with this view of our subject. Children and youth require much, varied, and regular muscular exercise during the period of bodily development. If the natural instinct for abundance of out-door exercise is repressed, the whole system becomes morbidly sensitive and irritable, and this condition, under the usual stimulating and enervating habits to which youth are so generally the subjects and the victims, such as tea and coftee, flesh eating, excessive clothing, feather beds, etc., is aggravated and intensified, until inflammatory se- cretions and ungovernable passions disorder the whole body, and un- balance the mind. In this state young persons are easily led into any habits of dissipation and debauchery which their associates or superiors are addicted to. The numerous examples of self- pollution or masturbation among studious young men and boarding-school girls, aiirely undermining the constitution, and laying the foundation for a brief life of infirmity and suffering, are melancholy evidences of mis- directed educational enterprises. The duty, therefore, of bringing every child up to some useful business pursuit, in which the sur )lus animal energies may be prafitably and regularly expended, &e -ms absolutely indispensable to its safety as we 1 as to the good of soci. ty; ft duty the neglect of which has cause; so many sons of wea.ch/ 396 HYGIENE. parents, who were so mistaught as to look with contempt upon honest toil, to turn out debauchees and vagabonds. But intellectual pursuits, or avocations which severely tax the moral powers and higher propensities, do not seem tc be inimical to high health and great longevity, when followed with *i consistent regard to general hygienic precepts. Dr. 3Iaddeu, in his "Infirmities of Genius," has given us tabular statements which go to show that those literary pursuits in which the imagination is vigorousl}- exerted are more inimical to longevity than scientific and philosophical avocations. He also thinks that "the earlier the mental powers are developed, the sooner do the bodily powers begin to fail ;" a remark which is correct only so far as it applies to the prevalent method of forcing the intellect into premature and precocious exertion, at the expense of the body. Poets and artists are rather noted for early deaths, but they have usually been in-egular and dissipated in their habits. Eminent theo- logians, philosophers, physicians, lawyers, jurists, etc., have died very frequently of apoplexy or palsy; but they were frequently addicted in the later periods of life to "luxurious feeding." Many individuals are designated by historians as "victims of excessive mental applica- tion," who were truly victims of intemperance. Dr. James Johnson, mistaking the ahuse of the body for the use of the mind, has expressed the absurd opinion that " a high range of health is probably incompati- ble witii the most vigorous exertion of the mind, and that this last both requires and induces a standard of health somewhat below par." This error of Dr. Johnson has arisen from observing that certain in- tellectual geniuses — Virgil, Horace, Pope, and others — were of feeble bodily health. It is much more rational to suppose that if " men of genius" would take better care of their bodies, they would manifest still more vigorous and enduring minds, than to impute what mental talent they do possess to bodily infirmity. Sad examples of the same mistake may be seen at all our seminaries of learning, where bodily infirmity and mental genius appear, to the superficial observer, to stand in the relation of cause and eftect. But, however satisfied and gratified teachers and parents may be with the " highest prizes" won by haggard fiices, contracted chests, gaunt abdo- mens, and dreamy slumbers, the true physiologist can only see, in the not distant future, sure-wasting consum{:)tion, hydra-headed dys- pepsia, crippling palsy, or nameless debility, as tlie probable consequence of this working of the machinery of mind out of all proportion to the bodily development; he nr.ust lament, while short-sighted friends rejoice at the prospect. PART IV. DIETETICS. Preliminary Remarks. — All intelligent physicians of a'i :ichool3 of medicine agree in the general proposition that plain, simple, natural food is most conducive to the recovery or preservation of health ; but when we come to the details as to what constitutes plain, simple, and natural food, these same physicians are at all points of the compass. Even hydropathic writers, who are singularly harmonious on every other subject in relation to their system of the healing art, are some- what discordant on this. The fact, however, may not result so much from differences of opinion as to what is intrinsically true in theory, as from different views as to what is expedient to attempt in practice. One remark of the author of the "Science of Human Life," all true hydropaths will have abundant opportunity to verify, viz. : " The more the practice of the physician conforms to the appetites of his patients, the more cheerfully and generously is he rewarded." Two dollars a day is not regarded as extravagant at a "first-class hotel," where the guests are provided with "every comfort" which renders them inva- lids ; but one dollar a day at a hydropathic establishment, where they ai'e forced to bear with all the privations that are necessary to restore them to health, is considered exorbitant; so difficult is it for the majority of people to reason against the current of their appetites, and understand in opposition to the impulses of passion and habit. This consideration, too, which all persons who practice a reform system in opposition to the acquired desires and immediate pleasures of their customers must be fi-equently reminded of, may not be without its in- fluence in determining the general character of many hydropathic tables, and possibly of biasing the opinions of hydropathic practitioners; for that man must be ignorant of human nature who does not know how easily judgment is warped by interest. I do not know that it is practicable or possible, amid the prevailing Ignorance and error, to sustain a hydropathic establishment, or any 34 398 DIETETICS. other public institution, on a dietary system sti'ictly physiological. A majority who are compelled to resort to the water-cures, of course, have been more or less mistaught; nor can their errors be wholly edu- cated out of them at a single interview. "Line upon line, and precept upon precept,*' even when commended and enforced by personal ex- ample, are necessary to change the cuiTent of deeply-rooted habits and ever-craving propensities. A large proportion of patients who for the first time visit these "cures" for the purpose of treatment, expect a change from their accustomed habits of eating and drinking to something more healthful. But such a change ! Many of them are startled with astonishment on their first appearance at a hydropathic table. They had heard of the beautiful brown bread, the exhilarating cold water, the substantial hominy, the admirable rice, the tempting fruits, the dainty baked potatoes, the delicious greens, and the keen appetites ; but while it was, perhaps, " distance that lent enchantment to the view,'' they were pampering the artificial appetite with rich dishes, and condi- ments, and seasonings. When, therefore, the matter is submitted to the evidences of the senses, the wheaten grits scratch the throat, the beef-steak is too dry to swallow without gravy, the bread will not go down smoothly without buttei*, spinach is insipid without vinegar, pud- ding is flat without wine-sauce, pea-soup is uninviting without pepper, pumpkin pie is odious without ginger, pastry has no relish without the accompaniment of cheese, and the biscuits are too tough to " melt in the mouth" without shortening. If perchance an article finds its waj' to the table by accident, or by the carelessness or connivance of the cook, in all respects what it should not be, it is morally certain to receive a warm eulogium ; while the articles selected with the greates': care, and prepared with the utmost pains-taking, and in every way precisely adapted to cure their maladies in the shortest possible period of time, are as certainly treated with dignified neglect or open ridicule. This I know is an exti'emo view, but not an uncommon reality, and these circumstances maj/ justify, if they do not compel, hjdropathic tables to be, to some extent, compromises with custom. Manj'^ pa- tients, with a full understanding of the subject, prefer to have a greater indulgence in matters of appetite, and submit to the severer water- processes such indulgence renders indispensable, in order to eflect a cure. But the evil is not wholly on tho side of the inveterate errors and perverse appetites of patients. Some persons who undertake to get up a hydropathic table are entirely ignorant of the whole subject of diet; some pretended establislnnents are merely "watering places," the table being Tsholly oc : le ordinary hotel plan. There is, too, some DIETETIC CHARACTER OF MAN. 390 difficulty always attending the prepEQ-ation and maintenance of a well- regulated table for invalids, for the reason that competent help is not easily found ; and again, the commercial adulterations of the materials of food, and the bad qualities so profusely furnished to our markets, require the closest attention and the most careful scrutiny. But all of these difficulties are surmountable ; errors of education are not necessarily fatal, morbid appetites are not absolutely incorrigi- ble, and a clear understanding of the causes, sources, nature, and rem- edies of all of them, is the pre-requisite for introducing a better order of things. • The aim of the enlightened hydropath in directing the dietetic practices of his patients, will be not only to cure then* present infirmities, but to teach them "the way of life" in relation to eating as well as to all other voluntary habits. And to this end he should for himself well understand, and for otl.>ers ever hold out to view, correct physiological principles, although he may rightfully exercise a wide range of discretion in the particular manner of conforming and reform- ing the habits and appetites of his patients, so as to induce them intel- ligently to love and permanently to practice " the better way." OHAPTER I. DIETETIC CHARACTER OF MAN. The arguments involved in the question whether man is by nature best adapted to subsist on a vegetable diet exclusively, or on a mixed diet of vegetable and animal food, can hardly fail to be interesting and profitable to all, although all may not draw the same inferences from the facts presented. Those who will attentively study Sylvester Graham's work on the Science of Human Life, will find this whole subject critically investigated and philosophically demonstrated. In the present work it is impossible to give more than a brief absti'act of the positions and evidences bearing on the general proposition. The Bible Evidence. — We learn fiom the first chapter of Genesis that, as soon as man was created, and placed on the earth, to "multi- ply, and replenish, and subdue it," his food Vi^as appointed in the fol- lowing words : "And God said, Behold, I have given you every herb bearing seed, which is upon the facr3 of al t.33 earth, and every tre^ 400 D 1 E T E C 1 C 3. in the which is the fruit of a tree yielding seed; to you it shall be FOR MEAT." Cei'taiuly nothing can be more clear and explicit than this dechu-ation, that the vegetable kingdom is the ordained source of maivs sustenance. But after the flood it is said that animal food was permitted. It seems to me a very strange moral hallucination that arrays a permis- sion to do one thing against a command to do the contraiy ! Those Avho prefer to make a permission instead of a command their rule of action will find, on a careful examination of the Scriptures, that wars, murders, polygamy, pestilences, famines, and many other vices and evils, have been permitted, " for the hardness of men's hearts." This doctrine of permission is derived from Genesis ix. 2, 3, 4 : " And the fear of you, and the dread of you, shall be upon every beast of the earth, and upon every fowl of the air, upon all that movetli upon the earth, and upon all the fishes of the sea ; into your hand are they de- livered. Every moving thing that liveth shall be meat for you ; even as the gi'een herb have I given you all things. But flesh with the life thereof, which is the blood thereof, shall ye not eat." To my understanding this permission only more strongly enforces the prior commandment. If we may suppose that man, after the earth had been peopled for several centuries, by reason of some set of circumstances we cannot now ascertain, resorted to flesh-eating, ia consequence of which he became so brutal, and ferocious, and de- praved, and wicked, and filled the land with so much violence, that it was found necessary to wash the whole surface of the earth cleai- of his polluting presence, saving only a single family to preserve the race from utter extinction ; and if then Jehovah had seen fit to reafl^irm His origintd law in the appointment of man's food, the language em- ployed, it seems to me, is admirably adapted to the purpose. The fear and the dread of man was stamped upon the whole ani- mal creation. This implies that man's supremacy above the lower animals was again pointed out. It did not ordain man to be a prcda- ceous animal himself, but affirmed his superiority. But into man's hands was the whole animal kingdom delivered. Well, for what pur- pose ? To eat ? Not to devour, but to protect. To rule and hold dominion over, not to ravage and prey .jpon. Or even if man Avere ordained to destroy and exterminate the anima kingdom, it would not follow that it was his duty to eat and digest it. God constituted man the lord of creation ; was it not an egregious blunder in man to mis- take himself for the tyrant of aH ? The inferior races of men fear and dread the superior; in fact, for aV practical purposes, the weake fire " delivered" into the hands of DIETETIC CHARACTER :F MAN. 4(h tlie stronger. But would it not be a perversion of privilege for the more powerful to eat the more feeble, especially when there was abundance of good wdiolesome food obtainable otherwise? If man is placed at the head of creation, formed and fashioned but little lower than the angels, and so much above the animal kingdom as to have do- minion over it, his duty seems to be to protect and govern it, not sen- sualize and riot upon it. The fear of God and the dread of the Al- mighty is upon eveiy human being who walks the earth ; but human beings look up to that Deity whom they both fear and dread, as the best of protectors, the most merciful of rulers, the kindest of fathers. If Queen Victoria has dominion over thirty millions of her fellow- creatures, she would be a very cannibal to eat a single one of them; and if a hundred millions of semi-civilized human beings are delivered into the hands of Nicholas of Russia, it does not imply his right to maltreat or destroy, much less devour them ! No one pretends to say that aR sorts of dtad animals were meant by the phrase, " every thing that liveth ;" and if it does not include all animals, why does it mean a7iy ? Surely the language is as broad as creation itself. But mark! Vegetable food is, indeed, a "living thing," after, harvest, and even when prepared for the table. The grains, and fruits, and roots still retain the living seed, the germ of vitality, even at the moment wdien they are ready for man's repast True, their germinating property may be destroyed by a process of cooking, but this militates nothing against our position. Now, animal food (save those trifling exceptions, raw fresh eggs ane raw fresh oysters) of whatever kind, is not "living:" and it imme- diately commences puti*efying the moment it is deprived of life ; and this process of decomposition can only be arrested by powerful anti- septics, as salt, vinegar, sugar, alcohol, nitre, arsenic, etc. Again, while man's dominion was to be over all that jnoveth upon the earth., his ordained fsod was to be every moving thing that liveth. Those things that move ujion the earth are most indubitably the ani- mals that creep, crawl, walk, run, jump, climb, fly, and swim. The moving things that live, when gathered and preserved for food, as well as when gi-owing in the fields and woods, are the waving grains, the spreading vines, the branching roots, ithe svs'^elling fruits, etc. Lastly, those who contend for flesh-eating on Bible authority admit that blood is peremptorily forbidden. This admission on their part completely refutes all the appearance of force they draw from their own interpretation of the doctrine of permission, for they never eat a particle of flesh, and would not eat it, witi 3ut a large admixture of blood. A piece of flesh deprived of its bloi. 1 is a dry, fibrous, stringy i02 DIETETICS. unsavory mass ; no one would eat it sooner than he would eat a piece of sponge or India-rubber. Yet who does not know that "steaks" and "roasts" rare-done, so as to bleed a little when carved, ai'e consid- ered by Christian epicures generally as the sweetest, daintiest cuts ? Even blood-puddings are considered a famous luxury by svome of those good Christians who profess to be, and no doubt really imagine they ai*e, obeying the commands of holy writ in the use of aninial fcod. It is admitted that both the Old and the New Testaments furnish examples of good men, and inspired men, who ate flesh ; but good and inspired men were neither all-wise in intelligence, nor all-virtuous in conduct. Though good and inspu-ed, they were still the subjects of ignorance and error — they were human. Nothing, however, is more apparent than the superiority which the whole tenor of Scripture teaching assigns to vegetable food. The history of Daniel, and John the Baptist, and Elijah the Prophet, are sti-iking illustrations. Whether our Saviour ate the animal fish is a question perhaps not easily solved, nor is its solution material to our purpose. But it is worthy of notice that the lotus plant of the Eg^^ptiaus is, even at this day, made into an edible preparation called fish. The Greek word opsarion, it is said by some lexicogi'aphers, does not signify fish, but some other delicate preparation eaten with bread. James and John were fishermen, with Zebedee their father, yet Calmet says that they never ate fish or flesh. Ezekiel speaks of an abundance of fishers who should live on the borders of the Dead Sea, yet Josephus says no animal fish wiJJ live in it. The balance of testimony is certainly strongly against the supposition that fishermen were fishers of aumials in those days, or that the fish employed as food was not a vegetable production. The Mosaic regulations in relation to animal food were evidently in- tended to resti-ain its employment, as fin* as the sensual people he had to deal with could be controlled, and to restrict those who would per- sist in its use to the best or least injurious kinds. But, stranger truth than the strangest fiction, many of our good modern Bible-professing Christians, who devoutly believe in " Moses and the prophets," make their dainty delicacies and luxuries on the very kinds of animals and parts of animals which jMoses, with the authority of " thus saith the Lord," peremptorily prohibited. The Anatomical Evidknce. — To the Bible testimony in favor of vegetable diet, may be added that of comparative anatomy. Natural history alone solves the problem bej'ond all controversy. Medical writers are constantly jisserting, and newspaper scribblers are contin- ually reiterating the statement that the conforn;ation of the human DIETETIC CHARACTER OF MAN. 403 bowy shows that man is intended to live on a mixed diet of animal and vegetable food; but neither of them support the position with a particle of evidence which can bear criticism. On the contrary, all the eminent naturalists the world has ever produced, as far as I know, are unanimous in the opinion that the anatomical structure of the human body, as compared with other animals, places man among the frugivorous or herbivorous animals, and affords no testimony whatever of his carniv- orous or omnivorous character. Baron^Cuvier, whose name stands at the very head of ^comparative anatomists, says: "The natural food of man, therefore, judging from his structure, appears to consist of fruits, roots, and other succulent parts of vegetables, and his hands offer him every facility for gathering them. His short and moderately strong jaws, on the one hand, a-nd his cuspidati being equal in length to the remaining teeth, and his tubercular molares on the other, would allow him neither to feed on grass nor devour flesh, were not these aliments previously prepared by cookmg." Professor La^^Tence states that "the teeth of man have not the slightest resemblance to those of carnivorous animals, except their ex- ternal enamel, and that the whole human structure most closely resena- bles those animals which ai"e naturally frugivorous — the simice, or monkeys." Thomas Bell, surgeon-dentist to Guy's Hospital, declares that "every fact connected with the human organization goes to prove that man was originally formed a frugivorous animal." Linnaeus asserts that "the organization of man, compared with that of other animals, shows that fruits and esculent vegetables constitute his most suitable food." Sir Everard Home admits that "while mankind remained in a state of innocence, their only food was the produce of the vegetable king- dom." Lord Monboddo, also a celebrated naturalist, says: "It appears to me that by nature, and in his original state, man is a fi*ugivorous animal, and that he only becomes an animal of prey by acquired habits." Dr. William Lambe, of London, after a critical examination of the question, came to the conclusion that "man is herbivorous in hi« struc- ture," and his conclusion has been ve/ified by more than forty years of personal vegetarian experience. He declares that "the adherence to the use of animal food is no more than a persistence in the gross customs of savage life, and evinces an insensibility to the progress of reason, and to the operation of intellectual improvement." Sylvester Graliam, of Northampton, Mass., w th a :niud singularly 404 DIETETICS. constituted to gi-asp first principles, has cai'efully examined the whole organization of the human body, and minutely investigated all its com- plicated parts, with direct reference to this question, more thoroughly probably than any other person who has ever lived. His theoretical conclusion corresponds with that of all other naturalists whose attention has been directed to the subject, and the experience of hundreds who have adopted the vegetarian system, partially or wholly, in consequence of his teachings, singularly exemplifies its truth. Against such testimony we have nothing bat the bare assumption of medical and dietetical writers who have never examined the subject at all, and who are as profoundly ignorant in relation to it as are those for whose edification they wi'ite. It is common and customary for such persons, whenever they make a book ©n any subject pertaining to medicine or hygiene, to repeat the stereotyped phrase that the teeth of the human animal combine the characters of both herbivorous and carnivorous animals, and constitute him an omnivorous, or all- devouring animal. This makes him one of the connecting links be- tween the two, and places him dietetically in the same dignified rank in the scale of being as the bear, hog, etc. The manner in which the omnivorous side of the question is supported is much more amusing than convincing. Dr. Dickson, tWe author of Chrono-Thermalism, modestly observes : " The most cursory examination of the human teeth, stripped of every other consideration, should convince any body ivith the least jrretensions to brains, that the food of man was never in- tended to be restricted to vegetables exclusively." Dr. Carpenter (Principles of Human Physiology), in allusion to the carnivora and herbivora, remarks: "Now, the condition of man may be regarded as intermediate between these two extremes. The con- eti-uction of his digestive apparatus, as well as his own instinctive pro- pensities, point to a mixed diet as that which is best suited to his wants." Dr. Dunglison {Human Health) makes the following singularly ridiculous assertion : " There is no doubt whatever, that if, from in- fancy, man, in the temperate regions, were confined to an animal banquet, it would be entirely in accordance with his nature, and would probably develop his mental and corporeal energies to as great a degree US the mi?vod nutriment on which he usually subsists." Professor Lee, who has a happy talent for "coinciding" in the opin- ions of others, fully endorses the "veiy judicious remarks" of Dr. Dunglison, and also remarks, on his own responsibility : "The physical organization of man proves that he is destined for a mixed kind of ali- ment." DIETETIC CHARACTER 0? MAN. 405 \ A volume of similar quotations could be extracted from the medical authors of the allopathic school ; but all alike are deficient in argument or evidence. When an attempt at argument is made, it always turns on the teeth and masticatory organs. These are said to be in man a little different from both carnivorous and herbivorous animals ; and hence the inference is drawn that man, because he is unlike either, is actually both. There is, indeed, a resemblance between the teeth of man and the teeth of both the carnivora and herbivora, as well as those of the omnivora; but there is, too, a difiierence, and the difference is just as significant as the resemblance. The truth is, that there is a very wide difference between the teeth, masticatory organs, and whole digestive apparatus of man and carnivorous animals ; a great difference between man and omnivorous animals in these respects ; a lesser dif- ference between man and the herbivorous or graminivorous animals ; and an exact resemblance between man and those animals known to be frugivorous. The single fact that man possesses the lateral or grind- ing motlojuof the lower ja,w, peculiar to frugivorous and gi-aminivorous animals, while he is destitute of the pointed, projecting, irregular, and tearing teeth, belonging to carnivorous and omnivorous animals, is per- fectly conclusive, in my estimation, as far as anatomy is concerned, that man is by nature in no sense or degree associated, dieteticaliy, with the latter classes of animals. But for the satisfaction of those who desire to see as well as hear the discussion of this subject, the following ocular demonstration is subm»itted : Fig. 152. Fig. 152 exhibits the masticatory or- gans of the carnivorous tiger. There is a resemblance between these teeth and those of the human animal ; yet no one will dispute that the differ- ence is more striking than the resem- blance. OccasionaDy the human teeth exhibit those deviations fi'om the orchnary form which are denominated tushes ; but such deviations are universally regarded as deformities, and such de- formities always give a carnivorous and ferocious expression to the countenance. How Irttie do human beings suspect the intimate con- nection that exists betw^een mental impressions and exercises and bodily conformation. Those tribes of the human family whose minds are most associated with animal food, and whose teeth are most frequently TJJN'DER JAW. lOQ DIETETICS. employed m masticating it, are most distinguished for a sti'uctm-e of teeth peculiarly irJiuman. Fig. 153, JATTS AND TEETH OF A PANTHER. In Fig. 153 we have a represent- ation of the jaw3 and teeth of an- other purely car- nivorous animal. It affords a good idea of the man- ner in which the jaws of the car- uivora open and shut, like a pair of shears, being wholly incapable of the least gi'inding or rotaiy motion. Fig. 154. JAWS AND TEETH OF A MINK. Fig. 154 represents another modification of carnivorous masti- cators. The teeth are nearly closed, and the dagger-like tusks are seen to be very different from those teeth which, in the human jaw, have received the appella- tion of canine. The face of the young lion. Fig. 155, does not make any very near approach to humanity, m the conformation of the teeth or jaws. A resemblance, of course, must be acknowledged ; yet, when the genei-al contour and expression of tb^ human face approximates to that of a carnivorous animal, it is by common con- sent denominated "savage," " rufifianly," etc. The poets and painters who vimlertake to represent to us their ideal of humanity invariably divest the features and expression of every trace character- istic of the ascendency of the lower range of animal propensities How would the "Portrait of a Gentleman," the "Flower Girl," "The Bride," or "The Cavalier," appear in the gallery of the American Art 7 YOUNG LION. DIETETIC CHARA'JTER OF MAN. 407 Union, with the angles of the mouth drawn down to the carnivorous range, and the canine teeth projecting omnivorously beyond the rest? Fig. 156. TINDER JAW AND TEETH OF THE HOG. We may now examine the intermediate class — the omnivora. The back teeth of the hog, Fig. 156, resemble exactly those of herbivorous, and the front teeth those of carnivorous animals. But if there is any thing peculiarly human about the masticatory apparatus of the swine. I am unable to perceive it. Fig. 157. JAW AND TEETH OF THE CAMEL. The masticatory organs of the camel, Fig. 157, particularly the cus- pid or canine teeth, show a much stronger resemblance to those of carnivorous animals than do those of the human animal; hence man, judging from the point of comparative onatomy alone, would be re- moved further from the carnivora than even the camel, which subsists on the coarsest herbage. The irregular arrangement of teeth are hero peculiarly fitted for tiincliing and breaking up the sprouts, stalks, b -anches, etc., which tonstitute a large propoition of this animal's food. 408 DIETETICS. Fin. 1j8. In the jaw of the horse, Fig. 158, another herbivorous animal, the incisors, or cutting teeth, are placed in front to crop the grass or other herbage ; and the grinding teeth for mashing and comminuting the food occupy the back part. There is no appearance of tearing or carnivorous teeth. Ascending the scale of the animal crea- tion, we may next look at the masticatory ap- BKULL OF THE HORSE. P^ratus of a purely frugivorous animal. In the orang-outang, Fig. 159, the articulations of the jaw, as with all herbivorous animals and with man, are adapted to the rotary or grinding motion. The teeth of the ape, or monkey Fiir. 159. JAWS AND TEETH OF AN ORANG-OUTANG. tribe, have a nearer resemblance to those of carnivorous animals than nave human teeth, which fact would place men, if possible, at even a greater distance than th^ orang-outanj Proni the cnrnivora It should DIETETIC CHARACTER OF MAN. 40y "•«iii2^2SS2ii^;a£8^SGi.a2iiii»i! HUMAIv" JAW AND TEETH. be noticed, however, that in some species of monkeys — the baboon for example — the cuspids da resemble the corresponding teeth of car nivorous animals, an arrangement which serves them for weapons of offense and defense, but not for cutting and tearing flesh. It will be ob- ^''■^''- served at a glance that the mastica- tory organs of the human animal, Fig. 160, ai'e still further removed from all resem- blance to those of carnivorous or omnivorous ani- mals than are those of the purely frugivorous orang-outang, or the purely herbivo- rous animals. The incisors (I) are evidently intended for biting and cutting the fruits, grains, roots, or other vegetables designed for his subsistence; the cuspid, corner, or canine tooth (C) enables him to grasp more firmly and retain more securely the alimentary substance ; and the bicuspids (B) and molares (G), or small and large grinders, are fitted to mash and grind all dry, solid, or hard articles of food. The human masticatory organs, on the whole, exhibit no evidence of any structural ari'angement which is not precisely fitted for and ex- clusively adapted to a vegetable diet. The human teeth can, however, cut and tear flesh to some extent; and so can carnivorous animals break and mash fruits and seeds to some extent. Experiments have also proved that each class of animals may be made to approximate the other, to some extent, in character and disposition, by changing their dietetic habits. Young tigers and young lions have been restricted to vegetable food, during which time they remained docile and govern- able ; but on tasting raw meat, the dormant propensity to tear the warm, quivering flesh, and drink the red blood of other animals, was immediately aroused, and all the ferocity and cruelty of a carnivorous nature was again in the ascendant. "Just as the twig is bent the tree is inclined," physiologically as well as morally. Those mothers who force their little children, even before they are capable of masticating a particle of it, to swallow flesh, and thus develop an early appetite for it, are little aware how seriously (Jiey are injuring the organizations an(3 corrupting the whole nature f the future men and women. I— 3i3 tlO D I E T E r 1 C S. Lastly, we h:ive, in Fig. 161, a view of iLe entire skeleton of man, compared with that of a pm*ely frugivurous animal. Not only is the agreement perfect with respect to the masticatory organs, but the whale digestive apparatuses of both aie precisely alike ; and even the entire conformation of the body of the orang-outang, considered die- tetically or physiologically, resembles the human animal, incomparably more nearly than any other animal does. How, then, can we draw from the structure of man, as compared with other animals, any infer- ences at war with the divine commandment recorded in the Scriptures ? The Physiological Evideivce. — Phj'siologists have noticed that the blood of flesh-eating animals undergo ^« putrefaction much sooner than that of a vegetable-eating animal. The chyle of flesh-eating men, when taken out of the body, decomposes and becomes putrescent in less than a quarter of the time required for that of the vegetarian to undergo the same process. All the secretions of vegetarians are more pm*e, bland, and copious, and the excretions — the sweat, urine, fecal matters, etc. — are less offensive to the senses, and less injm'ioiis in their exhalations, than are those of persons M^ho subsist on a mixed diet. The teeth of vegetarians are less affected with tartarous in- crustations, and their breath is mostly or entirely free from the rank, cadaverous, pestilent odor so connnon to flesh-eaters. ^Medical author- ities generally agi-ee that flesh diet makes the blood prone, and the whole body disposed to, the inflammatory and puti-id diatheses. Some few medical writers have, however, asserted that an exclusively vege- table diet predisposes to scurvy ; but as they have not sustained the assertion with any sort of evidence, it is hardly worth refuting. The vegetarian can always endure hunger and thirst longer without loss of strength, and susJain entire privation of food with much less suftering man flesh-eaters. The appetite of vegetable-eaters is invariably good, and food has always a keen relish, while it often fails with flesh-eaters • requiring frequent changes of dishes, or a variety of seasonings, to render it palatable. Digestion with the vegetarian is unattended with that disturbance, heat, irritation, oppression of the stomach, and dull- ness or drowsiness of the head, which flesh-eaters generally experi- ence after dinner, and which some physiologists, on the mistaken supposition that it was natural, have called the " fever of digestion.'* Drowsiness, sleepiness, and mental stupidity, so common after a full meal with flesh-eaters, are wholly unknown to vegetarians, when their other habits are correct. Th^se can resume any bodily or mental labor immediately after a meal, with incomparably less discomfort, and greater immunity' from evil consequences, than can flesh-ei.ters. DIETETIC CHARACTER OF MAN 411 Fig. 161. THE HTTMAIV SKELETON COMPAREr WITH THAT OF THE ORArrG-OUTANQ 412 DIETETICS. All the mental passions of the vegetarian are more governable and better balanced, more easily regulated by the judgment and controlled by the will, less violent, but more enduring than those of flesh-eatei-s. The firmest and most vigorous structures of body are found among vegetable-eatei-s, in proof of which we need only refer to the toiling millions of Europe and the Eastern nations. Vegetable -eaters possess an elasticity and flexibility of moving fibres, and a tenuity and purity of circulating fluids, which enable them to work theii- bodies and brains mor-e severely, more constantly, with greater ease and facility, and W'th less "wear and tear," than flesh-eaters can; and when fatigued by excessive exertion of body or mind, they will recover, by resting, in a much less period of time. Extremes of heat and cold, and exposures to atmospheric vicissitudes, are better endured by vegetable-eaters. When in ordinary health, those who subsist on an exclusively vegetable diet are never very fat nor extremely lean. All the senses of the vegetable-eater — tasting, smelling, hearing, seeing, and feeling — are more healthfully acute, and less morbidly sensitive than are those of flesh-eaters. Bodily sym- metiy and personal beauty have always distinguished those who have subsisted mainly on vegetable food from those whose principal diet has been animal food, other circumstances being equal. The Medical Evidence. — That vegetable-eaters are not only less liable to epidemical and infectious diseases of all kinds, but much more easily cured of them, either by the efforts of nature or ordinary reme- dial mewis, is a fact pretty well established by the observations of med- ical men. AVounds, bruises, burns, and scalds are also more easily and more perfectly cured. The united testimony of the English Vegetarian Societies, many of whose members have abstained from flesh for thirty or forty years, and some during their whole lives, is in fjivor of its superior healthfulness. The American Vegetarian Society, instituted in the city of New York in April, 1850, contains in its ranks old men who have for an ordinary lifetime enjoyed almost uninterrupted health, and several who have almost regenerated broken-down cxsnstitutions on an exclusively vegetable diet. The Bible Christians, of Philadelphia, who have adopted vegetable diet on religious convictions, have always, as a society, been remarkably exempt from epidemics, which have fre- quently prevailed around tliem. During the cholera seasons in New York — 1832, 1834, and 1849 — no persons whose habits of living ap- proximated very nearly to the •' Graham system" died of the disease ; and no one who lived strictly according to his teachings had an attack. Missionai'ies and teachers have, within a few years, gone fi-om the DIETETIC CHARACTER OF MAN. 413 United States to the sickly parts of Africa, and, by adopting an exclu^ sively vegetable diet, escaped all the attacks of disease which others have experienced, and which are usually considered as incidental to the climate. The same is true of Northern men who, in removing to or traveling throu|:h the Southern states, have adopted the vegetable system of diet. But more striking and, to many minds, more convincing evidence, is furnished in the numerous examples of chronic diseases and malignant ulcers, which have resisted all remedial agencies under a mixed diet, yet have been readily healed under a vegetable regimen. Dr. Lambe succeeded, in cases of cancer, scrofula, consumption, and other mala- dies which had progressed to the incurable stage, in arresting the rav- ages of the diseases, and protracting the period of life for many years, i by a strict vegetable regimen, and the use of distilled water for drink. \ The celebrated Dr. Twichell, of New England, has recently cured himself of a malignant tunTor of the eye, which has troubled him for ten years, and which had been once excised and once cauterized, uith but temporary benefit, by adopting a diet of bread and cream. I have now a patient under treatment for a tubercular affection of the lungs, who, two years ago, was a^/licted with a foul and malignant ulcer of the cheek, deeply involving the upper maxillary bone. After trying the ordinary medication in vain, and submitting to the operations of cutting and cauterization without avail, the patient, against the remon- strances of friends and physicians, abandoned flesh-eating, after which the ulcer healed rapidly. The Chemical Evidence. — All the light which chemistry is able to throw on the subject of diet is in favor of vegetable food exclusively. Nothing is more common than for medical books and writers to tell us that animal food is more nutritious, more concentrated, and more di- gestible than vegetable. But these terms are generally employed without any very precise meaning. The ti'uth is, some kinds of vege- table food, as the cereal grains, are more nutritive, pound for pound, than any kind of animal substance ; other kinds, as fi'uits and most esculent roots, are less nutritive. The terra concentration has scarcely any meaning applied to animal food, for although some kinds of animal food are more nutritive than others, there is, except in the separation of the curdy and oily matters of milk from the watery part, no method known of separating the nutritious from the innutritious element ; and such an invention, should it ever be produced, v/ould tend powerfully to bring animal food into disuse. Some vegetables, and some kinds of fruit, dige?", or rathei' dissjb:e in the stomach sooner than some kinda 414 DIETETICS. of animal food, but not as rapidly as other kinds; but the length of tiine necessary for the digestion of an ai'ticle of food proves nothing for or against it. If we determine the value of foods strictly by the rule of chemical analysis, according to the Liebig school, we shall find that good wheaten bread, rice, and lentils, contain four times as much nuti'itive virtue as the best flesh-meat, while potatoes contain at least an equal amount. If we admit Liebig's theory of the combustion of carbon to sustain the animal temperature, we shall find abundance of carbon, and the best hind of carhon, in vegetable food. And if we accede to the doctrine of the nitrogenous and non-nitrogenous distinctions of alimentary prin- ciples, we find nitrogen supplied in nearly fdl kinds of vegetation, and an inexhaustible resource, in case of accidental scarcity in the vegetable kingdom, in the atmosphere which surrounds us. The Experimental Evidence. — We have no account that Adam and Eve ever departed from the commandment of God in then* dietetic habits, and in the absence of all evidence to the contrary, we are bound to believe they were consistent vegetarians. Although the children of men went ash-ay in an early period of the world's history, '*by dip- ping their tongues in gore," and a large proportion of the human family has continued in the trangi-ession ever since, yet there have been, at all times, men of superior intelligence and high-toned morality, who have rigidly abstained from flesh-eating. Among them we find poets, philosophers, and prophets, distinguished alike for "temperance in all things," purity of life, rectitude of deportment, and length of years. Pythagoras raised up a society' of vegetarians 550 years before Christ. Josephus testifies that the Essenes, a sect of the ancient Jews, numbering several thousands, were long-lived because of their regular course of life and simplicity of diet, which Pliny tells us con- sisted of the fruit of the palm-tree. It is certain, however, that they were vegetarians after the Pythagorean philosophy. The Bramin priests, who are a very numerous sect, are all strict vegetarians. San- choniathan, a Phoenician historian, Hesiod, the Greek poet, Pythagoras, the philosopher, Herodotus, a celebrated ancient historian, Hippocrates, the father of medicine, Diodorus Sicculus, the historian, Ovid, the poet, JEtianus, a Greek historian, and Pliny, the Roman naturalist, all testify that the primitive inhabitants of the earth subsisted on a vegetable diet alone. Pliny, Plutarch, Galen, and Porphyry, testify to the good effects of vegetable diet in developing bodily vigor, and enabling men to bear hunger, *:hirst, heat, or cole: DIETETIC CHARACTER OF MAN. 415 Among the modern names of distinguished individuals who have borne testimony in favor of vegetable diet as conducive to the highest physiological and psychological interests of man, derived from observa- tion, reflection, and in most instances from personal experience, we may notice the celebrated Dr. Cheyne, of England ; Sir John Sinclair, an eminent British surgeon; Dr. Cullen, of Edinburg ; Dr. Iv. Jackson and Gen. Elliot, of the British army; Sir William Temple; Professor Adam Ferguson; Rosseau ; Newton; Dr. Whitlaw; Lord Bacon; Sir Richard PhillijDs ; Howard, the philanthropist ; Dr. Hufeland ; Peter Gassendi, a famous French philosopher; Dr. Taylor; Dr. Aber- nethy; Lord Kaims ; Professor Dick ; Shelley, the poet; Mr. Shillitoe ; Rev. John Wesley; Lamartine ; the Abbe Gallani ; Benjamin Frank- lin; Dr. Muzzey, of Cincinnati; Dr. Jennings, of Oberlin ; "Father Sewall, of Maine ; Dr. S. Graham, of Northampton ; Dr. Alcott, of West Newtown ; Rev. William Metcalf, of Philndelphia ; Dr. James, of Wisconsin ; Dr. Grindrod, author of Bacchus ; O. S. Fowler, the phreno^ "'^st ; and a host of others v/ho could be named. But ail human experience, rightly apprehended, is in favor of vege- tarianism. It is a fact which no intelligent historian will dispute, that the most robust and enduring laborers of all ages and countries ever have been, and still are, in the main, vegetable-eaters. The peasantry of England, Scotland, Ireland, Italy, Turkey, Greece, Germany, Swit- zerland, France, Spain, Portugal, Norway, Sweden, Denmark, Poland, and many parts of Russia, subsist principally, and many of them en- tirely, on vegetable food ; and the finest specimens of health, strength, and activity are found among that portion of the peasantry of several of the above counti'ies, who use no animal food at all. The greater portion of the inhabitants of Asia and Africa use but an insignificant ti'ifle of animal food. The millions of Hindostan and China use so httle animal food that it may be regarded as a seasoning rather than a substantial pait of their diet. The Greek and Russian laborers, and the lazzaroni of Naples, subsist on a diet principally of coarse, farina- ceous food, and they are as athletic and powerful a race as can be found. The Irish immigrants, whose brawny arms and powerful sinews perform the hard work of excavating our canals and construct- ing our railroads, which our flesh-bred American laborers have not strength to do, have generally acquired good, vigorous constitutions on the coarse, vegetable, potato diet of the old country. The Georgians and Circassians, the natives of the Otaheite, Sandwich, and Pitcairn's Islands, the people of the Marquesas and Washington Islands, the In- dians of Mexico, on the Tobasco, the Polish and Hungariaa peasants from the Carpathian Mountains, the Spaniards of Rio Saladc. in So^tJ^ 416 DIETETICS. America, and the Peruvians, subsist mostly on coarse, plain, vegetable food, and they are among the most beautiful as well as the most hardy and enduring people on earth. The slaves of Brazil, the laborers of Laguira, the Moorish porters at Gibraltar, and the porters at Terceria and Smyrna, subsist on a spare, simple, vegetable diet, scarcely ever partaking of animal food ; they possess a most powerful muscular development, and are able to carry burdens .^f from two hundred to eight hundred pounds. A glance at those nations and tribes whose inhabitants subsist mostly on animal food, will set the argument in a stronger light by the con- trast. TiiG Laplandei-s, Ostiacs, Samoides, Tungooses, Burats, Kamt- schatdales, and Esquimaux, in the north of Europe, Asia, and America; the inhal)itants of Terra del Fuego, in Southern America; the people of Andeman's Island in the Pacific, the natives of New Holland and Vun Diemen's Land, an.d the Calmuck Taitars, all possess a low, de- formed, and demi-brutal organization ; some of them are stunted and dwarfish, others are coai'se, rough, and hideous. Their principal food is fish, flesh, and all kinds of animal fats and oils which they are able to procure. It should be remarked, too, that the intellectual and moral constitution of these inferior races of men is as degi'aded and depraved as is their bodily organization. But it will be readily admitted by most persons that a diet nearly all vegetable is better than a diet nearly aU animal, while they will con- tend that a due admixture of animal and vegetable substances is the golden mean between the two exti'emes; and in support of this position we shall be referred to the well-fed of the Anglo-Saxon race, and partic ularly the better classes of Europe and America. But this objection is easily met. We have but to compare flesh-eating Englishmen, Irishmen, Scotchmen, Americans, etc., with vegetable-eating Englishmen, Irish- men, Scotchmen, Americans, etc., of the same class, and of the same general habits in other respects, and the problem is solved. The con- trast ever has been, and I am fully persuaded ever will be, in favor of the superiority of an exclusively vegetable diet. If, however, the past experience of the whole human family for six thousand years, and the coincident testimony of all respectable scientific authors who have ever investigated the subject is not satis factor}-, we can furnish living, acting, moving, practicing demonstrations in the present tense. James Simpson, Esq., president of the English Vege- tarian Society, stated at a public meeting held at Glasgow, June 17,, 1851, that of the individuals belonging to the societ}', numbering be- tween 600 and 700 adult members, 203 have abstained from all kinds of flesh for upward often years: 153 for more than twenty' years ; HYDROPATHIC COOKERY. 417 91 for thirty years ; 29 for forty years ; and 85 have abstained the whole of tiieir lives. Tiiese vegetarians belong indiscriminately to all trades and professions, and have, as a body, ahvays a much higher and more uniform standard of health than flesh-eaters under similar genera] circumstances, and many of them have experienced a wonderful im- provement in bodily vigor and mental vivacity. But we have equally interesting facts in the United States. The American Vegetarian Society, though of more recent date and fewnr numbers, has in its ranks full-grown men and women who have never tasted "flesh, fish, or fowl." Rev. Mr. Metcalfe, who is the correspond- ing secretary of the societj^, and also pastor of the Society of Bible Christians, who have adopted vegetarianism from religious motives, has practiced the vegetarian system for more than forty-one years, as has also his wife. In a late number of the Vegetarian Advocate he says : "We have raised a family of five children, none of whom have ever eaten flesh. They are all married to vegetai-ians ; they all have children, none of whom have ever used animal food; thej are healthy, vigorous, and intellectual." In this society there are now fifty-one persons who have never eaten flesh, nor tasted intoxicating drinks. CHAPTER II. HYDROPATHIC COOKERY. Practical Considerations. — Though I am most thoroughly con- vinced of the superiority of a properly-regulated vegetable over the best plan of a mixed diet, yet I am equally well av/are of the many difficulties in the way of the practical application of this truth. The greatest difficulty of all is the fact that any considerable change of dietetic habits, whether it be to better or worse, usually produces more or less disturbance of the aigestive apparatus ; and if the change be from a more concentrated and stimulating to a more simple, coarse, watery, and unirritating diet, the change will be attended with a degree of languor, depression, and sense of debility, proportioned \ery nearly to the extent that the individual has been injured by stimulation and concentration. This is an exceedingly important principle in hydro- therapeutics, as well as the most difficult point to manage successfully in the Vv'hole Water-Cure system ; hence it ought to be well under •^io!>■:l by both pi'actitioner and patien*. 418 DIETETICS It may be stated as a general rule, that the greater i,\e necessity for a change of dietelu habits, the more will the individual suffer tempor- arily in making such change ; the M'orse the physiological condition produced by dietetic errors, the more will the feelings rebel against a removal of the cause. This perverted sensibility is the rock on which » so many have been wrecked in their attempts to reform their dietetic habits. Reason points in one direction, but feeling impels another way, and usually the latter ti'iumphs. All pel-sons know hoiv they feel ; but all do not apprehend the true sources of their good or bad feelings, and the majority mistake the sense of mere stimulation for the condition of actual strength ; they do not distinguish between the feeling of strength and vital power ; they do not consider that strength or power is only shown in its waste or expenditure, not in its accumulation oi possession. To illustrate : A man who has long been accustomed to the habitual use of intoxicating liquor of any kind, will experience a great degree of prostration, some- times amounting to delirium tremens, on abstaining from it. The apparent exhaustion will be in the exact ratio that his system has been morbidly affected by the alcohol. The habitual tobacco-chewer, on abandoning the use of that narcotic, feels himself to be but the wi'eck of a man; his limbs tremble, his brain reels, and "horrors on horror's head accumulate." His perverted instincts cry out, as it were, for more tobacco, and his feelings tell him that the weed is the true "elixir of life," and if he takes another quid he is at once happy within himself, and at peace with all the world again. Those who have stim- ulated freely on tea and coffee will often suffer intense headache, gid- diness, and nervous debility for several days, sometimes for weeks, on discontinuing them, before the systetn will recover its normal balance, and feel natural without artificial aid- Here we discover the law of conformity. The human "organism has a wide range of adaptability ; it conforms itself as well as possible to every thing brought in contact with or forced upon it. This principle of adaptability is essential to its existence ; for if every succeeding dose of spirituous liquor, tobacco, tea, coffee, or other injurious agent, produced an effect equal to the first, the body would very soon be destroyed. The vital powers may have the ability to defend themselves against deleterious stimulants for half a century, more or less, and have natural ability' to sustain exist- ence two or three times as long, if not wasted in this unnatural war- fare. Let us apply these considerations to the employment of food. A person long accustomed to the use of animal food two or three times a <3ay. or of several kinds at a meal, will fgel usually a great Bense of weakness, or rati 3r a disagreeable craving Knd want of satis- HYDROPATHIC COOKERY. 419 faction, in the region of the stomach, on the adoption of an exclusive vegetable diet ; so, too, one accustomed to the employment of nearly all concentrated preparations, as fine or superfine flour, for the farina- ceous part of his diet, will find the first employment of coarse, unbolted meal, and many kinds of watery vegetables and fruits, attended with unpleasant distension of the stomach, flatulence, acidit}% etc., also, those accustomed to stimulating condiments, as pepper and mustard, generally find nearly all sorts of food to feel heavj'- and sit uneasily on the stom- ach, on first adopting plain, unseasoned dishes ; and even many per- sons who have used animal food very moderately once a day, experi- ence considerable disquietude in the digestive organs, with a constant craving for some kind of stimulus, on totally abandoning flesh-meat; and this craving may re-occ^ir occasionally for r.ionths. Now if all persons were tc. follow their feelings as the proper dietetic guide, all persons would forever continue on in whatever dietetic sys- tem should once become with them an established habit. It is clear, therefore, that in prescribing a dietetic course for invalids, our reason, and not their feelings, is the better guide. Our aim is not to pamper morbid, but to restore healthy appetites. I have had many patients under treatment whose first meal of wheaten grits and milk, or brown bread and baked apples, raised a tremendous commotion in the stomach, producing distension, nausea, and headache ; and yet in a few days the same persons would partake of them with a keen relish, and with perfect satisfaction to the stomach. But in laboring to introduce better habits of living, and in dealing with invalids, we must take mankind in general, and patients in partic- ular, as we find them, not as we would have them ; and in advising a particular course of diet, or in recommending changes in the accus- tomed regimen of individuals, we must, to be useful, have regard to what is possible in practice, as well as to what is ti'ue in theory. Our advice is sought by thousands who have not the means to carry out a well-regulated plan of vegetable diei ; and a well-regulated mixed diet IS far preferable, theifipeutically, to a very bad selection of vegetable food. At ordinary hotels and boarding-houses, the fruits and vegetables are not selected with especial reference to their dietetic qualities, and their attractiveness depends much more on the butter, sugar, vinegar, or spices, with which they are served, than upon their own intrinsic gustatory properties, while nearly all the farinaceous parts of the food are brought from the baker's shop, or prepared according to the recipes of "French" and "domestic" cook-books, which teach little else than the art of compounding dishes so as to produce the greatest possible uraount of dise/ise in the human bod\-. Here, then, is a predicament 420 DIETETICS. Many persons find it convenient or necessary to take their meals at these hotels and boarding-houses, where animal food constitutes the best articles of the table. Plain flesh-meat is not liable to the objection of concentration or complication, and if of good quality it contains the proper relations of bulk and nutriment. All the objections to animal food may be summed up in a single word — impurily ; yet if it be of the best quality and properly cooked, it is an absolute advantage, a cor rective to a diet consisting mainly of baker's bread and sweet cakes. How fai-, therefore, it is expedient for a Wate.-Cure patient, who intends remaining at an establishment a few weeks, and then returning to liis former boai'ding place, or usual dietetic habits, to adopt vegetarian- ism, must be left to the intelligent physician, in view of all the circum- stances of each particular case. It is very certain that many patients require, for successful treatment, total abstinence from all animal food, not even excepting milk, and that the majorit}^ will obtain more speedy and thorough cures under a well-regulated vegetable diet; yet it is equally certain that a large proportion of invalids can be cured, and can subsequently enjoy, corapai-atively speaking, very good health, on a plain mixed diet. But the duty of the true hydropath is not limited to being a mere curer of disease. His is a higher, nobler mission. He is, or should be, a reformer in the broadest sense. It may do for the dnig-tinkerer who only studies the philosophy of death, who contem- plates the machinery of life only in its abnormal manifestations, whose ambition is mainly to silence, scatter, subdue, change, cr otherwise modify the phenomena of morbid symptoms, and who is as profoundly ignorant of the philosophy of Hfe as of any other subject he has never studied — it may do for him to medicate the existing maladies of mortals with all his might, while he leaves the causes in operation which pro- duce other maladies as fast as he can modify existing ones. But better things are expected of a hydropathic physician, who claims a knowledge of the laws of life and health, and professes to cure disease by remov- ing the conditions upon which it depends, and preserve health by avoid- ing the causes which produce disease. While, therefore, we yield to circumstances we cannot control, until society can be more thoroughly indocti-inated in the ti-ue science of life, we should make the best w^e can of unavoidable evils. We can and should at once reject all the immense vai'iety of complicated dishes of animal food, all unclean and filthy animals, and all the unclean and unwholesome parts of animals, confining our dietetic prescriptions to a few of the veiy best articles and pre})arations. That patient or that individual whose appetite cannot be satisfied, as far as fles-h, fish, and fowl are ronrerned, on seven dishes po; wepk. vsith a ;hange for everv HYDROPATHIC COOKERY. 421 Ah} in the week, furnishes an example of a deeply-depraved appetite, and an additional evidence, if any is wanted, that all flesh-eating is a departure from the physiological laws which the Creator has implanted in the constitution of man. Preparations of Animal Food. — Consistently with the principles advocated in this work, all animal broths, soups, teas, all pickled, salted, and smoked meats, all kinds of shell-fish, all fried dishes, all dishes cooked in butter or other grease, all minced or other meat pies, all very oily or greasy animals or parts of animals, all and every thing pertaining to the swine — pork, bacon, lard, sausages, etc., and all very young or very old animals, are to be considered as among the things prohibited. Beefsteak, cut from the sirloin, well-pounded and broiled, is proba- bly the very best food that can be obtained from domesticated animals. The pieces called " porter-house steaks" are more tender, but too fatty. Mutton chops, prepared in the game way, are next in the order of preference. For those who have feeble teeth they are better stewed in water until they are very tender. These chops should be well cleaned of the fatty matters. Boiled mutton is nearly equal to the former in healthfulness ; the leg is the preferable part. Slighilu corned beef, boiled till the fibres cut easily, is admissible. The lean pieces are to be selected ; the rump piece, or round, is one of the best. Roast beef is also an admissible article. The sirloin piece is, on all accounts, to be selected for roasting. As the roasting process of cook- ing renders the fitty matter particularly obnoxious, this should be carefully trimmed off before cooking. Beef hash, made by chopping cold corned beef or beef -steak fine, and warming it up with three or four time*.' the quantity of cold boiled potatoes and water, no butter or gi'ease being employed, is not objec- tionable. The flesh of some wild animals of the herbivorous kind is at least as healthful as that of any domestic animals, as the deer, hnre, rabbit, etc., and may be prepared and employed under the same regu- lations. White fish, which are not oily nor strong, broiled or boiled, may be* occasionally substituted for flesh. The cod, halibut, trout, black-fish, white-fish, and perch, are among the best. Eels, salmon, mackerel, herrings, shad, sprats, etc., are among the greasy varieties. Fish aro more dry nnd unsavory Hian flesh without gravies. If a gravy is em- 4:12 DIETETICS. ployed, it should be made of water, milk, a little salt, and tliickened with a little flour or meal. The barn-yard fowl is the best kind of domestic poultry. The turkey does not dilier much in wholesomeness from the common chicken, yet its flesh is not as well relished without gravies or season- ings. Geese and ducks should be ruled away from the table. Chickens may be broiled, boiled, or stewed in water with eriual advantage, taking care to skim olT the floating particles of oil whoj cooked in either of the last two methods. Eggs, rare-boiled, are admissible occasionally '^hey should always be very fresh, and cooked by standing seven minutes in water, which is to be poured upon them at the boiling point, but not allowed to boil afterward. This method deprives them of the raw taste, and yet leaves both the white and yolk soft and digestible. Po?''hRd eggs, omelettes, etc., are outrages upon human stomachs. Here we have a list of the best or least objectionable kinds of animal food, which can be so managed, if desirable, that the same ai'ticle need not occur but once in two weeks ; and surely the appetite that cannot be satisfied on this extent of variety, would still want something more if it had all the beasts of the field, and fishes of the sea, and birds of the air, spread out before it. But the true policy of a dietaiy system, as far as relates to animal food, is to simplify as mucli as possible, and to employ as few kinds as may be ; therefore the very best articles in our list — beef and mutton — ought to come upon the table much oftener than fish and fowl. Milk, when employed at all, should always be used moderately by invalids, rather as a seasoning than a part of the food. Very little should be taken at the evening meal, as it is apt to irritate the kidneys, or produce restlessness and uneasy sleep, with fevei'ishness, and dry- ness or bad taste in the mouth. Sour milk, whey, or buttermilk, are no better in any case than pure water ; but many persons ai*e fond of them, and I regard them as entirely harmless. Boiled inilk is regarded by some as more suitable for dyspeptics. No doubt it will feel more agreeable in cases wherein raw milk pi-oduces flatulence ; but it is constipating, and in such cases milk had better be avoided entirely. Pot cheese, fresh curd, and very new pressed cheese are not objection- able when used moderately as relishes. The former article should never be made in the common brown earthen vessels, as the lead em- ployed in glazing them is acted on by the acid of the milk, and a poison ous salt of the metal produced. Sevend cases of poisoning from this cause hara been lately reported in the newspapers. Bu.tr. should always be as fresli as possible, but moderately HYDROPATHIC COOKERY. 423 salted, and eaten cold. Dr. Johnson (Domestic Hydropathy) gives us an excellent rule in relation to bread and butter. He says : " For breakfiist and supper there is nothing better than bread and butter. JBut the butter should be as small as possible in quantity.'^' Preparations of Vegetable Foods. — Vegetarians can prepare an unlimited variety of dishes, and still preserve the characters of sim- plicity and healthfuhiess. All pure and undepraved appetences, how- ever, are satisfied witli moderation in variety as well as in quantity. Invalids should not study so much to ascertain how many kinds of food they can bear, as to learn what particular combination of articles is most conducive to the recovery of health. But we can easily present an ample variety, so that all can select according to taste, fancy, or convenience, or in reference to personal peculiarities. This part of our subject may be conveniently arranged under the following heads : a. Breads. — Unquestionably the best bread is that made of coarse- gi'ound, unbolted meal, mixed with pure water, and baked in any con- venient way. The earliest bread-makers pounded the grain on a smooth stone or in a mortar, wet it with water, and baked it before the fire or in the ashes. Various savage tribes have made corn-bread in a similar manner, and all who have partaken of it testify to its delicious flavor and excellent quality. The inhabitants of new countries, where flouring-mills are not to be found, frequently resort to this method of bread-making from necessity, and they have a sweet and wholesome aiticle when they do not spoil it with grease, or shortening. Many of the New England housewifes formerly had a method of making bread without" raising or fermentation of any kind, and I believe it is still practiced to some extent. It is made generally of a mixture of wheaten and rye flours and Indian meal. Wheat-meal, with a small proportion of Indian, makes a fine unleavened bread. It may, however, be made of wheat-meal alone, or of rye and Indian, or of various other admix- tures. Fine wheaten flour alone will not make good bread in this way. Of whatever meal or flour composed, it is to be wet up with water or milk, or both, into a moderately stiflf dough, and baked in the old-fashioned iron baking-kettle for several hours. The New England custom was to make the bread in the evening, put it in the kettle, cover it sufficiently with hot ashes and coals, and let it remain until morning, when as good, sweet, and wholesome bread as mortal ever tasted, would be found on the breakfast table. For making unleavened bread, the grain should be thoroughly cleaned, all foreign ingredients removed, the husks of oats and buck- wheat ani the hulls of corn ca: ^rully separated- if ground at an 424 DIETETICS ordinary flour ing-mill, the mill-stones should be sharp, so as to cut th* seeds into fine particles. If mashed by dull stone;?, the bran appears in flakes or scales. The meal should never be bolted. Great pains should be taken to procure a j)lump, sound article of grain, and families would do wfll to keep a hand-mill, and gi'iud it for themselves, as all kinds of flour and meal are much better and sweeter fresh-ground than when kept a long time. A large cofFee-mili will answer very well, akhough it usually makes the meal rather too coarse and uneven. Wheat-meal makes the very best un'«avened bread. New meal is to be wet with 2Jure soft water — it is impoitant that the water be pure ; then formed into very thin cakes, and well baked in an oven, stove, re- flector, or before the fire on a plate or board. Indian meal, msmaged in the same manner, makes an excellent bread. It may be made thicker than the wheat-meal cakes. It is called in this coKatrj, Johnny- cake, or hoe-cake. The fine Indian meal often found at gi'oceries and provision stores, does not make good bread or cake ; it is, when cooked, heavy, sticky, and clamm}', whereas the coarse is light, dry, and porous. Oatmeal may be prepared in the same way ; it is more pleasant mad© into extremely thin cakes, or wafers. Rye, buckwheat, millet, and barley may be formed into similar preparations of bread ; but they are less agreeable, and, as the other grains are more plentiful and more economical, as well as more pleasant, it is hardly worth while to extend this list. In making any of the above breads, cold or Avarm water may be employed ; some prefer scalding the meal. The most common as well as the best kinds of unleavened bread made from mixtures of various coarse meals are: 1. Wheat and Indian meals in e]ual proportions. 2. Two parts of wheat-meal to one of Indian. 3. Three parts of wheat-meal to one of Indian. 4. Four parts of wheat-meal to one of Indian. 5. Equal parts of wheat-meal and oatmeal. 6. Six parts of wheat-meal to one part of soft-boiled rice. 7. Equal parts of lye and Indian meals. 8. Equal parts of rye, Indian and wheat-meals. 9. Two parts of rj^e-meal to one of Indian. 10. Two parts of Indian to one of rye-meal. 11. Two parts of Indian meal to one of rye-flour. Very good and wholesome breads can also be made of wheat or other meal, and the addition of some one of a variety of vegetables and fruits. Among the best are : 1. Three parts of wheat-meal to one of soft-boiled beans. 2. Three pounds of wheat-meal to one pound of good mealy potatoes. 3. Seven pounds of wheat-meal to two of soft- boiled split peas. 4. Three or four parts of wheat-meal to one of soft- ooiled chestnuts. 5. Two or three parts of wheat-meal to one part of good sweet or m'^derately t?.rt aj ydes, pared, cored, and stewed or HYDROPATIITC COOKERY. 425 baked. 6. Three or four parts wheat-meal to one of West India pumpkin, oi marrow squash, or cream squash. A fair article of bi-ead can also be made of three parts of wheat, corn, or barley-meal, to one of powderec. comfrey root ; also of three parts of wheat-meal to one (if boiled and pounded green corn. I am satisfied that if our good mothers and intelligent sisters would give their attention less to mixed meat dishes and cake compounding, and more to bread-making, they would improve very much on all th'-* methods of preparing bread-food now in use. For one I ran greatly in fiivor of the combination of meal witli roots and fruits ; and the few experiments I have been enabled to make in this line have satisfied mo that most delicious bread, and more advantageous, considered in refer- ence to the usual dietetic habits of society, than even the best wheat- meal bread, can be made of wheat-meal and good mealy Irish potatoes, or sweet potatoes, or good mealy apples and pears, and probably a variety of other fruits and vegetables ; nor can I see any reason why dried or preserved fi-uits can not be advantageously employed in this way, although I have never seen the experiment tried. I know il may be replied to this, that people may as well eat the clear meal-bread, and a due supply of the less nutritious fruits or vegetables with it. So the}' may. But if they will not, and loill use the proper proportions of each when compounded into the shape of bread, they had better have the bread. This kind of bread would also be a great conveni- ence, to say the least, to persons who are obliged to travel much, and who desire to " eat to live" while on a journey as well as when at home. Fermented hreuds may be made of any or of all the articles or com- binations mentioned above, liut wheat, from its larger proportion of gluten, is greatly superior to all other grains for making fermented bread. The best ferment /s good hop yeast or potato yeast. Milk yeast makes a very good bread, but it will not keep well. Distillery yeast, though much used in cities where distilleries and breweries are common, never makes good, sweet bread, but always imparts to it a strong, disagreeable, musty flavor. There are several ways of making good yeast, either of which may be employed, as most convenient. I know no better recipe for hoi) yeast than the folloAving, copied from Graham's Science of Human Life; "Boil a double handful of hops in a gallon of water for fifteen or twenty minutes ; strain off the liquor while scalding hot ; stir in Avheat-meal or flour till a thick batter is formed ; let it stand till it becomes about blood-warm, then add a pint of good, lively, fresh yeast, and stir it well, and then let it stand in a place where it wil/ kosp at the tempeiBture of about 70° Fah., till it i2Q DIETETICS. uecomes perfectly light." This yeast will keep from one to two weeks, if corked tight in a clean jug, arA placed in a cool cellar. Yeast rakes, which may be kept for weeks or months, are made by Btirring good light yeast into Indian meal, until a fine dough is formed, which is to be made into thin cakes and perfectly dried. It is best when dried by exposure to a warm dry cun-ent of air, or what is called a drying w'ind. Sunlight or fire seems to impair it^ properties. Some persons add a little rye -meal to make the Indian more adhesive. These cakes, which are commonly called hard yeast, require to be kept in a cool and dry atmosphere. One of these cakes, an inch thick, tvv-o inches wide, and three inches long, is sufl[icient for four quarts of flour or meal. They are soaked in milk or water until completely dissolved, and then employed like other j'east. Hard flour yeast, or rubs, is prefeiTed by some to the former prep- ai*ation. It is made by mixing the yeast with wheat-meal or flour so that it will be formed into hard lumps; it is then dried in a warm place, without exposure to the sun. The finer particles are for immediate use, and the larger lumps may be put into a bag, and hung in a dry, cool place. In using these "rubs," about a pint are necessary for six quarts of flour. It is usual to let them soak from noon till night, on the day preceding that for wetting up the bread. Some persons may desire to know hov\^ to make yeast without ye^t, in other words, how to procure the original ferment. It may be ob- tained by subjecting any kind of meal or flour to fermentation. Wheaten flour or meal is generally employed. Mix the meal or flour with water or milk into a batter or dough, and let the preparation stand exposed to a temperature of about summer heat — 60^ to 70° Fah., until it "raises" or ferments ; it will then communicate the fermenting property to any other material capable of undergoing a similar process. The ferment can be created more rapidly by the addition of mashed potatoes and molasses. Potato yeast is a favorite with some domestic bread-makers, and it is certain that excellent bread can be made with it. It will not keep as long {IS the hop yeast, but it has the advantages of rising quicker, and of not imparting the shai-p, harsh taste to bread that the former does, when not carefully managed. Miss Beechcr (Domestic Receipt Book) gives a good recipe, with the exception of the dist'llery yeast, which I have substituted by baker's yeast. I have also omitted the salt, which iippears to be a kind of fixture in every preparation or thing mentioned in her book : " Mash h:df a dozen peeled boiled potatoes, and mix in a hanJful of wheaten flour [or meal], and after putting it through a HYDROPATHIC COOKERY. 427 colander, add liot water till it is a batter. When blood-warm, put in a tea-cup of baker's yeast. When raised, keep it corked tight." Milk yeast, or risings, is made by mixing two table-spoonfuls of flour or meal with a quart of new milk, and keeping the preparation at about or a little below blood-heat for an hour or two. It requires nearly twice as much of this as of the ordinary hop yeast for a loaf of bread. For those w^io are fond of milk, this yeast makes an agreeable bread, to be eaten the next day after being made. In warm weather it soon spoils. All bread-makers ought to be thoroughly acquainted with the theory of fermentation; although many persons acquire, by practice and ob- servation, the tact of managing the fermenting process very well, a knowledge of its theory would enable all to succeed more uniformly, as well as qualify them to detect the errors and correct the mistakes of others. Panary fermentation, or, which is the same thing, vinous fermentation, is the decomposition of the sugar or saccharine matter of the grain, and the recombination of its elements so as to produce carbonic acid gas and alcohol. The alcohol is mostly dissipated by the heat of the oven, the remainder evaporating subsequently, and the carbonic acid gas, being retained by the tenacious gluten, puffs up or raises the dough. If the yeast is not intimately mixed with every I)article of the meal or flour by thorough kneading, the fermentation %vill be unequal, and some portions of the bread will be compact and heavy, while others are marked with open cavities. If the dough is weH kneaded, yet not allowed to raise sufficiently, it will be heavy, raw, and clammy; if fermentation is allowed to proceed too far, the starch and mucilage are, to some extent, desti'oyed, and the acetous fermentation commences, w^hich develops vinegar, rendering the bread disagreeable and sour ; and if the fermentation is allowed to proceed still further, the gluten is more or less decomposed, literally rotted, and the putrefactive stage of fermentation exists ; the bread is then exceedingly dry, harsh, and as unpalatable as a dirty chip. It will be seen, therefore, that the management of yeast bread requires the most careful attention, and affords room for the exercise of no small degi*ee of judgment. It is a common error to regard bread as not over-fer- mented unless it is sensibly acid to the taste. Fermentation may be carried so far as to destroy the richness and sweetness of the loaf, and yet arrested by the heat of the oven at a point just short of developing any appreciable sourness. It is here that the majority of domestic bread-makers fail. If it does not feel sticky and heavy, on the one hand, nor taste so«r, m the other, it is pronounced good. But all really good bread must, in addition to these negative qualities, possess th© i28 DIETETICS. positive recommendation of being in every way delicious to the senses. VVliether fermented bread is made of fine or superfine flour, or un- bolted meal, it requires essentially the same management. Wheat- meal, or Graham bread, however, requires, on account of the swelling property of the bran, a somewhat softer or thinner sponge than that of wheaten flour, and it should be baked one half longer ; an ordinary loaf should remain in a brick oven about one hour and a half. Although, as already remarked, wheat-meal makes the best fermented bread, j'et good rye-meal, or this, coarsely ground, and mixed with Indian-meal, makes a very good article of bread. Raised bread, or bread made light by means of acids and alkalies, is used to some extent in this country and in England. It has been thought by some that this method of bread-making was an improve- ment on the fermenting process ; but in numerous experiments I could never succeed as well with acids and alkalies as with yeast, nor do I conceive the plan to be as healthful, |)rovided both processes are man- aged in the best possible way. It is true that a part of the sugar is destroyed by fermentation, and it is true that if the acid and alkali usually employed exactly neutralize each other there is no extraneous ingredient formed and retained in the bread except common salt, while all the natural properties of the grain are left unchanged. The " choice of evils," then, is between the absence of sugar in one case, and the presence of salt in the other. Which is the greatest evil .' For making the best unfermented raised bread the sesquicarbonate of soda and hj'drochloric acid are employed, in the proportion of forty grains of alkali to fifty drops of the acid. The alkali is dissolved and diffused through the mass of dough, and then the acid is diluted and worked into the dough as rapidly as possible. The hydrochloric acid combines with the soda of the sesquicarbonate, forming common Bait, and the carbonic acid gas is set free to puff up the dough. Those who esteem salt an alimentary article, will reasonably presume that this bread is better than fermented; and those who add a large quantity of salt to their fermented bread, as indeed most commercial and publiti bakei's do, will have an additional argument in favor of the raised as compared with the fermented bread. Besides, the raised bread has the actual advantages that it may be put into the oven as soon as mixed, and eaten when recently from the oven without detriment, which is not the case with the fermented, although most persons do eat it fresh from the oven, and take the consequences. But I do not regard salt as an aliment; in fact I consider breads of all kinds essen- tially deteriorated, not only in flavor and consistence, but in physiologi' HYDROPATHIC COOKERY. 429 cal properties, by the admixture of salt in any quantity. It is the very last place where salt should be used, if employed at all. All tlie cereal grains, wheat especially, contain considerable quantities, comparatively, of earthy phosphates, principally phosphate of lime, which seem to he appropriate for the sustenance of the bony structure; but any ad- ditional and unnecessary admixture of saline or earthy matters in those aliments which are already specially furnished with saline and earthy materials, must be the very worst use we could make of them. If salt must be taken, let it be with those articles of food which contain the least, instead of the greatest proportions of earthy and saline matters, as grapes, apples, cucumbers, milk, and flesh-meats. There are a few general rules in regard to bread-making which may be conveniently summed up in this place : 1. The best ovens are constructed of an arch of brick, over which is a covering of ashes, and over this a covering of charcoal, with a finishing layer of bricks over all. This arrangement retains the heat so long that cakes, apples, and pies can be baked after the bread is taken out, and custards and other light articles after them. 2. A new oven should be heated at least half of the day previous to baking in it, and the lid kept closed after tlie firo is out until heated for baking. 3. The fire should be made nearly on the back side of the oven. 4. The oven must be heated till all tlie bricks look red, and are free of all black spots, but not hot enough to burn flour quickly when sprinkled on the bottom. A better test is the thermometer. 5. Bread is light enough for the oven as soon as it looks porous and full of holes, like sponge ; it will also exhale a brisk, pungent, but not in the least degree acid, odor. 6. When bread be- comes light enough before the oven is ready, it should bo kneaded a little, and then kept in a cool place. 7. When the loaf does rise too much, the best corrective is to knead in a solution of bicarbonate of soda, about a tea-spoonful for every three quarts of flour. 8. When taken from the oven bread should always be taken out of the pans or tins and placed endwise, and if the crust is very thick and hard, the loaf should be wrapped in a cloth waning out of cold water. 9. Iij making the sponge for fermented bread, the water or milk employed ' should be about blood-warm. 10. When the dough has been properly kneaded, it should be covered with a napkin or light woolen blanket, and kept at about summer heat, say 60" Fah., until the dough becomes light. 11. In very warm weather the sponge should not stand over night, unless kept in a very cool place ; even then better bread can be made by mixing the sponge in the morning, and baking in the after- noon. 12. All bread-makers should remember that the process of fermentation is arrested at a temperature below 50° Fah., that it pro- 430 DIE T E 1 i C 3. ceeds slowly at 50*', moderately ai 60", rapidly at 70°, and very rapidly at SO''. 6. Boiled and Roasted Grains and Seeds. — Good clean ivlieat, boiled in pure soft watei, and eaten with a little sugar, syrup, cream, or milk, is an excellent dish as part of a dietetic course. It requires boiling nearly all day to become entirely soft, hence the cracked wheat is much more convenient. Those who would hare a tasting apprecia- tion of the vast difference in the gustatory properties of different sam- ples of the same article, should eat, without any seasoning whatever, boiled wheat which has been raised on a new, fresh, virgin soil, and that raised on an old, worn-out, badly-tilled and viciousl^'-manured farm. The contrast might remind one of pine-apples and pine shavings. Hye, barley, and corn are equally wholesome, prepared in the same way, but not as pleasant. It is difficult t«. remove the skins of corn, even by a long process of boiling, without the use of ashes, or some other alkali. Rice is a good food when well boiled, but is too nutritious to eat alone. Those who employ it freely require a good proportion of pota- toes, or other vegetables or fruits, with it. When cooking, it should never be stirred so as to break up or mash the kernels. A very pleas- ant but rather rich dish is made by boiling the rice in water until soft, then stirring in a little milk, and simmering them together about fifteen minutes. Boiled rice is often used as a vegetable with the ordinary dinner, and as a dessert after dinner. For both purposes it is too nu- tritive, unless the dinner is extremely simple and abstemious. Boiled jj>eas and beans are perfectly wholesome at all stages of their growth. Very young peas want cooking but very little. Beans are liable to produce more or less flatulence, except in stomachs long accustomed to a very plain vegetable diet. They are more tough and indigestible when boiled in salted w^ater, as the salt hardens the outside membrane or skin. If salt is employed, it should be added as they are eaten. There are no vegetables that the taste which has been trained to the love of salt, so dislikes without it as rice and beans ; hence most cook-books direct that those articles have plenty of salt cooked through them. I know individuals, however, who have so overcome the desire for this condiment that they like even rice and beans better without it than with it. The small white bean is an excellent vegetable f»T win- ter use. It may be simply boiled in water, and seasoned with a little Bait and milk, or aflerward baked. Boiled green corn is usually put down as bad food by medical and dietetical writers. I can discover no reason for its condemnation. I HYDROPATHIC COOKERY. 431 have employed it freely for years at a table for invalids, among whom tvere always a greater or less number of dyspeptics, and I have never Keen any evil result from it. On the contrary, I regard it, when tender and milky, as excellent. 1 suspect the mischief imputed to it is due to the butter and salt with which it is usually eaten. It is also generally cooked in salted water, which has a peculiar effect in rendering it \vdrd and indigestible, much more so than is the case with peas or beans. It is incomparably better when boiled in pure water, and eaten with salt added to it, than when cooked in salt. The sweet corn is the best for boiling when green. Succotash, v/hich is a mixed disL of boilec green corn and boiled stringed beans, is a delicious and wholesome food, when seasoned with a little miik or sweet c)*eam, with but very little if any salt. Roasted green corn is not particularly unwholesome, though not as good as boiled. Parched corn is a favorite dish and principal food with some semi-barbarous nations, and in some parts of South America. It is perfectly w^iolesome. Roasted wJieat, rice, buckwheat, oats, barley, and chestnuts are wholesome, but the process of cooking all of them, except the latter, is too inconvenient to deserve much consideration. Rice, when torrefied, is considered more constipating than when boiled, and has hence been prescribed in cases 'of diarrhea. Those who must have some substitute for tea, coffee, cocoa, and chocolate, besides water and milk, will find a pleasant beverage in the infusion of the roasted seeds of wheat, oats, or barley — equal, in fact, to the famous " crust coffee," made by steeping toasted bits of bread-crust in hot water. c. Mushes. — Wheat, rye, and corn are the only gi-ains nmch em- ployed in the prepaiation of mushes; oatmeal is occasionally used. They are all made by boiling in pure, soft water, though in a very few dishes more or less milk is ised. WJieaten grits, or cracked loheat, ranks at the head of the list of mushes. As usually put up at the mills, wheaten grits require to be boiled five or six hours. If the grain is broken up finer, it may be cooked in a much less time. My own plan for several years has btien to procure the common grits, made from the best Ohio or Western wheat, and run them through a hand-mill, or large coffee-mill, whenever they are wanted for cooking. This secures the full flavor and freshness of the grain, and grinds the grits fine enough to be well cooked in an hour and a half. The most convenient method of boiling them is by means of a tin or iron vessel surrounded by hot water, and contained within another vessel which •■.omes in contact with the fire. This obviates the necessity of constan*-ly stirring to prevent them from burning on the vessel. They may be 432 DIETETICS. managed very well in an iron pot with legs, so that the vessel can Btand on the i"ange or stove without coming in direct contact with the fire. Milk, or a moderate quantity of molasses or sugar, are the only admissible seasonings for all kinds of mushes. Hominy is one of the best mushes. In this mai-ket it is prepared from the Southern or white corn. The fine-gi*ained hominy is usually boiled about an hour; it may be very well cooked in half an hour by boiling a few minutes, and then steaming it, without stirring, over as hot a fire as can be borne without burning. The coarse hominy, or samp, requires boiling five or six hours. It should be washed several times, and the water poured through a sieve, to separate the hulls. Two quarts of water to one of hominy are necessary. Rye-meal makes an excellent mush, and is particulai'Iy useful in cases of habitual constipation ; to those unaccustomed to the grain, its effect on the bowels is decidedly laxative. It is made precisely like cracked-wheat mush. Indian meal, if coarse-gi'ound, makes a good mush known as hasty pudding. White and yellow meal are equally agreeable to most persons in this dish. It should be stirred rather stiflf, and cooked about fifteen minutes. Oatmeal mush is a favorite with some pei"sons, and it makes a pleas- ant change for all. It is cooked precisely like Indian meal mush. In Scotland it is called stirabout. Graham flour, or wheat-meal, is sometimes cooked in the form of mush ; it may do for a change, but is not as good as the coarser prep- arations of wheat. For infants and young children it is much better than the fiirina which is so extensively used. Farina is occasionally made into mush, but I consider it too nutri- tious and concentrated to be employed in this way as a leading ai'ticle of food, or as a principal part of a single meal. d. Gruels and Soups. — Gruels are merely thin mushes ; they are usually prescribed to invalids laboring under fevers and acute inflamma- tions, or for the purpose of promoting the action of the bowels. For the latter purpose coarse Indian meal, Graham flour, or cracJced tvheat gi'uel are the best. A couple of spoonfuls of flour or meal ai'e suflicient for a quart of water. It need boil only for a few minutes. Rice is sometimes made into a thin mush or thick gruel, for the table. It helps to make up a variety. But few vegetable soujis are desirable. Split peas, soaked over night, and then boiled until completely diffused i-n the water, make one of the best dishes of this group. A pound of peas is sufficient for HYDROPATHIC COOKERY. 433 two quarts of water. Garden beans, and common field peas, and the marrow fats, either gi*een or dried, may be made into tolerable soups. Cook-books generally recommend saleratus to be put into all vegetable soups, and indeed into nearly every vegetable prepaicition that can be named, on the idle supposition that there is something terrible in the shape of an acid in every thing vegetable, which requires to be neutralized. It is a pernicious custom ; it is giving the stomach an actual poison to counteract an imaginary one. e. Puddings. — The majority of puddings found at ordinary hotels, Doarding-houses, and refectories, are vile compounds. Plain puddings are generally farinaceous mushes, in which sugar and milk are cooked. The addition of eggs renders all puddings indigestible for weak stom- achs, and unhealthful for all. The best kinds of plain puddings are not so objectionable in themselves as a part of some of the meals, as they are liable to be swallowed hot, unmasticated, and at the end of a full meal of other things. The very best puddings are made of cracked wheat, rye-meal, hominy, rice, stale brown bread, and Indian meal. Potato and apple puddings are very good, and several other kinds are perfectly admissible. Crackcd-ivheat pudding is made by boiling the gi-its perfectly soft in water, adding a due quantit}^ of clean brown sugar, or good New Orleans molasses, and milk, and baking in a moderate heat. Rije-meal, hominy, rice, and Indian meal puddings may be prepared in precisely the same manner. Hominy and Indian require a hotter oven than the other articles. Bread pudding may be made by soaking pieces of stale but sweet bread in milk until soft, then sweetening and baking it. A very good method is to cut a hole in a loaf of bread, add as much new milk as it will soak up through the opening, tie it up in a cloth, and boil it an hour. Potato pudding may be made of Irish or Carolina potatoes. Mix into a stiff paste two parts of boiled and mashed potatoes, and one part of wheat-meal ; tie it in a wet cloth dusted with flour, and boil it two iiours. Apple pudding is made in various ways. One good method is to alternate a layer of prepared apples with a layer of wheat-meal dough, until a tin pudding-boiler is filled, then boil three hours. Layers of soft-boiled rice, in lieu of the wheaten dough, make another kind of apple pudding. Rice and apple pudding is prepared by boiling half a pound of rice in a pint and a half of milk, till it is soft ; then fill the pudding-dish 1—37 184 DIETETICS. half full of apples pared and cored ; sweeten with molasses or orovrn sugar; put the rice over the fruit as a crust, and bake. Cracker pudding, of Graham or wheat-meal crackers, is made iQ the same manner as bread pudding. Tapioca pudding is made by pouring a pint of boiled milk on half that quantity of tapioca ; let it stand half an hour, then add another pint of milk, sweeten, and bake. Sago pudding is made in the same way. These are very bland, and not very nuti-itive, and their principal value is to fill the stomach and satisfy the appetite when but littJo nutrition is desirable or practicable. Corn starch pudding is prepared by mixing the starch with a sufficient quantity of milk to give it the due consistence, then sweetened and baked. It is rather indifferent tis an article of diet, and when made with eggs decidedly bad. Sweet apple pudding is made by putting a dozen good ripe sweet apples, cut into pieces, into a quart of milk, with a pint of Indian meal, and baking about three hom-s. If lht» apples are not very sweet, a little molasses may be added. Snoiv- hall pudding is made by paring and coring large apples, and inclosing them in cloths spread over with boiled rice ; they are then boiled an hour. They should be dipped in cold water before being turned out of the cloths. They may be eaten with syrup or sugar. Cottage pudding is one of the best preparations of which eggs form a part : Mix two pounds of pared, boiled, and mashed potatoes with one pint of milk, three eggs, and two ounces of sugar, and bake thi'ee quarters of an ^lour. Custard puQvaug is a preparation in which eggs are much more wholesome than they ai'c in other puddings, particularly tlie farina- ceous kind : Mix four eggs, well beaten, with a quart of good milk, and three table-spoonfuls of clean brown sugar; bake in custai'd cups, or a common pudding-dish about half an hour. Apple custard is another dish preferable to farinaceous puddings which contain eggs : Pare and core half a dozen good ripe, mealy, tart apples ; boil them in a small quantity of water till moderately soft ; put them into the pudding-dish, and sugar them over ; then add eight eggs which have been beat up with three table-spoonfuls of sugar, and mixed with three pints of milk, and bake half an hour. Macaroni^ vermicelli, and arrow-root are sometimes made into pud- dings ; but there are so many better articles they are not worth the tFOublo. f. Pastry. — "All pastry is an abomination," says Pari«, with whom HYDROPATHIC COOKERY. 435 the majority of dietetical writers coincide. The expression is not too sti-ong in reference to pies, as they usually come to our tables from the bakeries. Nevertheless pies may be made very good and wholesome, even much better than the majority of plain puddings. Pies, as they should be made, are but little different fi-om bread and fruit, with an extra quantity of sugar. The crust of a baker's pie is better adapted to kill a hyena than to nourish a human stomach ; and the crust of ordinary home-made or domestic pies is too full of meat-drippings, liog's lard, or butter, to be otherwise than pernicious to the stom- ach. But pie-crust can be made in a healthful manner. I know the majority of appetites will consider it harsh, rough, and tough, and many will turn away from it in disdain, because they cannot swallow it without masticating. But the fault is with the wrongly-educated appetite, not with the healthful article. It seems a sad pity that our fashionable eaters, w^ho are so violently opposed to chewing their own victuals, can not employ servants to perform this necessary duty for them, or invent some labor-saving masticating machine ! Excellent pie-crust can be made of wheat-meal, modified or short- ened with good mealy potatoes and fresh sweet cream. Rich new milk answers very well in the place of the cream, and if the fastidious appetite insists on having the crust a little smoother, the coarsest part of the bran may be sifted out. In the absence of cream, the crust may be raised or made light with sour milk and super-carbonate of soda, an alkali much less objectionable than saleratus, and the only one that ought to be employed in cooking. Indian meal may be used in lieu of wheat-meal in forming the crust; equal parts of each may be employed Nearly all the mild, sub-acid, and sweet fruits may be made intc pies; many kinds of pumpkins and squashes make delicious pies; some roots and leaves, as potfitoes and sorrels, make very good and whole- some pies. A few specimens of the best kinds wiU answer the pur- poses of this work : Apple pie may be made of green apples cut into thin slices, or of dried apples stewed, or of the fruit which has been preserved in its own inspissated juice. Moderately tart and very juicy apples make the best apple pie. Brown sugar or molasses is the best sweetening for all kinds of pastry. Pears and peaches^ when thoroughly ripe, make excellent pies, managed the same way as apples. Currants, when very young, or when perfectly ripe, are not objec- tionable. Gooseberries and cranberries are too acid, in all stages of their growth, for this use, although I do not apprehend a sound stom- ach, well ti-ained to a vegetable regimes^ would experience any diffi- 436 DIETETICS. culty from their employment. Indeed, I know individuals Tvho can and do use them without any apparent disadvantage. Straivberries, red raspherries, black raspberries, blackberries, wkortle" berries, black cherries, and red cherries, all in their season, when fully ripe, make delicious pies and tarts. Pumpkins and squashes are equally delicious and healthful. They are to be boiled, mashed, strained, mixed with milk or milk and water, moderately sweetened, and baked on a single crust. Of pumpkins, the West India is the best our mai'ket affords for pie-making, and among the best squashes for this purpose are the cream and the pumpkin. Potato pies ai'e not as inviting as the preceding. The sweet potato is the best. It is cut into squares, with a little sliced turnip, covered with milk or cream, and then with a crust. I have heard tomato pies well spoken of, but I have had no experi- ence in their making or tasting. Rhubarb pie is made by stewing the cut stalks till tender, sti*aining, sweetening, and baking on an under crust. In the usual method of pie-making, eggs are added. This pie is rather too acid for weak stomachs. Meadow sorrel, stewed and sweetened, is much less acid, and, to my taste, more pleasant than rhubarb, when made into pies or tarts. Custard pie is one of the best ways of eating eggs, providing tlie pie is made of nothing but eggs, sugar, and milk, and a crust as herein advocated. g. Cakes. — But veiy few kinds of cake are agreeable or desirable to those whose appetites are under the guidance of a reasonable degi'ee of reason ; and to all others no extent of variet}' and complication can give satisfaction. The following list comprises the best preparations of cake I am acquainted with : Wheat-meal cakes, made of fi'esh Graham flour, good brown sugar, and sweet cream, raised with sour milk and super-carbonate of soda, and well baked, is a much superior article, as far as health is concerned, to either of several hundreds, the recipes of which are found in com- mon cook-books. Sweet cream makes a much richer and sweeter cake than lard or butter. If the cream is wioderately sour, its acid will be sufficient to neutralize the soda without the sour milk. A very fair article can be made without the cream. This kind of cake, if pre- fen-ed, can be raised with yeast, but it should not, in such case, be eaten till the next day. FinefiouT cake can be managed in the same manner, but it is not as HYDROPATHIC COOKERY. 437 good as the coarse. When fine flour is used, molasses is better than sugar for sweetening. Indian meal cake, made of coarse yellow Indian meal, is very light aaid tender made in the same way. It is very good without the cream. It should be sweetened but moderately. Eggs ai-e almost always put in all kinds of Indian cake, but I think it is as pleasant without them, and it is certainly more healthful. Biscuits of wheat-meal or fine flour, or of wheat and Indian, or rye and Indian, may be made by the first-mentioned process, omitting the sugar. Good gingerbread, "with the part ol' ginger omitted," and also with- out alum and potash, can be made with rye flour. New Orleans mo- lasses, and sweet cream, raised with yeast, or with sour milk and super- carbonate of soda, and baked in small, thin cakes. Griddle-cakes are made of buckwheat flour, fine flour and Indian meal, wheat-meal, wheat and Indian meals, wheat-meal and rice, or of rye-meal alone, or with either of the other meals. They may be raised with yeast, or ^vith sour milk and super-carbonate of soda; the latter is the best method, beciiuse all feriuont^^d food is objectionable -"vhen eaten immediately after cooking. They are wet up with milk or water, or both, according to taste, and they may be baked on a soapstone gi'iddle without a particle of gi-ease. Sugar, molasses, or milk, is their proper accompaniment for seasoning. Wheat-meal, with a very little coarse Indian, and three paits of rye- meal to one of Indian, make the very best, sw^eetest, and most whole- some kinds of griddle-cakes. Buckwheat is improved by the addition of a small quantity of Indian. All of them, however, are very good alone. Rice griddle-cakes are prepared by mixing soft-boiled rice with a little flour or wheat-meal. Those who are not provided with soapstone gi-iddles are obliged to use a little oil of some kind to prevent the batter fi-om adhering. Olive oil, when perfectly sweet, is much better than lard or butter for this purpose. Good olive oil may also be used as a substitute for butter in oiling bread, cake, and pie pans, or in shortening bread or cakes for those who have not cream, and will have shortening of some kind. h. Roots. — All of the esculent roots — potatoes, beets, carrots, pai^sneps, turnips, gi'ound-nuts, artichokes, comfrey, etc., are equally healthful j>er se, but of different degrees of nutritive power, and of very differ- ent degi'ees of adaptability to weak stomachs, or stomachs accustomed to the ordinary concentrated or mixed diet. The potato, ground-nut, comfrey, and artichoke, are calle.l mealy roots, the others toatery. 4^6 DIETETICS. The potato fai- exceeda all the rest in amount of uuti'itive property, and is alone capable of sustaining the prolonged nuti'ition of the human being. Boiling is the best method of cooking potatoes; roasting in the ashes is the next best process, and baking, the next. When boiled, they should be taken out of the water as soon as they can be easily pierced with a fork, and then steamed about five minutes. Some prefer steaming instead of boiling ; the difference is very ti-ifliug. They are always richer flavored and more nuti'itious wiien cooked with their skins on, especially in the fall and eai'ly part of winter. A potato should always be pared very thin. Some cooks prepare them by washing and paring, and soaking in cold water over night ; others put them, pai-ed or not, as the case may be, into boiling water at first. The former is the best method for new, and the latter for old potatoes. Cold boiled potatoes, cut into slices, and slightly browned on a griddle, make an excellent relish as a part of the breakfast, and are not to be despised as a whole breakfast. For dyspeptics who have craving appe- tites, and for all who are liable to eat too much bread, or other very nutritive food, potatoes prepared in this way are peculiarly serviceable. Boiled potatoes, jammed up with a little milk or sweet cream, and seasoned with a very little salt, make as rich a vegetable dish as any dne ought to crave. When cold, they may be warmed up in milk, as a pait of either meal. The Carolina, or sweet potatoes, may be cooked in the same ways precisely as the common potato. They are generally preferred when roasted ; they are delicious either baked or boiled. All the other mealy roots may be cooked in the same manner as the potatoes. The watery roots are of essential service in a die taiy system of which farinaceous food or flesh-meat, or both, constitute the leading features. The parsnep, when boiled, is among the most digestible and nutritive of this division. It keeps well through the winter, and is most sweet, tender, and wholesome in the latter pait of winter and early in the spring, the very time when most needed, on account of the abse-nce of fresh fruits and the scarcity of green vegetables. A rich and excellent dish may be prepared by cutting the root into thin slices, boiling it in water until soft, and then simmering it a few minutes in milk. The beet requires boiling a long time ; it should always be 2ooked until perfectly soft. The turnip should be thoroughly boiled, but taken from the water as soon as well done. The caiTot is more nutr "ive than the turnip, but less so than the pai*snip or beet ; it is not usually rel'«hed as well witliout seasonings as the other watery roots. AH )f these roots may be roasted, baked, or stewed in water or milk/ II V D R F A T iJ i C C U K E E Y. 439 Tiit/are i .ost frequently yrie^^ at common hotels and boarding-houses, but (hat is, of course, the worst manner of cooking them. The radish possesses a very little nutriment, but its acrid property is objectionable, and as there are so many better things to eat, it is hardly worth re- taining. In selecting the watery roots, great pains should be taken to get those which are tender, brittle, and juicy. All the tough, dry, fibrous articles should be rejected. i. Green Vegetables. — Many of the articles known as " greens," or "spinach," are slightly nutritive and perfectly wholesome, and, like the watery roots, tiiey help to make a variety, and also offset the too highly nutritive property of farinaceous food, and the too stimulating property of animal food. Aspai'agus is one of the blandest, and most delicious and n^atritive of the class. It is good enough for any one to eat with no preparation but simple boiling. The weakest and most dyspeptic stomachs can almost always use it with comfort and satisfac- tion. Water-cress, celery, onions, and lettxice are generally eaten as salads. The first three are too acrid, and the latter is too narcotic. Boiled onions are not objectionable, except from their rank and, to many, disagTeeable odor. Boiled mustard loaves, potato tops, cabbages, cowslips, spinach, young beet plants, and a variety of other leaves, leaf- stalks, buds, shoots, flowers, are perfectly healthful to healthy stomachs. When cooked in butter, or boiled with salted meat, or mixed with vin- egar, tliey are objectionable only on account of their accompaniments. Lemon juice makes as pleasant seasoning as vinegar, and this or some other organic acid is all the condiment that can be admitted with a consistent regard to physiological truth. Whenever greens or vegetables are employed, they should be per- fectly fresh, not dry, wilted, nor long kept. J. Fruits. — As a general rule all sweet and sub-acid fruits, when full-grown imd perfectly ripe, are most wholesome, if eaten without any preparation or seasoning. If, however, they are too sour, a little sugar may be added, and the very acid fruits, as well as those not per- fectly ripe, are improved by stewing and sweetening. I have never found good grapes to disagree or produce even temporary inconveni- ence in the most delicate stomachs. I regard them as always prefer- able without cooking. Apples, pears, and peaches always agree with all healthy stomachs, and the worst dyspeptics may soon acquire the habit of eating them, not only with apparent impunity but with absolute ad- vantage, by partaking of a very little at first, and gradually increasing 440 DIETETICS. the quantity. Baked apples stand at the head of the class of cooked fruits. Apples, peai-s, and peaches may be made into an elegant dish by paring, boiling, sweetening with molasses, and serving them whole. This is an excellent method of preparing peaches which are not perfectly ripe, and but few sold in our city markets are so. Pared, and cut into slices, and sprinkled with sugar, is another very common and veiy good prep- aration. It is a common prejudice that there is something unwhole- some or pernicious iu peaches winch the skin tends to counteract or correct, hence both ought to be eaten together. The fact I believe to be, that both skin and pulp are perfectly harmless. Tomatoes, when fully ripe, are among our best fruits, and are relished by many persons without cooking. An excellent dish is made by scalding them a few minutes, to loosen their skins, peeling, and then stewing them sk)wly for an hour, or even two (as they are improved by cooking a long time), and then adding pieces of toasted bread. Water-melons and musk-melons are liable to })roduce colic and flat- ulence in very weak stomachs, but are unobjectionable as a pait of the dietary system of those whose digestive powers are not greatly impaired. The variety of musk-melon called nutmeg is the richest. It is the general fault of dried fruits that the poorer qualities ai'e se- lected for drying. Those w^ho purchase them in reference to their dietetic character, should select such as are of good, rich flavor, and not very acid. Dried raspben-ies, strawberries, whortleberries, and black- berries, stewed and sweetened, make a good addition to dried apples and peaches. Most of the dried plums which ai*e sold in our markets are too sour for pleasure or profit. Dried cherries are a troublesome article to handle on account of the stones, but they are among the most wholesome articles. French prunes, stewed and moderately sweet- ened, are excellent. The boiled fig is a good and very nutritious fruit. Pumpkins and squashes can be readily dried for winter use, by being cut into thin slices, and exposed to the sun, or placed in a heated oven. Peach leather and tomato leather, are prepared by squeezing out the pulp of the fruits when very ripe, and spreading them half an inch lliick on plates or shingles, to dry until quite hard. Ripe tomatoes are sometimes cut into slices without peeling, and dried in an oven. Tomato figs are made by scalding and peeling the fruit, then boiling it in one third its weight of sugar. The figs are then flattened, and dried in the sun, occasionally turning them and sprinkling with sugar. Currants and gooseberries are too acil for the majority of invalid stomachs. They raaj' be preserve.' in the gi*een state, but are no* worth the ti nble. DIETARIES. 441 k. Nuts. — These, with the exception of the boiled chestnut, perhaps, are not proper food for invalids, although, as previously remarked, they lU'e adapted to the digestive organs of man, and other frugivorous ani- mals, in a state of nature. The butternut and walnut ai'e too oily, an objection which no cookeiy I am acquainted v/ith can obviate. The peanut and beechnut are less oily, but so long as the world is full of better things invalids would do well to use them. /. Condiments. — In relation to condiments or seasonings, I have named milk, sweet cream, sugar in some form, salt, and the vegetable acids, as the only admissible ones. With the exception of salt, they are 'all more or less nutritive, and are really different forms of food. Although the most perfect nutrition can be secured without the aid of any of them, yet their moderate employment is not especially injurious, but, in reference to the imperfect character of many of our fruits and vegetables, sometimes an actual advantage ; and it is a great step in advance if v/e can induce the highly cultivated and grossly pampered appetites of civilized society to submit to the simplicity here enjoined. The great misfortune of the vast majority of people, and of invalids especially, is that they have stimulated away, or so pal- sied the organic instincts that they can not appreciate the intt^nsic properties of food. Every thing is flat, insipid, and unsatisfactory, save perhaps the best kinds of fruit, unless strongly charged with some exti'aneous seasoning. If we can induce them to abandon all cooked oils, greasy gravies, strong spices, and the whole list of enervating bev- erages, we can cure them of their diseases, and when they are restored to such a degi'ee of health and vigor as their remaining constitutional vitality admits of, they may take as many progressive steps as they please in simplifying and improving their whole plan of diet. There is room in this direction for the exercise of the best talent and noblest energies of the human mind. CHAPTER III. DIETARIES. General Rules for Invalids. — Although all kinds of natural food •i^ree equally well \^ith all persons in a pure state of nature, excepting .') fiii- as the mera influence it habit is conoerned. we have now X.9 442 DIETETICS. deal almost wholly with men in an artificial state. In a gi'eat variety of alimentary materials, therefore, all of which are intrinsically whole- some, there is an opportunity for the exercise of consideraMe skill in adapt- ing them to invalids, and so managing them as to restore the deeply- injured digestive powers and broken-down constitutions to comparative health and strength. The following mles, which are but a summaiy of the principles indicated in various parts of this work, may serve as a kind of chart to those who are not thoroughly familiar with all the therapeutic adaptations of diet. 1. The general errors in diet are too gi'eat concentralion, improper combination, excessive quantity, and imperfect quality of the aliment- ary materials. Each of these errors is equally important to guard against. 2. The diet may be equally simple and wholesome whether the number of articles employed be three or tlu'ee hundred, provided but few aiticles are eaten at a single meal. 3. Of whatever materials the diet consists, the due relations of nutri- ment and bulk must be maintained. Thus those whose food is princi- pally preparations of the cereal grains, require the largest proportion of juicy fruits and watery vegetables; those who eat principally animal food and potatoes, require a less proportion of the less nutritious foods ; and those who eat potatoes and other less nutritive roots freely, with little bread or meat, require the least of the watery vegetables and fruits, etc. 4. Chronic diseases of the digestive organs are always attended with constipation, diarrhea, or irregularity of action ; in ninety-nine cases in a hundred constipation is the primaiy morbid condition. All these morbid conditions require essentially the same plan of diet, but there ai-e two diseased states not uncommonly met with, where a pecu- liar modification of the general plan is desirable, if not necessary. One is an inflamed, abraded, or ulcerated condition of the mucous membrane of the duodenum, consequent on the acrid, coiToding bile which is emptied into that intestine from a diseased liver; and the other is the same condition of the rectum, or lower bowel, consequent on the existence of hemorrhoids or piles. In these cases unbolted farinaceous food, brown bread, crackovi wheat, etc., often irritates and increases the pain and mucous discharges, and as local quiet is import- ant for the healing process, a diet of mealy potatoes, baked apples, or raw gi-apes, with a very little fiirinaceous food, which may be farina, arrow-root, tapioca, or even wheat-meal, will aflford the patient more quiet and fiicilitate the cure. 5. Invalids whose diso '.ses have beer, specially produced by particu- DIETARIES. 448 lar articles of food, or a particular plan of diet, will almost invariably be inordinately attached to those articles of food, or that plan of living. Thus gout is often produced by concentrated farinaceous food, and it is very rare to find a gouty subject who has not a sti'ong repugnance to all other kinds of farinaceous food. Those patients, too, whose dis- eases are attended with an inflammatory diathesis produced by the ex- cessive use of flesh-meat, will almost always manifest a particular horror toward just what they need — strict vegetable diet. No person is more wedded to or more passionately fond of sti'ong green tea and fine tea biscuits, than the female whose stomach is contracted to half its natural size, and whose whole nervous system is completely shat- tered by their use ; and no spoiled child is more crazy after candies and sweet cakes than one rendered feeble, dull, gaunt, and cachectic by them. These facts should be understood by both pati^^nt and phy- sician ; by the latter that he may prescribe successfully and mteiligently, and by the patient, that through th« tribulation of denying a morbid appetite, he may work out a salvation from its consequences. 6. Invalids who have lost health under the ordinary way of living, should select a moderate variety of the very best articles of farinaceous food, and the mildest fruits and vegetables, and persevere in their use until health is re-established, gradually proceeding to the use of the coarser articles, or those fruits and vegetables which are called crude and flatulent. By managing carefully in this way, very bad dyspeptics will in due time be able to partake of nearly all healthful articles with- out discomfort. 7. No rule can be given for weighing or measuring the quantity of food for invalids, as it vai'ies with age, exercise, temperament, and pathological condition; a correct piactice is to eat sufficient to satisfj all demands of actual hunger, but not to the extent of producing a sense of oppression in the brain and muscular system. If the appetite be not excessively morbid, the intelligent observer will soon find, in the sense of hunger in the stomach on the one hand, and the feeling of weariness, fullness, oppression, and dullness in both body and mind on the other, where the golden mean of practice lies. But in extremely morbid states of the digestive organs, attended with a craving sensation, instead of natural appetite, the best practice is to appoition out such quantity as the judgment approves in view of all the circumstances of the patient, and adhere to it until a good degree of natural appetite is restored. 8. Above all things let the patient not become a monomaniac on the Bubject of diet. It is infinitely less injurious to eat too much, or too little, or something not strictly physiological, than to be always worrying 444 DIETETICS. for fear some error has been or will be committed. The mind must not be continually directed to the stomach, and on the watch for some new or old feelii>g or symptoms, to be modified, mitigated, or aggra- vated after every meal. The judgment should be convinced that the general plan is right, and that Nature has reserved to herself the ability to coirect slight deviations. Therapeutic Divisioys of Diet. — The "old school" works on diet and regimen give us eight technical divisions of diet, for medicinal l>urposes. As truth can always be seen to better advantage when con- trasted with its opposite, it may be useful to mention briefly the systen? we pronounce erroneous. 1. FulL Common, or Meat Diet. — This consists of plain animal aad vegetable foods, according to the patient's appetite ; and generally in indolent diseases, as scrofula, chorea, epilepsy, etc., and during the convalescent stage after fevers, beer, wine, or ai'dents spirit is recom- mended with it. 2. Animal Diet. — An exclusive diet of animal food is recommended only in the disease called diabetis. Pereira tells us that when patients are limited to animal food, a considerable variety is necessary to prevent him from loathing one kind frequently repeated, and for this variety Dr. Pereira names: ^^ Butcher^ s meat, bacon, poultry, game, fish, shell fish, cheese, eggs, sausages, and brawn ; and for common drink, to go with it, water, beef-tea, or mutton-broth.'''' This is sufficiently strong, in all conscience, for any sick person, but we have not a particle of evidence in medical books tliat a single diabetic patient ever got well upon it. 3. Vegetable Diet. — Although a vegetable diet is named among the varieties appropriate in certain cases of disease, an exclusively vegetable diet does not appear to be recognized as orthodox in the allopathic materia medica. Pereira disposes of it in the fo]lo^ving summary and contemptuous manner: "The exclusive employment of vegetable food, in conjunction with the use of distilled water, has been recommendec by Dr. Lambc, as a remedy for cancer, scrofula, consumption, asthma, and other chronic dise,^ses ; but he has, I suspect, gained few, if any proselytes to his opinions and practice." 4. Spare, or Abstemious Diet. — This means, in allopathic parlance a mixed animal and vegetable diet, with the use of fish instead of butcher's meat, becau&e the former »s supposed to be less stimulating DIETARIES. 446 and less nuti'itious than the latter. It is principally recommended in the gouty and apoplectic diatheses, plethora, etc. 5. Fever Diet. — This is also called spoon, slop, or thin diet. It con- sists of teas, toast-water, bai'ley- water, and acidulous drinks, ad libitum, with light saccharine and amylaceous preparations. 6. Loiv Diet. — This does not differ much in object from the former, although a different set of preparations are named as constituting it, as gi'uel, broth, milk, bread or biscuit, and light farinaceous puddings. It is prescribed in cases of accident, injuries, surgical operations, and acute inflammations, with the object in view of depleting the system, or effecting a change in the blood similar to that produced by bleeding. 7. Milk Diet. — This includes the free use of cowl's milk, and a moderate eraployn' ^nt of light farinaceous substances, as brecid, arrow- root, tapioca, sago, and even rice, batter or bread puddings. It is ad- vised mostly in consumption, and other pulmonary diseases, and after severe bleedings or hemorrhages, and sometimes for the strumous habit of children. 8. Dry Diet. — The object of a dry diet is to lessen the volume of blood, in cases of aneurism, valvular disease of the heart; it has also been recommended in diuresis and diabetis. It consists of the ordinary articles of a mixed diet, excluding fruits and watery vegetables, and taken with little or no drink. As being more philosophical, as well as hygienic, I propose the fol- lowing technical divisions of hydropathic diet, some one of which will meet the necessities of all classes of invalids, as well as all classes of well folks : 1. Full Mixed Diet. — Bread, mush, butter, cream, milk, potatoes, with some kind of fruit, for breakfast and supper ; for dinner, bread, vegetables, fruits, plain pudding or pastry, with flesh, fish, fowl, or eggs. This is calculated for persons in health, and for that class of in- valids v/ho have no special or disproportionate disease or derangement of the digestive organs. 2. Full Vegetable Diet. — Precisely the same as the preceding, omitting the flesh, fish, fowl, and eggs. Milk, cream, and butter are not included in the term animal food, whenever the term occurs with- out being defined in this work. This diet is to be preferred in all dis- eases attended with the inflammatory diathesis or gi-eat irritability of UG DIETETICS the nervous system ; in gout and rheumatism, in incipient pulmonary diseases, in scrofula, scurvy, neuralgia, in most of the cachexies, and in ueai-ly all of the ordinary female complaints. 5. Strict Diet. — Bread, mush, milk, sweet cream, potatoes, and good grapes or apples, or the equivalent to this set of articles for each meai. the quantity to be as exactly proportioned as possible to the nutritive demands of the bodily structures. This is adapted to nearly all chronic diseases attended with neither corpulency nor emaciation, but with a decided yet not extreme dyspeptic condition of the digestive organs. It is admirably calculated for that common and prevalent condition of body known as "liver complaint," and foravariety of nervous, rheumatic, and neuralgic affections which have been preceded by, and are con- nected with, a long-standing derangement of the biliary secretion; it is peculi.arly appropriate, too, in almost all forms oi skin diseases. In chronic catarrhal affections, and severe cases of bronchitis, laryngitis, and ulcerations of the throat, it is indispensable. 4. Abstemious Diet. — This is the same as a sti'ict diet, with the exception that the quantity of food should be rather below the point of complete nutrition. It is one of the hydropathic methods of depletion, and is the very "hunger-cure" itself. The especial object of abste- mious diet is to favor absorption and depuration. It is heflce adapted to glandular enlai'gements, and protracted cases of chill fever, fever and ague, and what is called "dumb ague," all of which are usually attended with enlarged livers and spleens. In malignant tumors, phagedenic and deep-seated ulcers, and foul skin diseases, it ought to be rigidly enforced, as long as the general strength will permit, or as long as the patient can keep about, unless the disease sooner yields. It is also often indispensable in some cases of mucous dyspepsia, attended with great intolerance of food and extreme tenderness in the epigastric re- gion. In blind, or bleeding piles, when they are inflamed and irritable, and the bowels disposed to griping and diarrhea, it is highly advanta- geous ; and in nearly all forms of female complaints, attended with great local relaxation, prolapsus, or other dispkicement, it is absolutely necessary to a perfect cure. 5. Dry Diet. — The object here is lo promote healthy and correct morbid secretions. When the saliva is imperfect, the gastric juice deficient or depraved, the bile acrid and irritating, the gums tender and spong5% etc., very solid food, which secures thorough mastication, distends the stomach gradually, and thus pvjjnotes the most perfect DIETARIES. i47 digestion, is an almost indispensable means of cure. It is seldom that it requires to be continued long, although no harm could result from con- tinuing it a lifetime, because it is, or should be, composed of a set of articles capable of sustaining perfect and prolonged nuti'ition. Crusts of bread, roast potatoes, Graham crackers, and uncooked apples, make a good arrangement of dry diet. Man}'' other selections can be made equally as good. Dyspeptics, \^ ho are h'oubled with excessive flatulency, acrid eructations, water-brash, sick headacne, etc., are benefited by this diet. 6. Watery Diet. — The object of this kind of diet is to satisfy the appetite and stomach, as far as may be, while the necessary amount of nutrient material is supplied, and at the same time wash out and deterge fi'om the body, drugs, minerals, alkaline or saline accumulations, and other impurities. It is in some cases a substitute for, and in many an improvement upon the practice of copious water-drinking. Due pro- portions of milk, grapes, parsneps, and potatoes, are an example of a watery diet. It is adapted to gravel, calculous concretions, biliary ob- structions attended with gall-stones, those forms of gout and rheumatism in which chalky deposits are formed in and around the joints, the dis- ease caWed fragilitas ossium, or brittleness of the bony structure, from excess of earthy particles and deficiency of animal matter. It is also advantageous in plethora and obesity, and may be resorted to in other cases wherein free water-drinking is advisable, but when pure soft water can not be procured. 7. Fever Diet. — This term is almost a misnomer. Strictly speaking fever and food are antagonistic ideas. No simple fever, if well man- aged, requires dieting in any way, save the negative one of starvation, until its violence is abated, and then the diet would more properly be called convalescent. It is, however, often desirable to satisfy the stom- ach or act upon the bowels, for which purpose the Indian or wheat- meal gi'uel may be administered. Toast-water, barley-water, lemon- ade, etc., are no better than pure water, as fever beverages ; yet they are harmless, and very often gi'atifying to the patient or friends. Diet for Public Institutions. — A glance at the established dietary systems of a variety of public institutions will enable the reader to see more clearly, by the contrast, the merits or demerits of the proposed innovations. For this purpose I have made such selections as will present a fair exhibit! n oi the leading ideas of the civilized world on this subject. ^8 diete: ics. Diet of the London Hospital Per day Breakfast Dinner Supper Common Diet. 12 oz. bread. "j I pint porter, men. I A pint do., women. Gruel. 8 oz. beef, with pota- toes, thrice a week. [^ 8 oz. mutton, with po- tatoes, twice a week. 8 oz. potatoes, and soup, with vegeta- bles, twice a week. 1 pint broth. Middle Diet. The same, ex- cept that 4 oz. of meat are given instead of 8 oz. L-w Wet. 8 oz. bread. Gruel. Broth. Gruei or broth. Milk Diet. 12 oz. bread. Gruel. 1 pint milk. ] 1 pint milk. Diet at St. Bartliolomeiv' s Hospital. Common Diet, > Broth Diet. 1 Fever Diet. Milk Diet. r Milk porridge. Milk porridge. Milk porridge. 12 oz. bread. 12 oz. bread. 12 oz. bread. 6 oz. mutton or 1 pint milk, with 2 pints milk, with beef. Milk porridge. tapioca, arrow- tapioca, arrow 1 pint broth, with 12 oz. bread. root, sago, rice. root, sago, or Daily <* pt-as or potatoes, 2 pints broth. as may be pre- rice, as may be lour times a week. 1 pint beer. scribed. prescribed. 2 pints beer, men. 1 oz. butter. Barley-water. Barley-water. 1 pint do., women. 1 oz. butter. 1 oz. butter tv.-ice a Bread pudding three week. times a week when ordered. In addition to the heer, in the foregoing tables, which English phy- Bicians, as well as English legislators and people, seem to regard as "bread in another form," wine, spirit, porter, etc., are permitted as extras, whenever prescribed by the medical officers. Diet at Gw/s Hosjntal. Daily 14 oz. bread. 1^ oz. butter. 1 quart table beer. 8 oz. meat, when dress'd. Middle Diet. 12 oz. bread, li oz. butter. 1 pint table beer. 4 oz. meat, when dress'd, and A a pint broth" 12 oz. bread. 1 oz. butter. Tea and sugar. Milk Diet. 12 OZ. bread. 1 oz. butter. 2 pints milk. Fever Diet. 6 oz. bread. 1 oz. butter. Tea and sugar. Half a pound of beef (for beef tea), or arrow- root or sago, when ordered. For each diet, gruel or barley-water, as required. The bread mentioned in all of these tables is undoubtedly common baker's bread ; nothing is said of its character in the reports. Under the head of dry diet, at St. Thomas's Hospital (England), we find : 14 oz. bread daily; 2 pints of beer! aa-i water gi-uel for breakfast; 4 oz. DIETARIES. 449 of butter four times a week, for dinners : and rice pudding and 4 oz. of butter for dinner the other three days of the week. No supper is allowed. Aiiiong the dietaries of Westminster Hospital (England), we find there is a special diet for the incurables, consisting of the daily rations of I lb. bread, h lb. meat, h ^^. potatoes, i pint milk, and one pint of porter ! At St. George's Hospital (England), under the head of Extra Diet, 2 pints of heer am allowed to each man, and 1 ^ pints to each woman ! Among the dietetic curiosities of Middlesex Hospital (England), is u Cancer Diet, consisting of 12 oz. bread, 5 lb. meat, ^ lb. potatoes, and 1 pint milk daily. Diet at London Lying-in Hosp-^. ial. Breakfast. — Tea, and bread and butter, ad libitum. Dinner. — Broth or gruel, until the third day, after which boiled mutton and broth Tea. — As breakl'ast. Supper. — Gruel, after the ninth day, then .bread and cheese and heer. Should the pati(;nt be delicate, she is allowed wine, tish, light puddings, or any thing she may fancy. Diet ai Bethlehem Insane Hospital. Breakfast . . . Gruel. Dinner Every day Table beer. Sunday n Tuesday \8 oz. cooked meat, 8 oz. bread, vegetables. Friday ) Monday 5 •'^^^^^'^ batter pudding, 4 oz. bread, 1 oz. cheese, or i oz. < butter. f Pea soup, with legs and shins of beef, 8 oz. bread. In thf Wednesday ... V summer months, baked rice pudding, 4 oz. bread, 1 oz ' cheese, or ^ oz. butter. Thursday 5 ^°^^^^ ^''^^^ puddings, 4 oz. bread, 1 oz. cheese, or ^ os. I batter. Saturday Rice milk, 8 oz. bread, 2 oz. cheese, or 1 oz. butter. Supper 8 oz. bread, 2 oz. cheese, or 1 oz. butter ; table beer. f Mutton broth, beef-tea, puddings, fish, meat, eggs, wine, Extras For the Sick .. .^ strong beer, etc., or whatever may be ordered by tha '- medical ofticer. . 8 oz. roast beef, 8 oz. bread. (Mem. If it fall on a meat day, Christmas Day. ) the patients have a meat dinner on the following day.) ( A mince pie, 6d. New Yearns Day. . Plum puddings, in addition to the ordinary dinner. Good Friday .... A bun. Id. Easter Monday . .8 oz. roast veal, 8 oz. bread, vegetables. Whit Monday ... 8 oz. roast veal, 8 oz. bread, vegetables. During the summer, about the month of August, 6 oz. bread, bacon, beans, 8 oz. bread, 1 oz. butter. Fruit, consisting of currants and gooseberries. I" the ixoflth of October, apple pies in addition to the ordinary dinner. Tne ordinal diet at the Edinburgh Hospital (Scotland), is, for 450 DIETETICS. hreakfast and supper — 1 mutchin of porridge, 3 gills of milk or beer. or 5\ oz. of fine bread, iiilk or beer! For dinner, on Sundays and Thursdays — 1 choppin of broth, 8 oz- of butcher's meat boiled in the broth, or beef-steak, and 5i oz. of bread. On Monday, Thursday, and Saturday, a choppin of broth made of beef and bones, barley, gi'oats, potatoes, and vegetables, and 5h oz. of bread. On Tuesdays and Fridays, potato soup, with beef and veal, or bones, and 5* oz. of bread. At the Royal Hospital, Phoenix Park (Ireland), the breakfast and 5?/j;>/?er are, ordinarily— 1 pint of oatmeal or rice gruel ; dinner — J lb. of meat, 12 oz. of bread, and 1 lb. of potatoes. A full diet consists of I lb. of meat, 1 lb. of bread, h lb. of potatoes, and 1 quart of beer.' The dietaries for the prisons in England and Wales differ principally from those of the hospitals in being more plain and simple. The pris- oners who are obliged to work are actually fed more healthfidly than in the hospitals, where the physicians are endeavoring to cure. In the prisons the beer is omitted ; there is a less proportion of animal food, and the suet puddings, mince pies, old cheese, etc., are, fortu- nately for the inmates, left out. In the English dietary system for paupers, the beer is also omitted, except when ordered by the physician. The following table is a fair specimen of the pauper diet of that nation : Dietary for Abie-Bodied Paupers. Breakfast Dinner. Supper. Bread. GrueL c ^ » — O Soup Bread. •3 « .J -3 1. .-i 33 oil Bread. Clieeae; Sunday ) ,, Frkl.y^ S"°'^''' Monday }Afen Thursday > IVomen Wednesday \ ^Jj'"' •' } Women .... ^ . 1 C Men .... ... oz. 8 6 8 6 8 6 8 6 pints. H ^ OZ 6 5 pints. 2 ^ oz. 6 5 oz. 12 10 oz. 12 10 oz. 6 5 6 5 6 5 6 5 OS. 2 2 1> i^^^rA^y\womea. :::::. In the above table, vegetables are not included in the weight speci- fied. Old peoi)le of sixty and upward are sometimes allowed 1 oz. of tea, 5 oz. of butter, and 7 oz. of sugar per week, in lieu of the gi-uel, fur breakfast. Chik'rcn above nine are allowed the same quantities as ivomen. The iietary system of the public institutions of the United States DIETARIES. 461 does not differ very materially from those adopted by the similar insti- tutions of Great Britain. Generally tea and coffee take the place of beer and porter, and a gi'eater proportion and variety of animal food and condiments are allowed. At the New York Hospital the dietary is : For dinner, on Tuesdays^ Wednesdays, Thursdays, and Saturdays — Beef soup, with beef and potatoes, and bread. On the alternate days — Mutton soup, with mut- ton and bread. On Mondays — Boiled rice, with one gill of molasses, is served ordinarily. For breakfast and snj^per — Black tea and bread ; 1 oz. of tea to every six, and a pint of milk to every eight patients. Special diet, as eggs, oysters, chickens, crackers, porter, wine, coffee, etc., is directed by the attending physician. Diet of the New York City Prison. Dinner Monday Mush and molasses. Tuesday Beef, with soup and bread. Wednesday ....Mush and molasses. Thursday Fresh boiled beef, with soup and bread Friday Mush and molasses. Saturday Fresh beef, with soup and bread. Sunday Mush and molasses, Breakfast . . . Coflee, with molasses boiled in it, and bread. The following dietary table of the New York Protestant Half-Orphan 4sylum, furnishes a fair specimen of the diet provided for children in i)ur public institutions : Dinner Monday Bean soup, with bread. Tuesday Mutton soup, with vegetables (potatoes, turnips, carrots), and bread. Wednesday .... Mutton, hashed with potatoes and rice ; clam soup, with rice, during the summer months, with potatoes and rice, or balls of flour boiled. Thursday Beef soup, with vegetables and bread. Friday Beef, hashed with potatoes and rice, and bread. Saturday Cold corned beef and bread; except during the summer months, when crackers and cheese are substituted for salt meat, which was found to produce bowel complaint breakfast . . .Bread and milk for the smaller children ; bread, with molasses, or sugar, or honey, for the larger ones. Supper Plain bread, except on Sunday evening, when gingerbread is allowed. At the Pennsylvania Hospital (Philadelphia), for breakfast— Tea, coffee, or chocolate, with sugar or molasses, and milk, and common baker's bread, are allowed at discretion. For dinner — Soup always ; meat of two kinuo s.^... .-f - >nf^rq1Kr. pork frequently; vege- tables . according to the season, poLctLO,^.b ...xways. For supper — Tea 4nd bread ; no butter allowed, unless prescribed. 452 DIETETICS. The dietary of the Blockley Ahus-house (Philadelphia) is verj'' similar to that of the New York City Prison. The dietary tables of the Baltimore, Providence, and Albany Alms- houses do not differ greatly from that of the Bellevue Alms-house in this city. The following is the general diet of the paupers at the Baltimore Alms-house, which may serve as a sample of the w^hole : Breakfast . . . Bread, and rye coffee sweetened with molasspa Supper Bread, and tea sweetened with sugar Dinner Monday Beef and soup. Tuesday Mush and molasses. Wednesday . . . i Thursday ....j^^^^^'^^o^P- Friday Herring, mush and mulasses, or hominy. Saturday Beef and soup. Sunday Pork and vegetables. The amount of animal food allowed each pauper is 8 oz. of beef, or .5 oz. of povk ■ each laborer is allowed 20 oz. of bread per day ; and aU others over one year old, 16 oz. of bread daily. At the Manhattanville Lunatic Asylum the diet approaches more nearly to that of an ordinary hotel or boarding-house. All the mate- rials are said to be of first quality, and all the articles are allowed ad libitum. The following is the table : Breafe/osf ... Meat, hashed with potatoes, or cold, with bread and butter, coffee, milk, and sugar. Dinner Monday ^Roast meat, beef, mutton, or lamb, with vegetables, rice, Tuesday 5 flour, bread, or fruit puddings. Wednesday , . . j '^aturdav \ ^°^P» "^^^ "ce or Indian mush ; pastry on Wednesday. Thursday Corned beef, ^vith potatoes, and other vegetables, and puddings. iTiday Boiled fish (either fresh or salted cod, fresh halibut, shad, mackerel, etc., in their season). Sunday Cold meat, warm vegetables, pastry, and cheese. Supper Bread and butter, tea or milk ; molasses gingerbread on Wednesday ; sugar cakes and cheese on Sunday evening. The intelligent physiologist cannot fail to notice several grave and important errors in the existing dietaries of all our public institutions. In some of them tea or coffee is allowed on some days, and refused on others. It would be an improvement either to refuse it wholly, or allow it daily ; for all articles which strong'ly stimulate the blood-vessels, or excite the nervous system, if administered one day, and withheld the next., l.eep the whole organism in a constant '.-i-ate of perturbation ; one day partially exhi!«'" •*"<^'' : - ' ' ..<..<-. .^uoirally depressed. Another error is in allowiog iuu sunu aiet, as meat and bread, one day, and the next reshi**mting the diet tc slop food, as soup ani mush, or DI3TARii:S. 453 mush and molasses, or both. The solid and nuti-itive !naterials, in whatever forms presented, should be nearly equal on each day. An- other sad defect is the meager supply of fruits and vegetables. In most instances they seem to be regarded as mere indulgences, whereas they ought to be considered and provided as a substantial part of the food itself. Again, when cakes, pastiy, and puddings are allowed, they are among the most unhealthfui and indigestible preparations. Such an unphysiological, irregular, and disorderly plan of feeding the inmates of prisons, asylums, or pauper-houses, must be exceedingly detrimental as regards the character, health, and well-being of the individuals sub- jected to their punishments or charities, and as regards the discipline, order and economy in which the public are more especially inter- ested. Every dictate of true humanity demands, and every consideration of enlightened public policy requires, that all persons, be they wicked, poor, or homeless, be furnished with such food as will be alike con- ducive to healthy bodies and sound minds. Society has a right to study economy, but not to the extent of depriving a fellow-creature, under the name of authority or alms-giving, of the materials of a pure and perfect nutrition ; but the expense of a perfectly wholesome dietary system would not exceed those in general use. There are so many goo9 things to eat in the world, and so many ways of preparing them, as taste, convenience, fancy, or economy may dictate, that our difficulty consists not in finding sufficient materials, but in raaking^judicious selections. The following tables are presented, not as being any better than a hundred others which could be constructed, but as landmarks to guide those who are not familiar with all the details of a dietary system founded on physiological principles. General Dieii^-ry for a Water- Cure in Winter Standing Articles for the Table. - Brown bread, white bread, cold cracked-wheat, hard biscuits or Graham crackers, water, milk» sugar, molasses or syrup, salt. Monday. . Breakfast . Cracked- wheat mush, baked 2JOtatoes, green apples stewed. Dinner Beef-steak, boiled potatoes, pea-soup, apples. Dessert — Rice pudding. Supper. . . .Indian cake, stewed prunes. Tuesday Breakfast . Rye and Indian gi-iddle-cakes, baked potatoe», dried apples stewed. 464 DIETETICS. Tuesday Dinner Wednesday. Thursday Friday , Saturday Sunday Supper . Breakfast Dinner . . Supper. . . .Breakfast Dinner . . Supper .Breakfast Dinner . . Supper. . , .Breakfast Dinner . . Supper. . . .Breakfast Dinner . . Supper. .Mutton chops, mashed potatoes, boiled pars- neps, baked tart apples. Dessert — I'ump- kin pie. .Indian mush, dried peaches stewed. . Rice gruel, cold potatoes browned, green apples stewed. .Corned beef, potatoes, cabbage, apples. Des sert — Ind:s.n pudding. .Milk toast, boiled apples sweetened. .Wheat-meal griddle-cakes, baked potatoes, green apple sauce. .Boiled mutton, potatoes, white beans, stewed cranberries. Dessert — Apple pie. .Dry toast, dried whortleberries stewed. .Water biscuits, boiled potatoes, dried peaches stewed. .Boiled halibut, sweet potatoes, beets, baked apples. Dessert — Custai'd. . .Stewed figs, hominy. .Rye-meal mush, cold sweet potatoes brown- ed, green apple sauce. .Roast beef, potatoes, turnips, dried currants stewed. Dessert — Tapioca pudding. .Wheat-meal sweet cake, baked apples. .Buckwheat griddle- cakes, dried apples and raspberries. .Roast beef, potatoes, Lima beans, baked tart apples. Dessert — Bread pudding, dried squash pie. .Oatmeal mush, dried apples and prunes stewed. General Dietary for a Water- Cure in Summer. Standing Articles — As in the preceding table. Monday Breakfast .Indian cake, young cunauts stewed. Dinner Roast lamb potatoes, asparagus, grapes Dessert— Tapioca pudding. Supper .Oatmeal mush, strawberries, Tuesday . Breakfast .Rye-meal mush, red cherries. Dinner Beef-steak, potatoes, green peas, stewed to matot.'^. Dessert — Strawberry pies. Supper, , . -pry toast, whortleben-ies. DIETARIES. 455 Wednesday.. -Brea^^asi . Cracked-wheat mush, red raspberries. Dinner Mutton chops, potatoes, beets, string beans. uncooked tomatoes. Dessert — Rice pud- amg. Supper Water biscuits, boiled peaches. Thursday Breakfast . Rice gruel, black raspberries. Dinner Corned beef, potatoes, spinach, gieen corra, tomatoes. Dessert — Raspberry pie. Supper Milk toast, boiled pears. Friday Breakfast . Rye-meal cakes, black cherries. Dinner. Boiled cod, potatoes, succotash, baked apples. Dessert — Custarc puddii.g. Supper Hominy, blackberries. Saturday .... Breakfast . Boiled rice, peaches. Dinner Beef hash, potatoes, squash, gi'een peas, to- matoes stewed. Dessert — Whortleberry pie. Supper Wheat-meal water biscuits, stewed black- berries. Sunday Breakfast . Oatmeal cakes, stewed gi'een apples. Dinner Boiled eggs or chicken, potatoes, succotash, musk-melons. Dessert — Blanc-mange. Supper Wheat-meal sweet cake, baked sweet apples. I need not say that in the above tables the dry and watery foods, and the proportions of nutriment and bulk, are so arranged that the dietary for either day of the week would do as well for two or three, or even all the days of the week. There are many cases of indigestion, attended with exti'eme derange- ment of the digestive powers, and also various chronic inflammations, complicated with great torpor of all the depurating organs, for which a more strict diet i indispensable. I propose, therefore, the following plan, which is substantially that which I have prescribed for several years. Particular Dietary for Dyspeptics. Breakfast Brown bread, apples, grapes, peaches, or pears, or other very ripe uncooked fruit, if sweet or subacid. Drink — Water, or a very little milk. Dinner Baked or boiled mealy potatoes, baked apples, or grapes, with brown bread; Dessert — Cold cracked-wheat mush, or oatmeal, oi plain boilec rice, with a little 46b DIETEriCS. sweetened milk, or brown sugar, for seasoning ; as* paragus, or green peas, in their season. Drink— A very little water. Supper Brown bread toasted, or Graham crackers, baked sweet apples. No drink, and the whole supper very light. Baked or boiled mealy potatoes may be substituted for the bread or crackers. Those who reject animal food, either from principle or interest, will find so much of the dietaiy for Water-Cure establishments, as conve- nience admits or occasion requires, suitable for them, omitting the flesh part. To show, however, the amplitude of our resources for eatables, without the shedding of blood, let us look at the subject in a tabular form : Dietary for a Vegetarian Hotel. Standing Articles. — Brown bread, white bread, rye and Indian bread, butter, pot cheese oi- fresh curd, sweoi. cream, milk, water, lemon juice, sugar, synip or molasses, or honey. Monday Breakfast . Wheat and Indian griddle-cakes, rice gruel, baked potatoes, stewed green apples. Dinner. . . .Mashed boiled potatoes, parsneps, squash, gi*een corn, apples, grapes. Desseit — Rice pudding, custard pie. Supper ... .Milk toast, cracked-wheat mush, potatoes, baked apples, stewed figs, blanc-mauge. Tuesday . . . Breakfast . Corn-meal cake, boiled potatoes, stewed peaches, stewed currants. Dinner. . . .Potatoes, white beans boiled, beets, tomatoes, musk-melons. Dessert — Tapioca pudding, pumpkin pie. Supper Dry toast, plain sweet cake, hominy, potatoes, whortleberries, stewed apples. Wednesday . .Breakfast . Rice griddle-cakes, wheaten grits, cold boiled potatoes browned. Dinner. Sweet potatoes, asparagus, cabbage, gi^een peas, tomatoes, green pears, baked apples. Dessert — Custard pudding, apple pie. Supper Cracker toast, Indian mush, potatoes, stewed prunes, stewed dried peaches. Thursday Breakfast . Graham flour hoe-cake, baked potatoes strawberries, apples. DIETARIES 467 Thursday Dinner Mashed potatoes, baked carrots, spinach, baked white beans, sweet oranges, baked apples, grapes. Dessert — Indian pudding, tomato pie. Supper Oatmeal mush, brown biscuits, potatoes, cus tard, boiled apples, peaches, or pears. Fnday. ^rea t/ii or mechanical nijary. 7 The only r^^-^^-bid effe ts of water result from improper tempeia- IHEORV AND PRACTICE. ture, and over-distension of the hollow viscera, or circulating xt^ueia from excess of quantity — eftecte never necessarily unavoidable. Modus Operandi of Water. — Contiary to the teachings of the standard medical books of allopathic, homeopathic, and eclectic sciico.s, we must ever bear in mind that disease is never a positu'e entiti/, but always a negative quality ; it is the aljsence of health, or of the ^tate, circumstances, and actions which coubtitute that oalance of funccional duty we cnll health. By refen-ing to the raisuse or abuse of son.e one or more of the li^'gienic agencies, we find the cause or causes oi those deviations from the normal state, which constitute the abnormal state, and which we call disease ; and now, by applying the above propositions to the causes which jn-oduce and the conditions which constitute dis ease, we will find the true grounds which indicate and demonstrate water to be a remedy of general, and even universal application. In a general sense, diseases are produced by bad air, improper light, impure food and drink, excessive or defective alimentation, indolence or over-exertion, unregulated passions, in three words — unphysiological voluntary habits. The conditions of the body in disease — the proximati causes against which all remedial effoi-ts are to be directed — are, in general terms, impure blood, unhealthy secretions, obstructions in the minute vascular structures, or capillary vessels, excessive action in some parts or organs, with deficient action in others, unequal temperature, etc., in other words, a loss of balance in the circulation and action of the various parts of the vital machinery, producing great discord in some portion of it, and more or less disorder in all. The general indications are, therefore, to remove obstructions, wash away impurities, supply healthful nutriment, regulate temperature, relax intensive and intensify torpid action, etc. ; and what like water, what but water, with its concom- itants, air, light, food, temperature, etc., can answer to these indications? To say that medicinal diaigs can answer these indications is sheer nonsense. They may respond to any other indications almost that can be named ; but these, never. They may change the issue, they may suppress a symptom, remove a pain, transfer an irritation, excite a new vital resistance, produce another obstruction, and so divide the or- ganic struggle between two points, ditninish vital powei", or increase vital expenditure ; hut none of these impressions or effects are really remedial, none of tliom meet the indications: and if physicians in gen- eral, and '^^inkind in particular, are not satisfied with the experiments of three thousand years, which, by the way, have destroyed ten times as many of the human family as thev have saved, let them by all means be satisfied, even if they liave to go on ii the same absurd. PHILOSOPHY OF WATER-CURE. blundering, and senseless, though veiy learned and scientific business, of drugging and killing, marring and scarring, for three thousand years longer. Water, according to the mode of application, can intensify or mod- erate any function; it can energize or abate any given action; it can be made to increase or diminish temperature, locally or generally, to any extent desired; hence, though not a universal cure — for diseases are not universally curable — it is a remedy universally applicable. But while water, judiciously managed, may be doing its appropriate work in alle- viating or curing disease, other causes may counteract, retard, or en- tirely prevent the consummation of any curative process. The patient may live badly in other respects ; something in his eating, or drinking, or sleeping, or exercising, or other voluntary habits, may be wrong, and constantly re-supply the causes of disease as fast or faster than the best remedial use of water can remove or overcome them; therefore, though water is put prominently foi'ward in the hydropathic systena ns in all cases the great panacea, it must ever be recollected that it is but one of several remedial agencies whose influence is equally to be regarded in preserving health or in curing diseases. To illustrate : Of fifty or a hundred invtilids at a hydropathic in- stitution, while all may employ water in the way of bathing in the best possible manner, one half of them will pretty certainly hold on to some unhealthful habit which retards or prevents the cure, or renders it imperfect. One- will nibble on candies or fruits between meals ; some in the cities will lunch on oysters or plum-pudding; some will eat flesh immoderately : others will persist in the use of butter or greasy meats sufficiently to keep them constantly bilious ; others will take salt enough to keep the whole body pickled, as it were, in an acrid brine; others will eat an undue proportion of fine flour, and keep the bowels all the while constipated ; others will endeavor to make up by the " stimulus of distension" foi- the lack of mustard, vinegar, and pepper ; others will drink tea or coffee, chew tobacco, or smoke cigara occasionally; and yet others will indulge in a dose or two of drugs now and then, stealthily, of course ; and so on to the end of the chapter of ♦' errors in Water-Cure. " It is true all these things are ruled out of the establishments, but they are, notwithstanding, very frequently practiced by many patients ; and what is particularly vexatious, ungrate- ful, and perverse, all the evil consequences of their bad habit are usually imputed to the Water-Cure ! It may be said that the physician ought to manage all these matters, and make all patients conform in all respects to a physiological regimen. This is not always possible, for with many invalids habit is much 6 THEORY AND PRACTICE. sti'onger than reason, and with some dyspeptics the craving of the morbid appetite for its disease-producing aliments, and conciinicnts. and narcotics, is not a whit more governable than is the drunl^ard'a appetite for those intoxicating poisons which have produced his insa- tiate craving. Both kinds of appetite are controlled, and finally over- come by a few; but sad experience tells the story that the majority are conquered and destroyed by them. In accounting for the therapeutic operation of particular processes of the water-treatment, we must never forget that Nature is the true physician. The restorative power is inherent in the living oi'ganism. All that the true healing art can do is to supply favorable conditions, remove extraneous materials, and regulate hygienic influences, and thus place the system as fully as possible under organic law. The humoral pathologists impute all diseases to a lentor, or morbific matter in the blood ; while the solidists and vitalists contend that the action of the solids — being too much increased or diminished — is the proximate cause of all diseases. The former bleed, leech, scarify, blister, sweat, puke, purge, stimulate, and antiphlogisticate ; and the latter bleed, leech, scarify, blister, sweat, puke, purge, stimulate, and antiplilogisticate too ! Here is diversity of cause producing identity of effect ; a postulate not dreamed of in natural philosophy. We may apply water to the ti'eatment of disease, on either theory, much more rationally than the allopath can his drugs and depletives. Whichever theory we adopt — and both are correct to a certain extent — we can alter, depurate, change, increase, restrain, or modify the fluids and actions WMth water and regimen, as well as with lancets and drugs, and with none of their necessary evils or ever-present dangers. We can even get minerals, chemicals, and other drug-medicines out of the body by means of water-treatment, whereas the ne plus ultra of drug medical science consists in getting the system full of them, and then abandoning it to its fate, and "the efforts of nature." It is no uncommon circumstance for patients to become severely salivated during ^vater-treatment. I have treated several cases wherein patients who had taken no mercury for several years, experienced all the symptoms of a "mercurial course," such as tender, fleecy gums, metallic taste, fetid breath, swelled tongue, and copious droolJing. Orher mineral poisons also produce great constitutional or local disturbance during the process by which they are expelled from the body. These drugs, as already intimated, all the other drugs in creation have no power to remove from tlie body. They may, like acids and alkalies, silence each other's specific action, or combine to produce a different action ; but they do not and cannot drive each other out of the systemt PHILOSOPHY OF WATER-CURE. The niiiriner in which \Aater purifies the body from mercury and other mineral poisons, alias medicines, aftbrds an explanation of itg mode of action in a great variety of morbid conditions. Referring to the laws of endosmose and exosinose, as explained in the physiological part of this work, we find that when animal membrares, living or dead, and whether connected to or separated from the body, have their opposite surfaces in contact with dissimilar iluids, an interchange takes place, which is continued until the constituents of both fluids become exactly similar, when all action between them ceases. Dr. E. Johnson (Domestic Hydropathy) has constructed the following dia- grams, which very well illustrate this subject: In fig. 162 a is a glass tube, the di- ameter of whose caliber is four tenths of an inch. Close one of its ends ac- curately with a piece of bladder, and fill, the tube with brine. Now take a much larger tube (6) — a common tum- bler will do — and fill it three quarters full with pure water. Then immerse the bladder-end of the small tube just under the surface of the water of the larger tube or tumbler, giving it an in- clination of about 45". In a short time a current of liquid will be seen rising from the bottom of the water in the tumbler, upward along its side, in the direction indicated by the arrows, through the bladder, and up along one side of the small tube to the surface of the brine ; then it descends along the ENDOSMOSE AND EXOSMOSE. Other side of the small tube, in the direction of the airows on that side, down through the brine, and through the bladder, down to the bottom of the water. The downward current is a current of brine descending into the water in the tumbler. The upward current is a current of pure water ascending into the tube to supply the place of ♦;he lost brine ; and this current will continue until the two fluids have become similar, that is, until the fluid in the basin has become as salt as that contained in the tube. "If now the tumbler be emptied, and refilled with pure water, the current will be re-established, and in this way the brine in the tube may be completely purified of its salt. " The currents will be seen with beautifu.. distinctness if some very THSORV AND PRACTICE. Fi?. 163. END0S■v50^;E A>'D EXOSMOSE. fine particles of indigo be suspended in both fluids — that in the tum- bler, and that in the t nbe " If the tube a, in fig. 163, which contains the brine, have a caliber whose diametei is four fifths of an inch, and if it be supported vertically, so that the bladder-end be immersed just below the surface of the water in the tumbler (6), two currents will be seen to ascend, in the direction of the arrows, through the bladder, one on either side of the tube, to near the surface of the brine. They now turn, and descend together in a double current through the middle of the brine in the tube, down through the bladder into the water, where they diverge, turn again, and again ascend. The double current descending through the middle of the tube is a cun*ent of brine coming down into the water in the tumbler. The two separate outer cuirents a jcending from near the bottom of the water in the tumbler, are twr) currents of water going up through the bladder into the tube, to supply the place of the brine which has descended into the water. '' Now when pure water is held in couitact with the external surface of the skin of the body, by means of the wet sheet, or any other means, |)rivisely the same conditions are established with regard to the fluids within the body, that is, on the inside of the skin, and the water which is in contact with its outer surface, as are established in fig. 163, between tlic fluid (brine) contained in the tube, that is, on the inside of the bladder, and the water in the tumbler, which is in contact with the bladder's outer surface. About eighty per cent, of the blood is v/ater, and it is this water which holds in solution whatever soluble substatices, whether poisonous or otherwise, happen to be present in the blood ; and it is this water, holding in solution fibrin, albumen, and the varioiis salts proper to the blood, which alone circulates in those myriad-'r of millions of millions of cajiillary vessels which are too small to admit the red paiticlos. When any poisonous matters are present in the blood, it is in this water of the blood that they are held in solu- tion, as Ou^ salt is held in solution in the water of the brine. " Xovy' when by means of the wet sheet, pure water is held in con- tact with the outer surface of the si in, and supposing that the water PHILOSOPHY OF WATER-CURE. r>f the blood, which is on the inside of it, is poise ned, say with bichloride of mercury, what happens is this : An interchange takes place between the fluid on the outside (pure water) and the fluid on tlie inside, viz., the water of the blood holding bichloride of mercury in solution. The mercury-and-water passes through the skin into the Wciter of the wet eheet, while the pure water of the wet sheet passes through the skin into the blood to supply the place of the mercury-and-water. As in figures 162 and 163, a double current is established ; a current of pure water into the body, and a current of mercury-and-water out of tho body ; and in this way, by frequently renewing the external contact of pure water with the skin, the blood is pm-ified of whatever poisonous or otherwise morbid matters it may happen to contain. "If a glass tube be partially filled with a saturated solution of salt (brine), one end of the tube having been first carefully tied over with bladder, and if the tube be suspended in the air, in a short time that side of the bladder which is exposed to the air becomes covered with salt. The brine passes through the bladder from the inner to the outer surfiice. When it reaches the outer surface the water evaporates, leaving the salt adhering to the bladder. " When a person has taken the nitrate of silver for a considerable length of time, it is well known that the skin becomes colored i)€rma- nently blue, from the lodgment of oxide of silver in the tissue of the skin, ^he nitrate being converted into a simple oxide. "It would seem that something similar happens here with regard to the salt of silver (nitrate of silver) and the skin, as happens with regard to the salt of the brine and the bladder, in the experiment just described above. The water of the blood, holding the nitrate of silver in solution, passes through the under layers of the skin until it reaches the rete mucosum, which lies immediately under the scar^-skin, not traveling along tho perspiratory spiracles, but permeating the tissues. Having L'eached this locality, the water of the blood evaporates, while the sil- ver, unable to penetrate the dry and horny cuticle, is left fixed in the rete mucosum." Similar experiments may be ti'ied, with similar results, with any of the soluble metaUic, mineral, or earthy salts, as of arsenic, iodine, sul- pliate of potassa, etc. I have known mercurial ulcers take place during water-treatment, on the lower exti-e-nities of patients whose bodies had, years previously, been thoroughly mercurialized, and which it was impossible to heal until after the body had become entirely cleansed t'l" the mineral by several months' treatment. \V.\TKR-TREArMENT AND DrU >rPF A.TMENT CONTRASTED. The 10 THEORY ANt PRACTICE above flifts mnply demonstrate tlie s jperioritj' as well as the more ra- tional philosophy of the water-treatment over the drug treatment on the humoral theory, ^ut the vitalists have much to say about "dynamic forces." With them ever^ thing goes hy 'impression, or siimuli. Dis- ease is jn'oduced by morbid impressions on the brain, or nervous system, which impressions are conveyed to the vfu-ious organs or parts of the body by nervous disti-ibution, or functional sympathy; and remedies operate by electric, magnetic, stimulant, alterant, or some other force- ful property which makes impressions on the nervous centers, and these impressions are thence radiated through the system, and counter- act, overcome, snbdue, or in some other most mysterious and utterly inexplicable manner, cure disease, or, perchance, by some unfortunate and unaccountable circumstance or aoMdent, render it worse. But there is something of matter-of-fact in this theory, as, indeed, there is in nearly all the vagaries which have ever possessed men's minds. We know that mental impressions do disturb or modify, arrest nr energize either and all of the functions of the body, and these im- pressions may be morbid or sanatory ; they may produce disease or remove it. But on this principle of physiological impressibility, is there not a better way of exciting counteracting morbid impressions than by drawing ofl the vital current, or poisoning the bod} through and through with pernicious drugs? Common sense replies in the affirm- ative, and all rational minds, unbiased by a miseducation, would respond, "there must be a better way." And here our "universal panacea," pure soft water, supplies the desideratum. On the theory of impressibility it is just what is desirable, and all that is requisite, if suitably aided by the other hygienic adjuvants. All the impressions made on the living body can only affect its functions as they j)roduce or an'est action or motion, which action or motion is muscular contrac tion. Cold water and ice are assuredly the most powerful constringing agents that can be applied to the living structures without destruction or injury; and hot water, or steam, is the most efficient relaxant that can be safely employed. For producing moderate conti'action or relaxa- tion, we have all degrees of temperaturt^ between the freezing and the boiling points. The remedial effects of water, thus far considered, are a complete substitute for all the depletory processes of the regular system, as bleeding, leeching, antimonializing and refrigerating, and all the classes of medicines called em.etics, cathartics, diaphoretics, diuretics, alteratives, tonics, and stimulants. But there are other classes which are called narcotics, nervines, and sedatives, to which opium, camphor, etlier. musk, castor hnnbane. rats'^nne, d jgsbane, wolfsbane, and divers PHILOSOPHY OF WATER-CURE. 11 o.'"her banes belong, which at first view seem more difficult to dispense with. There is something like a charm in the idea of sending down the the sick person's throat a dose which silences his pains and quiets his distress with magical celerity. But the charm is at once dispelled when we look to ultimate consequences. The very pain which the potent and ill-advised dose of the doctor has subdued is generally the warning voice of the organic instincts that something is wrong, or the effort of the organism to rid itself of an enemy. When the organic instincts proclaim to the v/hole domain of life, through the medium of the brain, that an enemy is present, that proclamation is felt, not heard, and its language is pain. It is one thing to silence the outcry of nature for help, but it is quite another thing to relieve her by dislodging the enemy. The first may often be done bj narcotics and stimulants; the second can be accomplished by the use of water. In fact, water will often succeed in promptly removing pain which the most powerful narcotics fail to mitigate. There may be inflammation, obstruction, engorgement, distension or contraction, the pain of which all the opium that can be taken short of deathful doses will not alleviate, and yet water of some temperature and in some form of application will relieve at once. There are also classes of medicines called acids, alkalies, anthelmin- tics, lithontrijytics, demulcents, etc. How, it may be asked, is water to substitute them? Simply by obviating the occasion for them. A patient has a sour stomach, and the doctor gives him soda ; another is afflicted with worms, and the doctor administers something to poison them to death ; another has gravelly concretions, and the doctor ad- vises chemical solvents; another has acrid bile which corrodes his throat, and the doctor prescribes lubricating mucilages, and so on to the end of life. But who cannot perceive that all this practice, as a part of the healing art, is absurd and ridiculous ? Who so stupidly blind as not to see that it is a mere patch-work, tinkering at effects without removing causes ? The water-treatment corrects the condition upon which the existence of these abnormal symptoms depend, v/hen of necessity they all disappear. In the works of the popular system we read much about " acceler- ating the change of matter." in order to renovate the tissues and rein- vigorate the functions. To do this it is recommended to bleed, purge, and mercurialize the patient down, and then, presto ! wine, tonics, and " senerous diet," to stimulate him up again as fast as possible, thus doing and undoing interchangeabh^ Bathing, with appropriate air and exercise, and plain simple food, will effect a change of matter incom parably more rapid, nnd without the destru-^tion of health ful r.-'interiuls 12 THEORY AND PRACTICE. or the iiijuiious '• dynamic force" of alcoholic poison. If there is sur- plus matter about or withm the body, water will wash it away, and if there is a deficiency of organic material, pure food and good r.igestion are the natural means to supply it. Again, the water-treatment, by regarding the skin as the leading depurating function of the ^^ody, follows out the indications of nature herself, which expels the gi-eatest amount of morbific agents, whether miasms, effete organic matters, or drugs and medicines, from the body, through the cutaneous channels. Instead of wearing out the alimen- tary cjinal, where but a small quantity, corapai'atively, of waste or offensive matter is ever found, with horridly }xtisonous emetics and bowel-sciaping cathartics, the principal detergent process is directed to the skin, where naturally five or six times the amount of excremen- titious matters are got rid of, that is, thrown off by the bowels. There is a principle recognized in the allopathic school, called counter-irritation or antagonism. Indeed, some late authors have gone so far as to consider it the fundamental principle of the whole drug and depleting system. It is based on the supposed law of the animal economy, that nature, or the vital powers, cannot maintain two different kinds of morbid action in different parts of the body at the same time. Thus, if a man has an inflammation of the stomach and bowels, and you produce a severer inflammation of the mouth and sali- vary glands with calomel. t>.e stronger mercurial excitement will absorb, as it were, the lesser inflammatory action; the latter will theu get well, after which the doctor may cure the drug-disease he has produced — the salivation — if he can. Such practice has no claim to the title of healing art ; it is doing an iirepai-able injury, with the ulterior possibility of a gi'eater good. Blisters, issues, escharotics, and the end- less compounds in the shape of irritating ointments and stimulating jiniments are predicated on no better philosophy than that of removing one evil by producing another. But admitting the fact that one disease does antagonize, or neutralize, or supercede another, the usual explanation is, I think, unsound. This vaguely-conceived *'law of the animal economy" is really no law at al'. It is the resistance that the vital powers make to morbific agents, which pathologists have misnamed a law of the animal economy. Two diseased actions, or diseases in two different parts of the body, or ob- structing or offending materials in two or more parts or organs, wili manifest different phenomena from what are observed when one part or organ only is affected, because vital resistance is then distributed to several pomts insteat' of being concentrated at one. If a person if laboring un^-<»r a fever, that contiiotion of the orgaa PHILOSOPHY OF WATER-CURE. IS ism which we denominate the febrile paroxysm is the manifestation of the vital struggle to defend the organic domain against some morbific cause, or to expel some injurious matter. If the vital powei-s are making the principal effort to the surface, the introduction of a cathar- tic dose of epsom salts would divert some part of this vitid effort to the bowels to meet, defend against, and expel the new enemy which is committing its ravages there, and thus purgation would result, while the depurating or remedial effect to the skin would be materially diminished. The seat of war would be changed, oi the battle-field divided, but so jf\ir from being " a friend in need," thf». saline purgation, by drawing off and WHSting a portion of vital power, would only prove a *' foe indeed." The water-treatment does not operate on the principle of antago- nism or counter-irritation, according to the popular theory, for it does not produce a train of morbid actions constituting a new specific disease ; nor does it put foreign, acrid, irritating, and deleterious ingredients into the blood, to produce some powerful impression at a dash, and then leave the vital powers to war against and waste themselves in counter- acting or removing them for months and years afterward. It has been objected, that a cold bath was a morbid impression, as much as a hot blister, because it is an artificial instead of a natural method of apply- ing water. But this argument is short-sighted. A cold hip-bath, for example, produces exactly the same vital phenomenn. action and re- action, that our bodies are subjected to every day, and hour, and mo- ment of our lives, differing only in degree. The first impression of the cold water causes the blood to recede from the canillaries ; but the vital powers soon meet the impression by an increased determination of blood to the part, to balance the temperature of the body, and soon the capillaries become distended with blood, the part red, turgid, and in a warm glow. If this process is frequently repeated, the general result is to develop the superficial or capillary circulation of the part, and to that extent unload the vessels elsewhere, remove internal con- gestion, etc. If the impression is too strong for successful vital resist- ance, if the water is too cold for the ability of the patient to react, of course the opposite efiect results; internal congestion is increased, and we have die abuse of the hygienic or remedial agent. This determination to the surface in consequence of the ijnpression of cold water, cannot be called a morbid action in any sense. If we gc out of a comfortably warm room into a very cold atmosphere, out hands and face may at first become pale, cold, the vessels contracted and bloodless ; but on returning to the room, and often under the con- tinued application of the cold, reaction takes place, and the}' soon 14 TIIEO.IV AND TRACTICE. opiiear more red mid turg'.d, and feel warincr than before their expo- sure, fur Ji few minutes, and then return to their usual appearance uno feeling. So the sJijrht disturbances of ihe circulation produced byordi- cary bathing is merely an intensified co->»vaction and relaxation, amount- ing to temporarily increased action, and followed by the same harmony of circulation sis existed before. Atmospheric influences, vicissitudes of temperature, vaiiations of exercise, etc when not extreme or vio- lent, produce tomporaiy disturbances of the circulation, which, so far from being morljid. are really sanatoiy, nay, indispensable to full health and vigor. Nature allows us a liberal range of immunity in the employment and enjoyment of agencies naturally harmonious with our eti-uclures and functions. But how difterent is the case if we take into the domain of life a Bubstance chemically incompatible with its structures, or an agent phys- iologically incompatible with its functions. Although they are met with the same vital resistance as a cold bath, or a hot bath, their temporary impression is iiever succeeded by absolute equilibrium and quietude. They leave either a mark or a void in their track. When chemically incompatible, as are all the metallic and mineral preparations, they act upon, corrode, decompose, and destroy some part or portion of some constituent of some solid or fluid, of some organ or structi ve. Familiar and melancholy examples of chemical incompatibility ai<^ found in the ulcerations of the mucous membrane of the mouth, throat, stomach, and bowels, produced by the ordinary employment of saleratus in cooking, and the rotting of the teeth and bones in consequence of a mercurial course. When they are physio- logically incompatible, like alcohol, tobacco, opium, etc., they exhaust, in-ecoverably, some portion of the vitality itself. The impressions of drug-agents of all kinds are constantly destructive or exhausting so long as they are kept up ; but the impressions from cold bathing may be continued during a whole lifetime without injury. It is true that, in water-treatment, we apply cold water to the body when hot, hot water when cold, etc., not to antagonize action, but to balance action; the gi-and general indication in treating all diseases hy- dropathically being to equalize the temperature, circulation, and action. The principle of antagonism, as practiced allopathically, tends to silence the cftorts of nature, to counteract the vital powers, to suppress the organic instincts, to obstruct the vis mcdicatrix naturce, to embarrass the cure, and, in the majority of ciises, to place the life of the patient in greater jeopardy than it would be with no medication whatever. The true philosophy of water-cure, ir. almost every essentia! point PHILOSOPHY OF WATER-CURE. 15 of doctrine, is diameti icaily antagonistical to the prevailing theories of the allopatliic schools. Some of the honioopathists have lately discovered that water acta on their favorite principle — similia s'anilibus curartur. It is to my mind inconceivable howw^ater can produce, in infinitesimal or any other quantities, any other c/?/na/?i/c effects than such as are referrible to tem- perature, bulk, or solvency. Water is the agent which homeopathy employs to dilute, and thus " enlarge the surface" and develop the pathogenetic property of its remedies ; but how it is to be reduced to its third or thirtieth potency by dilution, is a problem which may be safely laid away among the unaccountables. The eclectics, who " select the good and reject the bad" of all sys- tems, claim that water acts like a hundred other drugs which are in " harmony with the constitution." They pretend to eschew all poi- Bons, and use nothing but the " innocent remedies," which are best adapted to "aid and assist nature;" but, unfortunately for their fair pretension, we find a variety of vegetable and even mineral poisons among the everyday prescriptions of their writers and practitioners, as preparations of opium, and preparations of iron. Rationale of Drug-Medication. — All the standard works on physiology and therapeutics of the drug schools throw not a solitary ray of light on the modus operandi of drug-medicines. The effects which a thousand different drugs produce upon the various fiinetions of the human body, under almost all conceivable variations of conditions and circumstances, have been investigated with praiseworthy industry, and recorded with tedious minuteness and extraordinary precision. But why, how,, and wherefore these effects are thus and so, we are as ignorant, as far as their labors are concerned, as are the inhabitants of the moon, who, it is presumable, do not have access to their books. Wliy tartar emetic or ipecac produces vomiting, why jalap or senna purges, why mercuiy or tobacco salivates, why opium or cjitnip produ- ces perspiration, why nitre or green tea produces diuresis, why Spanish flies or boiling water raises a blister on the skin, why calomel or pink operates as a vermifuge, why aloes or iron operates as an emmena- gogue, etc., etc., are problems as deeply in the dark now as they were before the light of medical science dawned upon the world, for all that appears in the writings of the standard authors, or the teachings of living professors. But, fortunately for humanity, the principles upon which this ex- planation is founded are abroad in the world. Surely and steadily they , are working their way into the vnrlerstandings of reading and thinkinji 15 THEORY AND PRACTICE. oeople, nnd just so soon as they are generally appreciated will the drug pystcni of treating diseases be among the things that were. These principles are more fully developed in the writings of Sylvester Gra- ham than in those of any other author. The works of George Combe contain some illustnitions of them. The writings of Dr. Lambe, Dr. Alcott, Dr. Jennings, and Rausse, abound in teachings predicated on their recognition, Avhile the practice of Priessnitz and his followers is constantly demonstrating the cori'ectness of the explanation which they adbrd. I will try to present this matter clearly, for I am most undoubtingly convinced that the individual who fully undei-stands it will be exceedingly loth to swallow any apothecary drug, whether it go by the name of drag-poison or drug-medicine ; and he who has both philanthropy and intelligence will be as un\^^Hing to administer those foreign agents to other stomachs, as to take them into his own. There is a class of medicines known as tonics, or sti-engthening medicines. Books on materia raedica define them to be such articles as give tone, or tonic contractility to the moving fibres, and at the same time augment the activity of the digestive function. Now among the tonics we find a most incongi'uous set of materials, as quinine, arsenic, boneset, iron, wormwood, oak bark, quassia, aloes, rhubarb, copper, zinc, etc. All authors agree that if the use of a tonic is long continued, the effect is dehil'ity. Here is a paradox. A tonic medicine fii-st strenglhens, and then dchilitates. How are these results to be ac- counted for? When a drag-medicine of any kind, or a poison of any kind, is taken into the stomach, the organic instincts recognize the presence of a something which is neither food nor drink ; something unnatural ; Bomething which has no constitutional relation to any want or duty of any part or organ, hence an intrader, an enemy. The vital powers feel an attack upon the citadel of life, and prepare to act defensively. The lining membrane of the stomach is aroused to increased action ; an unusual quantity of mucus and serum is secreted to protect the coats of the stomach fi-om the poisonous or medicinal agent ; but the stomach does not suffer alone; the alarm is communicated to other organs, to nil parts of the system ; and this manifestation of increased vital action, this disturbance of the organism, this commotion of the body, is regarded by the doctors as a tonic effect! How words deceive ! If but a few of these "tonic" impressions are r.ade on the stomach, if only a few doses are taken, the vital powers, after enduring the siege, and defending themselves as well as may be, subside into their accustomed quiet, nnd tk? exhaus*;'.on, being n:t very gi'eat, is p PHILOSOPUY OF WATER-CURE. 17 specially noticed. But if these tonic impressions are kept up a long time, if the medicines be long continued, the vital expenditure is so great that the doctors onll the evidence of its loss debility ; and well they may. The organic instincts are finally wearied out, they become torpid, and refuse longer to respond to the impression ; the lash ceases to be troublesome. Now it is that the doctor, who wishes to still keep up a tonic impression, who desires to strengthen the system yet a little more, brings a new recruit into the field. He adrainistei-s another tonic ; no matter what, if it be a different one. It works like a chai'm ! The vital powers, though jaded and half palsied, are not j-et dead. A new eneny will startle them again; an unaccustomed imj)ression will again arouse them to resistance. If the first tonic was wormwood, the second may be arsenic, or vice versa. After the second tonic has spent its force, or, rather, after the vital powers cease to resist, a third one m;iy be brought to bear; and so on, as long as the patience of the patient or perseverance of the practitioner can endure. Thus do tonics continually strengthen the patient, and leave him weaker in the end. A decisive evidence of the correctness of this explanation is found in the fact, that every drug under heaven can be made to operate as a tonic. Mercury, lead, antimony, cod-liver oil, ipecac, gamboge, aqua fortis, or powdei'ed glass — as incongraous a medley as can be conceived — will produce tonic etifects, provided the dose is such as not to occasion any decisive evacuant or corrosive operation, by which the article is suddenly evacuated, or the structure altered. Cud-liver oil and ipecac have both had their day of reputation for. improving digestion, or fiit- tening the body. Why? Because when taken into the stomach, that organ being the point of attack, the vital powers are dispropoitionately directed to that organ in defense ; and if the doses are frequently fepeated, a determination of nervous or vital energy is established to- ward the digestive function. The digestive organs may thus be tem- porarily invigorated at the expense of all the rest of the body — a dear- bought method of promoting digestion and fattening the body, in the end. But why do some poisons or medicines produce vomiting, others sweating, others purging, etc. Simply because they are, by means of those violent or increased efforts of the excernent functions, got rid C)f. It is a law of the animal economy, that all injurious agents which gain admission, no matter how, within the domain of vitality, are coun- teracted, neutralized, or expelled in such manner as will produce the least injury or disturbance to the organism. If a very large dose of ipecac, for example, is swallowed, so large as to pi-ove immediately dangei'ous to life, or seriously destructive to the structural or functional integi'ity of the stomach, its action is met with such violence of resist- 18 THEORY AND PIIA..TICE. ance fts to produce severe spasmodic contractions of the muscular fibres of the stoiiiMcli and the nbdonVuial muscles, by which the ordinary i-er- istaltic motion of the alimentaiy canal is reversed, and vomiting results. If the dose be smaller, a pr^ fuse watery secretion is poured out upon it from the mucous and lining membrane of the stomach and bowels. to dilute it, and render its presence less harmful, while it is conducted along the alimentary canal by the ordinary peristaltic motion, and ex- pelled from the bowels, and thus we have a cathartic effect. If the dose be still smaller, it is laigely diluted with serum, taken up by the absorbents, carried into the mass of blood, and finally thrown off by tho skin, this being the manner in w^hich a small quantity can be most easily got rid of, and thus we have a diaphoretic operation. If the dose be even yet smaller, so that no special effort of the organism is made to throw it off at either emunctory, the vital powers meet, de- compose, and destroy it in the stomach, for which purpose there is an increased determination of blood and of nervous influence directed to the part, and hence we have its tonic effect. Thus may a single article of the materia medica produce, according to the quantity administered, the various and seemingly opposite operative effects of vomiting, j^urg- ing, sweating, and strengthening ; while each effect is attended with an absolute waste of vital power. It is well known, too, that all drugs lose a degree of their potency by repetition ; in other words, the vital resistance is gi-adually overcome or worn out, so that, to produce the same operative effect, the dose must be constantly augmented. Those who find a sufficient stimulus in one glass of brandy per day, frequently find ten required in a few years to produce an equal excitement ; those who commence on one cigar daily, generally end with several ; and those who find at first one patent pill sufficient to move the bowels, not uufrequently find twerfty or thirty an inefficient dose after the vital resistance liis been pretty thoroughly subdued. When medical books, therefore, tell us that drugs lose their reme- dial effects by long continuance, we are to understand that vital resist- ance is subdued; for so long as the organic instincts act a^a?r?s^ the remedy, so long will the phenomena of resistance occur, which med- ical reasoners, starting from mistaken premises, call medicinal. It may be remedial, and is, in a ceitain sense — rendering evil for evil. If a blistering compjund, which acts chemically or corrosively upon the structures, is placed upon the skin, serum is poured out, the cuticle is raised, a collection of water is formed as a barrier to the farther approach of the adversary, the scarf-skin is sacrificed to save the tiue fikin, and the red, turgid, inflamed blood-vessels show the violence of PHILOSOPHY OF WATER-CURE. i» this defensive struggle. It may be that the vital energies which were struggling against the cause of a deeper-seated pain are so diverted to the new point of attack — the blistered surfiice — that the prior pain is no longer felt. The doctor calls it cured ; it may be cured, and yet its cause be aggravated, and the patient only the worse fo-r the cure. The grand distinctive effects of homeopathic and allopathic practice are not to be explained on the principle of "■similia similibus caraniur^' nor upon the principle of '■'■ coniraria contrarius curantur,^' nor upon both principles together, but upon this principle of vital resistance we are considering. Let me illustrate this point. Tea, coffee, catnip, thoroughwort, uva ursi, milkweed, etc., aro medicinally diaphoretic and diuretic ; in other words, the vital powers expel them through the skin and kidneys, the expulsive effort being denoted by diaphoresis and diuresis. From improper food, vitiated air, impure water, or suppressed perspiration, the blood may be loaded with morbific matters, which the vital powers are naturally disposed to expel through these depurating organs — the skin and kidneys. Now while the vital powers are making a special effort to get rid of tho special cause of disease — morbid matter — let us see what happens by the special introduction of a medicinal drug. Precisely this. If tho drug be so small in dose as not to disturb seriously the first passages, and provoke vital resistance there — that is, if it be homeopathic — it passes on into the circulation, to be expelled thi'ough the skin and kid- neys ; thus, by adding another morbid cause to the existing one, both of which incite the vital powers to expulsive efforts through the same channels, the determination to the skin and kidneys is increased ; tho remedy does actually increase the remedial efforts of nature, for the simple reason that it provides a greater duty for nature to perform. When the morbid matter of the disease and the morbid matter of the drug are got rid of, we have a cure on the homeopathic principle. But suppose the dose to be allopathic, that is, large enough to pro- duce a strong impression on the stomach and bowels, and excite active resistance in the first passages. Here are then two sets of vital efforts at work in different directions, at variance with and counteracting each other; one to the skin, to expel the morbific causes of the disease, and the other to the primary nutritive functions, to resist the morbid matter of the medicine. The efforts of nature being thus divided and dis^ tracted, are rendered inefficient for either duty; but if the impression of the drug be very powerful, it may produce a new disease, and draw oft' all the remedial efforts from the skin and kidneys to resist its action, and then we have a cure on the allopathic principle. The disturb- ance of the skin and kidneys is silenced, and all that is required ia ZO THEORY AND PRACTICE. to recover, if possible, from the factitious malady — the effect of the drug. We can more readily understand how vastly superior the homeo- pathic practice is, in ail those cases of disease, as the simple fevere and exiinthv:.i^, wherein the efforts of nature are du-ected especially to the Bkin, and wherein they ai-e, in almost all cases, when left to themselves, equal to the task of overcoming the difficulty. The infinitesimal dose does not. to any appreciable extent, hinder tiie success of those remedial powers inherent in the living organism. We can account for another problem, too : the superiority of the allopathic practice in a different cliiss of diseases, in obstructions of and morbid accumulations in the alimentary canal, where the strongest impression of the allopathic dose can be made in the line of direction of the remedial efforts of nature. In the case of n simple fever the allopathic dose would interrupt the natural course of these remedial efforts ; but in a Cfise of constipalion from retained excrementitious matters, the homeupathic dose would work advers<^ly. I am far from denying that, under certain circumstances, drug- medication, either homeopathically or allopathically, may do much more good thnn evil, though I contend that such is not the general rule ; but I insist tliat the true healing art contemplates a method of medi eating diseases on an entirely different basis ; and a ti'ue basis, I daijn is furnished by the philosophy of the Water-Cure system, which al jures drugs, and depends w^iolly on hygienic influences. There is nothing in medical experience more speciously delusiv than the sti^mlating practice in cases of extreme prostmtion aiu debility. When a fever, for example, "turns," or completely subsides, the patient is weak and relaxed ; and if he has beeu severely drugged, he will be vc^v weak. The doctors of all schools, except the hydro- pathic, are always afraid the patient will "sink," or "run down," unless kept up with brandy, wine, quinine, or some other diffusible stimulant or tonic. Hence, no sooner is a fever subdued by reducing agents, than it is produced again by exciting agents, on the absurd theory of sustaining the uody on mere stimulation until it can recover its balance, or in some :"!\vsterious way acquire a faculty of existing without it. This "fallacy of the faculty" has been the death of no small number of the earth's inhabitants. It is no un'-ommon circumstance for a patient to be dosed with a quart of bnmdy, or a gallon of wine, in twenty-four hours, every swallow occasioning a new organic resistance, and a further waste of vital power, and imperiling the patient's life, while the doctor is firmly impressed with the belief that the patient's breath i-emains in his body PHILOSOPHY OF WATER-uURE. 21 only by virtue of the alcoholic stimulant. It is easy to account for this delusion. When the fever is up, the physician is afraid of death from its violence ; but he knows the patient will not die, in i^rdiuary case?, until the cold stage of the paroxysm becomes permanent. -When the fever is down — that is, in the cold stage — the patient is pak^.-cool or cold, the features sunken, and the pulse low, natural coiisequences of the previous febrile excitement. The organism now requires rest, quiet, perhaps nourishment. But the doctor, feiiring this depression will end in death, kindles up the fever again. So Icng :is the system will respond to stimuli, so long us the vital powers will manifestly resist the morbid impression of the stimulant, the body is not absolutely death-struck, and the doctor has the satisfaction of kijcwing that the patient is not now dying. But this evidence of his existing vitality is the expenditure of a part of that vitality, hence, although the stimulant causes him to manifest more signs of life, it also hastens oi endangers his death, for the simple reason that it causes a furthei waste of vitality. But it may be objected that our theory of vital resistance, though applicable to those agents which produce evacuation, or increased action of the circulating system, will not explain the phenomena produced by the narcotics, which operate in a very different mannei. Let us see. Medical books tell us that opium in small doses suppresses all secretions except the cutaneous, which it promotes. What is this but the effort of the vital powers, all concentrated, as it were, to expel it through the skin ? In large doses opium always creates nausea, and usually vomiting, evincive of the effort of the vital powers to expel it at once from the stomach. The pure narcotics, as henbane, belladonna, stra- monium, cicuta, prussic acid, etc., are really evacuants in relation to the nervous power. Being so deadly in their influence, they are met with an energy proportioned to their potency of dose, and the shock, as it were, is often sufficient to destroy the organism ir; a moment, like that from a Leyden jar, or a surcharged electric cloud. In very small doses the pure narcotics are thrown off more or less by all the excre- tory organs, but more especially the skin. In conclusion, we may find a convincing illustration in the effects of tlie very Sampson of the allopathic materia medica — mercury. Ko medical books pretend to explain the modus operandi of this drug, but all agree that it promotes all the secretions of the body- It is this gen- eral effect upon all the secretions which causes mercury to be regarded as a universal alterative, and administered, too, so freeiy and so fatally in almost all the diseases incident to humanity. But how and ivhy doesr mercury promote the f.itiviiy of aJ! the secreting organs? Because 22 THEORY AND PRACTICE. its operation is, although veryslow and gradual, is chemically; destructive to some of the constituents of all »he fluids and solids of the body ; hence it is every where met with active vital resistance, either to expel it at the natural outlets, or involve it in mucous, so as to neuti'aliz3 or lesson its ruinous consequences while it remains in the system. Its universally remedial operation is only the evidence of universal war in the organism, the final result oi which must inevitably be universal ruin, to a gi-eater or less extent, of the vital powers. Fig. 164. !:aif!l,;,i.M,, CHAPTER II. WATER-CURE PROCESSES. The hydropathic appliances embrace all the usual methods of vapor, warm, tepid, cool, and cold bathing, besides a variety of processes which have had their origin in the development of Water-Cure as a system. The Wet-Sheet Packing. — This process, the lien tuch of the Germans (fig. 164), is admi- i-ably calculated to answer two general indications, which are manifestly leading ones in a long catalogue of maladies, both acute and chronic, viz., to reduce the heat of the bodj* and the force of the circulation, and, as an al- terative, to correct morbid and restore healthy secretions. It produces also, incidentally, a powerfully detergent or cleans- ing 'efl'ect, and generally exerts a wonderfully sedative or sooth- ing influence on the whole nervous system. The first disagi'eeable sensation of cold is usually soon followed by a pleasurable warmth over the whole surface. It is capable of superseding, to advantnge, bleeding, antimony, salts, hydriodate of potassa (iodide of potassium), calomel, ond opium, and a hundred other more or less injurious agents- ^WTfFi THE WET-SHEET PACKING. WATER-CURE PROCESSES. 23 ^f In fevers, and in all acute inflammatory disorders, it may be employed with a freedom exactly proportioned to the degi'ee of morbid heat and force of the pulse ; that is, continued, with frequent changes, until the temperature and circulation are reduced to the natural standard, and the skin becomes soft and perspirable. Much sweating is not usually to be desired. In nearly the whole range of chronic complaints, there is one prev- nlent morbid condition, ever varying in intensity, yet consisting essen- tially in a deficiency of blood in the superficial and capillary vessek', find an accumulation or engorgement in the large internal vessels, with consequent congestion in some one of more of the viscera. To reverse this condition, relieve the overburdened internal organs, and supply the deficient external circulation, the wet-sheet process, aided by the proper auxiliaries, is the best known remedial agent. Dr. Gully well remarks : " This process repeated day after day, and sometimes twice daily, at length ^.re5 a quantity of blood in the blood- vessels of the entire skin, and thereby reduces the disproportionate quantity which was congested in the inner skin, or mucous mem- branes." If any one doubts the purifying efficacy of this process, he can have a "demonstration strong" by the following experiment: Take any man in apparently fair health, who is not accustomed to daily bathing, who lives at a "first-class hotel," where they fatten their own chickens and pigs on the refuse matter of the kitchen, takes a bottle of wine at' dinner, a glass of brandy and water occasionally, and smokes from three to six cigars per day. Put him in the "pack" and let him " soak" one hour or two ; on taking him out, the intolerable stench will convince all persons who may be present that his blood and secretions were exceedingly befouled, and that a process of depuration is going on rapidly. The time for remaining " packed" varies greatly in different cases. The average time is from thirty to sixty minutes, though in some few cases fifteen minutes is long enough, while others may remain envel- oped two hours to advantage. Persons of highly nervous tempei"a- ment, and rapid though feeble pulse, and those laboring under great deJjility with considerable irritability, should remain in the wet sheet only until the body becomes comfortably warm. Those having a more torpid circulation and phlegmatic temperament, unattended with much debility, may remain a much longer tiine. Much of the comfort or disagi'eableness of the process depends on the skill and dexterity of the attendant. There is at least as much Bcience in applying wet cloths to the naked body as in rubbing in an 24 THEORY AN DPRACnCE. ointment or putting on a blister. A person may be wi-appef3 up so elowly, loosely, and unevenly by an awkward hand, as to find the whole affair from beginning to end exceedinglj' uncomfortable ; or the cloth- ing may be so rapidly and nicely adjusted, as to give the patient an liour or so of actual enjoyment. Licht cotton, hair, or sea-grass mattresses, or even sti'aw, for those accustomed to very hard beds, may be used for "packing." On one of these spread from three to five large thick comfortables, then a l)iiir of soft flannel blankets, and, lastly, the wet sheet lightly wrung out, so as not to drip. Two pillows placed on the mattress are neces- sary for the head. The patient, lying down flat on the back, is quickly enveloped in the sheet, followed by the blankets and comfortables. A light feather bed may be thrown over the top, in which case two com- fortables less will be required. If the feet remain cold, bottles of hot water should be placed to them. Headache is prevented or removed by the application of cold wet cloths. In wrapping up the patient, gi-eat care should be taken to turn the clothing snugly and smoothly around the feet and neck. For very delicate persons, the sheet should at first be wnang out of tepid, or even warm water. On coming out of the " pack," the plunge, douche, rubbing wet-sheet, or towel washing may be employed, as either is speedily indicated. Some hydropathists recommend the sheet to be wrung as dry as possible, and others advise it to be used quite wet. I prefer a very wet sheet in all cases wherein the patient is not deficient in external heat. When the skin is very cold and torpid I would advise it to be J19 dry as the attendant can conveniently wring it. Some persons, whose pores are prettj^ eftectually closed up with bilious accumulations, find it rather difficult to get entirely warm at first. In a few days, however, the glow comes up readily, and it ceases to be dreaded. Such cases are benefited by a good deal of friction to the skin over the wet, and then the dry sheet. There are some few patients, of weak vital energies and extreme Fusceptibility, who very soon get warm in the wet sheet, and inmie- diately after grow chilly again ; and in some cases, if they remain yet half an hour longer, a comfortable reaction will come on again. Such persons should be taken out. if possible, during the glow upon the sur- face. If it so hfippens that they get an unpleasant chill after coming out, a thorough rubbing, followed by fifteen or twenty minutes dry packing, will usually obviate all injurious consequences. Headache, languor, muscular debility, and giddiness, if serious and long continued, generally indicate that the envelop has been continued too long. When thej' occur repeatedly the time should be shortened. W AT E R - C U R E PROCESSES. A linen is always to be preferred for " nackln (;bjcct of t!ie douche {doosli) b;ith, ■;!■■■: '■^i"r:l':t'"!^'\f'';!1^';i'"'i!!:^ (iir. Kio, is to arouse the activity liL,, „.,„ 01 the absuroent system, and th:s it certainly accomplishes in a most powerful and effectual manner. It is well adapted to chronic en- largements of the viscera, tumors, swellings and stiffness of the joinls, local attacks of gout and rheuma- tism, obstinate constipation, the in- cipient stage of tubercular con- sumption, and many other disor- ders. The force of the stream and time of application should be carefully adapted to the sti'ength of the patient. Very nervous per- ms, and those subject to a determination to the brain, must resort to i with extreme caution. Generally the stream should be directed to the back of the neck, along the spine, hips, and shoulders ; in chronic swellings of the joints the stream mn\ be directed to the aflected II— 3 ^ • THE DOUCHE 26 THEORY AND PRAOTICE. parts ; in cases of torpid bowels a moderate stream may be applied to the external abdominal muscles. No sti-oiig douche should ever be taken on the head, nor should it be long continued on any one spot about the spine or back bone. Douches may be so constructed as to produce any degi-ee of impres- sion, from that which is scarcely appreciable, to one as powerftil as the muscular system can endure, according to the size of the stream, its fall, pressure, etc. They may be verticah oblique, horizontal, or as- cendins- Those most generally muse are perpendicular streams from one to two inches in diamete^' Smaller streams, as inch and half inch are better in some cases The oblique and horizontal streams ran be more conveniently applied locally when indicated, and in many cases, fis in difficult respiration, it is advantageous to have the bodily position erect during its application. The ascending douche is particu- larly valuable in piles, prolapsus of the uterus or bowels, constipation from debility, etc. The sti-eam should not be forcible enough to cause absolute pain nor serious inconvenience; the stream may be half an inch to an inch. Warm water douches have been employed but little comparatively, but I think they are destined to grow in favor. In many cases of rigidity of the muscles, painful swellings, chronic inflammations of the joints, in neuralgic affections attended with exti'eme nervous irritabil- ity, and in spasmodic and bilious colic I have known excellent effects from sti-eams of warm water applied to the parts affected. They are also useful in obstinate constipation, retention of urine, amenorrhea, etc. As the object of a warm douche is to relax instead of contract- ing the muscles of the affected part, a small stream long continued is the best; it should be followed by the cold dash for a moment. The hose-bath is a modification of the douche ; it may be employed horizontally or obliquely to my ])art of the body, the force being regulated by a stop-cock. The Rubbing Wkt-Sheet. — This bath produces a strong and general determination to the whole surface. The sliock is generally rapidly succeeded by vigorous reaction, which is further promoted and maintained by active friction. It is applicable in all cases wherein a strong diversion from the internal viscera, o? the mucous membrane of the alimentary- canal, to the skin, is required. It is more or less serviceable in nearly every rondition of disease wherein the patient has sufficient reactive energy to prevent a permanent chill. In the primary stage of fevers, in the eirly stages of bowel complaints, colic, diarrhea, dysentery, cholera, etc , it is particularly valuable. In these WATER-CURE PROCESSES. 2T cases it should bo applied frequently lor a few minutes, and tlie skin inibbed energetically and perseveringly. In the great majority of skin diseases it is among the best resources of hydrotherapia. It is one of, the best kind of " wash-downs" to foUow the pack. The rubbing wet-sheet is an admirable bath for the ?odeutary and studious; for exliaustion consequent on severe rpental exertion; for mental disorders, and many states of insanity ; for nearly all spasraodie and epileptic conditions ; foi delirium tremens ; for night sweats- WHtchfulness, nightmare, etc. When employed drippingly wet {the aHpping sheet), a large tub or dripping pan is necessary for the patient to stand in. When wrung so as not to drip it may be used in any room or on a cavpcted floor. The sheet is thrown suddenly around the patient's body, which it closely envelops from the neck to the feet, and the body is rubbed by. the hands of the attendant outside the sheet; in ordinaiy cases fivo minutes are sufficient. Some prefer a larger sheet thrown over the head and reaching down to the feet, by which the patient can himself exercise by rubbing in front while the attendant rubs the back part of the body. I do not see any special advantage in this to offset its awkwardness. The patient can and should make active friction over the chest, abdomen, and lower extremities, if the slieet is thrown around the neck, leaving the head out. It is succeeded by the dry rubbing sheet, or rubbing with dry towels. ilmilDi'Mrti,. v('",' '.lit;!',. The Hip or Sitz-Batii.— The Fig. 166. sitting-bath answers the several indications of tonic, derivative, and Eodativc. It is invaluable in vv^eak- ness, irregularity, obstruction, and — x, torpor of the lower organs of the pelvis and abdomen. Any com- juon wash-tub will answer for its administi'ation, though it is more convenient to have vessels made for the purpose, the bottom raised ;•, few inches from the floor, the lr,tck side raised to rest against, l^he water, as a general rule, should cover the hips and lower the sitti^-g-bath. portion of the abdomen. It may be of any temperature, from very warm to extreme cold, according to the case ; and the time of appli' cation varies from five to thirty minutes. The cool and cold sitting 28 THEOfvi' iND PRACTICE. baths nre far the most fre(iuently indicated, and the usual time is from ten to fifteen minutes. In the cold stage of fever, the warm sitz-bath very much mitigates the severity of tlie chills, and if followed by the cold-rubbing wet sheet when the hot stage of the paroxysm supervenes, will often break up the attack in a few hours. In acute inflammations of the hver, stomach, l)oweis, spleen, and kidneys, hip-baths should be used very fre- quently, conjoined with the plentiful use of tepid or cool water in injections. Debility of the external muscles of the abdomen, caused l)V the excessive use of tea and coffee, or crooked positions of the body, evinced by short breath, weakness in the small of the back, and trembling of the knees, is greatly benefited by this process, used as cold as can \yell be borne. A *^lauket is usually thrown around the patient during this bath. The best tonic effect of hip-baths is secured by having them of short duration — five to fifteen minutes — and frequently repeated. A derivative effect is obtained by longer baths — fifteen to thirty minutes — and at gi-eater intervals. It must be noticed, however, that the effect of any bath is determined as much by the condition of the patient as the length of the bath. Tonic hip-baths are more or less derivative; but to get the gi'eatest derivative effect, the bath should be continued as long as reaction is vigorous, but not can-ied to the extent of producing the second chill ; if so, determination may take place to the internal organs instead of derivation fi'om them. Derivative hip- baths sliould not be carried to the point of producing paleness or livid- ness of the lips, general shivering of the whole body, nor nausea at the stomach, for they would thus endanger congestion of the brain or lungs. In treating affections of the head and chest, for which this bath is one of our best resources ^Teat caution should be exercised in managing them so as to secure a derivative without producing a re- vulsive effect. Some of the effects of sitting-baths, isually called derivative, are really se(/a/ae ; no matter, though, so long as they work curativel}'. In a general fever, for example, when the whole body is preter- naturally hot and turgid, a long-continued bath of tbis kind operates as a refreshing and fever-assuaging sedative. The temperature of the water, and its quantity', also have some mfluence in determining whether its effects shall be tonic, derivative, sedative, or repellant. The rule of practice, is to lessen the quantity of water, or raise its temperature, according to the coldness, torpor, and debility of the patient. WATER-CURE PRO 'BESSES. 29 The Shallow-Bath.— This. Fi^.i67. as usually employed, is a power- fully alterative, mildly derivative, ^^ p; : and moderately sedative bath. It :. - ■ ;~^' is sometimes used cool, seldom very cold, but generally tepid, from 65° to 75". The common shnllow-bath tub may be used, but a circular or oval tub, raised about twelve inches from the floor, is more convenient for the attendant. In private families any tub large enough for the pa tient to sit upright will answer. ~ '"^ "" The water should be from four the shallow-bath. to six inches deep. During the bath the abdomen and lower part of the body should be well rubbed by the patient if able ; if not, by an attendant; while the head is sprinkled and the back and chest rubbed by the attendant, who sprinkles those parts, or dips his hands occasion- }illy in water. When there is no chilliness, a pail of cold water {the 'pail douche) should be poured on the chest and shoulders to complete the process. This bath may be employed from one to fifteen minutes with those who are very feeble and sensitive to cold, and from fifteen to thirty minutes with others. It is usually followed by the dry rub sheet; sometimes also by the hand rubbing. When used for a long- time, the water is renewed as often as it becomes quite warm. Many nervous and delicate invalids will find this the best bath to fol- low the wet-sheet pack. It is also one of the best leading baths in the treatment of cutaneous affections, in mineral diseases, in mercurial affections of the joints, in sick headache and "rush of blood to the head," in apoplectic, epileptic, paralytic, and hysterical affections, in 'sun-stroke," intoxication, delirium tremens, etc. In some instances the half-bath has been continued for several hours v/ith decided benefit. When there is uLiform and preternatural heat of the surface, in any of the above-named diseases, it may be pro- tracted as long as those symptoms can hold out, with perfect safety ; but in all other cases short baths often repeated are preferable to very long ones; the former are never dangerous, the loiter j)ossihly may be The Half-Bath. — The half and shallow-baths are often spoken of as the same. Some authors make a distinction by calling the ord ■ nnrv shallow- bath a half-bath, when the water i& about one foot in at) THEORY AND PRACTICE. depth, so as to cover t e lower part of the abdomen, as well as the lower extremities. This is in efiect iutermediat* between the shallow- bath and full-bath, or plunge, and is employed when the reactive power of the patient admits of a stronger impression than the former, yet is not suffcient for the shock of the latter. It is specially adapted lo those cases ^or which the shallow-bath is indicated, when they are complicated wi.h great weakness of the external abdominal muscles, deficient action of the kidneys, obstructions of the liver, leucorrhea, menorrhagia, etc. In relation to time and temperature, it is to be reg- ulated by the same rales as the shallow-bath. Dr. Johnson (Domestic Hydropathy ) says, in allusion to this bath : "Place me under the most unfavorable circumstances, viz., in the heart of a large town, let me have my fair average of all sorts of cases, new and old, acute and chronic, slight and severe, and give me the shallow-bath, the sitz, and the wet-sheet, and no other bath whatever, and let me have an opportunity of frequently seeing my patients — I would undertake to cure or relieve more cases than are now cured or relieved by the ordinary drug-treatment in the proportion of two to one." I think the doctor is safe enough. It would not become me to speak for London practice, but as for drug practice in New York, I would confidently undertake the same task with either one of these three baths, or with a pail of pure soft water and a crash towel, without either of tlicm. mmi'z Tui Plu.xge-Bath. — Immers- ing the whole body up to the neck quickly, when the patient has room and opportunity to exercise his limbs under water, is all that is essential to the full benefit of this process. It is generally pre- ferred after the sweating process, and very frequently after the wet sheet, by those who are able to bear the exertion. The patient wears the wrapping-sheet and blanket (fig. 168) to the bath, hav- ing his feet sufficiently released to walk, and as p. useful pre- caution, wcXs the head and chest, and then plunge^ into the water, either head-forem>ist or feet-foremost, as he fancies. The shock pro- duced is much ess than most persons a ould suspect, while the reaction goi?;g from pack to plunge. WATER-CURE PROCESSES. 31 is generally rap'd, equal, and extremely agreeable. It may be advan- tageously employed more or less in the majority of all chronic diseases which are not attended with strong determination to the brain, great disturbance of the circulation, or difficulty of respiration. It is one of the most pleasant and refreshing morning baths taken on first rising from bed ; and by all, except the very feeble, it may ^ employed colder than any other bath can be, with equal comfort. Invalids with lungs so tuberculated as to prevent a full inflation, do not bear the plunge well, nor persons laboring under organic affections of the heart, nor those laboring under dropsical accumulations of the chest or abdomen ; in these cases it disturbs the circulation and respira- tion too much. But with all invalids or other persons who have mod- erate vigor and a pretty well-balanced circulation, with no serious local determinations or organic lesions, there can be no more agreeable or exhilarating bath. A plunge-bath may be easily constructed wherever there is a run- ning stream. A square plank box, four or five feet in depth, makes a good and cheap one ; its dimensions may be large enough for a swim- ming-bath to advantage, if there is room. The temperature of the plunge is usually from 55° to 65^, and the time for i-emaining in the bath varies from a very few seconds to two or thre ,' minutes, in chronic diseases; in high fever or general inflam- mation of the whole system, the patient may remain ten or fifteen minutes — at all events, until thoroughly cooled. The Foot-Bath. — Most persons are aware of the int>mate con- nection between the whole nervous system and the feet, maniteste:il by the extraordinary susceptibility of the soles of the feet to external impressions ; and such persons must readily appreciate the importance of this remedial appliance. The potency of mustard, onions, garlic, vinegar, ginger, pepper, and other pungents, applied to the feet, in a variety of aches, pains, cramps, and spasms, has long been celebrated among physicians and nurses. The intelligent hydropath will admit the importance of the principle — sympathy — upon which the employ- ment of those articles has been based, while he will produce every desirable result of them all with simple water. As a derivative in af- fections of the head and chest, it is often used in connection with the sitz-bath, with which it may be advantageously alternated. To prevent or remedy habitual cold feet, it is absolutely indispensable in a hydro- pathic course. Active exercise, in this case, should generally precede aftd follow the cold foot-bath. The rules given for the regulation of the eitz-bath will apply to this. Any vessel large enough to admit the f£9t 32 THEORr AND PRACTICE. and water enough to cover them ankle deep, will answer. The tim<» is usually from ten to fifteen minutes. Persons of very feeble circulation, and who are unable to take much exercise, should use shallow foot-baths for about five minutes, the water being not more than one or two inches deep. The feet or roes, or both, should be kept in motion during the bath. Walking foot- baths, where a stream of cool water can be found with a clean bottom, is a most efficient remedy for habitual :-old feet, and one of the best appliances for chronic headache, restlessness, sleeplessness, and also one of the most excellent and efficient strengthening processes for almost all forms of female weaknesses and obstructions. The warm foot-bath is often valuable to relieve sudden attacks of Jieadache, and soothe the nervous system when unusually uTitated Many delicate invalids who are habitually liable to cold feet, will find the wet-sheet pack more pleasant and agreeable by putting the feet in warm waiter for three minutes before being enveloped. Fig. IPO. The Head-Bath.— The com- mon method of bathing the head is by folds of wet cloths, or a sti'eam of water poured over the head. In ;' all acute diseases about the head, '!j attended with pain and increased -J tempei'ature, those processes are suf- : ficient, but in some chronic affec- tions a powerful derivative or sedative AYect is desired. For this purpose ihe patient lies extended on a rug or matti'ass (tig. 169), the head resting in a shallow basin or bowl, holding two 01- tliree inches of water, the shoulders being supjX)rted by a j)il- low. It may bo administered from fifteen to thirty minutes. When the pouring head-bath is employed the patient lies face down- ward ; the head is held by the attendant and projecting over the side v^f the bed : the bedding being protected by a sheet or blanket thrown aiound the patient's neck ; a tub is placed under the head to catch the water. The water is poured from a pitcher or other convenient vessel moderately but steadily for several minutes, or until the head is well cooled, the stream being jipplied principally 'o the temples and back pnrt of the head. This process is excellent n all high fevers, and in tJ\e cailv stages "^^ colic and chojpja morbus THi: Hi-Au-iJAiH. WATER -on RE PROCESSES. 33 Fig. 170 represents a convenient vessel for a Fig. 170. head-bath. Length from a to b, 11 inches; breadth from cto d,8 inches ; depth, 3^ inches ; height from the floor, 7 inches. The t jttom is concave. The cold cloths, or pouring stream 13 beneficially employed in convulsions, delirium tremens, rheumatic affections of the head, transferred gout, epilepsy, apoplexy, nose bleed, inflammation of the brain, etc. In chronic diseases of th©^ eyes and ears, earache, partial or complete loss of hearing from debility of the auditory nerves, dimness of vision from local debility, morbid depositions in the humors or structures of the eye, chronic catarrh, etc., the bathing vessel is advantageous. VESSEL. FOR THE HEAD-BATH The Shower-Bath. — This bath is greatly misused by many per- sons, and is genei"ally sadly mismanaged by allopathic physicians. Cases like the following are everyday affairs in New York : A patient has been under drug-treatment a long time without benefit ; he has been entirely unaccustomed to regular bathing in any manner, and has never taken a cold bath, nor has the doctor even hinted at any sort of a bath during his whole course of medication. But, getting discour- aged, the patient begins to annoy his medical adviser with questions about the Water-Cure ; the latter speaks in the highest terms of the remedial uses of water in ilie hands of competent persons; thicks it is a very good remedy indeed in many cases, but in this particular case it p)rohahly would not ansii^er ; it might produce congestion ! Still the patient may, if disposed, rry it and see — that is, on his own responsi- bility. He may try a shower-bath, and ascertain thereby how the treatment will be likely to operate. Influenced by these loose innen- does, and without any precautions or regulations, the patient takes two, three, or half a dozen shower-baths. Each one gives him a dis- agreeable chill, perchance a violent headache, and makes him fee decidedly worse in every sense. He goes back to the doctor, whc shakes his head porteutiously, looks "wondrous v/ise out of all his eyes," and exclaims, " I was afraid it wouldn't work well ; cold water is a very powerful agent; very dangerous when not properly managed.** Now the shower-bath is excellent in its place, but in almost all cases it is the very worst bath t3 commence on an invalid with. Generally p;it':oiits require considerrMe preparatory ti'eatraent before they can 1 34 THEORY AND PRACTICE. take it to advantage. Altliough it is ni'^re frequently ^.tescribed than any other bath by the drug doctor, the hydropath ^YOuld sooner dis- pense with it entirely than with any other. The shower-bath can be employed profitably only by those who have a good degree of vital heat, and a rather active and pretty well balanced circulation. It is contra-indicated in very nervous and ex- tremely susceptible persons, in those liable to nervous headache, pal- pitation of the heart, great determination to the lungs, or severely constipated bowels. Whether it should ever be taken on the head is a controverted pro- position. Many persons, to my certain knowledge, have taken it freely on the head as well as all over the body, ai^a daily bath, for years, not only without ai\', unpleasant symptom, but with uniform pleasure and advantage. But I have known many invalids with whom it would oc- casion more or less headache or giddiness, when applied to the head, and none whatever when only taken upon the rest of the body. The safest geHeral rule is to direct patients to incline the head forward so as to let the shock fiUl upon the neck, spine, and shoulders. It may also be fip^ely applied to the chest and abdomen. Its principal advantage is in affording a convenient morning bath; a good wash down after the wet she^t, when no other bath is specially indicated, and also after the hot and vapor baths. In the stupor of drunkenness a smait shower of cold water often restores sensibility very promptly. The cold shower has recently been introduced into tlie penal transactions of our criminal code. Refrac- ;.. tory culprits ai-e often brought to prompt obedience by its terrors. Tlie f prisoners are said to dread it worse than the old-fashioned, barbarous { methods of flagellation. It is certainly more humane, but is liable to do injury to those who are extremelj' susceptible, with a tendency to head alTections. This bath has long enjoyed considerable repute as a popular remedy for i.ckets and other cachetic affections of children. It is raanaget so injudiciously in home practice as to work more mischief than bene- fit, as the following anecdote will illustrate I once saw what was in- tended for a shower-bath, administered in this fashion : a good mother became anxious about her little boy, who was about a year and a half c-d ; he appeared to be "poorly," without having any particular dis- ejise for which a name could be found. The doctor g>ive it oil, rhu- barb, "a touch of calomel," elixir drops, worm seed, and strengthenmg things in abundance, but it stayed "poorly." Some kind neighbor ad- vise-i showering, and the mother concluded lo try it. The next morn- uiff wli'ch happenec" \ be of a keev blustering, November day, the IVATER-CURE PROCESSES. 35 mother, at early sunrise, drew a paijful of water from the bottom of a deep well, stripped the child naked, placed it out-door on the bare cold grouno, and then threw the pail-douche over it at a single dash ! The result was a fiiver, which lasted the child a week. The child should have been placed in a tub in-door, and the, water poured over it gently. Fig. 171. The Cataract-Baih. — This is a pleasant yet powerfully excitant bath Dr. Johnson, fi'om whose work I take the illustrative cut, thus describes it : In Fig. 171 a and b are two tin cylinders, con- taining six or eight gallons each. These are fixed at the top of the frame-work of an ordi- nary shower-bath, the common cistern and perforated plate being removed. By pulling a etring, these cylinders are tilted so as to dis- cbarge their water, as is seen in the plate. The inner side of each cylinder should have a lip, to give a more forward direction to the cataract of water. The cataract-bath may be employed for the same general purposes as the the cataract-bath. douche. It is a good substitute for the wave-bath, and for the. plunge in those who cannot bear the exertion required by the latter. The Dry Pack, or Sweating-Bath. — Wrapping in the dry blanket is managed precisely as the wet-sheet packing, with the omis- sion of the wet sheet. The flannel blanket comes in contact with the body, and a sufficient quantity of blankets, comfortables, or other bedding is thrown around to retain the hnimal heat. Very nervoua and irritable persons should not be wrapped very ti<:!;htly about the chest. A wet napkin should always be applied to the head, and the room should be well ventilated. The sweating process usually occu- pies two or three hours. Some few persons will perspire freely in less than an hour, and some will remain four or fivo hours without sweating much. ,f^ When the patie ^.t perspires with difficulty, exercising by extending the limbs forcibly, accompanied with der^p, full inspirations, will very much accelerate the process. One, two, or llirec tumblers of watei are taken at intervals luring the envelopment. Dr. Johnson recom- mends a little allopathi 5.uxiliaiy i" the. sh-.ipe of "a pint of hot, weaR, THEORY AND PRACTICE. bliick tea !" I would recommend the patient to abstain, teetotaliy, fioni all such nonsense. The patient should never remain long enveloped after sweating has become copious ; it is much better to perspire moderately and fre- quenll}'. On coming out of the sweating-blanket, some form of cool or cold bath should be taken, as the plunge, douche, shower, shallovv-- bath, or dripping-sheet. The sweating process is one of the severest of the Water-Cure appliances, and must always be managed with care and discrimination. If the patient becomes very restless, or if trouble- some headache, giddiness, or palpitation come on, he should be taken out. Patients will usually bear this application better after a few repetitions. Many people suppose, and some medical writers represent — among whom is Dr. John Bell, in his able work on Medical and Dietetical Hydrology- — that the sweating process is a regular part of the hydro- pathic routine. This is a gi-eat mistake ; sweating is not the rule, but the exception in water-ti*eatment. It is very seldom resorted to m any respectable establishment, and Priessnitz recommends it now much less frequently than formerly. It is the nearest approach to ^allopathic ti'eatment of any of our processes, being, when long contin- ued, depletive and debilitating. The sweating process is not applicable to any particular disease by name, but to a particular condition of body which is found in several disease.s. This condition is called plethora in medical books ; it means over-fulluess, grossnoss of the system. It is most frequently found ii gouty and rheumatic subjects. All very fat or corpulent persons pos- sess it, of course. It is the result of high living and indolence, or of active alimentation combined with defective depuration. Persons aSlicted with tihat unsightly disorder, obesity, can be assisted down to the standard of riormal bulk and personal comeliness by this manner of sweating, providing the alimentary supplies are also healthfully cur- tailed. The dry-blanket packing is very useful for those invalids who are too feeble to exercise sufficiently to overcome the chill produced by tlie wet-sheet pack, or other cold applications. With such, too, wrap- ping for half an hour to an hour is a good preparatory measure for other baths, and it may follow any bath when desirable to thus assist reaction. There is another class &f invalids still who may find benefit from the dry packing ; those who suft)^r occasionally, and at irregular intervals, severe rigors or chills, procee'ding from enlarged liver or spleen, or slight ulcerations Dr tuberculati ons of the lungs. Though it will not prevent the chills, it will mate I'ially mitisrito their severity, and thus WATEJR-CUKL PROCESSES. 37 indirectly assist the final removal of the cause. For this purpose the ' patient may be enveloped at any time when the chills trouble him, and remain until comfortably warm and fatigued with the position. The Vapor-Bath. — Somewhat akin to the sweating-blanket is the vapor-bath. Some hydropathic practitioners regard the vapor, and shower, and all other modes of water-treatment which were not pre- scribed by Priessnitz, as anti-hydropathic, as though nothing was ever to be learned save what Priessnitz personally tauglit, and nothing ever to be done save a routine repetition of his acts. Between the vapor- bath and sweating-blanket there is a difference in favor of the latter It does not disturb the circulation, quicken the pulse, or affect the respiration as much as does the vapor-bath, nor is it as liable to abuse from ignorance or carelessness. This last objection, however, applies rather to the usual than the necessary result of the vapor-bath ; for, if not made too hot, nor administered too long, the effect is scarcely ever disagreeable. It is better adapted to torpid, phlegmatic constitu- tions, than to the nervous or irritable, other circumstances being equal. It is valuable — yet not equal to the wet-sheet — in many forms of skin- diseases unattended with much irritation. In sudden colds, coughs from suppressed perspiration, in the incipient stage of most forms of rheumatism, in the first access of simple fevers, in influenza, and in mercurial diseases, it is more especially serviceable. It should never be continued to the point of producing dizziness; faintness, nausea, nor great lassitude. Some form of cold-bath should always succeed it, as the shower or plunge. The average time for remaining in a vapor- batn, when the steam is as hot as can be borne without discomfort, is from fifteen to twenty-five minutes. The " steam doctors" have brought vapor-bathing into unmerited disrepute by overdoing it. Many patients have been " steamed" so long as to produce a degi'ee of muscular relaxation and vital exhaustion, not fully recovered from in years. The process is, in their hands, usually accompanied with hot and stimulating drinks, " coipposition," "No. 6," etc., and frequently followed by a lobelia emetic ; all together making a power of medication which only very robust persons can endure with- out serious injury. Another error in the steam practice consists in not employing a sufficient amount of cold water after the hot vapor. Gen- erally the patient, when excessively heated, is dismissed with a mere sprinkling of a pint or quart of cold water, when he should have a dripping sheet, plunge, or half-bath. A vai)or-bath can be contrived in many ways. The invention of Mr. Jeremiah Essex, of Bennington, Vt., combines as 'nnny ::onveniences as any plan T have seen. 58 THEORY AND PllACTICE. Fig. 17i Fig. 172 is an inside elevation of Mr. Essex's bath, showing the ar rangeraent by which a person can take a cold or warm shower, or a vapor-bath at pleasure. Tr.e out- side casing is the box ot the bath, which may have .°creen sides, like the common kind ; and the tubes below, as they are small, and lying on the floor (the one, F, may run below the floor), caii be of no in- convenience. C is a small circular v.^ssel of water surrounding the tv je, E, seen in section, and cora- ♦ijunicates with it by a small open- ing inside, near its bottom. When the tube, E, is nearly filled, the vessel or chamber, C, contains water to the same height. F is a conducting pipe extending up into the tube, E ; and A is the handle of a piston, which extends down intJ E, having its lower end made to force the water up through the pipe, F, past the valve, H, into the shower vessel, G. This gives a cold shower-bath. To make a warm bath, D is a lamp placed under the vessel, E, which heats the water, when it may be lorced up as in the cold shower. To make a vaporbath, the pipe, M. seen parti}' in section, is attach- ed near the top of the vessel, C, and it has holes at its lower end to let the vapor escape into the chamber. When used for a vapor-bath, the piston should ,be withdrawn, and the inside hole in the vessel, C, closed up, when the lamp will generate the steam in a short time. The top of the vessel, C, to the tube, E, is made of a funnel shape, as rep- resented by B, to allow the water to be easily poured in. I is a faucet to drain off the water that may be in the pipe, and there is an attachment to the outside of the valve- case, O, to lift the valve, H, to drain off the water above. Hot stones or bricks may be used to generate vapor. The patient may sit naked on an open-work chair, with a couple of blankets pinned around the neck; a small tub or a common tin pan, holding a quart of water, is placed under the chair, and red-hot bricks or stones occEision- ally put into the vessel, so as to keep the vapor constanth^ rising froir the surface of the water. Another very simple plan is this : Procure a tin boiler of one or two gallons measure, with a tin pipe having two or three joints and a single elbow. The boiler may be heated on any ordinary fireplace or furnace; the pipe can be conducted under a chair or box on which the patient may sit, coveroi with blankets fron^ the neck downward. The vapoi COLD SHOWER, TTARM SHOWIER, AND VAPOR- BATH COMBINED. ^ATEPt-CURE PROCESSES. 39 or steam may be increased or diminished by regulating the position of the boiler over the fire. The sweating-cradle (fig. 173) is a convenient apparatus for such in valids as are obliged to k 3ep the bed. FiR. 173. PERSPIRATORY, OR SAVEATING-CR ADLE. Fig. 173 is a drawing of the perspirator, or sweating-cradle, a is a tin or copper bent funnel-shaped chimney, with a door, which is seen standing open. The small end of this chimney is open. The large end below has a tin bottom, with a hole in it to receive the little upright tin saucepan, b ; c ia the wooden bottom or end of the cradle, with a hole in it to receive the small end of the chimney, into which it fits accurately, but easily ; d d d d are hoops of wire or wicker ; / is a long, narrow piece of wood, into which the ends of the hoops are inserted ; e is a similar piece of wood running along the top, and perforated by the hoops. When the cradle is to be used, the clothes are to be taken off the bed, and the patient is to lie down on his back, with his head on the pillow. The cradle is tJien to be placed over him as high as his throat, its wooden bottom being at the foot of the bed, even with the bedstead. It is now to be covered with the whole of the bedclothes, and an addi- tional blanket or two. The clothes are to be neatly tucked in every where, so as not to let out the heat at any pcjint. But they must not hang down over the wooden bottom, and the foot valance of the bed had better be tucked up out of the way. The tin chim- ney must be kept clear of all clothes. Every thing having been thus neatly prepared, the tin saucepan, b, is to be filled three-quarters full with alcohol, and the spirit is to be set on fire. Then, taking hold of the long, straight handle of the saucepan, it is to be carefully let down through the hole in the bottom of the chimney, and the door closed. The Wave-Bath. — This process consists merely in extending the body at length in a swift current of v/ater, the })atient holding on to a rope, or some other contrivance, to enable him to keep his position. It helps to make an amusing variety in the watery part of our materia medica, but has no other advantage not obtainable by the douche and plunge. The Rivef-}3ath. — This amounts practically to an out-door, cold. 40 THEORY AND PRACTICE. or tep.d plunge-bath, according to the temperature of the water. In- valids should not, as a general rule, bathe in the rivers more than from ten to twenty minutes, when the water is tepid ; at all events they should avoid great fatigue and the second chill. When the water is cold the time must be correspondingly diminished. The Rain-Bath. — At some of the water-cures, patients have amused themselves with rain-water bathing whenever the propitious clouds have furnished the requisite shower. For those who are able to walk rapidly a mile or two, a_i-ain-bath is excellent. The constant evaporation from the surffice and the active exercise effect a rapid "change of matter;" and the process seems to combine the virtues of the wet-sheet pack and the dripping sheet in an efficacious manner. It is scarcely necessary to add that tlie patient should be dressed in light, thin clothes during the walk, and on returning to his room be well nibbed with the dry sheet, and keep up modei-ate exercise for half an hour or so after dressing. Fountain or Sprat-Bath. — This is a modification of the shower or douche-bath, or rather a combination of both. It consists of a num- ber of small streams thrown off laterally, and diverging as they recede froAi the fountain. It makes a pleasant and very excellent application to the chest and abdomen, in affections of the viscera of those cavities, when the sti'onger impression of the douche cannot be borne, or is not indicated. Dys{)eptics and consumptives can generally employ it more or less to advantage. It is a good process in pleurodynia, or pain in the side, in lumbago and neuralgia, and in partial palsy or extreme debility of the muscles of any part. Applied to the pelvic region, it is well adapted to excite functional action in atonic states of the organs, amenorrhea, chlorosis, constipation, suppression or retention of urine, etc. Portable Shower-Bath. — This is a modification of aftusion, the water being showered instead of poured over the body, and in effect it amounts to precisely the same thing as the ordinary process of affu- sion. Convenient macliines, holding two quarts or more, for shower- ing by hand, sire made by most of the tinsmit'lis. The Affusion-Bath. — Pouring water over the neck, chest, and shoulders, tht natient standing in a tub when it is desirable not to wet the fioor, is caL d afi'usion. It is as good as any other form of bath whei-e its indication is simply to cool the body, as in tlie hot stage of WATER-CUR li PROCESSES. 4i fevers and active inflammations. Dr. Currie employed affusiong ex- tensively, and with remarkable success, in the treatment of scai'.ol fever, measles, small-pox, and other diseases, at Liverpool, England, half a century ago ; but, unfortunately, the medical fiiculty of the present day, who acknowledge the superior success of his practice, do not see fit to imitate it. Affusions are performed with tepid, cool, or cold water, according to the degree of morbid heat attending the disease. Towel or Spoage-Bath. — Washing the whole surface of the body with a towel or sponge is a very good prophylactic ; and it may be employed in water-ti-eatment as a substitute for various other baths, when the requisite apparatuses for the latter are wanting. The pecu- liar advantage of this bath is, it can be taken at any time and place, whenever and wherever desired. The tovv'el is preferable to the sponge, because its friction is more perfect and uniform. I should be unwilling to dress, on rising from bed in the morning, without first rub- bing the whole surface with a wet towel, unless some other general bath was accessible ; and a towel and quart of water can always be had at a hotel or on board a steamboat. Five minutes can never be em- ployed in any more profitable way. That parent can hardly be said tc " train up a child in the way it should go," who does not instruct it in the use of a towel wash, or some other bath, every morning, at all seasons of the year. Wet-Dress Bath. — This is a modification of the wet sheet, ena- bling the patient to dispense with the services of an attendant — a mode of self-packing. A linen sheet is fashioned into the form of a night-dress, with large sleeves; and after the bed is prepared, the dress can be wet and thrown on; the patient can then get into bed, and wrap himself sufficiently,, to get a very good vv^arming up. If the bed- clothes are not too heavy, nor wrapped too tightly, almost any person. not extremely feeble, can remain in this wet dress all night without the least injury, shocking as the idea may be to our allopathic friends. Warm and Hot Baths. — These are objected to by some German hydropaths, as not being Priessnitzian, but for no other reason that I can imagine. They are, however, only occasionally employed at the American establishments, not being a regular part of any judicious course of treatment. But for quieting particular symptoms, and al- laj'ing excessive nei-vous instability, they are sometimes eminently ser- viceable. In cramps, colic, spasms, and :3nvulsions, they operate ad- 42 THEORY A :> D PRACTICE. mirably. It sonietiiiies happens thai a patient, while under treatment, will, witliout any unusual exposure, experience all the syraptouis of a severe cold, leverishness, headache, sensitiveness to the atmosphere, chilliness, and various aches and pains All these disagreeable symp- toms can generally be rejuoved at once by a hot bath for ten minutes ; and if the bath is succeeded by a pail douche, shov^rer or drippmg sheet, no appreciable debility will result. Patients who have taken large quantities of mercury, antimony, or nitre, are peculiarly liable to febrile disturbances, and to occasional swellings of the joints and stiff- ness of the muscles, which a warm or hot bath at once relieves. For all of the purposes above intimated the bath should be as warm as the patient can bear without discomfort; a temperature that is warm to 3ne may be hot to another ; the proper temperature ranges from 90® to 110^. The Swimming-Bath. — The exercise of swimming is eminently health-preserving, and might with propriety have been treated of in our hygienic department; but as it is also eminently therapeutic in some forms of chronic disease, the subject is not inappropriate here. For that large class of invalids who are consumptive from feeble lungs and contracted chests, and for a still larger class of dyspeptics, who are costive from torpid or contracted abdominal muscles, there is no better exercise than that of swimming. All persons, too, whether invalids or not, ought to know how to swim, on prudential considerations. As all the exercises involved in the various methods of learning to swim are just as serviceable to the invalid or well person, as those which may be practiced after the art is acquired, and for the purpose of enabling the inmates of hydropathic establishments, where suitable streams or ponds of water can be found, to do themselves two services at once, I copy from one of Fowlers and Wells' publications the fol- lowing illustrations : Various supjwrts may be re- ^^^' ^^■*' sorted to while the learner is getting accustomed to the ne (|r=:ir?^4- ^^^^^a^^ - =r=_r^^- _ . ^ cessaiy motions. Corks and r- ' ' bladders are convenient. Fig. ?.£.,- . rsamem^mmmvm-': - ^''^ represents a bladder, well ^^ r ^^^^B^sW^j ^ blown, and fastened over the — '"--"'^-"-t-^^ gf!^^^g'^=- shoulders by a rope passed un- der the chest. Ijarge pieces SWIMMING. WITH A BLADDER. i , 01 cork may be attached to each end of a*l-ope and ustd for tl 3 same purpose. The supports WATER-CURE PROCESSES. 43 Fig. 175. SWIMMING WITH THE PLANK. Fisr. 176. must always be carefully secured near the shoulders, for, should they slip down, they would plunge the head under water. Swimming with the plank (fig. 175) has two advantages. The young bather has always the means of saving himself from the eft'ects of a sudden cramp, and he can practice with focility the neces- sary motions with the legs and feet, aided by the momentum of the plank. A piece of light wood, three or four feet long, two feet wide, and about two inches thick, will answer very well for this purpose. The chin may be rested upon the end, and the arms used, but this must be done carefully, or the support may go beyond the young swimmer's reach. The rope (fig. 176) is another artificial support, which has its ad- vantages. A rope may be attached to a pole, fiis- tened — and mind that it be well fastened — in the bank, or it may be at- tached, as shown in the engraving, to the branch of an overhanging tree. Taken in the hands, the swimmer may practice witli his legs, or by hold- ing it in his teeth, he may use all his limbs at once. swimming with the rope. The rope, however, is not so good as the plank, as it allows of less freedom of motion, and the latter might easily be so fixed as to be laid hold of by the teeth, and held securely. Wherever a descending- gi-ade can be found, the learner can soon become a good s\'\Tmmer, with no artificial assistance, by wading in the water up to the neck, and then paddling to the shore. In swimming, the feet should be about two feet below the surface. The hands should be placed just in front o^' the breast, pointing for- ward, the fingers ke})t close together, and the thumb to the fingers, so as to form a slightly hollow paddle. Now str-ke the hands forward as far as possible, but not bringing them to the surface ; then make a Bweep backward to the hips, the hands being turned downward and outr«'ard ; then bring thera back under the body, and ^ith as little re* 14 THEORY AND PRACTICE. sistance as may be, to their former position, and continue as before. The hands have three motions — First, from their position at the breast, thej are pushed straight forward ; second, the sweep round to tho liips, like an oar, the closed and hollowed hands being the paddle por- tion, and their position in the water and descent serving both to propel and sustain the body ; and, third, they are brought back under the body to the first position. Having learned these motions by practicing them slowly, the pupu should proceed to learn the still more important motions of the legs. These are likewise three in numbei : one of preparation, and two of propulsion. First, the legs are drawn up as far as possible, by bending the knees, and keeping the feet widely separated; second, they are pushed with force backward and outward, so that they spread as far as possible ; and, third, the legs are brought together, thus acting power- fully upon the wedge of water which they inclosed. Some works upon swimming advise that the propelling sti'oke of the arms and legs should be used alternately ; but this is not the method used by good swimmers, or by that best of teachers, the frog, of whom T would advise all new beginners to take lessons. It is better that the feet should be brought up at the same time that the hands are carried to their first position ; the propelling strokes may then be combined so as to give the body its most powerful impetus, as a boat is rowed best with simultaneous sti'okes. The motion in the water should be as sti'aight forward as possible, and the more the head is inmiersed the easier is the swimmiiis:, Ris- ing at every stroke — breastmg, as it is called — is both tiresome and inelegant. All these movements should be made with slowness, and deliberately, without the least flurry. The learner will soon breathe naturally, and as the motions are really nature, he will not be long in acquiring them. If he draw in his breath as he rises, and breathe it out as he sinks, he Fig. 177. PLtTPTOLN-G OR DIVIXG. will time his strokes, and avoid swallowing water. Those who have been accustomed to fresh water must be particularly care- ful when they go into the sea, the water of which is veiy nauseous. In leaping into the water, feet first, which is done from rocks, bridges, and even from the yards and masts of loftv WATER-CURE PRO JESSES. 45 Fig. 178. TREADING WATER. vessels, the feet must be kept close together, and the arms either held close to the side, or over the head. In diving head fofemost, the hands must be put together, as in the engi-aving (fig. 177), so as (o di- vide the water before the head. The hands are also in the proper position for striking out. Treading the water (fig. 178) is a favorite position, and useful as a means of resting in swimming long distances. The position is perpen- dicular ; the hauds are placed upon the hips, as in *,he vignette, or kept close to the side, to assist in balanc- ing the body, being moved like fins at the wrist only. The feet are pushed down alternately, so as to support the head above water ; and the body may be raised in this way. to a considerable extent. While in this position, if the head be thrown back, so as to bring the nose and mouth uppermost, and the chest somewhat inflated, the swimmer may. sink till his head is nearly cov- ered, and remain for any length of time in this position without motion, taking care to breathe very sloAvly. In swimming on either side (fig. 179), the motions of the legs have no alteration, but are performed as usual. To swim oa the left side, lower that side, which is done with the slightest effort, and requires no instructions. Then strike forward with the left hand, and sideways with the right, keeping the back of the latter to the front, with the thumb side dovrnward, so as to act as an oar. In turning on the other side, strike out with the right hand, and use the left for an oar. To swim on each side alternately, sti'etch out the lower arm the instant that a strike is made by the feet, and strike with the other ai-m on a level with the head at the instant that the feet are urging the swimmer forward; and while the upper hand is caiTied forward, and the feet are contracted, the lower hand must be drawn toward the body. This method is full of vaiiety, and capa- ble of gi'eat rapidity, but it is alsr very fatiguing. Thrusting (fig. 180") is a beautiful variety of this exercise, and much used by accomplished swimmers. The legs and feet are worked as Fig. 179. SIDE SWIMMING. 46 THEORY AND PRACTICE. Fiff. 180. THRUSTING Fig. 181. in ordinary swimnjing, but the hands and arms very dififereutly. One arm, saj the right, should be lifted wholly out of the water, thrust forward to its utmost reaching, and then dropped upon the water with the hand hollowed, and then brought back by a powerful movement, pull- ing the water toward the opposite armpit. At the same time the body must be sustained and steadied by the left hand, working in a small circle, and as the right arm comes back from its far reach to the arm- pit, the left is carrying in an easy sweep from the breast to the hip. The left arm is thrust forward alternately with the right and by these varied movements great rapiditj^ is combined with much ease. Swimming on the back (fig. 181) is the easiest of all modes of swim- ming, because in this way a larger portion of the body is supported by the water. It is very useful to rest the swimmer fi-om the greater exertion of more rapid methods, and especially w^hen a long con- tinuance in deep water is unnvoid- ~- able. The swimmer can turn SWIMMING ON THE BACK. easily to this position, or if learn- ing, he has but to incline slowly backward, keeping his head on a linr» with his body, and letting his ears sink below the surface. Then placing his hands upon his hips, he can push himself along with his feet and legs with perfect ease and considerable rapiditj*. The hands may be used to assist in propelling in this mode, by bring- ing them up edgewise toward the armpits, and then pushing them down, the fingers fronting inward, and the thumb part down. This is called ''winging." The hands may be used at discretion, the application of force in one direction, of course, giving motion in the other; and the best methods Fig. 182. are soon learned when once the pupil has acquired con- fidence in his buoyant pow- ers. Floating (fig. 182) is so useful a part of the art of riiOATiNG. swimming, that it cannot be WATER-. 'URE PROCESSES. Al too soon obtained. In salt water, nothing is easier ; and in fresh, to most persons, it requires but the slightest exertion. The feet should be stretched out, and the arms extended upward, so as to be at least as high as the top of the head, and under water. The head must be held back, the chin raised, and the chest expanded. The hands will easily keep the body in this horizontal position, and by breathing care- fully a person may float at ease for hours. Could a person, unable to swim, but have the presence of mind to take this position, he could scarcely drown. To heat the water, the legs are raised out of it alternately while swimming on the back, the body being sustained by the hands. AVhile swimming on the breast, one leg may be carried backward, and taken hold of by the opposite hand, and the swimming continued with the leg and hand kept unemployed. This is said to be usefu* when taken with the cramp in one leg. Sivhnming under water should be done with the eyes open. If you v/ould swim midway between the bottom and the surface, make the strokes of the arms and the hands inward, i.e., toward you, as if you would embrace the water by large armfuls, keeping the thumbs turned rather downward. These are most important manoeuvres. You are thus enabled to pass unseen across a river or branch of water, or to search for any thing which has fallen to the bottom, and also to rescue any one who is drovv^ning. Beating, and swimming under water should not be attempted until the swimmer becomes expert in the other processes. Eye and Ear, Baths. — Various conti'ivances have been employed to bring the batlnng processes to bear on the eyes and ears more pow- erfully than by means of wet cloths. The best are ascending, or ob- liquely ascending douches or showers. The force should always be moderate, but may be applied for a considerable time. They are useful in chronic inflammation, unattended with much pain or intoler- ance of light, partial blindness or deafness from torpor of the nerves or obstruction of the vessels, weakness of vision Avithout preternatui'a! sensibility, specs, incipient amaurosis, :;atheri \g in the ears, etc. The Nasal-Bath. — Sniffing water up the nostrils, or drawing it so far into the nasal cavities as to be ejected by the mouth, is very useful in chronic inflammation, and in a relaxed or weakened state of the mucous membrane of the nose. In common colds, and catarrhal af- fections, the process is salutary. For debility", relaxation, or dryness of the mucous membrane from tfee use of snuff, it may be employed perseveringly to advantage. For nose-bleeding, the water should be iS THEORY AND PRACTICE. as cold as possible. After the removal of soft polypi from the nostrils, iced-Avater should be employed frequently to constringe the vessels. In em})loying the nasal-bath, the water should be taken up by gentle, full inspirations, not by a sudden jerking motion, fis this often gives pain and increases iiTitation. The Oral, or Mouth-B.vth. — Gargling the mouth with pure cold water should not be omitted in inflammatory affections of the throat or palate. For sore or swelled gums, toothache, hoarseness, and all vitiated secretions, cool or cold water should be frequently held in the mouth until it becomes wa»-ra, and often repeated. In apthous or cankerous affections of the mou h, water should be employed in the same way. Relaxation or falling of the uvula, or soft palate, can gen- erally be relieved or cured by gargling perseveringly with the coldest water, or by holding lumps of ice in the mouth. Tobacco-chewers should first abandon the filthy habit, and then employ the cold mouth- bath to restore the natural sensibility of the mucous membrane, and a healthful secretion of saliva. Thk Arm-Bath. — For old ulcers, and recent or chronic swellings of any part of the arm, holding the affected pai't in cold water fiom fifteen minutes to an hour, will greatly assist in healing the ulcer or Absorbing the swelling. Eruptive and rheumatic affections, in fact, ail morbid conditions of the upper extremities, attended with preternat- ural heat, shorJd be treated locally, bj- holding the part diseased in cool or cold water, or wrapping it in wet cloths, to be fj-equently changed, until the temperature becomes natural. In erratic complaints, "which are liable to change the seat of inflamm;ition, as with gout, iheumatism, especially mercurial rheumatism, care should be taken to discontinue the cold application as soon as the morbid heat is thoroughly subdued. When cold applications increase the pain, warm or hot may he substituted. Thk Ha>'d-Bath. — Habitual coldness of the hands, or numbness* is relieved by holding them fi-equently in very cold water, rubbing them smartly at the same time. Warty excrescences are often cured by chilling the hands severely by holding them a long time in the cold- est water. The Finger-Bath. — This is employed for felons or whitlows, and other similar affections. The temperature of the water should, in all cases, be that which feels most agreeable dii)ing its application WATERCU RE PROCESSES. 49 The Leg-Bath. — The lower limbs are much more liable to chronic swellings, ulcers, gouty and rheumatic enlargements, etc., than the upper, on account of the adverse relation of the force of gravitation to the weakened vessels. The knee-joint is occasionally affected with a chronic inflammation of its membranes — synovitis — for which the leg- bath is serviceable. A tin vessel, shaped something like a boot, large and long enough to take in the leg above the knee, is a convenient means of administering this bath. If the patient is crippled, an India- rubber bag, constructed with straps, by which it may be hung upon a chair, or fastened to the side of the bed, is more convenient. It may be employed from fifteen minutes to one hour. There is no danger of producing metastases, or driving the disease to internal parts, in any forni of rheumatic or gouty inflammation, provided the application is not continued beyond the point of reducing the temperature to the natural standard. The Drop-Bath. — This process is not often resorted to, nor is it even mentioned in some hydropathic books. Still it is sometimes ser- viceable, and ought to be understood. Wiess gives the best description of it: " This term is applied to single drops of water falling from a height of several fathoms. A vessel is filled with very cold water, and fur- nished with a small aperture, through which the watei* passes in the form of drops. The small aperture should be partially closed by a plug, to prevent the drops from following each other in rapid succession. By these means their operation is considerably increased, and it be- comes yet more potent if we allow the drops to fall upon a particular part at certain periods, and rub the part during the intervals. The reaction about to commence will indeed be thus interrupted, but will afterward make its appearance in a more powerful and energetic form. "The violent excitement and irritation of the nervous system pro- duced by these baths, render it necessary to restrict the use of them to half an hour ; nor are they, indeed, adapted for vital parts, or such as are abundantly supplied with nerves. " They are often used with more eflfect in obstinate and chronic cases of paralysis than the douche or affusion, with which they may alternate. Powerful and continued friction with a horse-hair glove is never in this case to be neglected after the baths." The Air-Bath. — This is not quite a water-cure process, but as air, as well as water, in all its adaptations to health-producing purposes, belongs to the V/ater-Cure system, the air-bath may be properly con' 11—6 50 THEORY AND PRACTICE. sidered in this place. It consists of the sudden exposure of the whole body, in a state of nudity, to cool or cold air, or even a strong currept. It is employed under precisely the same regulations as a cold-water bath. It is certainly a very invigorating process, and may always be safely applied to the whole body when the body is in a sensible glow or when the temperature is above the natural standard, and generally, also, when the temperature is at the natural standard, provided there is no sensation of chilliness present. It is useful, moreover, to expose any painful or inflamed part to cold air, at any time when the sensation of cold is agi'eeable. The aii'-bath has sometimes followed the wet- pack, the same friction, exercise, etc., being employed to keep up comfortable reaction after it. Sitting naked in a cold room for from ten minutes to an hour has been practiced by some persons as a hygienic measure. There are few persons who cannot bear a moderate degi-ee of such exposure to advantage. Those of feeble circulation would do better to walk, jump, dance, or exercise in some other way. Franklin, whose practical sagacity and keen observation have attained a world-wide celebrity, accustomed himself to sit and read half an hour or an hour, on rising in the morning, before dressing- Walking the room in a state of entire nudity, has been resorted to for the purpose of promoting sleep in veiy restless, dream-disturbed i'idividuals, and it is said to conduce remarkably to quiet and refreshing sleep. 1 have known the experiment tried frequently, and always w^ith good efiect. Patients suffering fi'om fevers and inflsramatory disorders, under the popular practice, generally have their sufferings greatly aggi'avated by too much bed-clothing. From a vague apprehension of catching cold, they are half stifled with excess of heat. There is no danger what- ever of cold air in any quantity or degree in such cases, so long as the whole surface is preternatui*ally hot Fomentations. — Warm and hot fomentations are useful in a variety of morbid conditions. They are sedative and relaxant, and are appro- priate in cases of spasmodic pains, muscular contractions, periodicEd headaches, hysterical convulsions, etc., when the state of the system is not actively inflammatory, nor the local part preternaturally hot. In the latter case, cold applications are the most efficacious to allevia!'« pains or cramps. A very good and perfectly safe rule for all practical purposes, in the selection of cold, cool, warm, or hot local applications, is the sensations of the patient. That temperature which feels the best is the best. This rule will apply to cramps, spasms, coUc, tooth- WATER-aURE PROCESSES. 5> ache, b'ackache, prratic and irregular pains from various chronic dis- eases, lumbago, pleurodynia, etc. But it must be recollected that all very warm or hot applications are always for occasional, never for constant employment. They are to be regarded in every case as temporary expedients, sper'ally intended to quiet pain, subdue local irritation, and remove irregular muscular contractions, or as adjuvants to the general curative course; and rightly managed with this view, they are highly important as well as pleasant resources. They produce temporary relaxation, but no permanent debility when used in connection with more or less cold bathing, as would be the case were they employed alone. The French method of hot fomentations, so highly commended by Dr. Gully, is as efficacious and perhaps more convenient than any other in use : A piece of flannel thrice-folded is put into a dry basin, and very hot water poured on it, sufficiently to soak it. The flannel is then put into the corner of a towel, which is twisted round it, and wrung until the flannel is only damp. It is taken out of the towel, and imme- diately laid over the par'r to be fomented, and upon it is placed a double fold of thick flannel, dry. o: part of a light blanket. The patient then, if it be the abdomen which is fomented, draws the ordinary bed- clothes over him, and remains quiet for five or six minutes, when another flannel freshly wrung out is applied, the former one being withdrawn. The cloths seldom require changing more than three or four times. Generally relief is obtained in ten or fifteen minutes. I have very often witnessed the best eflfects from this fomentation in nervous and dyspeptic headaches, in globus hystericus — the sense of suffocation often accompanying hysteria, and in painful menstruation. It is also frequently effectual in relieving, for the time, asthmatic fits, convulsions from teething or indigestion, neuralgia in the head or face ; it will gen- erally also produce relaxation of the bladder or howels, in cases of re- tention of urine and severe constipation. In those severe derangements of the stomach and liver, attended with excessive nausea, severe retching and vomiting, intolerance of food and drink, etc., its use, in connection with the pouring of cold water over the back of the head and temples, will usually afford prompt relief, as I have many times experienced. For all these purposes the fomenting cloth should be large enough to cover half or two thirds of the surface of the abdomen. There are some delicate invalids, of bloodless skin and feeble vitality, who find it extremely difficult to get comfortably warm in the wet sheet, and such may be very much assisted by a fomentation to the abdomen for five minutes before and after the pack. 62 THEORY AND PRACTICE. Jiest, and not exercise, should succeed the application of* hot fo- mentations, except when they are employed as an auxiliary to and followed by a cold bath. I have thus far spoken only of hot fomentations to the abdomen; and indeed in nine cases out of ten where this process is indicated at all, the place and manner described will answer all purposes. Yet in various local, spasmodic, or periodical pains they may be applied as near the part affected as possible. In affections of less severity, wet cloths of any kind, applied as hot as can be borne, will prove sufficient. Bandages. — These may be local warming or cooling processes, as indicated, and answer all the purposes of the awkward, bungling, and ex- pensive luachinery of liniments, lotions, poultices, embrocations, blisters, rubefacients, epispastics, cuppings, issues, burnings, and other external drug appliances of the old school. A warming bandage^ or compress, is simply one or more folds of linen cloth, wet in cold water, applied to the part aftected, and covered with a dry cloth or other material, to retain the animal heat. A cooling bandage, or compress, is a similar w^et application without the dry covering, or with the covering so light as to allow the animal heat readily to pass off. In both cases the cloth is to be renewed as often as it becomes dry. As usually managed, these compresses are both cooling and warming, the first impression being cold, and the re- action leaving a glow upon the surface ; but they can be made to pro- duce a constantly cooling effect by very lightly covering and frequently changing them, or a very heating effect by covering them with flannel or other non-conducting material. Coarse hnen cloth, as common crash toweling, is the most suitable cloth to be wetted ; and for the dry covering, the same material, or any common muslin, will answer in warm w^eather, and soft flannel in cold weather. India rubber, gutta percha, and oiled silk have all been in repute, and a few^ years ago were very generally employed for cov- erings. I regard them all as objectionable. They do indeed serve to prevent evaporation, and retain more peifectly the animal heat, and they also keep the part moist longer; and they seem, too, to have a more drawing or derivative influence, if the more ready production of eruptions or boils indicates such influence. But they retain the effete perspirable matter which should pass off; and their non-conducting, or non-electric property renders them relaxing and weakening to the cu- taneous function. It seems to me that, in all cases, cloth coverings are the best. If they produce a less number of boils or less painful eruptions, the cure WATER-CURE PROCESSES. 63 will nevertheless be as prompt and even more perfect. When the Bkin is torpid and cold. Canton or soft, light, woolen flanLel answers every purpose ; and if necessary, for very feeble patients who are unable to take much exercise, two or three thicknesses may be used The Chest-Wrapper. — This is advantageously employed in nearly all chronic diseases of the chest, as incipient consumption, bronchitis, in the very early stage of hydroihorax, or dropsy of the chest, spas- modic or periodical asthma, etc. It may be made of crash toweling, or two or three folds of muslin, and fitted, with arm-holes, loosely to the trunk of the body from the neck, nearly or quite down to the hips. The outside covering is l similar wrapper, made of the same material^ or of flannel. The inner, or wet wrapper, is tied as tightly around the body as desired by tapes, which are attached to the top, bottom, and middle, and the outside or dry wrapper is either tied around it, or the nner one is buttoned to the outer. There is some discrepancy in the views of different hydropaths, &3 to whether the wet cloth should extend entirely around the body, or a few inches over the spine be left uncovered. Here again, as in most of the vexed questions which occur in hydropathic bathing, the feelings of the patient are our best guide. If the wet cloth over the spine does not produce any disagreeable chilliness, pain, or uneasiness, different from what is experienced when the partial wrapper is worn, I would have it entirely encircle the trunk ; otherwise a space of from four to six inches in the center of the back should be uncovered by the wet cloth. This may be worn day and night for several weeks, provided it pro- duces no uncomfortable chilliness during the day, and does not become so warm and dry as to make the patient restless during the night. In the former case it should only be worn during the warmest part of the day, or during the time allotted to exercise, or from the morning bath until noon, or from the forenoon bath until evening. In the latter case it may be worn during the day, and omitted at night. It usually re- quires wetting when worn constantly, in the morning, toward noon, toward evening, and at bedtime. The Abdominal Wrapper. — The wet girdle, or abdominal com- press, as this is generally called, is more generally employed than any other local hydropathic application. Derangements of the digestive organs are so preva ent nowadays that those who do not thus complain are exceptions to th? general rule , and for all of these complaints this U THEORY AND PRACTICE. bandage is ftppropriate. It is also serviceable in all chronic diseases of the liver, and in acu e diseases of the abdominal viscera, as inflamuintiou of the stomach and bowels, cholera, dysentery, cholera morbus, diairhea, etc., it is always employed w ith benefit. A gi-eat deal of ingenuity has been wasted in conti'iving abdominal compresses. But the best invention of all is three yards of common crash towel cloth. One half of this is wet, and moderately wi-ung; the wet end is applied to tne side of the abdomen, then the bandage is passed across the abdomen, and around the body, followed by the dry half. This brings two folds of the wet part over the front of the abdo- men, and one behind. Whether it is to be extended entirely around the body, must be determined by the rule mentioned as applicable to the chest-wrapper. The proper crash cloth is from twelve to sixteeh inches wide, and covers the trunk from the short ribs to the hips, de- scending a little over the latter. As with the chest-wrapper, it may be worn constantly or occasionally. It should never be applied so tightly as to hinder in the least free respiration. It may be kept in place by tapes or pins. This bandage is employed more or less in all cases of dyspepsia, liver complaints, constipation, paralysis of the lower limbs, affection of the pancreas, spleen, kidneys, and bladder, obstructions of the mesen- teric glands, all forms of mismensti'uation and female weakness, in a word, in all chronic morbid conditions of the abdominal and pelvic viscera, and in all states of weakness or relaxation in their ligaments or muscles. Persons who have weakened the abdominal muscles and viscera by sedentary habits and crooked bodily positions, experience great benefit from its use. Frictio'. — Hand-rubbing, towel-rubbing, nibbing the skin over the wet or dry sheet, and with a flesh-brush or horse-hair gloves, are among the accompaniments of the bathing processes. Their object is to assist reaction and promote capillary circulation. As a general rule, patients should practice as much self-rubbing as convenient, at the same time that they are assisted by the attendant, because the exercise of so doing is an advantage of itself. As a general inile, too, the amount of friction in each case should be proportioned to the bloodlessness and torpor of the skin ; and another general rule may be stated in relation to friction, which is, tliat it should be active and rapid, i-ather than harsh or scraping; rather magnetic than forcible. Some invalids, on the mistaken notion that the harder they are rubbed the more wiL they bectme vitally magnetized, I eep the attendants at work, if they be good-natured, and object not, intil completelj exhausted ; hence WATER-CURE PROCESSES. 56 the physician should always insti'uct the attendants well in this partic- ular duty. Temperature of Baths. — Hot, warm, tepid, cool, and cold are only employed as approximate terms. Water that feels hot to one may be only warm to another, and what is cold to one is sometimes tepid to another. The sensations of the patient are generally a bet- t(!r guide for regulating the temperature of a given bath than is the thermometer ; still, the latter is indispensable in many cases, and in all convenient. As a general rule, the more feeble and delicate the pa- tient, the more sti'ictly should we follow the test of his feelings in ad ninistering tepid, warm, cool, or cold baths. When the circulation is I'igorous, and the vital temperament well developed, we may regulate any bath with sufficient precision by the thermometer. It is a useful precaution, when commencing treatment with very susceptible pa- tients, to test their sensibility to different temperatm"es of water, after w^hich the physician or patient can prescrirje them thermomet- rically- Some Water- Cure books seem to make it an especial point to be thermometrically exact in directing particular baths for given dis- eases, as for example : sitz-bath, at 59'^, shallow-bath, at 63°, half-bath, at 74°, etc. These nice distinctions are not to be arbitrarily imitated, but may be regarded as landmarks, to keep us within reasonable bounds. Baths may be distinguished into cold, below 65^ Fahr. ; tepid, 65^ to 80° ; warm, 80° to 98° ; and hot, above 98°. But a better division may be made thus : - Very cold, 32 no 40°. Cold, 40° to 55°. Cool, 55° to 65°. Temperate, 65° to 72°. The term moderately tepid, warm, cool, or cold, when occurring in this work, means some degree between the bath named and temper- ate, or the next bath in the scale, reckoning toward temperate-; thus moderately hot would mean a temperature between 98^ and 85°, etc. Duration of Baths. — There is the same mystical yet unmeaning exactness about the time of continuing a given bath, to fulfill a particu- lar indication, in many Water-Cure books, that there is about the tem- oerature. But here, again, we have better guides than seconds and "•ninutes, in the feelings of the patients and in the effects produced. It Tepid, 72° to 85°, Warm, 85° to 98°. Hot, 98° to 115°. Vapor, 98° to 125°. 56 THEORY AND PRACTICE. is true an experienced hydropath can, on examining a patient, determ- ine at once about the proper length of time to administer most of his baths ; but this time should nhvays have a nearer relation to the condi- tion of the patient, and the sum total of all the treatment prescribed, than to the name of the disease. A general rule may be laid down, that all patients should limit all baths to a period shott of producing any very depressing chill ; and never continue any one to the point of pro- ducing a second chill after the reaction has once taken place in the bath. In home-treatment the safer way is to incline to frequent and short baths, rather than few and long. General Rules for Hydropathic Bathing. — 1. No bath should be taken on a full stomach. General baths, as the wet-sheet, plunge, douche, shower, etc., should not be taken until the process of diges- tion is nearly or quite completed — from three to four hours after a full meal. Local baths, as the hip, foot, hand, leg, etc., may be taken in an hour after a light, and two hours after a heai'ty mea' Bandages may be applied at any time. 2. Patients should not eat immediately after a bath. An hour is soon enough after a full, and half an hour after a local bath. 3. All patients who are able should exercise moderately previous to a bath, unless at the bath, time the body is already in a Avai*m glow ; and after a bath, according to muscular strength. The more exercise short of absolute fatigue the better. By absolute fatigue I mean that degree of exhaustion which is not readily recovered from on resting. 4. In very warm weather the most active exercise should be taken before breakfast; and during the heat of the day it should not be crowded beyond what is perfectly agi'eeabie. 5. No strong shock should ever be made upon the head. A shower or pail- douche, poured but not dashed on, is not objectionable for those who enjoy a tolerably well-balanced circulation, and are not subject to nervous headache. 6. Profuse perspiration, or great heat of the body, is no objection to any form of cold bath, provided the body is not in a state of exhaustion from over-exertion, nor the breathing disturbed. This point is gene- rally misunderstood by physicians, and medical books of the old schooa are wholly in error about it. The majority of peopit imagine that the sudden transition from cold to hot is dangerous. The danger is all on the other side — in applying cold when the body is already too cold. Again, it is thought that a cold bath, when the body is dripping with sweat, will check the jjerspirafion, and do inimense mischief by driving it in! This is a irere phantasy. The matter of perspiration is a WATER-CURE PROCESSES. 57 viscid, waste, dead, effete material, and its presence on the surface has nothing whatever to do with the effect of a cold bath. It may be as safely washed of!' v>'ith cold water when the body is hot, as can any other extraneous matter adherent to the surface. But persons are often injured by going into cold water when the body is hot and perspirable. Granted. I have known several young men made cripples for life by this practice. Now what is the ex- planation ? Either the body was too cold, or in a state of exhaustion, or the respiration was materially disturbed, or the stomach was loaded, or all of these conditions existed together. There is a reciprocal re- lation between circulation and respiration, which cannot be greatly disturbed without injury. If a person jumps into cold water when out of breath from violent exercise, he endangers his health, because the intimate sympathy between the action of the heart and lungs will pre- vent reaction to the surfjice, and the result is internal congestion. Under all other circumstances, a warm or hot skin is favorable to any cold application, while the state of perspiration is a matter of no sort of consequence one way or the other. Dr. Johnson remarks : "Being in a state of perspiration is no objection to taking any bath, except the sit'/,, foot, and head-bath." If the rules I have laid down are duly ob- served, there can be no force in the objection of Dr. Johnson. 7. When full treatment is prescribed, as three, four, or five baths a day, the patient should take the most powerful, or those which produc the gi'eatest shock, on rising, and in the early part of the day. 8. Wetting the head, and even the chest, is a useful precaution be- fore taking any full bath, and especially important for patients who are liable to head affections. Water-Drinking. — The indiscriminate drinking of large quantities of water, as has been the custom at some establishments, is not to be commended. The amount that can be taken to advantage varies greatly according to disease, temperament, exercise, diet, etc. Per- sons of large chest and abdomen, of florid complexion and active capil- lary circulation, can drink with satisfaction, and require, Avhile under ti'eatment, a free use of water as drink — from twelve to twenty tum- blers. On the contrary, those of thin, spare body, nervous tempera- ment, and especially if the skin appears bilious, and the pores, as it were, glued together, cannot take, with profit, more than three to six tumblers daily. In the former case the water is rapidly absorbed from the stomach, and thrown off by the skin; in the latter case it lies, as it were, like a dead weight in the first passages^ and i« finally carried "id' mainly by the kidneys. 68 THEORY AND PRACTICE. Considerable allowance must also be made for the amount of exer- cise the patient can take, and the kind of food partaken of The greater the amount of exercise, the more cutaneous ti-anspiration, and the more water required. Those who use much animal food, salt, or other seasonings, grease of any kind, or concenh'ated farinaceous food, require a much larger quantity of water — other circumstances being equal, than those who resti'ict tliemselves to a plain vegetable diet. Patients should always drink to the extent of thirst ; but for a general rule while under treatment, water should be taken most freely early in the morning, after the bath, and again about the middle of the fore- noon ; a less quantity still in the afternoon, and little or none in the evening. Very little should be drank at meals. There are some few dyspeptics whose stomachs are so contracted and sensitive, whose livers are so torpid, and whose capillary circula- tion so diminished, that even a single tumbler of cold water produces a painful heaviness and disti'essing chilliness of the stomach. Such in- Viilids should begin with half a tumbler, or even less, and gi-adually but carefully increase the quantity, as it can be borne without producing unpleasant sensations. In such cases, too, the water drank should never be very cold ; the best temperature is from 55° to 65-'. Drs. Gully, Johnson, Wilson, and Rausse, very severely and very iustly repudiate the indiscriminate practice of large water-drinking, which is so highly and exti'avagantly recommended in some works on Water-Cure. I have seen not a little mischief result from it ; in home practice water-drinking is particularly liable to be overdone. Some persons have boasted of the "ravenous appetite" produced by drinking twenty or thirty tumblers of water a day ; but I cannot understand the advantage of ravenous appetites ; they are generally indicative of ex- cessive morbid irritation in the stomach. The rule for those who have not an intelligent hydropath to advise with, is to foUow the sensations of the stomacli ; take all that produces pleasurable sensations, and no more. More or less water should always be taken after each bath. Exercise should succeed water-drinking, and, ;is already intimated, it should be proportioned to the amount of water taken. Lavements and Injections. — These are used as cleansing and relaxing, or tonic and contracting processes. For the former purposes tepid or \varm water is employed, and for the latter cool or cold. On the first attack of acute diseases of the bowels, cholera, dysentery, colic, diai'rhea, etc., copious tepi3 injections should be promptly resort- ed to. and succeeded, aftei the alimentary canal is well cleansed, by CRISES. 59 cool iijjections. In obstinate constipation from debility, cold injections should bo employed daily until general treatment and diet can repro- duce the ordinary peristaltic action. In hemorrhoids an injection of a small quantity of cold water just previous to the expected movement of the bowels, greatly assists the healing process. Chronic diarrhea gen- erally requires cool or cold injections occasionally. In all chronic mu- cous or muco-purulent discharges from the bowels, bladder, urethra, or vagina, injections of a temperature suited to the susceptibility of the part affected, or the degree of inflammation, are an indispensable part of the treatment. In gleel, leucorrhea, prolapsus, and monorrhagia, they should be freely used as strengthening processes. After parturition the vagina should be cleansed with a cool injection. The most conve- nient instrument for self-treatment is the pump syringe for the bowels. The curved tube vaginal syringe is indispensable for females. In some affections of the uterus and vagina, a small tube speculum is necessary to be introduced to enable the water to come in contact with as large a surface as possible while employing the sitz-bath. The Union India Rubber Company, of this city (office 19 Nassau Street), has just brought out an admirable apparatus for throwing water up the rectum or vagina with any degree of force required. It consists of a bag, holding a gallon or more, which is filled with water and elevated, by hanging on a hook or nail, six, eight, or ten feet. The force of tlie stream is regulated by pressure on a long tube which conveys the water from the bag or fountain ; and to the end of this tube suitable pipes are adjusted to convey the water up the vaginal or intestinal passage. This apparatus is cheap and not liable to get out of order. CHAPTER III. CRISES. Doctrine of Crisis. — The doctrine of crisis is as ancient as Hip- pocrates. Acute diseases, when left to themselves, often terminate by some spontaneous evacuation ; and chronic diseases, when left to the unaided remedial powers of nature, are frequently resolved by some external eruption or internal abscess. Under water-treatment, acute diseases are generally relieved by mild yet ejffectual functional efforts of all the excretory organs, unattended with any gi'eat commotion in 60 THEORY AND PR A CnCE. the organism, or strong determination to any me em inctory, or sinA- log of the vit'al powers, which can be called in any sense critical. But with chronic diseases the case is often very different. Many cases, indeed, recover without any disturbance which can properly be denominated a crisis ; others recover after repeated disturbances, more or less severe, which ma}' be called critical efforts ; and others, after one or several pai'oxysras of general or local excitement, attended with some profuse evacuation, severe boils or eruptions, a general feverish- ness, or an aggravation of old, half-forgotten aches, pains, or other local affections. Forms or Crises. — The most common forms in wnich crises, or critical efforts, present themselves are, diarrhea, boils, and general feverisliness. Ba'ls present all manner of appeai^^nces from the hard, diffused, inflammatory swelling, with scarcely any suppurating point, to the deep, fully-matured, sub-cutaneous abscess ; there may be one or several at the same time, or they may succeed each other for weeks or months, and be very painful, or scarcely troublesome. Those of full habit, sanguine temperament, and active external circulation, are most subject to boils and eruptions. Diarrheas, when purely critical, come on without any accidental or unusual exposure or dietetic error, and continue with greater or less se- verity from three days to two weeks. There is not usually much pain, griping, or disti-ess of any kind in the bowels, but the evacuations are thin, Avatery, and frequent ; generally there are from three to six or eight motions in tsventy hours. In persons who have been most sub- ject to piles, the motions will be most frequent, and attended with con- siderable hearing down or dragging sensation about the lower bowel, and the discharges will exhibit a great amount of mucous or slimy mat- ter, often intermixed with blood. A critical looseness of the bowels is not attended with debility like an ordinaiy diarrhea ; if long contin- ued, there is, of course, some degree of languor, but then the dis- ckarges are very easily checked by hot-sitz-baths and cold injections. Those who have long 'abored under derangements of the digestive or- gans, and particularly those with torpid livers and constipated bowels ; more especially, if these conditions are complicated with pale, yellow, bloodless skin, and shriveled, superficial, capillary vessels, are most lia- ble to critical evacuaticns by the bowels ; and, as far as my observa- tion extends, they are iu 'ariably beneficial, always being succeeded by B decided sense of improvement in the patient's entire physiological condition. The term " feverishness," does not very well express the other coca- CRISES. 61 moa form of critical action, but I know of no better one to employ. It is characterized by more or less of the symptoms which attend an at- ^ack of simple fever, but they appear in a more disguised and irregular form. There is chilliness and heat, languor, depression, backache, headache, genei'al restlessness, great sensitiveness to cold, etc., etc., but, unlike the same symptoms in a paroxysm of simple fever, they do not follow each other in the order of the cold, hot, and sweating stages. This febrile disturbaace continues from one day to a week, when, un- less aggravated by improper ti-eatment, the body recovers its balance of action and feeling, and the patient feels himself advanced at least one step on the road to health. Other manifestations of critical disturb- ance, as eruptions, rashes, profuse sweatings, copious discharge of urine, vomitings, free evacuation of bile, etc., stiffness of the muscles, pain and swelling of gouty and rheumatic joints, fetid perspirations, where compresses are worn, etc., occasionally occur, but require no especial management save moderating or suspending a part or all of the cold treatment, as the general disturbance of the system is more or less violent, and employing soothing applications, as indicated. Management of Crises. — The management of crises is not diffi- cult ; generally all that is required is an omission of some part or all of the stronger baths, according to the violence of the crisis, and the use of such mild and soothing appliances as are most agreeable to the pa- tient. The patient should exercise or rest, as he finds either most comfortable, diet very simply, and use water locally to boils, eruptive or inflamed parts — of the temperature that feels most pleasant. If there is violent headache, it may be soothed with the hot abdominal fo- mentations. If the whole body is sore, tender, restless, and irritable, a hot bath should be taken for ten minutes ; and if diarrhea progress- es so for as to materially weaken the patient, the hot fomentation, or hot sitz-bath, with cold injections, should be employed. Full treat- ment should not be resumed until the critical disturbance is entirely abated. Rationale of Crisis. — I do not know that it is possible to explain catisfactorily to the professional or non-professional reader the true ra- tionale of critical action, since all the language employed in relation to vital laws, organic instincts, remedial actions, etc., is necessarily more or less figurative. Authors on Water-Cure all agree that crises do oc- cur ; some regard them as of general occurrence, the cures without such phenomena being exceptions to a general rule ; others con'^end that cures can generally be made without crises, these being the ex- 6 «2 THEORY AND PRACTICE. ceptions ; and still others regard the majority of the crises as the re- sult of injudicious or excessive treatment. It is perfectly certain that many bad cases of chronic disease are cured without any appearance of crises whatever; it is equally certain, in my judgment, that some few cases are utterly incurable without the production of a decided crisis ; and 1 am full^ ronvinced that in many ciises crises are rendered unnecessarily and even dangerously severe by excessive or injudicious ti'eatment — generally too cold or too shock- ing treatment. If a patient is kept continuously chilled, so that com- fortable reaction does not take place between the baths; or the douche is applied so severely as to produce a state of unusual nervousness, the crises will be very apt to be injuriously violent. Hence the safei' gen- eral plan of treatment, especially in home practice, is to take the slower yet surer way — do only wdiat is clearly proper, and keep always on the safe side. In this way we only lose a little time, for which life or health should never be periled. The diet has an important bearing on the severity of the crisis. In all cases, the more plain, simple, and sti'ictly physiological is the food taken, the less severe and disti-essing will be the critical efforts.; all gross, greasy, high-seasoned food, or complicated dishes render a se- vere treatment necessary to cure, and this necessarily involves a more violent crisis. It is a great error on the part of some physicians to al- low a hotel table, and then depend on harsher water processes to ef- fect the cure ; the blame, however, is not all on the side of the physi- cians, for many patients prefer to " eat what their souls lust after," and take the harder treatment, greater suffering, and less perfect cure. Doctor J. Weiss sa^'s {Hand-Book oj Hydropathy) : " This natural vital process is not to be regarded a'' morbid, for, with the existing dis- ease, it has nothing in common. While a disease lasts, therefore, no crisis can ensue. The appearance of the crisis announces a return of the vessels in the diseased parts to their normal activity, the resump- tion of the proper functions assigned to them ; or, in other words, the emancipation of the organism or its organs from disease. This is the sole signification of the crisis, according to experience and nature." Doctor E. Johnson remarks : "That the system, by virtue of its own inherent energies, sometimes purges itself of morbid matters by a crisis; that is, by establishing some temporary outlet through which such morbid matters may and do escape, is perfectly certain. The Alei)po boil, small-pox, measles, and many other well-known diseases, prove this to demonstration, and beyond the possibility of question. In all these rases the crisis is clearly the means of cure. Without such or riome si)7iilar crisis, the patient must die. Whether the water-treat- CRISES 63 ment has the power of urging nature to the establishment of such temporary outlets is another question, to which I can only reply, that I believe it has." Doctor GuWy remarks {Water- Cure in Chronic Diseases) : "In the course of the efforts which nature makes, with the co-operation of the Water-Cure, it sometimes happens that the new distribution of blood which they bring about is so energetically affected as to cause morbid congestions of blood in other organs than the diseased viscera. In this manner congestion of the lower bowel takes place, and is exhibited in diarrhea ; general congestion of the skiti takes place, and is exhibited in sweats of various kinds ; or partial but more intense congestions of the skin take place, and are exhibited in eruptions of various liinds, and in boils of various degrees. To these exhibitions of transferred ir- ritation and circulation the name of crisis is given. * * * Critical ac- tion, then, as a result of the water-treatment, signifies that the viscera have been enabled to throw their irritation and blood upon some other owgans, the lower bowels, or skin ; and that this excess of blood, and this irritative action attempts relief by throwing out large fcecal secre- tion, or unusual cutaneous secretion. This is all that can be said of a crisis; it is an outward and visible sign of the exercise of a power on the part of the inward organs to save themselves by a transfer of mischief to parts less essential to life." Doctor Shew observes {Water- Cure Manual): "A crisis may be said to be a visible effort on the part of nature or the natural powers of the system, to rid it of some morbid matter or matters in it, or expelling them at some of the natural outlets of the system, as the skin, bowels, and kidneys. These appearances occur in the form of boils, eiTiptions, sweatings, diarrhea, mucous and bloody discharges, high-colored urine, feverishness, and the like. * * * The true philosophy of these appa- rent aggravations of disease is probably this: As the living power, or that which we call nature, becomes invigorated, a greater antagonism against disease is set up ; the disease then makes a more desperate ef- fort to remain, and, in the commotion thus caused, there appears to be an increase of the same." Doctor J. H. Rausse remarks {Water- Cure in every Known Dis ease) : " The conditions of disease during the Water-Cure, and partic ularly during the critical periods are, throughout, different from every thing which has formerly been witnessed. It cannot be otherwise, because this cure stirs up, little by little, all latent and most deeply-hid- den matters of disease, and eliminates them through boils, etc. ; on the contrary, all former methods of cure suppress the commotion of the struggles of disease, and force the causes of disease inward. The es- 04 THEORY AND PRACTICE sential distinction between water and medicine is, that the former drives the peccant matter out of the body ; the latter, however, drives it into the bod}'. For this reason the mediciner seldom perceives that the causes of diseases are material, the water-doctor, however, makes this sensual perception in every disease. Hence arise the various views of the corpondity and spirituahty of disease." Essentially all the authors above quoted mean the same things, how- ever fancifully or fantastically their ideas may be clothed in language. Remedial efforts are always going on in the organism when it is in any way morbidl}' affected ; and when those efforts are disproportionately manifest at one or more points of the body, or through one or more of the depurating organs, this manifestation is called a crisis. Critical ef- forts attempt to perform a threefold duty : eliminate morbid matters, balance the circulation of blood, and equalize the distribution of nerv- ous energy. This latter duty is too generally overlooked. Some au- thors write as though all the good effected by a crisis, a boil, for exam- ple, was the riddance of a specific quantity of morbid material ; but this is a very narrow view of the subject : that is indeed one, but the least of the remedial effects accomplished. The amount of morbid matter deterged from an extraordinary boil in a week would not equal the or- dinary daily elimination of morbid matter from the skin or kidneys. The greatest effect, therefore, is the restomtion of more efficient vital action, the better radiation of vital power from the presiding centers of organic life. All morbid actions are evidences of the remedial efforts of nature to overcome morbid conditions or expel morbid materials. All that any truly philosophical system of medication can do, or should attempt to do, is to place the organism under the best possible circumstances for the favorable operation of those efforts. We may thwart, embarrass, interrupt, or suppress them, as is usually the case with aUopathic prac- tice, or we may direct, modify, intensify, and accelerate them, as is the legitimate province of hydropathic practice. But we must confeSv'» to the parodoxical proposition, that the symptoms of disease are the evi dences of restorative effort ; the effort, however, may be unequal to the end in view, and hence the powers of nature are to be assisted by re- moving obstacles, diverting irritation, etc. To place this subject in a stronger, and perhaps clearer light, let us imagine that before our eyes stands an invalid, laboring under a corapli- calion of common infirmities, having also "suffered many things of many physicians," and that by some clairvoyant or other kind of vision, we can see through him. What do we discover ? The whole mass of blood is thick, dark, >iscid, and loaded with bilious particles; the CRISES. 65 liver is indurated and torpid, and secretes but .ittle bile, and that little remains so long in the biliary passages that it becomes partially decom- posed, and, to some extent, putrescent and acrid: and wliere it enters the duodenum, it corrodes its mucous surface ; the stomach has been BO long plied with luxurious living, that its vessels are red, inflamed, and its secretion of gastric juice almost entirely suspended ; the colon or large bowel is clogged up with hardened fcecal matters, and the rectum or lower bowel is full of hemorrhoidal tumors ; the mucous membrane of the throat and mouth is covered with an erythematic eruption, and the nerves of the tongue and palate are semi-paralytic ; the skin is livid, rough, and eruptive, its capillary vessels over-distended with thick blood, and its pores clogged up with dead, effete matters; from the de- ficient external capillary circulation the internal vessels are overloaded and engorged ; the heart labors, throbs, and flutters ; the lungs are so oppressed they cannot expand freely, and the system is not sufB- ciently decarbonized ; the kidneys are distended, swelled, and their secretion imperfect, high-colored, and full of sediment; and last, though not least, the brain is constantly pressed upon by the current of ve- nous blood which is there dammed up, as it were, by the general ob- structions, producing vertigo, headache, and a thousand indescribable morbid sensations, etc., etc. Such is not an overdrawn picture of a large proportion of Water- Cure invalids. Now, what happens under treatment ? The first ef- fect of the water processes is to relieve the more prominent, yet more external, and less important of the symptoms, as morbid heat, inflam- matory action, pain, irritability, symptomatic fever, restlessness, sense of general oppression, etc. ; this is usually accomplished within four weeks, and the patient feels a newness of life ; his spirits becojue buoy- ant, his step more elastic, and he experiences a sort of general bodily exhilaration ; but, like the marred and scarred sapling, which has been bent to the ground, and rises up again when tfie superincumbent pressure is removed, he has wounds and bruises to heal. During the treatment, changes have been going on in all the machinery of vitality ; obstructions have been more or less cleared away ; torpid muscles aroused to action ; long-smothered sensibilities stirred up in half-pal- sied nerves; the excitability of the contractile tissues re-developed; universal commotion has pervaded the domain of organic life. In this state of general perturbation, when some parts and organs are surcharged with blood, and others blood'ess — some inflamed, and oth- ers torpid — some excessively irritable, and others almost paralytic — some preternaturally sensitive, and ot-:ers almost devoid of sensation — some oppressed witii heat, and others depressed by cold — with impure 66 THEORY AND PRACTICE. secretions in many organs, and excrenientitious matters choking up the capillary vessels more or less in the different structures, it may well be supposed that the vis medlcatrix naturcB vio\x\di present many phases of irregular and disorderly action ; sometimes concentrating the whole remedial effort in one direction or to one outlet ; sometimes dividing it between several parts, and sometimes making it, with more or less force, successively in various dhections. These efforts are attended with waste or expenditur of organic force, and sometimes this expenditure for a time exceed, the replen- ishment; hence "reaction," as it is called, fails, and the patient feels a temporary depression, in which condition he is veiy apt to imagine the treatment "does not agree with his constitution." Now it is that the faith and skill of the patient and physician are put to the severest test. If the patient now takes his feelings for his guide, and abandons all treatment, he may commit a fatal error for himself, and give the whole water-system a bad name ; and if the physician perseveres in the use of very sti'ong impressions oi- very cold treatment, this temporary de- pression may become permanent, or, at least, unnecessarily painful and protracted. All the patient requires is rest, soothing appliances, and en- couragement. If he feels very weak, let him follow his feelings in the matter of exercise ; walk, sit, or keep his bed precisely as he can best en- joy or endure himself. If he is feverish, chilly, or in pain, administer lo- cal fomentations, or the warm or hot bath. In brief, he needs an expec- tant, nursing management until the organic powers have thoroughly rested themselves, and in three, six, or ten days, more or less, full treatment may be resumed to advantage. But where disease and disorganization have pervaded a large extent of the domain of life, these efforts, and these sinkings, these general or partial crises, these " ups and downs" may be many before health is re-established ; and the physician who undertakes specifically to i^ro- voke a crisis, with the view of curing, as it were, at a single dash, com- mits a gi'ave mistake. Crises, or any number of critical efforts or dis- turbances, are always to be desired, but never to be sought by vio- lence. It often happens that patients whose bodies are extensively diseased, yet not verj' much exhausted in muscular power, experience very gi'Ctit benefit at a Water-Cure during the first month, after which they suf- fer a slight aggravation of many of their difficulties, and thus remain several months npparently in statu quo, not realizing within themselves, or manifesting externally, any decisive indications of restoration, and yet in a few months longer find themselves in good health. Such cases, if which I have seen many, prove to us that tie process of repara- THE PULSE. 67 tion, in the domain of the organic economy, like that of growth and de- velopment, is slow, silent, gradual, and almost imperceptible, and that, although we may rid the system of obstructions, morbid deposits, and active disease by the diligent employment of the Water-Cure pro- cesses, the re-establishment of firm and vigorous health requires weeks months, or years, and is influenced favorably or adversely by every cir- cumstance and habit of life. CHAPTER IV. OF THE PULSE. Mature of the Pulse. — All persons who undertake the general direction of hydropathic appliances, ought to be familiar with the char- acter and indications of the arterial pulsation. There is no surer test of the degree of existing vitality, or of the balance of circulation, and no better guide for the administration of water-treatment; while its va- riations denote, with considerable accuracy, many pathological condi tions of the different organs and systems of the vi-tal domain. For these reasons, this chapter may properly form a connecting link be- tween the theoretical and practical departments of this work. The beating of the arteries, caused by the afflux of blood propelleci through them by the contractions of the heart, is called the pulse. Its characters relate to the force, frequency, strength, and equality of the pulsations themselves, and of their intervals. The most convenient method of ascertaining the state of the pulse is by compressing the ra- dial artery at the wrist, with the balls of the first and second fingers ] the main force is to be applied by the finger which presses on the ar- ter3^ above, or toward the heart. Its streyigth is determined by the de- gree of compression it will bear before it will cease to be felt by the ^ngGY farthest from the heart. Varieties of Pulse. — Medical authors enumerate many kinds of pulse, which are both fanciful and ridiculous. All the distinctions which are of practical utility are the following : The pulse is called regular when its beats are uniform in force, fre- quency, fullness, etc and irregular when it lacks uniformity in thesa respects. 68 THEORY AND PRACTICE. A normally strong pulse resists moderate, yet yields readily to sa vera pressure. X pretcrnaturalhj strong pulse is almost incompressible. A strong pulse is never very frequent, mrely exceeding 80, and never, i>er- baps, 90. A hard pulso offers nearly as great resistance at first as a sti'ong pulse, but yields more easily and con:pletely to strong pressure. A soft pulse feels full and round to the finger, but yields steadily and readilj' to pressure. A full pulse gives to the finger the sensation of repletion or fullness. A contracted pulse is neai'ly the opposite of the full pulse, the pulsa- tions being narrow, deep, and somewhat hard. A frequent pulse has an unusual number of strokes in a given time. The natural frequency of the pulse at the vai'ious stages of life is sub- ject to considerable diversity. The average may be stated as follows : In the embryo, 150 ; at birth, 130; one month, 120; one year, 112 ; two yeai-s, 105; three years, 100; seven years, 90 ; twelve years, 85 ; puberty, 60 ; adult age, 70; old age, 65. A slow pulse makes less than the usual number of strokes in a given time. A quick pulse is one which strikes sharply and suddenly, as it were, against the finger without reference to the number of pulsations : hence it may be quick and frequent, or quick and slow. A quick pulse is never very frequent, seldom over 90. The pulse is said to be tense when the arteiy resembles a cord fixed at each extremity ; when it feels still harder and smaller, it is called winj. A deep pulse is that which cannot be felt without difficulty nor with- out strong pressure. A tremulous pulse is one wherein each pulsation oscillates. A weak or feeble pulse beats lightly against the finger, ceasing en- tirely on very slight compression. A small pulse unites the character of the weak or feeble with the contracted pulse. A sharp pulse is a combination of the quick and frequent ; the arteiy Bti'ikes the finger both abruptly and mpidly. The pulse is called critical when it becomes free, open, soft, etc., after having been irregular or abnormal in these respects. The dicrotic or double pulse is that in which the finger is struck twice at each contraction of the heart : once lightly and once more forcibly. An intermittent pulse is that in which a beat is occasionally missed THE PULSE. 69 as it were ; the intermissions are usually quite irregular, as one in five, six, ten, or twenty. There are many technical distinctions of pulse, which are either unimportant, or merely subdivisions of those already named, as, ardent^ when the artery seems to raise itself to a point in order to strike the finger ; goat-leap, an imperfect dilatation of the artery, being suc- ceeded by a fuller and stronger one — the artery seems to leap, as it were; convulsive, unequally frequent, or unequally hard ; deficient, a feeble beat, which seems every instant about to cease ; depressed, a pulse both weak and contracted, or deep; /iZz/brm, resembling a thread, slightly vibrating; fiichering, i. e-, deficient; hectic, the weak, feeble pulse observed in hectic fever ; intercussent, one in which a superflu- ous pulsation seems to occur occasionally ; intricate, unequally slow and imperfectlj^ developed ; jarring, jerking and sharp ; languid, slow and feeble ; large, an open and full beat ; long, one which strikes the finger to a great extent in length ; low, the pulsations scarcely per- ceptible ; resisting, slightly tense or hai'd ; undulating, the pulsations resembling the motion of waves ; unequal, the pulsations being unlike, .or returning at unequal intervals ; vermicular, resembling the motions of a worm ; vibrating, jarring, like the motions of a musical string ; oppressed, small, contracted, and slow ; laboring, the blood seeming to be but partially emptied at each pulsation, etc. Indications of the Pulse. — The preter naturally strong piulse is characteristic of high fevers and active inflammations. It is the kind of pulse which is said to hear bleeding well ; bleeding does not immediately nor sensibly prostrate the patient ; but often relieves pain and lessens sensibility. When this pulse exists, no matter by what name the disease is called, the cold ablution or wet sheet may be freely employed and safely continued until the pulse is reduced to the natural standard. The hard pulse indicates a less degree of inflammatory action, or a great degree of irritation, without gi'eat debility. It is found in many forms of acute and sub-acute inflammation, as gout, rheumatism, pneu- monia ; in that form of continued fever called synochus ; in many cases of what is called bilious remittent fever, in the early stages of intermittent fever, during the hot stage of the paroxysm, and gener- ally in the early stages of the exanthems — measles, small-pox, scarla- tina, erysipelas, etc. Bleeding renders it softer for a few hours, but, unless the cause is removed by some other means, the hardness soon returns. Cold applications may be employed ui der the same restric- tions as for the strong pulse. TO THEORY AND PRACTICE The soft pulse is always found in the normal state of the circulation. and sometimes attends diseases which are not marked by active inflam mation, nor much debility. Bleeding always sinks this to a weak, con- tracted pulse. In water-treatment mild applications are most bene- ficial. The full pulse indicates a good degi'ee of superficial capillary circu lation. Bleeding always permanently depresses this kind of pulse , but cold applications are generally veiy well borne. It is generall}i found in apoplexy, the hot stage of fevers, the mcipient stage ol pulmonary consumption, etc. The contracted pulse indicates capillary obstruction and intense en- gorgement. Epidemic cholera affords an exti'eme example of this kind of pulse. It often " rises" on bleeding, to sink more deeply soon after. The frequent pulse indicates irritation or inflammation, and when very frequent gi'eat debility. Irritable temperaments manifest a more frequent pulse than the phlegmatic ; and females have a more rapid pulsation than males. A frequent pulse may be strong up to about 90 per minute ; but beyond that point debility is generally proportioned to the frequency. In complicated affections of the thoracic and abdom- inal viscera, the frequency of the pulse is an important indication of the locality of the principal morbid condition. Thus, in dyspeptic con- Bumptian — an affection which commences with a diseased liver and stomach, and ends with tubercles or ulcers in the lungs — the pulse will be modemtely slow while the abdomen is the principal seat of disease : it will gi-adually increase in frequency, as the disease extends itself to and occupies the lungs; and be very frequent when the vis cera of the chest have become the point most dangerously affected Nothing is more common than for experienced physicians to make the most egi'egious mistiikes in diagnosticating between diseases of the liver and lungs, or between dyspepsia and consumption ; but the fre- quency of the pulse, aided by other symptoms, ought always to insure a correct diagnosis. The importance of this symptom is enhanced by the fact, that in most chronic diseases of the abdominal organs, the pulse is preternaturally slow : while in all idiopathic affections of the chest it is more or less preternaturally frequent. In those dyspeptic affections or disorders of the liver, attended with a dfy, husky cough, a tenacious secretion of the throat, or a glutinous mucous expectora- tion from the lungs, there is always danger of confirmed consump- tion when the pulse begins to beat with considerable frequency, say from 80 to 100. The slow pulse indicates torpor, inaction, especially in the functiong THE PULSE. 71 auxiliary to digestion. Compression of the brain, from contusion, or ef- fusion, or engorgement, not unfrequently produces a very slow pulse. Dyspeptics and hypochondriacs often manifest an extremely slow pulse. In all of the above cases the pulse frequently sinks to 50, and oc- aionally to 40. A change in dietetic habits„if it bo from highly-season *^d, stimulating, or animal foods, to plain, simple, vegetable dishes, is always accompanied with a reduction in the frequency of tVie pulse. The long and slender arteries of tall and slim individuals beat less frequently than the shorter, thicker vessels of an opposite organization. The quick pulse is similar in its indications to the hard pulse ; but usually denotes a greater degr&e of irritation or inflammation. The tense pulse denotes excessive irritation with considerable de- bility. It is usually found in constitutions which possess great activity with little strength. The deep pulse is merely owing to the situation of the artery, which runs deeper beneath the integument than usual. The tremulous pulse indicates extreme nervous debility with violent irritation, or excessive internal congestion. Tea, snuff, alcoholic bev- erages, and cigars are among its common causes. The iveak ov feeble pulse indicates debility merely. The small pulse denotes debility with more or less local irritation. The sharp pulse indicates more or less debility with gi*eat irritation. The critical pulse denotes the subsidence of irritation ; a more perfect equilibrium in the circulation, and a general improvement in the patient's condition. The double pulse usually attends organic affections of the heart or large arteries ; yet it is sometimes found in very nervous dyspeptics, especially those who have indulged freely in nervines and narcotics, aa coffee and tobacco. The intermittent jmlse is exti'emely common with dyspeptics, nerv- ous invalids, sedentary persons, and those who are subj^^ct to constipa- tion, and also with old pereons. It not unfrequently occasions great alarm, being erroneously supposed to indicate aneurism, heart disease, or some other formidable and fatal malady. It indicates thick, viscid blood, capillary obstruction, or nervous exhaustion. Overloading a weak stomach, almost always produces an intermittent pulse for a time, as do night suppers, and going to bed soon after eating. The sub-varieties of pulse indicate complications of the conditions which give rise to the more distinct varieties, and are attributable to constitutional peculiai'ities, personal habits, local irritations, and many other circumstances relative to the individual, the disease, and the treat- ment- 72 PART V . PATHOLOGY AND THERAPEUTICS. CHAPTER I. OF FEVERS. Olassification of Fevers. — The nosological arrangements of fe- vers, as found in medical books, are all, in my judgment, unphilosoph- ical and absurd. Without wasting any of my limited space in exposing their errors, I will at once propose a classification which shall, at least, make a nearer approximation to pathological propriety. Nosological Arrangement of the Simple Fevers. 0. D 11 Marsh Fever. 1. Ephemeral. — One day Fever, 2. Inflammatory. — Synochus — General Inflammation, C Yellow Fever, ( Ship Fever, 3. Typlwid. < Nervous Fever, Spotted Fever, ( Putrid Fever. { Camp Fever, I Jail Fever, (^ Hospital Fever. 4. Remittent. \ ^^^^ Remittent, I rutrid Kemittent. i Quotidian — Everyday Ague, 6. Intermittent. < Tertian — Third day Ague, ( Quartan — Fourth day Ague. ' Hectic Fever, Symptomatic. P^^'-peral Fever, "^ ^ Mesenteric Fever, ^ Milk Fever. ' Small-pox, Chicken-pox, Cow-pox, Measles, Scarlatina, Erysipelas. Miliaria. ^ Plague 6. Eruptive. FEVERS. 7S From this arrangement I have excluded the " bilious fever" and the *' syuochus," or " mixed fever" of authors. A mild form of the putrid typhus, when accompanied with bile in the stomach, and a yellowish conjunctiva, is often called bilious fever ; so, also, is either form of re- mittent. The "synochus" is said by some authors to be bilious in the beginning, and typhus in the end. This is simply absurd. Other au- thors denominate it inflammatory at the outset, tending to a typhoid termination. This is mistaking an aggravation of symptoms for a change of type. Bystanders are often astounded at the bedside of the patient by hearing the physician announce that the fever has changed type, from bilious or inflammatory, to typhus or typhoid. All this 1 regard as sheer nonsense. All that it can mean in plain English is, the patient is worse, or has approached the critical period or turn of the fever. The "congestive fever," as it is generally called in our Southern and Western states, is merely a severe form of intermittent or remittent, attended with the symptoms of a disproportionate engorgement of the brain or lungs. Sometimes a malignant form of typhus is called con- gestive fever, and occiisionally almost all forms of fever, accompanied with severe congestion of some important viscus, are designated by this unmeaning term. European authors have entitled similar cases "pernicious fevers," by way of distinction : a more uncouth and sense- less appellation than congestive. Doctor William Jenner, professor of pathology in University College {BraWnvaiWs Retrospect, Part XXIII.), has lately classified continued fevers into tifphoid, typhus, relapsing and fab ricula. This "relapsing fever," we are told, is known by a reproduction of most of the febrile symptoms in about a week after the patient has become convalescent. He is then, without any apparent exciting cause, without any error or indiscretion on his part ^'eattacked with violent fever, which lasts sev- eral days, and then termmates in profuse perspiration. A more ap- propriate name for this febrile disturbance is drug-fever. It is per- fectly clear to my mind that, after the patient's body has been satu- rated, as it were, with drugs, as in the ordinary treatment of a fe- ver, the vital powers will endeavor to get rid of the dnig-medicines aa soon as they have recovered sufficient energy to make the effort ; and this eflbrt is what Dr. Jenner distinguishes as a distinct species of fe- ver, which he calls " relapsing," and treats with another couree of drugging. This explanation is confirmed, if not demonstrated, by the fact that the patients whose fevers are treated hydropathically, never have a re- lapsing repetition of the fever, nor any thing like it. 11—7 7i PATHOLOGY AND THERAPEUTICS. General Character of Fever. — A fever is a simultaneous ab- normal disturbance of most or all of the bodily functions, such disturb- ance being manifested in periodical paroxysms, more or less severe and prominent, of cold, hot, and sweating stages. It commences with languor, lassitude, and general disquiet, followed by shivering, rigors, or chills, then succeeded by hot flashes over the surface, with aching sensations in various parts of the body, particular- ly about the small of the back. Finally a preternatural heat, redness, and turgescence pervades the whole body, accompanied with head- ache, furred tongue, frequent pulse, deficient secretions, and prostra- tion of strength. Sooner or later the superficial heat and redness par- tially or totally subside, and the paroxysm is terminated with more or less general or local sweating. Either stage of the paroxysm may be disproportionately severe, and eithei "^ay be so slight as to escape notice. Causes of Fever. — It would be a profitless waste of words to enu- merate specifically all the circumstances which ai'e supposed to be among the predisposing and exciting causes of fever. In a general sense they may be summed up very briefly : local contagions or poi- sons, unheakhful food, impure water, vitiated air, personal uncleanli- ness, over-exertion, atmospheric vicissitudes, gluttony, intemperance, etc. Medical books are lull of amusing specimens ot thoughtless state- ments on this prolific subject. Thus Hooper, in his " Physician's Vade-Mecum, with Improvements by Guy and Stewart," gives us the oredisposing causes of inflammatory fever in the following v>'ords : ' Plethoric habit of body, with a strong muscular system ; a good and unimjjuircd constitution !^^ If muscular strength and a good constitu- tion predispose us to disease, it is certainly very dangerous to have good health ! The same author gives us, as among the predisposing causes of yellow fever, "the male sex," and among those of miliary fe- ver, "the female sex I" It is of such stuff" that many medical books are made. I only mai'vel that some transcendent genius has not re- corded human nature as a predisposing cause of disease ! Theory of Fever. — Since medicine became a system — it never was a science — theories of fever have, nore than any other subject, displayed the genius of ihe great masters of the profession. The very names of all the different ones that have been written, would fill a vol- ume ; yet, at this day, we have in our medical schools no generally- recognized theory All is now as vague, indefinite, and unsatisfactor} FEVERS. 75 as in "the dark ages;" and the existing opinions of living authors re- garding the nature of fever, are specularions of the most chimerical character. Still, the whole subject seems simple enough. The reason wliy an explanation has never been found is, I apprehend, because it has never been sought in the right direction. A man who shou^j look to the moon all his lifetime in search of the "philosopher's stone," might not discover it though lying at his feet. Medical philosophers, instead of rationally tracing the effects of riotous living and abused hygienic agen- cies, have expended oceans of midnight oil and centuries of brain la- bor in trying to Lliink out some specific, strange, hidden, occult, myste- rious, extra-natural thing, substance, elemeni, or cause, whose exist- ence should, in some magical manner, account for all the phenomena of fever. Of course, all their toil has been in vain. It has been rathei worse than labor lost, for the writings and teachings of medical books and medical schools are so tinctured and mystified with the vagaries of medical professors, that the student of n^^dicine is morally certain to get his mind more or less befogged, and his judgment to some extent warped by their influence. Type of Fever. — A man of strong, vigorous constitution, accustomed to an active out-door life, yet regardless of healthful habits, eating and drinking what comes in his way, as is the fashion of the world, is ex- posed to unusual cold, wet, heat, labor, or some similar vicissitude. In a day or two he has a fever. Its type will be injiammatory^ because his vital energies are strong and his viscera powerful, and in him na- ture — the organic instinct of self-preservation — is successful in throw- ing the morbid action to the surface. If the disturbing causes are slight, it will be ephemeral in duration; if more severe, typhoid. Another man, of feeble constitution and sedentary life, is similarly exposed and similarly attacked. His fever will be typlins. There is less ability to react successfully, and the ujuernal commotion is pro- portionally greater. The surface is less turgid, but the viscera sutler more internally. The brain manifests delirium, the lungs engorge ment, the liver congestion, the stomach and bowels torpor or relaxa tion, and some physicians will call it congestive fever. If either of the above patients has been gross in his eating habits ; if pork, ham, sausages, cheese, and fine, constipating, farinaceous food have constituted a large proportion of his diet, he will have a yellow tongue, bitter taste in the moulph, bile in the stomach, etc. Then hia fever may be called hilious. The man of impaired constitution ani.' wea*-: digestive powers, who 76 PATHOLOGY AND THERAPEUTICS. is attacked with typhoid fever, will have the nervous form, if his brain and nervous system have been particularly abused, overworked, or stimulated by tea, coffee, liquor, or tobacco, and the putrid form if his personal and dietetic habits are gross, and particularly constipating and obstnicting. The yellow variety is produced by causes which especially operate to impair the secretion of the liver, as excessive heat, animal or vege- table miasms, combined with gross diet and stimulating drinks. Every kind of animal food, except, perhaps, milk, in very warm climates, I regard as a predisposing cause of yellow fever. The other forms of typhus, called ship^ spotted^ jail, camp, and Jios- pilal fevers, are nothing more nor less than the common or typhoid fever, modified by local causes and particular personal habits. Remittent fever may be of the neiTOus or putrid tendency, for the reasons already assigned. Its remittent character is owing undoubt- edly to a disproportionate affection of the liver and spleen, a condition of obstruction and engorgement produced by noxious effluvia, or any impurities from decaying vegetable and animal matter, to which the system has been for a long time exposed. Intermittent fever is the result of the same causes operating more gradually, that is, in less force, and for a longer time. The periodicity of the paroxysms must be referred in part to organic laws and in part to constitutional peculiarites. This view of remittent and intermittent fevers is confirmed by the fact that enlargements and indications of the large glandular structures, the liver, spleen, and pancreas, are most frequent in those who have been the subjects of protracted agues. Symptomatic fevers are merely states of constitutional irritation from local causes, generally chronic topical inflammation. Thus hectic fever is a general febrile distm-bance from tubercles or ulceration of the lungs. Puerperal fever is a consequence of inflammation ot some one or more of the abdominal or pelvic viscera or appendages, gen- erally peritoneal inflammation afi;er childbirth. Mesenteric fever arises from worms, indigestible food, etc. Milk fever is occasioned by an inflammatory state of the female breast. Eruptivt fevers are characterized by an accompanying rash, effior- esence, eruption, or pustular aflfection of the skin. They are gener- ally contagious, and depend on a specific virus, which works through the blood like a ferment. The precise modus operandi by which this infectious element is first produced cannot be precisely explained; yet the principle or law of its generation and operation is sufficiently ob- vious. Vegetable ferment, called yeast, it is known is produced from decomposition of vegetable matter. This is in reality a rotting process. FEVERS. 77 by which certain proximate principles are decomposed and so rear- ranged as to constitute an entirely new product. The new product, of course, holds an unphysiological scale of chemical affinities in rela- tion to the constituents of tht healthy fluids, and hence when brought into contact with those fluids, another set of chemical actions, decom- positions, and recombinations takes place, by which some element is changed, modified, or destroyed. We know, too, that when animal secretions or excretions are in a certain decomposing state, which is exactly analogous to vegetable fer- mentation, they will, by being brought into contact with the blood of a healthy person, produce more or less of a similar change or decom- position in its elements. Poisoning from dissection is a familiar illus- tration. Personal filthiness, combined with foul and unclean food, will develop an infectious matter and disease the sti'uctures, and by contact, communicate a similar morbid action to another in compara- tive health, as the horrible story of prostitution in cities can tell. We can then easily understand the law which develops infection of all kinds, if we cannot detect its chemical nature ; and for all practical purposes, a knowledge of the law is sufficient. All large collections of rotting or decaying vegetable and animjd sub- stances engender the poisonous ferment of contagious and other fevers ; and if we look over the whole surface of the globe, we can easily find sources enough to account for all the infection, whose re- sults are manifested in putrid, malignant, and contagious fevers, dys- entery, cholera, etc. Theusands of human bodies, and the carcasses of beasts, lie rotting on the battle-fields of this blood-stained earth, from which currents of deadly virus are borne by the winds to infect the breath and blood of people at a distance of hundreds and thousands of miles ; the graveyards and cesspools of all large cities are constantly sending forth streams of death in all directions ; and hardly a country place can be found where there are not local sources of this deadly ferment in the shape of hog-pens, distilleries, slaughter-houses, etc. And when the infectious ferment is once produced, it has the power of propagating itself whenever it can find congenial elements in the fluids of our bodies, our only defense being vigorous functions and pure bbod — good health. Rationale of Fever. — The living organism is endowed with the inherent power of self-preservation. Each organ or part, to a certain extent, resists all morbific influences, and expels all morbific materials from the body through the various excretories. If the causes of dis- ease — all of which may be suaiJied up under the heads of impure or 78 PATHOLOGY AN!/ THERAPEUTICS. obstructing materials, and exhausted nervous power — diminish the dep- urating power of the skin, the liver, bowels, kidne^-s, and lungs, in- crease their labors to keep the body pure. If the liver becomes clog- ged up, the lungs, skin, bowels, and kidneys undertake the office of the impaired organ. If the kidneys are impaired functionalh% the skin, lungs, etc., have an augmented duty. But the causes of disease often operate and increase sc gradually that all the excretory functions are impaired. Hence the effort to relieve the system must be gen- eral — universal commotion takes place. Some organs were originally stronger than others ; some have been more injured than others by bad habits or previous diseases ; hence the stniggle will not be equally balanced. Though all the vital energies co-operate in the " effoit of nature," they will act with in-egular and unequal energy. The whole vital machinery is thrown into disorder. There is a fever. The kind of fever depends on the circumstances already adverted to. But alternate action and repose is a general, universal law of the animal economy. After the organism has prepared itself for the rem- edifd and expulsive effort (the cold stage), the vital instincts (vis medi- calrix natum) direct their whole energies to the surface (the reactive or hot stage), as the best channel of purification. At length fatigue ensues, and repose must and will be had. The heat abates, the heart's action becomes milder, the turgescence subsides, and the collapse, or sweating stage, concludes the pai'oxysm. If the morbific causes were slight in intensity, and the morbid ma- terial small in quantity, the single struggle may have sufficed to set the vital "house in order." Then the paroxysm VviU not be renewed. Othenvise it will be repeated again and again, until "victory or death" results. If this view of fever is right, the drug-system of treatment must be ^vl•ong. Instead of "aiding and assisting nature," it tends to smother her efforts, and adds still other extraneous agents for the vital powers to contend against. But it may be asked, by way of objection to the treatment I shall advocate : Why, then, if the paroxysm of fever is a remedial effoit, do you disturb this effoit with your cold, or tepid, or hot-water pro- cesses ? Why cool the hot stage of a fever with cold bathing, and object to cooling it by cold bleeding and cold ditigging ? I answer : The organic instincts are true to nature : they are infallible in the matter of mere existence. But they are not intelligent ; they ai'e not reasoning entities. It the stomach is attacked with a poison, say a " blue pill" or a glass of grog, it will be true to itself, and yet be sat- isfied to pass the offending agents off to the liver or the skin. If the FEVERS. 79 bowels are attacked with a portion of epsom salts, or a dose of " No. 6," they will either pass it off rapidly, or, failing in that, pour out se- rum to defend themselves. If the circulating fluids are charged with animal oils, the capillary vessels will deposit it in the cellular tissues. All these particular functions act also for the general good ; but while each and every function participates in a general way in the preserva- tion of the w^iole domain of life, each organ has its own special law of self-preservation. Hence when all the organs are struggling to re- lieve themselves, disorder, and riot, and excess may result. And here right reason may come to the aid of instinct by supplying favorable conditions, as perverted judgment has brought the ti'ouble about by forcing unnatural conditions upon the organism. By all those means which help those efforts of nature to maintain or obtain the circum- stances which constitute the normal state, without calling out a further expenditure of vital power, nor adding still other morbific agents, nor chemically ;j?juring the 'sti'uctures, we may truly practice "the heal- ing art." Crisis of Fever. — Since the days of Hippocrates, the opinion has prevailed that fevers naturally, if left to themselves, evince a tendency to run a certain course, and terminate in a given time by a sudden ag- gravation of the symptoms, called sinking, or a complete subsidence of them, and the commencement of convalescence. This change has been called the crisis, and the days on which it occurs, critical days. The 3, 5, 7, 9, 11, 14, 17, and 20, have been regarded as critical days. Because of this tendency, many drug-authors are opposed to all at- tempts to break up the disease or shorten its course. Their plan is to conduct it through its course ; but how do they propose to conduct it through its course ? Why, by poisoning the body through and through, with course after course of drugs! There is nothing known to civili- zation more thoroughly barbarian than the drug-treatment of a fever. The subject of crises in acute diseases is of no practical consequence v/hatever. Under water- treatment, the only crisis observable is the cure. Crises proper, under hydropathic management, are known only in chronic diseases, and in these neither crises nor cures are scarcely' known in allopathic practice. Duration of Fever. — The ordinary duration of inflammatory fe ver is from one to two weeks ; the nervous form of typhus, from four t'" R'x, or even eight weeks ; the putrid form from two lo three w^eeks; remittent fever from two to four weeks, when treated according to the popular system. Intermitting fever is often -'broken" in a few days, 80 PATHOLOGF AND THERAPEUTICS. but seldom cured, and generally reoccurs at uncertain intervals for months or years. E})liemeral fever is frequently converted, by one unfortunate dose, or a severe bleeding, into a protracted fever which runs several days or weeks. Under water-treatment it is very rare for any fevers, except the eruptive, to hold out over a week ; and in erup- tive diseases, whose febrile excitement usually continues from seven to eleven days, the violence of the disease is generally entii*ely subdued within one week. I have never yet personally known a fever run over a week under water-treatment, and I have treated all the common forms in New York city for the last seven or eight years — ephem- eral, inflammatory, typhus, ship, scarlet, measles, small-pox, etc. General Treatment of Fever — The indications are : 1. To equalize the circulation. 2. To purify the body. Practically these distinctions may be more nice than wise ; for all the means best calcu- lated to fulfill one indication are also the best adapted to the other. Bathing. — Nothing in the way of medication is more beautifully sim- ple and promptly successful than the hydropa,thic management of a fe- ver. The temperature of the body is the sure and invariable guide for the water processes. If the whole surface of the body is hot, cold wa- ier is to be applied by frequent ablutions, or the rubbing wet sheet, or the wet-sheet pack, and often repeated until the temperature is re- duced to the natural standard. The pack is the most pleasant and most eftectal process, and its soothing and tniuquilizing effects upon the whole nervous system far exceed all the opiates in the world. If the temperature rises again, the processes are to be repeated in the same manner. If the feet are cold, they should be held in hot water a few minutes, or a bottle of hot water may be applied to them. Es- pecial attention must be given to warming the feet in all cases where the head is oppressed and the lower extremities are inclined to be cold. In what are called low or nervous fevers, there is often great heat and irritation of the head, and great torpor, coldness, or numbness of the lower limbs. In these cases it is indispensable to balance the circula- tion by cold applications to the head and hot to the feet before resort- ing to tlie wet sheet. In very low fevers, and in all cases attended with extreme prostration and unequal temperatm^e at the outset, fre- quently sponging the body with tepid water, is better than the wet- sheet pack, or very cold ablutions, for the reason that the shock of the latter tends still more to disturb the equilibrium of the circulation. Local pains, spasms, etc., are to be relieved by cold applications or warm fomentations, jis either feels most gi-atefVil. As a general rule, cold compresses are most beneficial \Ahen there is constant heat, tender- FEVERS. 81 ness, and distention ; and warm applications are indicated when the disti-ess is periodic or spasmodic, or when unattended with heat, tur- gescence, or soreness. Severe headache may be generally relieved by cold wet cloths, and always readily subdued by pouring cold water over the temples and back part of the head for several minutes. This pro- 1 cess will also generally relieve the severest retching, nausea, and vomiting. I have never tried the process of immersion in treating fevers, but have every confidence that it would prove eminently efficacious in all high fevers — fevers attended with uniform and general heat of the sur- face, and a strca^, hard pulse. There is now living in a secluded town in Missouri an old farmer, who has practiced Water-Cure even longer than Priessnitz. A com- munication from him, addressed to the publishers of the Water-Cure Journal, will occupy two or three pages with as valuable matter as 1 could select from any source whatever ; and, notwithstanding the au- thor modestly desires to have some other name take the credit of giv- ing his experience to the world, 1 shall take the liberty to record hia name, and present his letter in his own farmer-like and unaffected sim- plicity of style and language : " East Prairie, Mississippi Co., Mo., JVbu. 30, 1850 "Messrs. Fowlers and Wells:* "I am a farmer, in my seventy-fifth year. I have t;iken your Jour nal since January last, and have taken Wilson &c Co.'s little Dispatch for two or three years, and have always sent to him for any books he advertised on the subject of the Water-Cure, with the request that he would send me the best and plainest he could procure. I think I have seven or eight of them, but in .'lone of your Journals, nor in them, do I see where fevei's have been treated with the success that I have treat ed them with for more than thirty years, and I have never failed in & single case to make a perfect cure in a few minutes. Strange as this may seem, it is nevertheless a fact, and this is the reason why I trouble you with these lines. I have no -nterest in deceiving you or any other person ; and as for having my name published in your Journal as a gi"eat Water-Cure doctor, I wish you not to publish this, but give it to some person of your acquaintance in w^hom you have confidence, who will give it a fair trial, or to several, and if 'it succeeds, as I know it will, publish the fact in any person's name you please except mine. " I have treated all fevers, fever and ague, etc., alike. My plan is simply to bathe at the time the fever is the highest; if the fever hag passed its highest point, and is g.^ing oflf, I let the patient alone until it 82 PATHOLOGY AND THERAPEUTICS. returns. I know nothing of wet sheets, bandages, etc. ; but when the fever returns, or gets as high as I think it will go, I put the patient in a hogshead that I keep for bathing. I have him go entirely under wa- ter, head and all, for thi-ee or four tini'^s, keeping his head under each time as long as he can conveniently hold his breath ; then let him dab- ble in it up to the chin until the heat is reduced to the natural temper- ature, and the patient feels comfortable ; then let him come out and wipe dry with towels, put his clothes on, walk about, lie down, or do as hi^ inclination leads ; eat what he will, drink w^hat he pleases ; as for rubbing, I do nothing of the kind. I pay no attention to the temper- ature of the water, the object being to bring the patient to the naturd heat, and this can be done in fifteen or twenty minutes. "When I have no convenience for bathing, and, in fact, sometimes, as a matter of preference, I pour water on the patient's head, instead of bathing; and, surprising as it may seem, this always has the same effect that bathing has, and I do not know that it takes longer to cool the body in this way than it does by bathing. I have the patient lie with the head over the' edge or side of the bed, so that the water will not wet the bedding. I then get a bucket of the coldest water, place it under the head, and pour the water over the back of the head from one temple to the other, the patient lying with the face down- ward. I pour it on moderately, and at the height of the fever ; I think it will have little effect if done at any other time. Pouring water on the head in this way will cool the whole body nearly or quite as soon as going all under water, as before directed. If the water is not poured on long enough at first, the fever will return in a few minutes, but re- peat the pouring then as at first. I have known the fever return twice before it was finally driven away. " The next day after the treatment the patient is capable of attend- ing to business as usual, and I do not recollect a case in which the pa- tient had another attack the same season. There is one thing I can- not understand — how pouring water on the head should relieve the stomach of bile ; but so it is ; let the fiatient be ever so sick at the Btomach, and incline to vomit ever so much, in two minutes after you begin to pour water on the head, the stomach is relieved, and there is no more of that trouble. As before stated, the cure is completed in a few minutes, and it is a permanent cure, and a cu' e that all persons can perform at home without any inconvenience. The shortest time I have seen noted in any of your books to cure tl e fever and ague is five diiys, and that with your wet sheet, etc. ; I am sure this plan is a great deal easier, and much quicker ; and again, these books give no direc- tions wheB io commence the treatment, which I am certain is a mate- FEVERS. 63 rial point. I am sure if my mode is not employed as directed, cit the height of the fever, it will fail. As stated in the beginning, I am no doctor, neither did I make this discovery myself. I lived forty-two years on the Sciota bottom-land'', in Sciota county, Ohio, the most no- ted place for bilious complaints pe-haps in the world. A physician who had attended my family, being about to move away, I asked him whom 1 should apply to after he was gone, in case of sickness. He then told me how to apply water in all cases of fever I have now tried it more than thirty years, and have never failed. " The effect the cold bath had on me last spring, in the worst dysen- tery I ever experienced, which I learned from Dr. Show's Water- Cure for the cholera, no person would believe. I could name a great many cases of different kinds of bowel complaints, which have been successfully treated with Water-Cure ; but it is a very smart under- taking for me to write a few" lines, my hand is so unsteady, and I fear it will be a greater task still for you to read them. But I thought it was a duty I owed the community to make known my experience in the treatment of fevers with water, especially as there is considerable stir at this lime about the Water-Cure. But I have found that almost ninety-nine in a hundred have been opposed to the application of cold water in any case whatever. The few who have tried the cure as di- rected, have never failed to get well speedily ; yet, even they would almost always, on the next attack, apply to a drug-doctor. In the cases of small children, I have induced their mothers to hold them in a buck- et or tub of water, and wet their heads continually for five minutes. I have never known this fail to cure the chills and fever ; let it be done also when the fever is at the highest. "I am respectfully yours, etc., "Abraham Millar." Since I have been in possession of the old farmer's experience, I have employed the pouring head bath more freely than ever be- fore, and never without decided benefit. I deem it a valuable aux- iliary to the wet sheet in all high fevers ; in low fevers it cannot be as promptly successful, yet may be very serviceable ; but care must be taken to keep the lower extremities warm, lest its application should produce reaction toward the brain. It will not, of course, cure pro- tracted agues which are complicated with enlargement of the liver or spleen, but may in those cases very much shorten the duration of the disease if employed according to Mr. Millar's directions. There is another very simple and very efficacious method of treating an ordinaiy fever, which has the advantage of always being convenient 84 PATHOLOGY AND THERAPEUTICS. and may, fcr this reasou, be preferred by those who do not well un- derstand the management of the wet sheet, or who have not convex nieuces for the immersion or plunge-bath. Place the patient in a hip- bath — a common wash-tub — and two pails of water will answer ; let the water be of a moderate temperature, 65° to 75°, and wash him all over the back and chest while in the tub ; apply, also, several folds of linen to the head, wet in cold water, and changed very often until the head becomes cool, and if there is the least tendency to coldness of the feet — as there will be if there is great determination to the head — put them in a pail of warm water. The patient may remain in the bath five, ten, or fifteen minutes, if his strength permits. This process may be repeated as often as theie is an exaggeration of the hot stage of the febrile paroxysm. When the patient is too weak to sit in the tub, the head and feet maybe treated as just recommended, and the whole surface of the body frequently sponged with tepid water while the hot stage continues. There are some cases of low nervous fevers wherein the heat is very unequally developed — the pulse very small and weak, the head oppressed or giddy, with great tendency to faint on slight exertion. In these cases reaction is so feeble that the full pack, so far from soothing the patient, increases the internal congestions, rigors, and local pains. Here the proper plan of treatment is to soak the feet occasionally in warm water, applying very cold compresses to the head at the same time ; apply cold wet towels to the stomach, bowels, and back when- ever there is continuous heat and tenderness about those parts, and sponge the whole surface of the body over with tepid water frequently whenever there is general and uniform heat and dryness. Continue this plan until the fever is gradually and finally abated. Water-drinking. — Water should always he taken freely when there is thirst ; and when the heat and dryness of the surface is great, and the tongue parched, it should be taken as copiously as the stomach will bear without unpleasant distention, even though there be no distinct sensation of thirst. In this case it should be taken frequently, but in small quantities at a time. The Excretions. — When the bowels are not entirely free, they should be moved bj'^ one or more tepid injections. This may be done either be- fore or after the cooling processes have been employed. Subsequent- ly injections are only required whenever a sense of fullness, hardness, distention, etc., of the abdomen indicate an accumulation of foecal mat- ters, whether this condition occurs daily, or only once in two or three days. Indian or wheat-meal gruel promotes the action of the bowels, and for this purpose they may be taken to advantage when the consti- F E V E H S. 8& miion is considerable. Emetics are rarely necessary ; I never pre- scribe them, except there is evidence of crude ingesta recently taken into the stomach. In this case the patient should drink warm vs^ater until vomiting occurs, or relief is obtained without. Copious warm wa- ter-drinking will often relieve nausea and distress from offensive acids. acrid bile, or irritating secretions in the stomach and duodenum, even though it does not produce sickness or vomiting. Regimen. — Of the importance of free ventilation, perfect cleanli- ness about the room, frequent changing of the bedding, and the prompt removal of all offensive dejections or excretions, I hardly need speak. Common sense ought to be a sufficient guide in this respect. But there is general error committed by physicians and nurses, in the manage- ment of a fever, to which I wish to call especial attention. While all admit the free access of air, many are inclined to shut out the light. This error is more prevalent, according to my observation, in the country than in the city. The patient is often kept in a room so darkly shaded that there is an uncomfortable feeling of dampness or chilliness within, especially when the room is opposite the sun side of the house, or the house thickly surrounded with trees and shrubbery. The influence of light is not only vivifying to the patient, but it tends, also, to decompose and dissipate putrescent or infectious particles which gather in the sick room. There may be cases where the eyes are so excessively irri- table and tender to light that it is necessary to shade them, but tliis should be done by a green vail or other eye-shade, while a good de- gree of light is admitted into the room. These remarks apply, of course, to natural or daylight, not artificial or lamp-light. In relation to food and drink, the rule of practice is not difficult to memorize. The patient should drink at all times to the full satisfac- tion of the sensation of thirst; although, as just observed, when thirst is violent it should be taken frequently in small quantities. Crust-wa- ter, corn-coffee, lemonade, apple tea, etc., are no better than pure water in any case ; but as patients often have a craving for them, and as they are both grateful and harmless, I would never object to them. Food should not be taken at all until the violence of the fever is mate- rially abated, and then very small quantities of the simplest food only should be permitted, as gruel, with a little toasted bi-ead or cracker, boiled rice, mealy potatoes, baked apples, etc. There is not a more mischievous or more irrational error abroad in relation to the treat- ment of fever th5iin the almost universal practice of stuffing the patient continually with stimulating animal slops, under the name of " mild, nourishing diet," beef tea, mutton broth, chick m soup, panada, etc. The fever will always starve out before the patient is injured by absti- 8 86 PATHOLOGT AND THERAPEUTICS. nence, at le'FLAMMATION OF THE LuNGS PnEDMONIA P>'^EUMOMTIS — ' i PERIP^'EUMo^'T — Lung Fever — Pleurisy. — All of these terms have | been employed to designate the same essential disease, which is an \ acute inflammatory condition of some part or all of the substance of the j lungs, or of their surrounding membranes, or of both. Medical authors j apply the term pleurisy to the disease when it primarily attacks the I pleura; and the tevui pneumonia^ i)r j^ncuinonitis, \yh.en the primary j attack appears to be in the parenchyma, or substance of either or both j lungs. The term peripneumonia nolJia, or bastard pneumonia, has been | given to a modification of the disease, attended with a low, typhoid ] fever of the nervous tj'pe, which has sometimes prevailed as an epi- ' deraic. Practicallj', all these distinctions are useless; for whether the ; mflammation first affects the investing membranes or the substance of the lungs, it soon involves both ; and precisely the same treatment ia indicated whether we call it one or the other of these technical names. Syynptoms. — Sometimes the constitutional symptoms appear first, as rigors, flushed, purplish face, injected appearance of the eyes, furred tongue, etc., and sometimes the local symptoms precede ; these are great heat and sense of weight about the chest ; dull, deep-seated, or acute pain ; short and dry cough, with a slight mucous expectoration ; frequent, short, and anxious resj)iration. In a day or two the expecto- ration becomes viscid, and more or less rusty-colored, yellow, or bloody. The pulse is full, strong, and quick, or small, weak, and frequent, as the fever approximates tlie inflammatory or tj'phoid t\-pe. Dr. Shew* VISCERAL INFLAMMATION. llj m his Manual, mentions "no pulse" as among the synr:ptoms, but this is most assuredly a mistake. Teiininations. — This disease terminates by resolution, suppuration, gangrene, effusion, or hemorrhage. Under thorough water-treatment from the outset, it has always, within the scope of my experience and observation, terminated very promptly by resolution. Special Causes. — Extreme vicissitudes of temperature, unequal ex- posure of the body, cold or wet feet, exposure to wet or cold when the body is in a state of exhaustion from sleeplessness or over-exertion, are especially conducive to this disease. Peculiarities of Treatment. — If the general febrile symptoms pre- cede the local, the wet sheet is to be resorted to, and repeated accoi-d- ing to the degree of superficial heat. When the local pain, cough, difficulty of breathing, etc., appear, the chest-wrapper should be con- stantly worn, covered with a dry cloth, and renewed five or six times a day. The shallow tepid-bath, or if this is impracticable, the tepid sltz-bath, should be employed once or twice in twenty-four hours. When the heat is unequally developed, the pulse low, the patient ex- tremely prostrated, and the extremities pale or cold, the warm sitz and foot-bath are serviceable. Free tepid injections are generally advisable; and when the expectoration is painfully sticky and scanty, w^irm water- drinking, to the point of slight nausea, or even moderate vomiting, vf ill afford speedy relief. Inflammation of the Heart — Carditis. — Whether the mus- cular substance of the heart is ever the seat of an inflammatory affec- tion which is capable of distinct recognition, is a disputed point. But inflammation of its investing membranes, though a rare disease, is re- cognized in all standard works ; as 2^^'>'icarditis- -inflammation of the heart-purse, or pericardium; endocarditis — inflammation of the inter- nal membrane which lines the cavities of the heart. For all practical purposes, they may all be considered as simply inflammation of the heart. Symptoms. — With general febrile disturbance there is more or less acute pain under the left nipple, toward the lower extremity of the breast-bone ; this pain radiates toward the left armpit, and sometimes extends downward to the elbow or wrist ; the pain is increased by pressing upward against the diaphragm, and by lying on either side. The pulse may be full, hard, regular, and jarring, or small, rapid, un- equal, and intermitting; there is great difficulty of breathing, an insup portable sense of oppression, frequent sweats, often alternated with very dry and hot skin. The countenance is pa-e, sharp and mai-ked 118 PATHOLOGY AND THERAPEUTICS. with gi'eat anxiety and ten'or: sighing, sobbing, and hiccc.igh are fre- quent, and sometimes delirium, convulsions, or insomnolence attend. Special Causes. — Among the predisposing causes of this affection Hooper mentions, " the male sex, and the age from ten to thirty." If he had said that males between the ages of ten and thirty are most subject to the disease, his talk would have been rational; but to put down such circumstances as causes is flat nonsense. The most com- mon cause of heart diseases is the allopathic treatment, alias mal- treatment of gout and rheumatism, which produces a metastasis of arthritic inflammation from the membranes of the joints to those of the heart. Peculiarities of Treatment. — The hydropathic management is pre- cisely the same as for inflammation of the lungs. Inflammation of the Liver — Hepatitis. — Acute inflammation ■)f the liver is, in this climate, a rare disease ; but is rather frequent in hot countries, especially with those who indulge freely in flesh-eating and spirit-drinking. Symptoms. — Pain in the right side under the short ribs, increased by a full inspiration, or by lying on the left side ; dry, husky cough shortness of breath, shooting pains about the chest, sympathetic pain in the right shoulder, yellow appearance of the white of the eye, and sometimes yellow skin ; the urine is high-colored, and there is either costiveness or diarrhea. Chronic inflammation of the liver — hepatitis chronica of the books — often manifests some degi-ee of most of the symptoms above-mention- ed, but is distinguished by the absence of general fever. Peculiarities of Treatment. — Apply the wet girdle around the upper part of the abdomen, over the seat of the principal pain ; in all other respects manage as in the case of inflamed lungs. The bowels should be thoroughly cleansed in the outset with warm water enemata. Inflammation or the Spleen — Splenitis. — This is an exceed- ingly rare disease. It is known by severe pain in the left side opposite the liver, with a sense of heat and weight, and considerable fullness and tenderness; the pain is increased on pressure. The treatment is the same as for inflamed liver. Inflammation of the Stomach — Gastritis. — Dr. Good distin- guishes acute inflammation of the stomach into two forms, adhesive and erytliematic. In the former variety the fever is high, ^: inflamma* tOry ; in the latter, low, or typhoid. VISCERVL INFLAMMATION. 119 Symptoms. — With general fever there is severe fixed pain and burn- ing heat at the pit of the stomach ; painful deglutition ; the pain is in- creased by pressure over the stomach; frequent vomiting, hiccough, sudden and extreme prostration; hard, wiiy, rapid, and often irregular and intermitting pulse ; intense thirst ; restlessness and anxiety ; tongue red, parched, and of a glay,ed appearance. Frequently the inflamma- tion extends to the bowels, attended with diarrhea and great tenderness of the abdomen, constituting the gas'ro-enteriiis of authors. Special Causes. — In a majority of cases gastritis is the effect of pov,-- erfu! iiritants or chemical poisons taken into the stomach. It is some- times produced by drinking largely of very cold water when the body •is excessively heated by exercise, especially in persons whose stomachs are enervated by spirituous liquors. Unripe fruits, decayed vegetables, and putrid animal food, sometimes excite it. Peculiarities of Treatment. — Apply wet cloths freely to the wholo abdomen, of the teinperature which feels most agreeable and soothing to the patient. Generally quite cold water answers the best. Small quantities of ice or iced-water may be frequently taken. Drink ad lihitum of water of a moderate temperature — 60° to 70^. Tepid in- jections are generally necessary ; when diarrhea attends they may be used cold. The entire wet sheet envelopment should be employed two or three times a day "when the febrile heat is general and excessive. Inflammation of the B'owels — Enteritis. — This disease, like gastritis, is divided into the adhesive and erythematic varieties, by Dr. Good. The former variety is attended with obstinate constipation ; the latter with diarrhea. Symptoms. — With more or less of general fever there is acute pain in some part of the abdomen, gradually extending over the whole ; the pain is increased by pressure, and accompanied with tension and swell- ing. The patient lies on the back with the knees drawn up, and can scarcely suffer the weight of the bed-clothes. The bowels are usually obstinately constipated, but sometimes diarrhea attends ; and there is co.^stant nausea, ard more or less vomiting of bilious and sometimes of highly offensive foecal matter. The pulse is frequent, hard, and con- tracted. Special Causes. — Long-retained and hardened foeces ; constipating ibod ; iiTitant poisons ; impure aliments. Diagnosis. — Enteritis is distinguished from colic by the presence of fever. In colic the pain is diminished by pressure. Peculiarities of Treatment. — The constipated state of the bowels requires the free employment of copious tepid injections; in all othei 120 PATHOLOGY AND THERAPEUTICS. respects the treatment is the same as for gastritis. It is not advisable, however, to resort to the injections until the heat and tenderness of the abdomen has been somewhat reduced by the external applications. When severe diarrhea occurs, the wai*m sitz-bath and cool injections may be occasionally employed to advantage. Inflammation of the Peritoneum — Peritonitis. — Authors dis- tinguish three varieties of acute peritoneal inflammation ; peritonitis jnoj^er, when the lining serous membrane of the abdomen is generally affected ; omentalis, when the omentum is the principal seat of dis- ease ; and mesenterica, when the inflammation aftects principally that portion called the mesentery. Symptoms. — The usual accessory symptoms of general fev^r are eucceeded by a sense of heat and pain in the abdomen, usually confined to one part, but gradually becoming diffused. There is great teuder- uess or soreness of the belly, without inclination to go to stool, and a considerable degree of tension and swelling comes on, which ordinarily increases for several days ; the patient finding most relief when lying motionless on the back, with the knees somewhat elevated. The tongue is not much altered at first ; the pulse is small, weak, and very frequent. This disease frequently attends as a symptom of puerperal fever, which fever is generally the result of bad management during the period of childbirth. Diagnosis. — It is distinguished from colic by the pain being increased on pressure, and frequency of the pulse. It is not so easily distinguish ed from enteritis; but this is of no consequence, as the treatment i& "^ all respects precisely the same. Inflammation of the Kidney — Nephritis. — Symptoms. — Gene- ral fever, pain in the region of the kidney, extending to the groin and along the ureter to the neck of the bladder. The pain is deep-seated, often dull and obscure, but always sncreased by the erect posture, hy coughing or sneezing, or by firm pressure. It is also increased by straightening the leg of the affected side. To avoid this the patient instinctively reclines on the aflfected side, and bends the limb so as to relax the muscles of the gi'oin. There is frequent desire to urinate, with great difficulty or inability^ to expel the contents of the bladder. The urine is generally bk)ody at first. The tongue is white, the pulse is hard and frequent, the bowels are constipated, the abdomen is tym- panitic, with wandering pains, and the patient labors under great de- pression of spirits. Special Causes. — Acrid diuretics, hard water, gravel, violent exer cise of the muscles of the back, hardened foeces in the colon. VISCERAL INFLAMMATION 121 Diagnosis, — It may oe distinguished from lumbago by the pain following the com'se of the m"eter, and by the difficulty of urination. Peculiarities of Treatment. — If the fever is not violent, and the heat of the surface is irregular, the warm hip-bath will alleviate the pain. If the heat of the surface is great and uniform, the cold hip- bath will produce the greatest relief. One or the other should be fre- quently emploj'^ed, with general and topical treatment, as in other 'isceral inflammations. Inflammation of the Bladder — Cystitis. — Idiopathic inflamma- tion of the bladder does not often occur. It does, however, sometimes result from the common causes of inflammation, but is more frequently the consequence of gravel, stone, long retention of urine, maltreated gonorrhea, and such drug-irritants as cantharides, ardent spirits, tur- pentine, and various essences and balsams. Symjptoms. — General fever ; acute pain, swelling, and tension in the region of the bladder ; pain and soreness increased by pressure above the pubes, or in the perineum ; vomiting ; tenesmus ; frequent mic- turition, with great difficulty in discharging the urine ; heat and smart ing in the urethra; great general irritation, restlessness, and anxiety. Peculiarities of Treatmeiit. — On account of the structure of the urethral passage, the warm hip-bath should be at first employed for half an hour, or until sensible relief is experienced. This should be succeeded by the cold compress, which should be worn constantly and very frequently renewed, occasionally alternating with the warm hip- bath. The febrile symptoms are to be trea.ted with the wet-sheet pack, followed by the dripping sheet or tepid half bath, as often and whenever they are indicated by the general heat. The vomiting may be relieved by warm water-drinking, followed by sips of cold water or bits of ice. The tenesmus requires copious injections of warm water, followed, after the bowels have acted freely, by the injection of as much cold water as the bowels can conveniently receive. The warm foot-bath is useful when there is the least tendency to cold extremities. Inflammation of the Uterus — Hysteritis — Metritis. — This disease has been divided into two varieties — simple, when occurring in the unimpregnated organ ; and puerperal, when attacking the womb soon after delivery. Symptoms. — Nearly every symptom characterizing inflammation of the bladder attends also inflammation of the uterus ; in the disease un- der consideration there are the additional symptoms of pain extending with great severity to the loins, and shooting down the thiglis, and ao Il-r 122 PATHOLOGY ANE THERAPEUTICS. increase of pain in the hypogastric region on the patient's making a deep inspiration. There is also a sense of weight and bearing down, with a frequent, small, and wiry pulse. Special Causes. — Suppressed mensti'uation, exti'aordinary mental emotion, astringent or irritating injections. Peculiarities of Treatment. — The ti'eatment for the preceding dis- ease is equally applicable to this. Inflammation of the Testes — Orchitis. — This affection is read- ily known by the pain, heat, redness, and swelling of the pait affected ; it is attended with more or less general fever. It only requires the constant application of water, either by compresses or the hip-bath, of such temperature as is most soothing to tiie pain ; and the wet-sheet pack or tepid full-bath, according to the degree of general heat. CHAPTER III. ARTHRITIS. Arthritic inflammation comprehends the various forms of gout and rheumatism. The peculiarity of this kind of inflammation consists in its being confined mainly to the fibrous tissues — the muscles, and struc- tures around the joints. Its character is also eiTatic, often shifting its seat of morbid action from shght causes. The diseases included under the present head may be gi'ouped as in the following arrangement : Gout. Regular, Atonic, Re cedent, Misplaced. Rheumatism. < Inflammatory, Articular, Lumbago, Sciatica, Muscular, Chronic. Gout — Podagra. — Dr. Good tells «s (Study of Medicine) "that the predisposing cause of a gouty diathesis, when it first forms itself in an individual, is plethora, or the state of the system produced by full living and indolence." Strangely inconsistent with this remark the same author observes: "There is no disease to which the human frame is subject that has lei to such a variety of opinions both in the- AETHRITIS. 128 ory and practice, many of them directly contradictory to each othei", as the gout ; and I may add, there is no disease concerning the nature and treatment of which physicians are so little agi'eed." Nothing can be more conclusive of the absurdity of the whole philosophy of the popular system, and the empiricism of its whole practice, than this general agreement about the producing cause of a disease, and this general d4sagreement about its nature and treatment ! Symptoms. — Regular gout is characterized by a violent inflamma- tion and swelling of the joints, enduring for several days, and grad- ually subsiding with itching and desquamation of the cuticle. It usually comes on an hour or two after midnight, with excruciating pain in the joints of the great toe, which grows worse as the day advances, grad- ually ceasing toward evening, to return with more or less violence the next morning ; and so on for several days. The attack is preceded b}- various symptoms of digestive derangement, and with coldness, numb- ness, and cramps of the extremities. The atofiic or disguised form is attended with greater general debility and worse dyspeptic symptoms, while the aflection of the joints is but slightly painful and inflammator}'. The local affection often alternates with the symptoms of indigestion, when pain in the stomach, nausea, vomiting, eructations, etc., occur, and the patient is dejected and hypochondriac. Cramps in the trunk and extremities are common, and there may be either obstinate cos- tiveness or diarrhea. Sometimes the affection of the joints alternates with a disturbance of the viscera of the chest, producing palpitation, syncope, or asthma ; at other times with the head, which is affected with vertigo, cephalalgia, and sometimes even with palsy or apoplexy The recedent or retrograde form is marked by a sudden subsidence of the inflammatory state of the joints, succeeded immediately by an af- fection of some internal part, where is thenceforth the seat of the morbid manifestations. The head, heart, or lungs may be affected, producing the results named in the preceding remark. The mis- jplaced variety is denoted by an inflammatory affection of some inter- nal part or organ in a gouty diathesis, whether preceded or not by an inflammatory affection of the smaller joints, which, however, always very soon disappears. Diagnosis. — Gout may be distinguished from rheumatism by its commencement in the small instead of the large joints ; also by the peculiar manner of attack. When the gouty diathesis is strongly mark- ed, the joints of the toes, and sometimes those of the fingers, are per • manently enlarged and disfigured. Causes. — The gout is emphatically tlie disease of the gourmand and the epicure. Wherever this diathesis prevails, there has nature 124 PaTHOLOGF and THE a APEU TIC S. stamped, ia painfully legible characters, the penalty- of riotous living. A vegetable-eater and water-drinker has never, probably, been afflicted \vith any "joint-racking rheums" like unto this malady, since the cre- ation, unless inherited. It is said, indeed, not to be exclusively confined to " high life," as it is occasionally known among the poor and laboring classes. No doubt the indigent and hard-working can eat and drink iu such a way as to produce it. Yet we know this is very uncommon ; and we must regai-d the disease as, in a general sense, the legitiraato fruit of fashionable yet unnatural luxury. Flesh and wine represent the nature of its predisposing causes. The free indulgence in animal food of any sort, and the free use of fermented liquors of any kind, aiJ« among its prominent causes ; and when to these are added con- centrated and constipating fo^d, with sedentary or indolent habits, we have the general condition which produces the gouty diathesis in its greatest intensity. The diathesis sometimes exists in those who eat intemperately and drink temperately, or vice versa. In gouty subjects, the functions of alimentation so frequently overact those of elimination, that the surplus materials obstruct the capillaries, and the retained morbific matters so change the secoruent action, that chnlky concretions are formed in and around the cavities of the joints, iu the ligaments, tendons, and membranes, in the little mucous bags — hurscE 7nucosa — which surround the joints, in the cellular substance, and even iu the pores of the skin. The joints of the fingers and toes, more especially the latter, are fiequently enlarged, hai"d, and tender, ocCfisionally ulcei'ate, and sometimes form fistulous openings, through which oozes a whitish earthy matter, consisting mainly of urate of soda. Treatment, — The indications are : 1. To relieve the paroxysm. 2. To prevent its return. These mean, in other words, to mitigate the pain, and restore general health. Cold or very cold wet cloths should be constantly applied to the affected parts until the pain subsides ; or the feet or hands, when inflamed, may be held in cold water until the preternatural heat is subdued. There is no danger whatever of pro- ducing metastases to the internal organs — as bleeding, blistering, drastic purging, etc., do produce — by the application of cold water io the in- flamed joints, provided the application is not continued beyond the point of reducing the temperature to the natural standard. The gen- eral feverishness attending the paroxysm requires the wet-sheet pack, so managed as to produce moderate perspiration, followed by the shal- low tepid-bath. Water-drinking should be as copious as the stomach can bear without painful distension, and the diet should be of the "hunger-cure" kind. To overcome the gouty diathesis requu'es a systematic employment ARTHRITIS. 125 of the water processes, with the sti-ictest general regimen. A daily- pack for an hour, followed by a plunge, dripping sheet, or half-bath, a daily tepid shallow-bath for ten minutes, with the pail douche over the shouldei's, a daily hip-bath at about 65° for fifteen minutes, a daily foot-bath at about the same temperature for ten minutes, constitute the average number and strength of the bathing part of the regular ti-eat- ment. In addition to all this, the douche may be applied to the affected part with as much force as can be borne without much pain, and mod- erately along the spine, two or three times a week. With these pro- cesses the patient should exercise all that his strength will admit of, short of absolute exhaustion, and drink all the water the stomach can endure without pain. The diet must be plain and unconcentrated, consisting mainly of vegetables, ripe fruits, and unbolted farinaceous preparations. Nearly all medical authors agree that gouty subjects ought to be put upon an abstemious vegetable diet. Even many writers who insist that man is naturally omnivorous, and cannot subsist on an exclusively vegetable diet, seem to forget their darling theory, and prescribe for this disease what they specially interdict in almost every other. The bathing part of the treatment may be managed in various ways, according to convenience, with equal efficacy. The following plan, with such modifications as circumstances will naturally suggest, is adapted to all ordinary cases : In summer, a plunge-bath on rising in the morning, followed by a long walk; at ten a.m., the pack and douche ; at four to five p.m., half-bath and pail douche; at half-past eight p.m., sitz-bath. A foot-bath may be taken at either nine a.m., five to six P.M., or evening, or at ail of those times. In winter, a pack and half- bath in the morning,; douche at ten a.m.; half-bath at four to five p.m.; sitz in the evening ; foot-haths as above. Gouty patients who have been drugged extensively, their nerves enfeebled and their constitutions shattered with opium, colchicum, veratrum, elaterium, antimony, etc., must be managed w4th more care and tenderness. They will not bear as cold nor as vigorous treatment. For such, the pack and dripping sheet, the tepid shallow-bath, and oc- casionally, when they become unusually tender and irritable, the full warm-bath, followed by the tepid pail-douche, are the best leading water appliances. Ciises in Gout. — While under ti'eatment, gouty patients are liable to critical disturbances in the form of boils, diarrhea, and particularly to a general feverishness, during which all the affected parts, and sometimes the whole body, becomes highly and suddenly inflammatory and painful. The full warm-bath, or the moderately hot bath, is usefuJ 126 PATHOLOGY AND THEK APE UTICS. once or twice during the latter form of critical distui'bance, which usually lasts several days. Diarrhea, if severe, requires the warm sitz-bath and cool injections ; boils need nothing but wet compresses. Whenever the crisis is sev( re, all active treatment should be suspended; wet cloths, or cold water in any convenient way, may, however, be applied to swelled and pamful parts during the crisis the same as at other times Rhkumatism. — Like gout, rheumatic affections are almost invariably connected with derangements of the digestive apparatus, and generally preceded by unusual disturbance in the functions of the primary nutri- tive organs. Some authors, indeed, maintain that gout and rheumatism are convertible maladies, often blending together, or running into each other, in their varied local manifestations. In fact, rheumatism might very well be defined as gout of the larger joints ; while the stiffness, lameness, and rigidity of the muscles, and the thickening and swelling of the structures in and around the joints, are about as common to either manifestation of the arthritic diathesis. Symptoms. — Injiammaiory rheumatism presents all the essential sj-mptems of inflammatory fever, or synochus, with the addition of ex- treme soreness and tenderness over the whole surface of the body, and also acute pain in some one or more of the larger joints, or in the small of the back, rendering all motion of the body and limbs extremely diffi- cult and painful The patient is often unable to get on or off the bed without assistance, and then the effort is attended with gi-eat suffering. The articular variety has been called rheumatic fever, or acute rheu- matism. It differs from the former in being attended with much less general pain and soreness, and a much greater inflammatory action and swelling of some one or more of the large joints and surrounding muscles, generally the hip, knee, elbow, or shoulder. Lumbago is the variety in which the pain is felt chiefly in the loins, usually shooting upward. In the form called sciatica, or coxalgia, the pain is felt mostly in the hip-joint, the disease also being attended with an emaciation of the nates or buttock of the affected side, or an elongation of the limb. In the variety called muscular, the pain is experienced mainly in the muscles of the diaphragm, or in the intercostal muscles between the ribs, when the pain is gi-eatly increased by a full inspiration. This form has been called plcurodyne, pleuralgia, and sjyurious jjleurisy by authors; and not unfrequently mistaken for real pleurisy, and the patient bled, leeched, and blistered not a little to his disadvantage. CJironie rheumatism is characterized by pain, rigidity, and weakness of the lai'ger joints and surrounding muscles, acco*upanied with no regular ARTHRITIS. 127 fever, and but slight occasional febrile paroxysms, and with very little perceptible swelling. This form of rheumatism is almost always re- lieved temporarily by warmth, hot applications, stimulating liniments, etc., while all the other forms are frequently aggravated by them. The fever attending rheumatic attacks is peculiarly accompanied with frequent and irregular sweats, which, however, do not prove iu any sense critical, nor exert anj'' marked influence upon the course of the disease. Causes. — Unusual exposures to wet and cold while the body is in a state of exhaustion or obstruction, seem to be the general producing causes of all forms of rheumatic affections. Treatment. — The proper management of the first, or inflammatory variety, is alm.ost identical with that of inflammatory fever. In some cases where the joint or joints most affected nre so tender that the least motion produces excruciating pain, a combination of relaxant and cooling processes will give prompt relief, as the warm fomentation, or warm douche, followed by the coldest wet cloths or pounded ice. The articular form requires a less vigorous application of the wet sheet, or other general cold treatment, but a more persevering application of cold compresses to the affected joints. Lumbago and sciatica, and that form called musculai', in addition to moderate general treatment, are relieved with the greatest facility by the hot fomentation to the parts affbcted with pain, stiflness, and rigidity, followed by the cold covered compress, or, what is better still, the warm douche followed by the cold, the tem- perature and force of the stream to be regulated in some degree by the patient's feelings. Chronic rheumatism, in whatever form mani- fested, requires the same general management as gout, the leading curative indicati-on being to restore the general health. As constipation is an almost universal concomitant or antecedent circumstance, especial attention must be given to the state of the bowels, which should be kept free by means of injections, and an opening, plain diet. So long as the mercurial mania rages among the medical gentlemen of the allopathic school, so long will the hydropathic phyician be continually called upon to treat manj'- anomalous varieties of chronic rheumatism, made such by the mercury with which the patient has been dosed in the treatment of some acute disease. Such patients are peculiarly sensitive to vicissitudes of weather, and do not bear as cold treatment as those whose systems have never been mercurialized. The wet-sheet pack, followed by the tepid half-bath, once a day, the tepid half-bath followed by the pail douche, and the occasional employ- ment of the warm-bath, followed by the pail douche or shower, consti- oite the best general plan of managing mercurial rheumatism. Some- 128 PATHOLOGY AND THERAPEUTICS. times the ti-eatment will set the remains of the mineral, which has long lain dormant, as it were, in the system, in motion, and reproduce sali- vation, spongy gums, fetid breath, metallic taste, or other evidences of mercurial action. During this mercurial excitement, no very active cold treatment should be employed. The tepid sponge-bath, or half- bath, with such local applications as the local pains demand, the temper- ature being such as feeis most agreeable to the part affected, may h« employed until the manifestations of movcurial action subside, when the regular ti-eatment may be resumed. When the whole surface becomes extremely susceptible and sore, the hot-bath, followed by the tepid wash or pail douche, should be employed. The general regimen applicable to gout is equally so to rheumatism. CHAPTER IV. INDIGESTION. Wherkver the refinements of civilization and the luxury of plen- teousness exist, dyspepsia, in some of its protean shapes, seems to be the general condition of the inhabitants. I do not agree with Dr. E. John- son (Results of Ilydrojjathy) that "constipation is not a disease of the bowels ;" nor do I coincide in his notion that mental excitement is the sole cause of indigestion. I admit, however, it is one among several very efficient causes of that extensive train of morbid maladies which we call dyspepsia. Nosologists have enumerated more than one hundred distinct dis- eases, to which they have assigned specific characters, and which they have scattered through various and dissimilar genera, orders, and class- es ; yet each is nothing but a mere circumstance of deficient or imper- fect performance of the digestive function. Thus Dr. Good, in his elaborate system of pathology, ejevates such symptoms of digestive derangement as heartburn, water-brash, flatulence, depraved appetite, colic, constipation, teething, etc., to the rank of idiopathic maladies. I shall undertake to associate ail these manifestations of one general morbid condition into a more natural arrangement, and treat of them in the present chapter. The propriety of thus gi'ouping together several classes of diseases which have been usually considered not only as idio- pathically distinctive H:t as demanding: ^^idely different and even oppo- INDIGESTION. 129 site methods of treatment, is enhanced by the fact that they are all really cured by the same general plan of hydropathic medication Diseases of Indigestion. Dyspef.fc'ia ' Morbid Appetite, Morbid Tliirst, Heartburn, Flatulence, Constipation, I Sick Headache, r Chronic Hepatitis, Liver ) Jaundice, Complaint) Gall-Stones, t Duodenitis. r Toothache, Misdentition-I Tartar of the Teeth, l Excrescent Gums. Iliac Passion, Painter's Colic, Wind Colic, Surfeit, Constipated Colic, I Constrictive Colic. ( Bilious, 1 Flatulent, Spasmodic, Infantum. r Feculent, Bilious, j Mucous, Diarrhea <;^^ij.y_ Serous, Intestinal Colic < . Tubula" j-Bezoar, I Calculus, Concretions I g^y^^^j^^,_ /-Alvine Worms, Worms t. — A morbid condition of the liver is as constant and as necessary a concomitant of indigestion as is a morbid condition of the stomach. In some forms of deranged digestion the stomach and bowels appear to be the seat of the more prominent morbid phe- nomena, and in others the liver presents evidences of being dispro- portionately affected. Its pathological conditions are various, but its ftinctional derangements may all be comprehended under the general term of liver complaint. Syjnjjioms. — Chronic hepatitis is a state of passive or chronic inflam- mation of the organ. In addition to a variety of dyspeptic symptoms, there is sense of weight, fullness, or other pain in the region of the liver, which is increased by deep pressure ; sometimes the pain is re- ferred to the left side ; at other times to the right shoulder, or between the shoulder-blades ; there is frequently darting, irregular, and fugitive pains along the breast-bone and through the chest ; some degree of enlargement or hai'doess is usually obvious to the touch under the short ribs of the right side ; the countenance is sallow ; the bowels are costive ; the stools ai'e clay-colored ; the patient is torpid, inactive, and desponding, and there are occasional attacks of jaundice. Dropsy fi-e- quently follows this form of diseased liver. It is also generally attended with a diy, husky cough, and a slight hawking, or spitting of a thick, tenacious mucus, especially in the morning, when the sputa appears dark and cai'bonaceous, as though charcoal-dust had been diffused through it. The cough is immediately caused by the engorged or swelled liver pressing upon the diaphragm, and the viscid secretion of the mouth or throat is owing to the irritation of congested and acrid bile. This cough and expectoration may be distinguished from that which has its seat in the lungs or their appendages, by the sloio puhe^ and the prominent hepatic or dyspeptic symptoms. Jaundice — the icterus of tlye books — has been commonly distinguished into the yeJlaw and black, or green, according to the discoloration of the skin from impacted and partiallj- pmtrescent bile, to which some authors have added the subvar'«>ties of hiliary — p ■^duced by a resorption of INDIGESTION. 133 bile; gall-stone — resulting from obsti-uction of the bile-ducts from in- spissated bile; spasmodic — produced by spasmodic stricture of the bile ducts; hepatic — resulting from schirrus or induration of the liver; in fan tile — occurring in infants ; and black vomit — the regurgitation of morbid bile into the stomach, and its ejection, mixed with dark, gru- mous blood. Jaundice, in a general sense, is known by debility, languor, inactivity, heat and pricking of the skin, bitter, nauseous, or acrid taste in the mouth, yellowness of the conjunctiva of the eye, and subse- quently of the whole surface of the body ; the bowels are irregular, the urine high-colored and yellowish, the pulse is usually slow and weak, the mind is downcast and gloomy, or listless, wandering, and irritable, and there is feverish heat and dryness of the skin. When the disease is proti'acted, the skin turns greenish, brown, livid or lead en, blotches appear in difterent parts, and the discharges from the bowels are dark, pitchy, and bloody. Tlie special or immediate cause of jaundice is torpor or inactivity of the liver, by which the viscid par- ticles which should be secreted in the liver, and passed off in the for?Ti of bile, are left in the blood. The existence of gall-stones is known by the acute and sometimes excruciating pain they occasion when passing through the common bile-duct from the liver into the duodenum; this pain is felt in the epigastrium, extending to the right side and back, and occurs in severe paroxysms, with intervals of comparative ease. The pain suddenly remits when the calculus reaches the intestine. Duodenitis is an inflammatoiy state of the mucous membrane of the duodenum, at the point where the bile enters this portion of the intes- tinal tract ; it is occasioned by the contact of acrid and hritating bile, and known by a sickening, sinking, gnawing sensation just below the pit of the stomach, with tenderness to external pressure, often so gi'eat as to make the weight of the hand or of the bedclothes painful. Treatment. — All that has been said in relation to the treatment of dyspepsia, applies with equal force here. There are, however, some modifications of the general plan of management required in some forms and stages of the disease, or rather group of diseases under con- sideration. The state or condition of liver disease described as chronic hepatitis, in which the bile is still imperfectly secreted, but its quality exceedingly vitiated, requires more especial attention to the stomach and bowels. Wai"m water emetics are serviceable to deterge the biliary ducts, whenever nausea, bitterness in the mouth, and unusual sense of fullness in tl^ right side indicate obstruction ; and if the bowels are costive, with general fullness and tenderness, tepid injections should be 184 PATHOLOGY AND THERAPEUTICS. freely emploj-ed until these symptoms are removed, when cool or cold 'ues should be substituted. Jaundice presents many complicated varieties of morbid phenomena, all of which are usually denominated " nervous debility ;" a term not entirely inappropriate, since the thick viscid blood, consequent on the retained matter of bile, being unable to peneti-ate freely the minute capillary vessels, where nutrition of the nervous, as well as the other structures, is effected, the nei-ves are really impoverished for want of sustenance. In this form of diseased liver, too, the skin is dry and feverish, or clammy and cold, in either case weak, obstructed, and bil- ious, yet bloodless. Reaction, though sometimes active and prompt, is always feeble and ti^ansient ; hence we are to begin the general treat- ment with the gentler processes, employing water of a mild temper- ature, gradually intensifying the force and lowering the temperature of the bnths, as the superficiiil circulation of the patient improves. The half-bath may be commenced at about 85° or 90°, and gradually reduced to 75° or 70°; the sitz may be employed at first at 75°, and by degrees lowered to 60°; the cold sheet half-pack, or entire warm sheet pack, is advisable at fii"st, gradually proceeding to the ordinary wet- sheet envelopment as the skin becomes invigorated. In some case?, where there is considerable tendency to feverishness, the whole body will readily warm up in the wet sheet, and the glow increase for twenty or thirty minutes, when it will begin to decline, in spite of any amount of extra bedding. Such patients should be taken out of the pack as near the height of the reaction as possible, and bottles of hot water should be applied to the feet, and in extreme cases to the armpits also, to enable them to remain still longer enveloped. The dripping rub-sheet is one of the best appliances in cases of extreme torpor and bloodless- ness of the surface, the temperature not being so cold as to leave a permanent chill. It should 6e particu'tirly borne in mind, that no patients in the con- dition of " nervous debility" under consideration, will tolerate extremes of treatment, be they hot or cold. There is not sufficient blood in the superficial capillaries to react against very cold impressions, and for the same reason steam or vapor-bathing, or the ordinary hot-bath, has a peculiarly relaxing and debilitating effect, a vigorous capillary circulation being just as necessary to defend the body against one extreme of tem- perature as another. The existence of gall-stones only requires the hot fomentation and warm sitz-bath, with copious warm water drinking, to facilitate their passage, and mitigate the pain. As duodenitis is caused directly by morbid and acrid bile it will dli INDIGESTION. 135 appear whenever the healthful secretion of the liver is restored. Some- times it disappears when the condition of the liver changes from chronic inflammation to jaundice — from morbid action to no action. Occasion- ally ulceration takes place from the long-continued corrosive effect of putrid bile, resulting in death suddenly and unexpectedly. MiSDENTiTiON. — Teething, tooth-edge, toothlessness, and deformity of the teeth, are placed by Dr. Good in the catalogue of diseases be- longing to the genus before us. Teething, it seems to me, is rather 2 natural than a morbid process ; and, although often accompanied withx much pain and suffering, and various diseases, these are all owing to some obstruction or irritation in the digestive organs, producing a gen- eral feverishness of the system and an inflammatory state of the gums. Tooth-edge is the peculiar tingling or uneasy sensation experienced in the teeth from some kinds of gratino; or jarring noises, or from certain acids and acrid substances. Toothlessness results from constitutional defect, external violence, internal drug-medicines, decay, or old age. Deformity of the teeth is generally an unfortunate inheritance, for which the child is indebted to the bad dietetic or other habits, or infirmities, of one or both parents ; a great degree of deformity, however, may be produced by bad habits in the dietetic and medical management of the child itself. The diseases properly coming under the present head are, toothache, tartarous teeth, and excrescent gums, all specially connected with or dependent on depraved or impaired digestion. The history of all the animal creation, and of the whole human race, shows that there is a most intimate relation between sound, clean, symmetrical teeth and healthy, fine, vigorous gums, and correct dietetic habits. The uni- formly healthy condition of the teeth of wild animals, and the general rotting state of those of domesticated animals illustrates this fact suf- ficiently. The exciting cause of toothache is usually "taking cold." It may exist in connection with caries or ulceration of the teeth, or with eX' treme irritability of the dental neiTe without structural decay. The cure may be found in holding tepid or cool water in the mouth, renew- ing it as often as it becomes quite w^arm, rubbing the fiice and neck with the hands dipped in cold water, the shallow foot-bath, and absolute fasting until the pain abates. Very few toothaches can hold out against a fast of twenty-four hours, even if no other medication is resorted to. Rubbing the teeth and gums smartly with a brush dipped in cold water, even until the gums bleed freely, often relieves toothache promptly. Tartar of the teeth consists :yf concrete saliva hardened by the earthj^ 136 PATHOLOGY VND THERAPEUTICS. materials which it secretes. The remote cause is undoubtedly the excessive amount of earthy oi extraneous ingredients taken into the system with the food and drink, more especially derived from hard wa- ter ; and the immediate cause is deficient mastication, the food being soft and sloppy, and not demanding sufficient exercise of the teeth to keep them clean. In many instances the mouth is most foully disfigured by tartarous concretions which have destroyed the gums and alveolar sockets. The tooth-brush, aided by some mild dentifrice, is the best palliative we can employ. To effect a cure, the teeth must be cleaned by a careful dentist, and then the dietetic habits must be placed under physiological law. Excrescent gums may be either soft, spongy, or fungous, or in the form of firm, unyielding lumps or jiardened knobs ; they are always symptomatic of scurvy, or some disorder of the digestive organs. They can only be cured by attention to the general health. Sometimes the excrescences, when considerably protuberant, have been extirpated with caustic, ligature, or the knife ; but unless general health is re- stored, they will soon grow again. Colic. — All those diseases comprised under the generic head of cholic, or belly-ache, are characterized by griping pain in the bowels, mostly in the region of the umbilicus, and attendea with vomiting and costiveness. ^ Symptoms. — The species called iliac passion is accompanied with painful retraction or drawing in of the navel, and spasms of the muscles of the belly ; the vomiting is exceedingly violent, ejecting bile from the duodenum, and often stercoraceous matter from the bowels; and even some cases the injections inti-oduced into the rectum have been ejected by the mouth. This is the disease called introsusception or in- tuS'Susception in medical books, and so denominated from the circum- stance that one portion of the affected intestine, constringed and les- sened in diameter, has fallen into another. Paintefs colic — known also as Devonshire colic, colica poictou, and colica rachialgia — is so termed from the remote cause being the in- troduction of lead into the system, and hence mostly confined to paint- ers. In the neighborhood of smelting furnaces, pigs, poultiy, and other animals are said to be affected with this complaint. It is evinced by a pain at the pit of the stomach, at first dull and remitting, but grad- ually becoming more violent and continued, and, as it increases, ex- tending upward to the arms, and downwai-d to the navel, back, loins, rectum, and bladder, and frequently extending to the thighs and legs. From the navel it sometimes shoots with so much violence to e-ach sid© INDIGESTION. 187 that the oatient feels as if some person were cutting him in two. Tho external muscles are extremely sore and tender, and can scarcely bear the slightest touch. Momentary relief is occasionally experienced after the vomiting of acrid bile and slime, but the pain soon returns. Tn about a week or less, if recovery takes place, relieving sweats appeal-, and the bowels discharge large quantities of excrement, con- sisting of hard lumps, or scybala, mixed with blood and dirt-colored mucus, afier which the patient is Ctjnvalescent. Paralysis of the fingers, hand, and arm comes on after several attacks. It may be poor consolation to wine-bibbers to know that litharge, and other preparations of lead, are extensively employed in the manufac- ture of sweet and sub-acid wines, and that where such wines are freely drunk, this kind of colic is very prevalent; nevertheless, such is the fact. Dr. Samuel Cooper, author of a surgical dictionary, remarks : " Dur- ing the sixteenth and seventeenth centuries, when preparations of lead used to be given in large doses medicinally, the colica pictonum and paralysis, in their severest forms, appear to have been very frequent." Wind-colic — colica Jlatulenti a — is evinced by acute pain extending to the pit of the stomach, accompanied with great fullness and flatulence, often impeding respiration; it is relieved by pressure, expulsion of wind, or bending the body forward. It is chiefly produced by crude or unripe fruits, long fasting, grief, fear, etc., and is a fi-equent attend Hnt of dyspepsia and chronic diarrhea. Surfeit — colica cibaria — is usually produced by loading the stomach with an excessive quantity or indigestible quality of food. Occasionally it results from poisonous vegetables or animals taken into the stomach. Various kinds of shellfishes, and several species of other fishes, are known to have been followed by an attack. It is characterized by pain, nausea, and dizziness, until vomiting takes place, terminating afterward in a griping looseness. There is also, in some cases, an eruption of the skin, with constriction in the throat, an intolerable sense of suflbcation, swollen eyes, extreme thirst, and a burning heat over the whole surface. Constipated colic — colica constipata — is caused by indurated foeces, or other intestinal concretions, and is known by severe griping pain, obstinate costiveness, gi-eat tension with little flatulence ; the vomiting sometimes accompanied with foeces ; the costiveness is attended with bloody strainings, terminating, when not fatal, in a free discharge of the infarcted matter. The constrictive species — colica constricta — results from a permanent Btricturft existing in some pait of the aliraentq^y canal. Its symptoms are — a sense of striclure ; a fee mg of flatalenci* gradually passing off 138 PATHOLOGY AND THERAPEUTICS. by the stricture; the bow'jls taidy, and discharging with difficulty sinull liquid stools. In the early stage of the disease there are colic pains and costiveness, alternating with bilious diarrhea ; after the dis- ease has existed some time, solid foeces are rarely passed, and only after a gi*eat effort, and they are of an extremely slender caliber. Pa- tients have I)een known to subsist more than thirty days without any evacuation from the bowels. Treatment. — The general mauageraeni of colic consists mainly in the employment of copious warm water injections, to free the aliment- ary canal of its accumulated contents, conjoined with frequent hip or half-baths, which may be either hot or cold, according to ch'cumstances, to quiet pain, and overcome whatever inflammatory or spasmodic con- dition may exist. In some cases, hot water proves the best sedative, and in other cases, very cold water is most efficient. It is fortunate that in almost all cases, and probably in every case, when warm water fails in giving relief, cold water promptly succeeds. The desirable temperature can generally be very readily determined by the febrile or non-febrile character of the symptoms. If there is considerable heat and fixed soreness about the abdomen, with a general feverishness of the whole body, cold or very cold water is most appropriate ; and when the whole body is inclined to coldness and torpor, and the ab- dominal pains are griping and periodica], hot water is indicated. In mild cases, the hot fomentation, followed by the cold compress, will remove all local distress. Wherever the hip or half-bath is employed, the abdomen and back of the patient should be thoroughly rubbed dur- ing its administration. The moderate drinking of water, or tepid water, assists the relaxant effects of the other processes. In the first-named variety — colica ileus — the stricture of the intestine is sometimes so great as to produce a degree of strangulation, liable to be followed by inflammation and gangrene, especially if drastic or irri- tating purgatives are resorted to, as they generally are in old-school practice. The faeces in tliis, as in the other forms of colic, may be so hardened as to require the handle of a spoon, or some similar contriv- ance, to remove them from the rectum. For these reasons, as large a quantity of water as the bowels can well receive should be injected, and the process frequently repeated. The warm stream douche, fol- lowed by the cold dash, is excellent as a local application. The second variety — painter's colic — demands, in addition to all the treatment required for the ileus form, thorough detersive and invigora- ting nvanagement. The wet-sheet pack, cold or warm, according to the external lieat or colc'oess of the patient, followed by the dripping wet-sln;et or towe -wasb and this by the dry sheet and dry hand rub- INDIGESTION. 189 bing, will best accomplish the cleansing and strengthening part of the remedial plan. The thii'd variety — wind, or flatulent colic — the hot fomentation and a single mjeccion are usually sufficient to remove. If it resist these means, the warm. douche to the abdomen, followed by the dash of a pail of cold water to the belly and legs, will effectually disperse it. The fourth variety — surfeit — requires a thorough warm water emetic, a free injection, and a rigidly-abstemious diet, or absolute abstinence, for a few days. The fifth and sixth — constipative and constrictive — ^forms, are cured by a frequent and persevering employment of tepid injections and sitz-baths, as leading processes, assisted by hot fomentations, the wet- sheet pack, and other appliances, as the general symptoms indicate, Especial attention should be given to rubbing, kneading, gently pound- ing, or otherwise exercising the muscles of the loins and abdomen. The diet should be of the coarsest kind — cracked-wheat, rye-mush, Indian gruel, hard wheat-meal biscuits, good fresh ripe fruits, etc. Cholera. — The gi-oup of diseases comprehended under this generic term, is characterized by vomiting and purging, gripings in the bowels spasms in the arms and legs, often flatulent eructations and dejections, with great anxiety and prostration. The usual succession of symptoms is — Vomiting, purging, spasms, prostration, and collapse. In the spas- modic cholera, however, the vomiting is generally preceded for hours or days with looseness or diarrhea. Cholera is distinguished from colic by the presence of purging, and from diarrhea by the absence of vom- iting in the latter disease. In the bilious variety — commonly knov/n as cholera mothus — the vomiting and purging are copious and frequent, with a redundancy of bile. In the severest cases the vomiting is vehement, the dejections very painful, the spasms violent, and the agony intense. In the worst cases the extremities are cold, the pulse is small, frequent, and un- equal, and the patient sometimes dies within twenty-four hours from the first attack. The exciting causes are usually a surfeit, acrid bile, indigestible articles of food, drastic purges, emetic drugs, especially tartar emetic, etc. Tlie flatulent form — wind cholera — is particularly characterized by the absence of bile in the discharges ; the vomiting and purging are rare ; but in their stead there is great and oppressive flatulence and retching, with windy eructations and dejections. This form of the dis- ease is rather peculiar to dyspeptics. Spn^'"wdic cholera — called also malignant, epidemic, Asiatic, Indian, 140 PATHOLOGY AND THERAPEUTICS. \ blue, and pestilential cholera — is generally epidemic, though not con- ; tagious. The first symptoms are usually experienced during the night, ■ sometimes commencing with a slight general uneasiness and moderate i diarrhea ; at other times the symptoms come on violently, and follow ; each other rapidly. In fatal cases death usually occurs at some period : between six and twenty-four hours ; in a few fatal cases the patient j lingers two or three days. The ordinaiy course of symptoms is, more , or less diari-hea ; the discharges at firet feu^^ent, but soon presenting j the appearance of rice-water or gruel ; there ai*e flying pains, or sense \ of coldness in the abdomen, as if purgative medicine were about to I operate ; the countenance is pale ; there is nausea, vomiting, prosti'a- tion of muscular power, and nervous agitation ; cramps in the legs, ; arms, loins, and abdominal muscles, more or less severe ; small weak pulse, intense thirst, and urgent desire for cold wnt.er ; in most cases { cold, clammy skin ; all these symptoms may appear successively or al i most simultaneously. In some cases the premonitory symptoms exist ' for eight or ten days ; and sometimes the patient is prostrated at once. ' When the disease comes on suddenly, the cramps usually commence in the fingers and toes, rapidly extending to the trunk ; the eyes are sunken, and surrounded by a dark circle ; there is vomiting and purg- j ing of white matters mixed w^ith flocculi ; the features are sharp and contracted ; the expression of countenance wild and confused. The i face, extremities, and often the whole surface of the body, manifest a \ varying intensity of a leaden, bluish, or purplish hue ; the extremities [ are shrunk, the nails blue, the pulse thready or wholly imperceptible j at the wrist, arm, axilla, temple, or neck ; there is gi*eat restlessness, ; incessant jactitation, severe pain in the epigasti'ium, loud moaning or groaning, difficult and oppressed breathing; difficult inspiration, with short and convulsive expiration ; voice hoarse, whispering, or nearly , suppressed and plaintive ; the tongue is white, cold, and flabby, and the i external temperature often sinks below 80° ; convulsions recur at short ; intervals, or a constant tremor exists. The secretions of bile, saliva, ] tears, and urine are entirely suppressed, and a cadaverous odor exhales ; from the body. The patient retains his faculties to the last. i Either of the alcove symptoms may be disproportionately severe, or j it may be entirely absent. Those usually regarded as pathognomonic are, watery dejections, blue appearance of the countenance or sur- i face, thirst, coldness of the tongue, and pulselessness at the wrist. The fourth variety — cholera infantum — is peculiar to infants, and j prevails extensively during the warm season in nearly all of our cities, j In ordinary cases the diarrhea precedes the vomiting for several days; but in severe ones vomiting also occurs from the beginning. The dl*- ■ INDIGESTION. 141 charges at Jirst aro composed of ordinary foecal matters; but, as the disease progresses, they become watery and variously colored, from a dirty white to a brownish, and sometimes greenish hue. Sometimes those discharges are frothy, like yeast, and mixed with the food, which })asses the bowels almost unaltered ; in some cases the discharges are bloody, as in dysentery. There is raging thirst, the tongue is dry, but scarcely furred ; the febrile heat is very irregular ; the body emaci- ated ; the skin grows dry and ash-colored ; the abdomen is very much heated toward the termination of the disease ; the pulse is small, weak, and frequent throughout. It usually runs its course in about three weeks. Treatment. — Bilious cholera ii: its early stage requires copious warm water injections, and free warm water-drinking, to cleanse the whole alimentary canal as promptly as possible. When the discharges liave existed for a considerable time, and the patient is greatly exhausted, or after the employment of the cleansing processes above named, frequent sips of cold water should be taken, and moderate cool injections em- ployed after each dejection. The cold compress should be applied to the abdomen, and very frequently changed. When the griping is ex- treme, the hot hip-bath should be resorted to; and the cold hip-bath when there is much external heat and tenderness of the abdomen The wet-sheet pack and the pouring head-bath are appropriate and very efficacious, and often magically soothing processes, after the stomach and bowels are freed of their irritating contents. The Jlatulcnt form may be relieved by hot fomentations or hip-baths, and moderately cool injections. In indicating the appropriate hydropathic treatment for spasmodic cholera — the most frightful, yet not the most fatal pestilence of mod- ern times — I feel no small degree of embarrassment ; not that I regard the Water-Cure, which I claim to be a sufficient system in all other functional diseases, as an exceptional failure in this, but because it has no power to reclaim the dead ; and in many cases an attack of this disease is a death-stroke. Persons of gi'oss habits, the intemperate, the debauchee, the riotous liver, and those whose dietetic habits have been peculiarly enervating and constipating, are especially and almost exclusively the subjects and the victims of this penal scourge. The nature of the disease is an intensely irritated or peculiarly inflamma- tory state of the mucous membrane of the stomach and bowels ; the diarrhea, which the drag-physicians regard and treat as though it were the essential disease, being a mere indicent, eifect, or symptom of this general morbid condition. That debility and obsti'uction in the primary nutritive functions constitute the essential condition, wliile inflammatory 142 PATHOLOGY AND THERAPEUTICS uction and serous discharges constitute the leading manifestations of the disease, is rendered probable, if not proved, by the fact, that no indi- vidual of correct dietetic habits — such habits as are advocated in this work — ever yet had the disease. This is certainly true of the Gra- hamites and Vegetarians of New York, in all the seasons — 1832-34 and 1849 — that it has prevailed epidemically ; and as far as T can leai-n — and I have taken no little pains to ascertain the fact — throughout the wide world. When I say that dietetic enors are prominent among the producing causes of malignant cholera, I do not mean exclusively habits of glut- tony and intemperance. Many persons, intending to diet preventively, have dieted in exactly the way to produce it. Medical councils, boards of health, and sanatory committees have g*>nerally given authoritatively more bad than good advice, both as respects avoiding the disease and curing it. The preventive measures officially recommended in New York in the hot season of 1849, consisted mainly of "flannel next the skin, tlie warm bath occasionally, a gi'eater proportion of animal food, and fine, constipating, fai'inaceous food." Under the delusion that "the diarrhea was the cause of all the symptoms which followed, and that if the diarrhea could be prevented, no cholei'a could occur," rice, dried beef, bakers' fine bread, with animal food two or three times a day, and the almost entire prohibition of fi-uits and vegetables of all kinds, became substantially the preventive plan of living — a plan which was faithfully followed, even unto death, by many persons and several physicians in this city. The ti'ue preventive plan is exactly the oppo- site in every respect. The drug-treatment of cholera would be amusing for its inconsisten- cies, did its consequences not border so closely on the ti-agical. A great variety of plans of medication, dti'ectly opposite to each other, have been ti-ied with equal success, which fact ought to be conclusive with every unprejudiced mind that the whole is purely empirical. Let us place a few of the opposite plans of treatment recommended to us on high authority in juxtaposition : Bleeding and antimony — opium and brandy; copious libations of cold water — powerful internal stimulants, as capsicum and cajeput oil ; 3metics of mustard, ipecac, antimony, and blue vitriol — iced-water, or bits of ico, to allay sickness at the stomach; cathai'tics, as calomel, castor-oil, colocy nth, jalap, colchicum, and croton oil — astringents, as sugar of lead, lime-water, and nitric acid ; hot water, fomentations, dry heat, wine, and alcohol — cold water, solutions of potash, soda water, and eflfervescing draughts ; mustard plasters and blisters to the stomach, caustics to the spine — large doses of opium and stiychnine ; inhalation of oxygen gas — injections of saline INDIGESTION. lU solutions into the veins ; galvanism and mercuria frictions — x.ibacco, and the exhausted air-bath, etc., etc. In the early stage of the disease, a free injection of tepid or rather warm water should be administered frequently; meanwhile the thirst should be assuaged, and the heat of the stomach mitigated with frequent but moderate draughts of cold water, or bits of ice, and the cold com- press to the abdomen, well covered with dry, soft flannel. Before the surface becomes very cold, or the patient sinks into collapse, the drip- ping wet sheet, followed by the dry sheet, and both accompanied with active and persevering friction, should be employed ; the wet-sheet pack also works admirably in the early stages. If the patient is too weak to bear these processes, and in the later or collapsed stage, the surliice should be well rubbed with a cold wet towt>\ and this succeeded by active friction with dry soft flannel or the dry hand; the injections should then be frequently employed, but of cool water, and moderate in quantity. In the very outset of the disease, provided there is much nausea and retching, I would employ a brisk warm water emetic, and follow it with sips of cold water according to the degi'ee of thirst ; the cool or cold hip-bath is also a valuable assistant in any stage of the dis- ease preceding the collapse. When the spasms are violent, the external friction should be proportionally vigorous. In bad cases, two or three stout, active attendants ought to work upon the patient by means of wet and dry rubbing alternately, so as to promote the super- ficial circulation as much as possible, and thereby relieve the internal congestion. Cholera infantuyn is generally easily cured by cool injections, the abdominal compress, and the tepid towel- bath or ablution, as often as the surface manifests any considerable feverish heat. The patient may drink of pure water according to thirst. When the evacuations from the bowels are mixed with blood, the injections should be quite cold. In protracted cases, the child should be placed, once a day, when the fever is highest, in a tepid half-bath and the abdomen, back, chest, and even extremities well rubbed with the bare hand. The food must be exceedingly simp re. Wheat- meal mush and rice, seasoned with a little sugar or milk, are the best articles. Diarrhea. — The gi-oup of diseases properly arranged under this head are characterized by frequent and copious discharges by stooi, with a sense of weight and uneasiness in the lower belly, and without severe griping or tenesmus ; nausea and vomiting are occasional, but riot usual incidents. All forms of diarrhea may become chronic, in wh.ich event tliere is great emaciation. 144 PATHOLOGY AND THERAPEUTICS. In the feculent variety — diarrhea fusd—ttie faeces are of common pality, but simph' loose and copious. The bilious variety — diarrhea hiliosa — is only distinguished from the former by the bright yellow color of the discharges. In the mucous form — diarrhea mucosa — the dejections consist mainly of, or contain a large quantity of mucus. This affection has sometimes been called catarrhal diarrhea. The white looseness — diarrhea alba — is characterized by dejections of a milky color, resembling a mixture of water and lime, with a frothy scum. This hfis been called chylous diarrhea by some authors, on the mistaken supposition that the non-absorption of chyle was its imme- diate cause. It is chiefly found in persons whose digestive powers have been shattered by severe fevers ana severer drugs, and by ex- cessive indulgence in stimulating food or drink, or narcotic irritants, as alcohol and tobacco. In the fourth variety — called lientery — the dejections consist princi- pally of undigested aliment, which passes rapidly through the aliment- ary canal, with but little change. In the serous variety — diarrhea aguosa — the discharges are almost entirely limpid and water}'. Tubular diarrhea is known by dischai'ges consisting more or less of membrane-like tubes, or fragments of membranous tubes, which are whitish, viscous, and inodorous. This membranous secretion is of the same nature as that which takes place in the mucous surface of the tracliea in cases of croup. Its ex})ulsion from the bowels often alarms the patient, who mistakes it for a portion of the bowel itself. In some instances, membranous tubes half a j'ard in length have been evac- uated. Treatment. — In a genei-al sense, the treatment of diarrhea, when protracted or chronic, is essentially the same as for dyspepsia, of which it IS mostly symptomatic. The feculent form, being occasioned by ex- cess in quantity, or an irritating quality of food, requires no medication save the negative remedy — fasting. Bilious looseness is readily relieved for the time by one or two copious tepid injections. All the other forms must be ti'eated on general principles ; the local iiritation may be relieved by sitz-baths, cold injections, cold compresses, hot foment- ations, etc., as either may be indicated, while the cure must be found in a restoration of the general health, for which purpose all the means recommended for the treatment of dyspepsia must be had recourse to. In all forms of chronic diarrhea the diet must be carefully attended to ; it cannot well be too bland and simple and the whole I'egimeu I9« ill all respects, the same as for dyspepsia. INDIGESTION. 145 Intestinal Concretions. — There are three kinds of stony con- cretions found in the stomach or intestinal canal, all of which are the result of indigestion connected with constipation. One kind, called bezoar or hezoardus, is frequently found in the stomachs of ruminating animfils, especially the goat, but very rarely in the human stomach. It consists of a central nucleus of gravel, straw, glass, seeds of plants, etc., around which a vegetable mattei;|Or animal secretion is closely agglutinated, having a glossy whito or i^^bright metallic luster. -These concretions w^ere formerly regarded gssi febrifuge by physicians, and worn as amulets by the superstitious. Another kind — intestinal calculus — more frequently found in the human stomach, is composed of the same earthy and sandy matters as are found in the bladder in calculous affections of that viscus, and are of various sizes, from a pea to a hen's egg. The long-continued use of chalk, magnesia, etc., so generally prescribed for acidity of the stomach, is a frequent cause of these concretions ; hence dyspeptics are peculiarly liable to them. Preparations of iron, , - itrticularly the carbonate, when administered medicinally, have been known to accu- mulate in the bowels and form concretions. The third kind — scybalum — consisting of indurated mucus or oily mat- ter mixed with hardened foeces, results from constipation, by which the excrementitious matter remains too long in the cells of the colon, or some other part of the alimentary tract. The discharges are usually in the form of hard roundish balls, from the size of a pea to that of a walnut. The substance called auihergrls, found in the larger intestines of the cachalot, or spermaceti-whale, is supposed to consist of the hard- ened foeces of the whale, and to be the result of constipation ; hence the more sickly the animal when harpooned, the more productive and valuable is its yield of ambergris. It is generally difficult to recognize these affections by the symp- toms, save wiien their character is revealed by the appearance of the concreted matters in the ejections or dejections. Usually, however, there is more or less pain or uneasiness at a particular point in the abdomen, and occasionally a hard, lumpy tumor, which either produces an external uneasiness or swelling, or may be distinctly felt on pressure by the fingers. Treatment. — All we have to do in the way of medication is to get rid of the morbid accumulations by copious warm injections, and piiv the patient on plain, unconstipati :g, healthful fiTiit and farinaceous diet Worms. — Pathologists are not all yet agreed whether invermina- tion — worms, or the lai'vje of insects inhabiting the stomach or intes- ir-13 146 PATHOLOGY AND THERAPEUT CS. tines — is natural or abnormal. It is not very long since a Kind of worm-mania prevailed in the medical profession, by which a multitude of diseases were ascribed to vermination. Dysentery, plague, mea- sles, small-pox, hydrophobia, itch, syphilis, piles, cholera, and even toothache, have been imputed to various kinds of animalculae, vermin, or insects. There is no manner of d ubt that worms are suspected, by physi- ciansjflnd nurses, to occasion VtHous ailments of children much oftener than they really exist : but it is -equa'ily true that they do occasionally eftect a lodgment, and become developed in the alimentary canal, pro- ducing a variety of symptoms indicative of gastric and intestinal irrita- tion. Their origin is not so clear. In some instances it is quite ob- vious that the young or ova of some species of worms is taken into the stomach with the ingesta ; generally when drinking of stagnant or marshy waters, or when eating decayed or infected fruits and vegeta- bles, or partially decomposed and putrescent animal food. It is also highly probable, at least, that the minute eggs, or ovulu, of various ani-* malculae floatii.^ in the atmosphere, and collecting, especially in damp places, on the alimentary materials, get an entrance into the digestive cavit}^ and, providing they find in foul secretions, retained excrernenti- tious matters, or impurities of any kind, a proper nest, quicken into life, grow, and become finally so strong and vigorous as to resist the ordinary solvent property' of the vital fluids, and the expulsive efforts of the unaided vis medicatrix naturce. This idea makes the existence of worms depend on a morbid condition, which I believe to be the fact ; for I have never yet known any kind of vermin to trouble chil- dren who have been fed and reai-ed healthfully. Dr. S. Cooper and many other medical writers of credit assert that worms are most prev- alent among the poor, dirty, ill-fed classes of society, and particularly in persons who reside in damp, marshy countries. Alvine worms are those which exist and find a proper nidus in the stomach or alvine canal ; they are mostly found in children and sickiy adults, producing emaciation, a swelled, hard belly, gnawing or pungent pain in the stomach, pale countenance, fetid breath, and irritation of the nostrils. These worms have been arranged into five varieties, viz., the long round-worm, long th'-iad-icornt, long taj)e-worm, broad tape- worm, and JluJce. The first and second varieties ai'e much more com- mon than the others. The latter is rarely founi in man, *^^hough the most common to domestic animals. Anal worms exist in or near tbe rectum or lower bowel. They excite a troublesome itching or iiTitation of the part, often preventing sleep, and sometimes occasioning pair, or faintcebs in the stomach. INDIGEtoTION. 147 The varieties found in this locality are tte ascarides, called also iliread-ivorm, and maw-worvi, the beetle-grubs, and the 60/5. The first variety is most common, and is somewhat migratory, being occa- sionally found in the stomach and bladder. The last two kinds are very rare in the human animal. The erratic worms, which are occasionally though not frequently found in the alimentary canal, are the hair-worm, the erratic leech, and the maggot. These are called erratic, because they do not find a proper habitation in the stomach or intestines ; they produce spasmodic colic, with severe gripings ; and sometimes vomiting, or dejection of blood. The first and second varieties are chiefly found where the stagnant, muddy, and putrid waters of marshes, pools, and ditches is drank. They sometimes, when accidentally introduced into the hu- man stomach, attain an enormous size, and deviate so much from their ordinary shape as to be with difficulty recognized. Dr. Good says (Study of Medicine) : " It is highly probable, however, that they can only live in dyspeptic patients, or persons whose digestive powers are infirm ; for there are few or no animals capable of resisting the solv- ent pow^er of the gastric juice when secreted in full health and vigor." The third variety find their way into the stomach in the condition of eggs or hoppers, which are deposited in various articles of food, par- ticularly in all strong and stale meats, cheese, bacon, etc. Diagnosis. — Dr. Heberden has most clearly presented the general train of symptoms which determine the existence of worms; "Head- ache, vertigo, torpor, disturbed dreams, sleep broken off by fright, screaming fits, convulsions, feverishness, thirst, pallid hue, bad taste in the mouth, offensive breath, cough, difficult breathing, itching of the nosti'ils, pains in the stomach, nausea, squeamishness, voracity, lean- ness, tenesmus, itchings at the anus toward night, at length dejection of films and mucus. The broad tape-worms produce the severest mischiefs on the body ; the teretes and ascarides (round and thread- worms) sometimes lurk scarcely suspected, unless there is itching of the anus, or they are traced in the foeces." All of these symptoms, however, may arise from any continued irritation in the fii-st passages ; hence, in forming our diagnosis, we must take the greater number of the above symptoms in connection with the absence of any other re- cognizable malady to which they can reasonably be attributed. " In ail obscure diseases," says Swediaur, "attended with symptoms that are chiefly anomalous, the suspicions of the physician should be directed to intestinal worms." Treatment. — It is obvious tliat the radical cure of worms must de- pend upon removing the morbid conditi:-^ which renders the ahment- U8 PATHOLOGY AND THERAPEl TICS. ary canal thoir habitable abode ; this implies a restoration of vigorous functional actions, and pure secretions ; and to effect this we must again resort to all the medication suited to dyspepsia. Some exti'a management, however, is necessary to dislodge the intruders from their slimy beds, and loosen their hold upon the mucous membrane. This can be best accomplished by copious injections of cold water occasion- ally, and rigidly simple and uuconcentrated food. A perfect "ver- mifuge" diet may be found in two articles — the crusts of good, sweet wheat-meal bread, and good, ripe, uncooked apples. It is important tjiat most of the food be hard, so that it be well masticated, and that it be eaten slowly, so that the stomach be not overloaded. Dry toasted brown bread is also admissible ; and cracked wheat may be used mod- erately by way of variety. All slop food is especially objectionable Those mothers who have pampered their little ones on fine sweet-cake until it has produced worms, may find it somewhat difficult to restrict them to the coarse bread whicVi will cure them. Still, they can do it, and should. HEM0RP..H0IDS. — Di". Good limits the definition of the varieties of the diseases comprehended under this generic term to "livid and pain- ful tubercles or excrescences on the verge of the anus, usually with a discharge of mucus or blood." This definition excludes those swell- ings of the veins near the anus and within the rectum, which are termed hemorrhoidal varices^ and which almost all persons who are habitually costive are more or less troubled with, evinced by pain and -difficulty in passing the foeces, which are slightly streaked with blood. Dr. S. Cooper, and, indeed, nearly all medical authors, regard the va- rious forms as originally mere swellings of the veins. Description. — In their simplest state piles consist of varicose tumoi"9 of the anal veins, covered with a slight thickening of the mucous membrane of the rectum. They are first noticed in the form of small fleshy tubercles, generally of a brownish or pale red color and either situated within the anus, or descending from the rectum. They have rather a solid and spongy feel, and when quite external are pale, and more elastic and ti-ansparent ; they frequently appear and disap- pea]' very rapidly. Piles often contain a centi-al cavity, filled with flu d or coagulated blood ; and by repeated attacks of nflammation the swe'.J ings gradually enlarge into caruncular excrescences about the verge of the anus, either within or without, of various shapes and forms, from pea-sized to fig-sizod. and are frequently so painful as to prevent either sitting or walking. When these caruncles are hard, florid, in- compressible, without discharge, and intolerably sore ic the touch, the INDIGESTION. 149 affection is called blind piles. When the irritation accompanying them induces a discharge of whitish mucus from the neighboring glands, it s called ichlte piles. When the hemorrhoidal vessels, which form or suppoit the growing tumors, are so distended as to burst and bleed freely, it is denominated bleeding piles. And when warty excres- cences spread about the perinfEum, or within the verge of the anus, it is called caruncular piles. Usually pile tumors become larger and firmer with every reappearance ; and when they have been strangu- lated for some time by the pressure o-f the sphincter, repeatedly gorged with fluids, or of very long standing, they become fixed and permanent in size, and acquire a greater degree of solidity ; they are then a source of almost constant pain and trouble from protrusion, inflammation, or ulceration, and often occasion a most distressing pro- lapsus of the lower bowel. Special Causes. — Among the causes assigned in medical books, we find " local irritation produced by indurated and retained fceces ; purga- tive stimulants, especially aloetic purgatives." This may all be resolved into constipation, and the medicine given to cure constipation. Prob- ably more than half the adult population of the United States are suf- ferers, to a gi-eater or less extent, from piles in some form. For eight or ten years past, during which time my attention has been especially called to this subject, I have found a great majority of invalids who have applied for water-treatment, whatever might have been the char- acter of their leading malady, to be also afflicted with this. Its special and almost exclusive cause is concentrated food, inducing constipated bowels ; but it is almost always greatly aggravated by the purgatives which have been given, by regular and irregular quacks, on account of the constipation. Most of the patent pills, from which newspapers derive so 'm'ge a revenue, and the people so many shattered constitu- tions, are s4rongly aloetic, and hence peculiarly calculated to inflame and relax the vessels of the recturii, already irritated and engorged by their hardened contents. Many frightful cases of external protrusion, or falling down of the anus, have come under my observation in the persons of habitual pill-takers* In some cases the bowel has prolapsed thi'ee and four inches. Dr. Good names " peculiarity of constitution" as one of the causes of pile tumors ; and Dr. Copland (author of a Medical Dictionary) "conceives that piles are most common in persons who possess a very strong action of the sphincter ani, and are hence habitually predis- posed to a spasmodic stricture of the rectum." These remarks, from tliese eminent auth'Ors. I consider eminently nonsensical. Nothing but tlie false philosophy :1 a false system could ever induce such erudite 150 PATHOLOGY AND THERAPEUTICS. and critical scholars to perpetrate such absurdities. According to my experience, nine oui of every ten of relaxed, debilitated females, who must of necessity possess a very weak instead of very strong action of the sphincter, as weli as of all the other muscles, are affected with pile tumors. Treatment. — Piles may be promptly relieved by local appliances ; but the cure depends on restoring the integrity of the digestive functions. The general management is essentially the«same as for dyspepsia. When the tumors are inflamed and painful, very frequent sitz-baths, of a low temperature, 60° to 50°, with oft-repeated injections of a small quantity of cold water, should be employed, until relief is obtained; after which about four to six ounces of very cold water should be thrown into the rectum every morning previous to the expected action of the bowels. When the bowel is prolapsed, the patient should keep the horizontal position mostly, and apply the coldest wet cloths to the fundament. Sometimes an excessively irritable or highly inflammatory condition of hemorrhoidal tumors, occasions a severe and protracted diarrhea, the discharges occurring as often as once an hour, or every half hour, con- sisting mainly of small quantities of bloody mucus, or slimy matter tinged with blood, and accompanied with considerable tenesmus, gi'ip- ing, or bearing down sensation. Such attacks usually last a week, and not unfrequently two or three weeks ; the patient generally, and the doctor sometimes, mistake the case for dysentery. Here injections do but little service ; the wet-sheet pack, two or three times a day, and the wet abdominal bandage very frequently changed, are our most ad- vantageous resources. The dietary part of the management is of first importance. In some few cases the mucous surfiice of the lower bowel is so tender and irritable, that almost all food seems to act as a mechanical irritant; the patient, however, at such times needs but very little of any kind, and this may be boiled rice, farina, Graham flour mush, tapioca, etc. But generally the unbolted and unconcentrated forms of farinaceous food are prefemble, as in all other forms of indigestion. Hard warty excrescences around thef anus, or scattered over the perina^um, may be removed with entire safety and facil'fty by the liga- ture, or knife, or clipped off" with a pair of scissors. Removal by ex- cision and by ligature hfis often been practiced in the other kinds of he-morrhoidal tumors, but there is always danger to be apprehended from hemorrhage in the one case, and from sympathetic inflammation in the other; moreover, if all the resources of hydropathy and hygiene are judiciously drawn l )on, there is not the least necessity for these Burgica operations. FLUXES. 161 CHAPTER V. FLUXES. I ADOPT tliis generic term, not because it is clearly appropriate or distinctive, but because it is familiar. The only species strictly per- taining to this genus are catarrh and dysentery, both essentially febrile diseases, and each consisting of a peculiar inflammation of some portion of the general mucus membrane ; each exhibits two varieties, thus : r^ ^ 1 S Common, t\ ^ S Acute, Catarrh { Dysentery < ( Epidemic. ( Chronic. Catarrh. — This is an inflammatory affection of the mucous mem- brane of the fauces, often extending to the frontal sinuses or bronchia, or both; it is attended with sneezing, obstruction of the nostril, and more or less mucous expectoration, or discharge from the nose. Symptoms. — In comynon catarrh — cold in the head or chest — the fever is slight ; there is a sense of weight over the eyes, and fullness in the head, and the nostrils pour forth a thick, acrimonious ichor, which ex- coriates the skin ; the voice is hoarse, and more or less cough attends. In the epidemic form — injiuenza — the attack is sudden, and the fever severe and strikingly depressive ; there is great heaviness over the eyes, extreme languor, anxiety, and oppression at the praecordia, with frequent sighing, sickness, and violent headache. The pulse is very frequent, and peculiarly irregular; the skin is moist, with a tendency to profuse sweating, but the heat of the body is seldom considerable ; the tongue is white or yellowish, but moist; sometimes there are severe general or local muscular pains, and at other times erysipelatous patches appear in different parts of the body. The danger of this disease is not in proportion to the violence of the symptoms, as compared with all other febrile diseases, for usually the symptoms are extremely vio- lent for one or two days, and then as rapidly subside; great debility, however, frequently exists for weeks or months after convalescence is established. Often severe pains attack the chest, and in such cases physicians, regarding them as indicative of pleurisy, have endangered the patient's life by venesection. Special Causes. — Common catarrh is usually traceable to taking cold. Influenza, like Asiatic cholera, is usually epidemic, and has prevailed at all seasons of the year, in every state of the barometer, thernometer, and hydrometer. Dr. Good very cautiously imputes its 152 PATHOLOGY AND THERAPEUTICS. specific cause to some "atmospheric iotemperaraent;" Dr. Weber has suspected "negative electricity" of the mischief; but none of the modern theories are any improvement on that of Hippocrates, which was " providential interposition ;" nor the very modest suggestion of Sydenham, who was rather disposed to ascribe it to '■'■some oecult and inexplicable changes wrought ir the bowels of the earth itself, by which the atmosphere becomes contaminated with certain effluvia, which predisposes the bodies of men to some form or other of disease." I ofluenza is the most widely-spreading epidemic known, having some times exteuvfed over all Europe and a part of America in the same season. Treatment. — This is exceedingly simple. Practically, common ca- tarrh may be regarded as a high fever^ and influenza as a loiv fever In the former affection, the wet-sheet pack is specially indicated as the leading measure, repeated according to the general feverishness ; and in the latter, the tepid ablution, frequently repeated, and followed by the drj--blanket envelop when the body feels chilly after the bath, with the chest-wrapper, well covered when the lungs are troublesomely affected, and warm hip and foot-baths when the abdominal viscera are disproportionately disturbed. Generally the bowels require to be moved by free tepid injections at the outset; and when there is considerable nausea and retching, the vrarm water emetic should be administered. The general regimen is the same as for simple fever. Dysentery. — This iisease was called bloody fiux by the old authors. It is an inflammatory affection of the mucous coat of the larger intes- tines, accompanied with griping and tenesmus ; the dejections are frequent and bloody, and the foeces are discharged irregularly. Symptoms. — In the acute variety, the abdomen is painful or tender ; the fceces are discharged with difficulty; mucous and bloody dejections alternate, or are variously diversified iu color and consistence ; the at- tending febrile disturbance is considerabie, and may be of the high or low character — the syncchus or typhoid type. What is called chronic dysentery is sometimes a milder and more disguised form of the disense, but more generally it is common diarrhea modified by local circumstances, or a sequel of maltreated acute dysen- tery. In plainer English, it is frequently a drug-disease. This remark need not excite surprise v/heti the formidable array of diug-poisong which modern medical science has brought to bear upon this disease, and upon the patients' constitutions, too — calomel, corrosive subli.nate, sugar of lead, antimony, nitrate of si vor, opium, capsicum, oil of tui*- pentine. mineral acid^. etc. — is taken 'uto account. Chronic dj^sentery FLUXES 153 is attended Wjth but slight fever, and that usually of the hectic type. Either vai'iety may be attended with ulceration of the bowels, and puru- lent, sanious, or membranous evacuations, or discharges of pure, un- mixed blood. Special Causes. — Dietetic errors of all kinds are the principal pre- disposing, and undue exposure to cold, damp, sudden alternations of temperature, etc., the chief exciting causes. Bad water and marsh effluvia sometimes occasion the worst forms of the disease. Treatment. — Medical books are as discordant in relation to the treatment of dysenter}^, as they are in the case of cholera. In treating the disease hydropathically we must ever keep in view the character or type of the fever, which is in reality as much a part of the disease as is the local inflammation of the colon, or other large intestines. When the general fever is violent, the wet-sheet pack or half-bath should be employed, according to the degree of heat. Moderate draughts of cold w^ater should be frequently administered, and the whole abdomen constantly covered with the wet compress, which should be very often changed, until the pain, heat, tension, etc., subside. In the early stage one or two copious tepid injections are advisable, to clear the aliment- ary canal of its irritating crudities, after w^hich moderate cool injections are to be employed occasionally. Sometimes very cold or iced water has a more soothing effect upon the griping and tenesmus than any other temperature, and reference should always be had to the patient's feelings in regulating the temperature of the water. Hip-baths, the temperature low in the ratio that the general fever or heat of the abdomen is high, may be advantageously employed once m two or three hours. I have seldom found any difficulty in curing this complaint in children, in a very few daj^s, by two or three daily tepid w^ashings of the whole surface, the constant application of the wet compress to the abdomen whenever and as long as the heat was above the natural standard, the free use of cool or cold water as a drink, and one or two tepid injections at the outset. The diet should be: entire abstinence until the violence of the fever and local inflammation are both sensibly abated, and then as bland as possible — boiled rice, rice gruel, wheat-meal mush or gruel, toasted brown bread, etc. When ulceration takes place in the intestines, and the discharges exhibit pus, puti'id sanies, or black, grumous, fetid blood and slime, the diet may be wnth propriety restricted, for a week or two, to rice or arrow-root. I have never known relapses, or "sequelae," which are so common an I so formidable after an attack of this disease and a course of drug- treatment, occu in % patient who was treated hydropathically from f^r:'t to last. 164 PATHOLOGY AND THERAPEUTICS. CHAPTER VI. CACHEXIES, Literally, tJie term cachexia means bad habit of body, a condition which exists more or less in all diseases. But there is a class of dis- eases pre-eminently distinguished as being caused by or attended with universal depravity of the organization, or general derangement of all the bodily functions, constituting, in fact, a constitutional taint or mal- conformation, which may be transmuted through many generations, with either increasing or decreasing intensity, as the voluntary habits of each successive generation are more or less in conformity with physiological laws ; and this group of diseases may be appropriately considered in the present chapter, as expressed in a tabular arrange- ment: Consumption < '' Tubercular. Catarrhal, Apostematous, Laryngeal, Hemorrhagic, ^ Dyspeptic. Atrophy, Anhaemia, Climactenc, I. Tabes. r Arabian Elephantiasis -^ Italian, I Asturian. Hemorrhage < Marasmus < '' Epistaxis, Haemoptysis, Haematamesis, Haematuria, Uterine, ^ Anal. ( Simple Scurvy, Scurvy i Land Scurvy, I Sea Scurv^'. Plethora \ Sanguine, ( Serous. Scrofula, Melanosis, Cancer, Catacausis. Most of the above diseases, and several which 1 have thought proper to consider under other heads, are included in the order dysthetica, in Dr. Good's nosologj-, a term which signifies " an ill-conditioned habit.*' Consumption — Pulmonary Consumption — Phthisis Pulmon- ALis. — Consumption of the lungs is the most general evidence and the most fatal result of the artificial and enervating habits of civilized society. In the city of New York, about 2000 die annually of this disease and in Boston, Philadelphia Baitimore, and a majority of tho CACHEXIES. 156 other cities of the United States, the mortality from this source bears nearly the same ^lation to the population. In most other countrief in which civilization has made equal progress, the disease has commit- ted equal ravages. Dr. Young has calculated that it destroys, prema- turely, one fourth of the inhabitants of Europe. Females, from their more sedentary, indoor, and relaxing habits, are rather more liable t^ this malady than males. The period of life between puberty and middle age — fourteen to forty — is more especially favorable to the operation of the causes of this disease, ant the greatest ratio of mor- tality occurs between the ages of thirty anc forty. The greatest num- ber of deaths, in this latitude, takes place in the coldest months of the year. This fact, however, does not prove that the cold season is more conducive to the development or causation of consumption, but that consumptives are more liable to sink at that particular period. Symptoms. — Tubercular consumption is by far the most frequent and most intractable form ; and, indeed, some authors regard the existence of tubercles in the lungs as essential to the character of true phthisis. It is usually connected with a stronglj^-marked scrofulous diathesis, is more insidious in its approach, and more delusive in its progi-ess than either of the other varieties. Man}- persons are born with such a malformation of the chest, and so great a predisposition to tubercles, that the slightest aberrations in the manner of life suffice to induce that condition of engorgement, mal-assimilation, and morbid deposition which eventuates in general tuberculation of the pulmonary structures. The special symptoms are, short and tickling cough ; the pain in the chest is slight ; there is either a sense of tenderness or weight experienced at the upper part of the lungs ; the breathing is ha- bitually short, and a full inspiration is impracticable, the attempt increasing the sense of weight, soreness, or aggravating the cough; the expecto- ration is generally scanty and small in ""uantit}^ in the early stages, and in many cases it is very trifling throughout ; the matter expectorated is a watery, whey-like sanies, sometimes tinged with blood, and as the disease progresses, thick, tenacious, curdy, or cheesy particles are ex- creted. Sometimes small, irregular stony concretions are formed by the deposition of earthy matters — mainly carbonate of lime — in the substance of the tubercles, and expectorated as the process of ulcera- tion releases them from their inclosures. Emaciation does not become 6ti-ikingly apparent until the diseas-- has made severe inroads upon the constitution, and not unfrequently e body maintains its ordinary full- ness until the gi-eater portion of the ungs is fiitally occupied by tuber- cular formations. In those cases att^ ided with but trifling expectora- tion, there is, of course, but little ul> -ation ; yet generally some \<\T^ 156 PATHOLOGY AND THEll A P EUTICS. tious of the tubercles are ulcerating, and forming open, irregular cavi- ties in the substance of the lungs, while in other parts of the pulmonary sti'uctures. the process of tuberculation is going on. As the functional powers of the lungs become impairec, the pulse becomes frequent and feeble, the breathing gi'ows shorter, ineguliir chills come on, succeeded «by some degree of feverish heat; and in the last stages, night sweats, diaiThea, swellings of the limbs, etc., denote the ra})idh' approaching fat«l termination. In this form of consumption, the hope of recovery often attends the patient almost to the dying hour, and schemes of business or pleasure, or new projects for recovery, occupy his thoughts until within a few days or hours of death. There has been much controversy among medical theorists whether tubercles are the product of inflammatory action, or of irritative action, or of an action to which some other technical term should be applied. The discussion is entirely unprofitable. It is enough to know that the general condition of the body is one of debility; that the local condition of the part diseased is one of engorgement, and its secretions changed from a healthy to a morbid charactei*. It is also a disputed point whether tubercles in the lungs are curable in any case, some eminent authors taking the position of their absolute and unconditional tatality, while others, equally respectable as practitioners and pathologists, con- tend that cures havs resulted in a few instances. Dr. Good, in allusion to a remark of Dr. Woolcombe, that 55,000 victims annually die of consumption in Great Britain, makes the follow ing very singular observation : "During the last half-century, it is said to have been considerably on the increase ; but this is perhaps chiefly owing to the gi-eater number of infants of delicate health who are saved from an early grave by the introduction of a better system of nursing than was formerly practiced, yet who only escape from a dis- ease of infant life to fall before one of adolescence or adult years. And, for the same reason, savages rarely suffer from consumption, as they only rear a healthy race, and lose the sickly soon after birth." 1 think a better explanation can be found in another way. Much of the increasing mortality is justly atti'ibu table, in my opinion, to the intro- duction of a worse system of nursing infants than formerly prevailed, to wit : close rooms, hot slops, tight clothing, nick-nack food, apothecary drugs, etc., by which the bodies of the infants become sickly, stunted, feeble, and susceptible before they emerge from their cradles. The reason that the savages seldom have consumption is because they are comparatively exempt from the peculiar debilitating customs of our "better system." Thr statement that they lose all their sickly children is wholly gratuitous. CACHEXIES. 157 In tlie catarrhal form the cough is frequent and violent, with a copious expectoration of a thin muco-purulent matter, rather mixed with blood, but generally offensive to the smell. There is considerable soreness of the chest, and transient pains shifting from side to side. It comes on after repeated colds, or a protracted catarrhal affection. The aposicmatous variety is known by a diy cough, which returns fitfully ; fixed, circumscribed, obtuse pain in the chest, which is some- times throbbing or pulsatory ; the patient experiences great difficulty in lying on one side. The cough at length terminates in a sudden and copious expectoration of purulent matter, which sometimes threc:*"en3 suffocation. These symptoms are immediately owing to the formation of an aposteme or abscess in the lungs. When the collection of matter is considerable, the patient often experiences severe rigors or chills, and manifests a iiigh degree of irritative fever. After the discharge of the matter, the patient is sometimes permanently relieved ; but usually the relief is temporary, and all the symptoms recur repeatedly at longer or shorter intervals, as new abscesses form and discliarge their contents. In some few instances no expectoration takes place, the patient dying before the abscess breaks. Laryngeal phthisis is that modification of the disease in which ul- ceration commences in the larynx before any extensive morbid altera- tions have occurred in the lungs. It is distinguished by excessive irri- tation and tickling in the larynx, with a cough dry and husky at first, but soon attended with a slight discharge of purulent mucus, frequentl}' streaked with blood ; there is also remarkable hoarseness, which occa- fuonally goes and returns without any assignable cause, and a sense of soreness or tenderness about the upper part of the throat ; often there is some degree of actual hemorrhage from the diseased part. All these symptoms may occur in the last stage, or near the fatal termination of either of the other forms of consumption, more espe- cially the tubercular ; and also in the worst cases of bronchitis ; they can, therefore, only be properly regarded as a distinct variety of phthi- sis when they take the lead in the morbid manifestations. When the ulceration of the larynx, instead of preceding disorganization in the lungs, comes on after ulceration in the lungs has long existed, the pa- tient complains more particularly of a sore, oppressive sensation in the throat, as if some foreign mass were lodged in the larynx ; and this sensation is generally accompanied by more or less difficulty of swal- lowing; it is, too, usually accompanied with a peculiar hoarseness, or, rather, roughness in the voice. In most cases it is a fatal omen, occui-- ring only a few days, or at most a few weeks, before death. The hemorrhagic variety is churacferizol by repeated attacks of i4 !58 PATHOLOGY AND THERAPEUTICS. hcTmopfysis, or bleeding at the Jungs. The coughing or expectoration of a large quantity of blood, may indeed be, and usually is, an acci- dental occurrence in a'l the other form= of the disease, especially the tubercular and the dyspeptic vai-ieties : nevertheless, it sometimes takes place without evidences of any considerable organic change either in the lungs or digestive organs, and recurs with such frequency and violence as to exhaust the patient, producing all the train of constitutional symp- toms which marks the progress of the other vai'ieties of consumption. It is intimately connected with the next variety — dyspeptic phthisis — and usually depends immediately on an excessively engorged condition and relaxation of the pulmonary vessels, this condition being chiefly owing to a shriveled, bloodless state of the superficial capillaries, or to an enlarged liver, or, which is more common still, to both of these cir- cumstances combined. Dyspeptic phthisis is that form of pulmonary consumption which is preceded by protracted disease of the digestive organs ; the lungs are atlected sympathetically, or, rather, the morbid condition is extended from the abdominal viscera to the lungs ; the liver being usually the organ most concerned in the primary malady. This variety of con- sumption is niore common than is generally supposed, constituting, in fact, a majority of the cases we meet with. It is seldom correctly dingnosticated, from the fact that, when the lungs become promi- nently the seat of the morbid phenomena, the prior evidences of digestive derangement, or disease of the liver, are overlooked ; very often the latter are so obscure as to be wholly disregarded, unless the physician discovers their relation to the affected lungs by a careful investigation of the history of the patient, from the first appearance of ill-health. Dr. Wilson Phillip says that drunkards, whose digest- ive powers have been broken down by ardent spirits, frequently fall a sacrifice to this disease ; and he regards those who have suffered se- vere attacks of dyspepsia, and what are called bilious complaints, as peculiarly liable to dyspeptic consumption. Diagnosis. — As it is only in the incipient stage of all forms of con- sumption that we can have any reasonable assurance of effecting a radical cure, it becomes exceedingly important to detect the malady before it has made irremediable advances. It is impossible to give a list of symptoms which may be relied upon as pathognomonic. When- over the imfient experiences habitual cough, be it ever so slight, and habitual expectoration, of whatever character, with shortness of breath, a sense of i)ain, fullness, weight, or uneasiness in the chest, with an increasing feeling of general languor or debilty, the case is probably consumpt/on, and should thencefath receive the closest scinitiny. If CACHEXIES. 169 these symptoms have been preceded by dyspeptic indications, or evi- dences of disordered or torpid liver, the danger is greater ; and if the constitution is manifestly scrofulous, stUl gi-eater apprehension may be entertained. In the early stage of the dyspeptic variety, tlie cough and expectoration occui chiefly in the morning, and are hardly noticed during the remainder of the day; the expectoration consists of a small quantify' of tenacious mucus or muco-purulent matter, generally dis- colored in the morning by a carbonaceous, dark-colored stain, as though charcoal dust had been diftused through it. The early symptoms in all forms of consumption are obscure and insidious ; and those which attend its progress and mark its several stfiges ai-e subject to very great diversity*. But the general progress of the symptoms may be enumei'ated as follows : The patient first be- comes sensible of unusual languor, and breathes with less than usual freedom ; his respirations are shorter in duration and more frequent in number. He coughs occasionally, but does not complain of its being troublesome, and he very rarely expectorates when coughing. Some degree of pain, soreness, weight, or uneasiness, will be at this time experienced in some part of the chest whenever the patient makes a deep and prolonged inspiration. As these symptoms increase, the pulse becomes more frequent and weaker, particularly in the after part of the day. After the disease has made a little further progress, there is feverish feeling or hectic flush toward evening, a tendency to undue perspiration during the night, and either the sleep is disturbed by fits of coughing during the night, or a considerable paroxysm of coughing takes place early in the morning, leaving the patient with a greater feeling of feebleness and relaxation. This assemblage of symp- toms may be considered as constituting the first stage. In what may be regarded as the second stage, in which the disease is evidently established and generally hopeless, the cough increases in fi'equency, and, from being dry, is accompanied with a purulent mucus, varying from a watery whey-like matter occasionally tinged with blood, to an expectoration of genuine pus, v/hich may be variously colored — livid, deep black, light brown, light green, bright or dark yellow, hard and lumpy, or soft and shredy, flattened or round, fetid or odorless. In many cases of the tubercular form it is very scanty, while in a ma- jority of the catarrhal it is extremely copious. The uneasiness in the chest is now felt more constantly, and the sense of weight has become permanent ; hectic fever is fully developed, and the breathing is often accompanied by a sound somewhat like the ticking of a watch. The strength fails rapidly, the body emaciates, the pulse beats more fre- quently and feebly, generally ranging from 100 to 130 ; yet in some 160 P A T H L G :. V AND T H E R A P E U T I C S. instances of the dyspeptic variety I have known tha pulse to preserve the slow, languid motion characteristic of that form of digestive de- rangement in which torpor of the liver is a prominent condition, until the last. The teeth usually increase in transparency, and the eye man- ifests an unnatural brilliancy, the sclerotic coat becoming of a pearly white. The fingei-s are shrunk, except at the joints, which become prominent ; the nails are bent for v/ant of support ; the nose is sharp ; the eyes sunken ; the countenance wears a peculiar but mortal smile ; the whole body is shriveled ; the spine projects, instead of sinking, from the decay of the muscles; and the shoulder-blades stand out like the wings of birds. The third stage is attended with diarrhea, apthous or ulcerated throat, difficulty of swallowing, dropsical swellings in different parts of the body, and various other symptoms indicative of the final exhaustion of the powers of life. Although extreme emaciatioL usually occurs before death, yet in a few cases, particularly in the apostematous variety — which is the form most frequently designated as the quick or galloping consumption — the progress of the local inflammation is so rapid, that the extensive disorganization of the pulmonary structure produces a fatal result be- fore the body is greatly attenuated. In a few instances recoveries have happened after extensive vomica, or abscesses, have been formed in the substance of the lungs; and a veiy few examples are recorded in which the patient has survived the entire destruction of one lung. Pathological Appearances. — Dissections, which do not prove the nature but the effects of disease, show, in almost all cases, an indurated and ulcerated condition of the lungs. Tubercles are formed indiscrim- inately in all parts of the cellular texture of the lungs, but more fre- quently and abundantly at its upper and posterior parts. They exhibit every diversity of size; are generally whitish and opake, like small absorbent glands, but sometimes semi-ti*ansparent, like caitilage, with black dots in their substance. They often augment by degrees til] they attain half an inch in diameter : but usually, when about as large as peas, they begin to soften in the renter, and finally open by one or more small apertures into the neighboring bronchiffi, or remain for a longer time closed, and constitute small abscesses, filled with a curdy, half-formed pus. In some cases large abscesses are formed, without any trace of tubercles; in a few cases the lungs appear hardened, he- patized, or shriveled into a leathery appearance ; and occasionally tlio whole cellular substance is occupied by tubercles, with little appearance 3f excavations or open ulcers. Physiological Sign^ — Much atter*;ion has, of late years, been be- AC HEX IE S. 161 etowed upon percussion and auscultation as means for ascertaining the exact morbid conditions or structural derangements of the thoracic viscera and the stethescope, invented by Laennec, has come into very general use, as a convenient acoustic iiistrument for the purpose of determining, with greater precision, the abnormal changes which take place in the lungs. There is no doubt that, by much experience, the practitioner can, in many cases, decide with much greater accuracy as to the exact point of the lungs most diseased, and, possibly, as to the extent in which the disease has involved the lungs in disorganization, with the aid afforded by a careful stethescopic examination ; yet, on the whole, I regard the instrument as of very little practical value. So far as the prospect of cure and the proper course of medication are concerned, the intelligent physician can derive no advantage from the stethescope ; and even experienced practitioners are about as liable to diagnosticate eironeously with as without its assistance. I can name at least one person in the city of New York whose lungs m ere pro- nounced incurably tuberculated by an experienced profesr^or of stethos- copy, who is now in the enjoyment of excellent health. Special Considerations. — Consumption has been regarded as conta- gious by some. There is no question that all diseases have a tendency to propagate their kind — like causes like — yet this disease is not more chargeable with "personal communicability" than a majority of others. It may, indeed — and I have known such instances — be acquired by a vigorous, healthy person, who has no hereditary predisposition, by a ong and intimate intercourse with, or attendance upon, a patient who has declined under it; as, for example, a husband or wife, devoting himself or herself assiduously to the care of a bosom companion through all the stages of the malady, occupying the same room, sleep- ing in the same bed, and personally performing all the acts of kindness and duty required by the patient's condition, may in time become simi- larly affected. It has been remarked by most authors that any sud- denly suppressed evacuation or accustomed discharge, is peculiarly lia- ble, especially when a predisposition exists, to induce consumption. I think, however, all the danger from this source could be obviated by a proper attention to the general health. A suppression of the menstrual secretion in females is supposed peculiarly to conduce to the foi'mation of a consumptive diathesis ; but more generally the suppression follows as a consequence of prior disease of the lungs. Pregnancy often arrests the progress of the disease, even when far advanced ; but it recurs in all its force soon after the function of gestation is completed. Treatment. — It is the common consent of the medical world that consumption is incurable, especially in all stages afte ' the first ; and 102 PATHOLOGY ' " -" -; ^ APE U T I C S. those few examples of cures recorded in medical works have confess- edly rccoveied "spoutatieously," or by "the efl'orts of nature," at all events, witnout the beuefi':s of drug-medication. Under water-treatment some cures of apparently hopeless cases have been made; the majoritj% however, who have thus far sought the aid of the new S3Stem have deferred it too long, yet, although they have necessarily tailed of being radically cured, they have, in nearly all instances, been greatly bene- fitted, while in many cases life has been extended for several years. Practicall}', we are to regard tJie affection of the lungs as a local ex- pression of a general disease ; hence the constitutional management is of incomparably more importance than the topical. Every measure which tends to invigorate the general system, and eveiy appliance which will conduce to a more free expansion of the lungs, and assist in relieving their congested condition by diffusing the accumulated blood over the surface, must be perseveringly employed ; while, negatively, all sources of irritation and debility must be sedulously avoided. In- stead of bundling up in flannels, and sitting down by a hot stove, or lounging in a warm room, the patient must dress as liglitl}^ as possible without actual discomfort ; he must take as much out-door exercise as his strength will permit, and spend as much of his time in the o^en air — in walking, riding, sailing, etc. — as possible, without exhausting fatigue. Horseback exercise, I think, is not advisable after the disease is lairly formed, the other kinds being altogether preferable. High mountainous regions are certainly preferable to low lands for consump- tives, the air being not only more dense but more pure. A residence inland, and a voyage at sea, are both preferable to a residence on the sea- shore, in a case of confirmed consumption, for the reason that there is less uniformity of climate and temperature in the latter locality than in either of the other situations. A removal to warmer and more equable climates — Florida, Cuba, MadeuM, etc. — is not necessary to the cure of the malady. In some cases, however, it seems to stay its progress, while in others the change hurries it on rapidly to a fatal termi- nation. Medical authoi-s wholly fail to account for these diverse results. The explanation is probably this : Of those who go to the South, or to more genial latitudes, some are affected with primary disease of the liver and digestive organs, the lungs being secondarily or sympathiti- cally diseased ; while in others the lungs were the organs primarily affected with local disease. The former will decline with greatly accelerated speed on going to a much warmer latitude, but the latter will geneialiy experience a temporary alleviation of symptoms. A great variety of muscular or gymnastic exercises can be employed to advantage ir. expanding the chest Striking the elbows or backs of CACHEXIES. 1G3 the hands together behind the back ; making gentle circular motions with the hands while both arras are extended laterally from the body; striking the hands out laterally alternately, etc., are useful methods. The body must always be kept in the erect posture whether exercising or at rest, sleeping or waking. One of the very best respiratory exer- cises is that of taking slow, deep, full inspirations, holding the breath as long as convenient when the lungs ai'e fully inflated, and then expir- ing very slowly ; this may be practiced a few minutes at a time, and repeated many times a day. Silver tubes have been constructed to assist the consumptive in expanding the lungs in this way, and in many cases very great benefit has been derived from them ; still they are no better than a common goose-quill, nor have either any advantage over the practice of respiring through the nose in the same slow, regular manner. Let it be remembered, that in all kinds of exercises care must be taken not to greatly disturb the breathing or accelerate the pulse. Within this limitation they should be as frequent and active as possible. Dumb-bells afford a good exercise, but they must be handled gently, and not be very heavy. The play of graces is also excellent. With regard to diet, no disease, not even dyspepsia, requires a more rigidly plain and abstemious course. The general plan of dieting is the same as in cases of dyspepsia. But the irritable state of the general system, coupled with the inflammatory condition of the lungs, causes the most ti'ifling disturbance in the digestive organs to result in a much more serious injury to the lungs. I have repeatedly seen all the symptoms severely aggravated, the expectoration entirely changed for the worse in character, the cough greatly intensified, and all the ad- vantage gained by a month's faithfuL treatment lost by a single injudi- cious meal. Consumptives labor under one disadvantage which dyspep- tics do not in the matter of dieting. The latter feel whatever hurts them in the stomach, and hence in their feelings have a better guide to direct them in the choice of food, or rather in respect to what may be profitably abstained from. The former have the sensibility and irri- tability more concentrated upon the lungs, and frequently have no other evidence of wliat agrees or disagrees with the stomach than the better or worse character of the pulmonary symptoms. Experience, there fore, is, with the consumptive, a more blind guide than with the dys- peptic. Judgment must reign supreme here, and appetite and morbid sensibility obey. For these reasons the diet may be, and, on the whole, should be, more bland, watery, and innutritious than is tolerated in the majority of cases of dyspepsia. I believe nearly every case will do better by entirely abandouing all animal food, save milk, and even this should be used zst 101 PATHOLOGY AND THERAPEUTICS. a seasoning rather than as a substantial part of the meal. Coarse bread, wheaten grits, the mildest vegetables and best fruits, constitute the best articles of food, and a sufficient variety, as far as the question of recov- ery is concerned ; and even this simplicity will avail nothing unless strict moderation in quantity is at all times observed. In many cases, and in all in which I have advised the experiment, the patient has been evidently advantaged by taking a very light breakfast, a moderate dinner, and no supper at all. The oppressed lungs require all the room and all the quiet possible to obtain during sleep ; and a trifi'tng load or uritation in the stomach will often produce a restless night, and a more engorged condition of the lungs. In all cases except those attended with considerable emaciation and severe dyspeptic symptoms, rather free water-drinking is advisable ; not, however, to the extent of sensibly oppressing the stomach. From five to ten tumblers can usually be taken daily to advantage. In regulating the bathing processes, we must keep in view a three- fold condition — general debility, feverish excitement, and local inflam- mation. Consumptives generally bear cold bathing well, but the baths should seldom be very long continued. When the superficial heat is not materially deficient, nor the hands and feet inclined to much coldness, the cold wet-sheet pack for an hour, followed by the tepid shallow bath, for five mitmtes; the half-bath at 72°, five to ten minutes, and the hip-bath at about 65°, fifteen minutes, with the constant em- ploj-ment of the chest-wrapper, constitute a plan of bathing v.^hich, ^^^th such modifications as will be suggested by individual circumstances, is adapted to the majority of cases. The walking foot-bath I have known peculiarly serviceable in several cases. The douche, of mod- erate force, is a useful adjunct in the early stage of the tubercular variety; and in the incipient stage of all forms, I have observed mani- fest relief of the local symptoms by the spray or fountain applied to the chest daily, or every other day. In the latter stages, when the patient is troubled with rigors or chills, the dry pack, during the cold Btage, will usually shorten the duration of the chills, and mitigate their severity. Night sweats may be checked or palliated by the rubbing wet-sheet at bed-time, if the patient is able to bear it, if not, by spong- ing the surface with tepid water. When extensive ulceration or tuberculation exists in the lungs, the patient will be extremely sensitive to cold, and the teinpemture of the water should be milder; care should be taken, under these circura stances, to avoid any bath which occasions much of a shock to the system. For the benefit of snich consumptives ns are compelled to do the CACHEXIES. 166 best they can with home-treatment, it may be stated that very little bathing is absolutely essential, if the patient will attend sU'ictly to all the other resources of hygiene. One or two sponge-baths or tow^el- washings daily, and oue or two sitz-baths, with the employment of the chest- wrapper or abdominal girdle, as the local symptoms are more prominent in the respiratory or digestive organs, all of which processes the patient can manage with very little assistance, will answer all remedial pur- poses, provided the patient keeps in tlie open air as much as possible, takes almost constant but not violent exercises, according to his strength, and lives on the smallest quantity of coarse, bland food, which will range above starvation. I cannot conclude this topic without a paragraph of animadversion upon the popular allopathic method of doctoring consumptives. I have known so many scores of persons killed outright, so many cases of incip- ient converted into confirmed consumption, and so many confirmed con- sumptives hurried out of the world, by diug-medication, that I cannot speak or write on the subject, except with language of earnest denun- ciation against the senseless and murderous practice of reducing and poisoning the systems of those unfortunate invalids, whose vital powers are wasting fast enough without being aided by " medical science." The ordinary treatment may be resolved, substantially, into opium, bleeding antimony, blisters, and expectorants. Each article and each process, 1 affirm, is individually injurious, and all are collectively pernicious. The opium lessens the effort at coughing, by which the lungs endeavor to free themselves of a morbid secretion, but aggravates the actual diseased condition of the lungs. The bleeding lessens the patient's sensibility — feeling — for a brief period, and renders him less conscious of his disease ; but it is at the expense of his vitality. The antimony lessens the febrile excitement, and diminishes the force of the circulation by deadening the nervous influence, and destroying the abilit}^ of the muscular fibres to act at all. The blisters abate the pain and soreness in the lungs by paralyzing the natural sensibility, or overwhelming the lesser with a gi'eater pain ; but they render the intercostal muscles sore and sensitive, make a free expansion of the 'ungs more painful and more difficult, and thus tend to fasten the disease irrecoverably upon the sj^stem. Expectorants, which are given to facilitate the excretion from the bronchial ramifications, make the patient raise easy by in- creasing the quantity to be raised ; and as the secretion of mucus, or pus, is already morbid and in excess, there can be no possible ultimate advantage in increasing it. I know very well the theories — and they are quite "too numerous to mention" — upon which such practice is advocated and defended ; but theyare as absurd and irrational as the 166 PATHOLOGY AND THERAPEUTICS. practice is unsuccessful and death-dealing. Of the lengthy catalogue of specifics which have had and still have a reputation in the medical world for curing consumption — digitalis, cod-liver oil, etc. — I need uot speak. If the fact that all the patients who are cured by them soon go to their graves, is not a suflficient commentary, and if the forty or fifty deaths in the city of New York returned weekly tx) the inspector's office by the physicians under the head of consumption, do not suffi- ciently attest the follacy and falsity of the popular theory and practice, as far as this malady is concerned, no explanation that I could offer would be of any avail. Marasmus. — A morbid condition, of which general emaciation of the body, with debility, without local inflarani-n to death rapidly under the "tonic" and "supporting ' system of l iron and wine; and concluded the sad stor^- of mortality with an "able ; ai'gument" in favor of the same treatment as the only hope of the | patient ! | Elephant iasis. — This affection, called in English elephant skin., . consists of a thick, livid, rugose, tuberculated. and insensible state of : the skin. It is attended with gi-eat debility, and a variety- of morbid i symptoms, the sum total of which evince a general depravation of all | the fluids of the body. Among the most prominent of these are re- j marked, highly oftensive perspiration, and fierce, staring eyes. ; The first variety — Arabian — black leprosy — is hereditary in Arabia ' and India, and is in those countries regarded as contagious. It is also \ known in the high northern latitudes of Norway, and is very prevalent in Iceland. The tubercles are chiefly confined to the face and joints; < the voice is hoarse and nasal; the hair, except on the head, falls oft'; ] the nose is swelled and scabrous ; the lips tumid ; the nostiils preter- i naturally dilated ; the lobes of the ears are enlarged and thickened, i and beset with tubercles; the external sensibility is so obtunded that ; pinching or puncturing th^ skin occasions no pain. At length the I tubercles crack and ulcerate ; ulcerations also appear in the throat and | nostrils; the breath becomes intolerably fetid ; the nose falls off ; the \ |ialate is destro3'ed ; the fingers and toes become gangrenous., and drop j off one after another. CACHEXIES. 169 The Italian variety is found cbiefly among the Milanese and Vene- tian peasantry, who live in wretched hovels, breathe foul air, and eal gross and unwholesome food. The disetise comes on with languor, listlessness, gloom, weakness and stupor in the lowei' extremities, ver- tigo, mental confusion, etc. These symptoms, which usually occur in the spring, are followed, as the warm weather increases, with burning and itching over the whole surface, except that of the head, and tliese are succeeded by an eruption of rosy papulae, scattered generally over the skin, and terminating in tubercles of a shining red color. During the summer the tubercles desquamate, and the skin finally recovers its natural color. In the winter the patient recovers some degi-ee of strength, but the symptoms reappear with increased violence with the return of spring, and again subside on the recurrence of cold weather, and so on for several years in succession. In the end, delirium, furious mania, or stupid melancholy, diarrhea, and dropsy come on, and not unfrequently the miserable victim terminates his sufferings by the act of suicide. The variety called Asturian, is the Asturian leprosy of Sauvages, and some other nosologists, and the mal de la rosa of the Spaniards. It is found among those who inhabit filthy tenements, crowded, unven- tilated rooms, swampy valleys, etc. It differs from the preceding variety in attacking the head as w^eil as the other parts of the body ; the tuber- cles are peculiarly painful, highly fetid, more deeply furrowed with cracks, and more disgusting to the sight. Treatment. — Cleanliness, in the broadest acceptation of the word, comprises the whole remedial course. Frequent cool or tepid bathing or washing of the whole surface, copious water-drinking, and a dietary restricted to plain vegetables, fi'uits, and farinacea, are all the details which need occupy these pages. Hemorrhage. — Occasional or accidental hemon*nages occur m a great variety of diseases, not connected with any general taint or dep- ravation of the organism. But it is only when bleeding results from an impaired or partially putrescent quality of the blood itself, or from a debility and reiftxation of the coats of its containing vessels, or from both o^ these conditions together, constituting the hemorrhagic diathesis, that the. effeotion propei'ly peitains to the genus before us. A flow of blood A'om the nose, lungs, stomach, bladder, uterus, or anus, may result from local congestion or incidental plethora — constituting the entonir, hemorrhages of Dr. Good — and either of these conditions may depend on temporary or occasional causes ; the group of diseases, therefore, included in the present genus, comprises only the atonic lT-16 i.O I'ATIIOLJGY AND TU ER .V f £ L T IC S. hemorrhages of authoi-s. When the heinorrhRgic diathesis has become established, nos«-b]eeding is most common during the periods of youth end of senescence ; bleeding from the lungs occurs most frequently between the ages of fifteen and thirty-five ; and in .more advanced Ufe the tendency is to more frequent hemorrhages from the abdominal and pelvic organs In the first yav\ety—ej)istaxi:> — nose-bleeding — the quantity of bloou lost is. in some instances, enormous. Examples are recorded of its continuance for several daj'S, and eren weeks, of the quantity of blood discharged amounting to ten, twenty, and even forty pounds. In the second variety — hcemoptysis — spitting of blood — bleeding from the lungs — it is often difficult to determine from whence the blood issues ; whether from the fauces, posterior cavities of the nos- trils, the lungs, or the stomach. In haemoptysis the blood is thrown up chiefly by coughing ; the blood is of a florid, arterial hue ; there is a sense of tickling about the fauces ; moreover, it is usually preceded by flushed cheeks, more or less pain in the chest, with some degree of dyspnoja. Sometimes, however, there are no precursive symp- toms, and the blood is rather hawked or spit up intermixed more or less with saliva, and is of a darker color ; but in this case an irritative cough ensues, and the blood is mingled with a frothy mucus. When the spitting of blood is from the cavities of the nostrils, it will cease on lying procumbent, or bending the head forward, and will then probably flow from the nose. When it proceeds from the fauces, the fact can generally be ascertained by ocular inspection. In h(smalemesis — vomiting of blood — bleeding from the stomach — the blood is of a dark color, is thrown up by vomiting, and is usually intermixed with food ; the discharge is preceded by tensive pain about the stomach, and accompanied with anxiety and faintness. In some cases the blood is discharged from the bowels at the same time. In hematuria — bloody urine — the hemorrhage is from the bladder or kidneys, and the blood is discharged at the urethra, sometimes in- termixed with urine. The evacuation is preceded by pain in the pel- vic region, and accompanied with faintness. Uterine iiemon'hage is called menorrhagia in most medical books, and described as an excess of the menstrual discharge. This is a mis- take. It is not a profuse catamenial secretion, but an actual bleeding from the uterine vessels. In fact, it is always attended with a real deficiency of the menstrual flux. It sometimes occurs in young girls from habits of self-abuse ; and is very liable to attack unhealthy females on the final cessation of the menses, and occasionally attacks fenialei far advanced in life. ACHEXIES. 171 In anal hemorrhage the blood flows principally from the hemor- rlioidal vessels; it is preceded by a sense of pain and weight in the rectum ; and, when the patient is of rather full habit, by headache oi vertigo. Special Causes. — The ordinary exciting causes of disease, operat ing upon an exhausted or depraved organism, in which relaxation of Jie muscular coats of the capillary vessels in a prominent condition, may excite either form of hemorrhage we have considered, as the predisposition exists, more particularly in the organ or part which is the seat of it. All these varieties of hemorrhage are, however, very frequently the result of external violence, or symptomatic of other local affections, in which case the treatment is to be mainly directed to the primary malady. Thus epistaxis may be the result of exposure to the direct rays of the sun, sudden and severe cold in the head, violent coughing or sneezing, and various emotions of the mind ; haemoptysis occurs sometimes from an enlarged liver pressing against the lungs, suppressed perspiration, straining of the respiratory muscles, excess in eating and drinking, suppression of customary discharges, etc. Haematemesis is often the consequence of shocks, contusions, vomiting, pregnancy combined with constipation, violent passions, schirrus, or cancer of the stomach, etc. Heematuria results frequently from a blow or a fall, gravel, stone in the bladder, ulceration, severe inflamma- tion, and the use of some kinds of irritant drugs, as canthLrides. Uter- ine liemorrhage is occasionally caused by polypi in the womb, or other structural derangements ; and anal hemorrhage is a veiy common symptom of hemorrhcidal tumors, or piles. Treatment. — The indications are — to excite contraction in the bleed- ing vessels, balance the circulation, and invigorate the general system. Locally the coldest water, or pounded ice, may be employed, untd the flow of blood is checked. For nose-bleeding, a cold stream or iced water may be applied to the back of the neck, and cold water frequently sniffed up the nostrils, at the same time the head should be freely ex- posed to the cool or cold air, and the bleeding pait be kept entirely uncovered. In bleedings from the lungs and stomach, sips of the cold- est water, or even bits of ice, may be occasionally swallowed, while the coldest compresses are applied over the stomach and chest. In bleedings from the urethra and rectum, cold injections and cold hip- baths are the local appliances. In all cases the patient must keep quiet, and avoid any source of bodily or mental excitement; and if there is feverish heat or inflammatory excitement, the whole body must be promptly cooled with the dripping-sheet or ablution. When the extremities are preternaturally cold, rubbing them thoroughly, first 173 PATHOLOGY AND THERAPEUTIJS. with cold wet cloths and then with dry flannel, is advisable. To accom- plish the third indication, we must pursue the appropriate management for the restoration of general health. Scurvy —Dr. Good defines the general symptoms of the scurvy — scorbutus — "livid spots on the skin from extravasated blood; languor, and loss of muscular strength pains in the limbs." The first vai'iety, simple oi petechial scurvy, is almost always a se- quel of protracted and debilitating fevers, especially of the putrid type. Rarely, however, it occurs in persons of a gross and full habit, who are not regardful of liygiene in their personal habits. It is character- ized by numerous small spots resembling flea-bites, chiefly on the breast, ai-ms, and legs ; the visage is also pale. In the hemorrhagic variety — land scurvy — the spots are circular, of a purple liue, and of different sizes ; sometimes in stripes or patches irregularly scattered over the arms, trunk, and thighs ; occasionally tliere is hemorrhage from the mouth, nostrils, or viscera; and there is gi'eat debility and depression of spirits. In severe cases the patient has the bloodless, exhausted appearance observed in anhaemia ; and blood flows irregularly and often profusely from the lungs, stomach, in- testines, and uterus, as well as from the mouth and nostrils. In the nautical variety — sea scurvy — the spots are of different hues intermixed with livid, principally at the roots of the hairs; the teeth nie loose; the gums are spongy and bleeding; the breath is very fetid, and the debility is extreme. The joints soon become weak, and there is often a shrinking of the flexor muscles, rendering the limbs useless, and constituting what has been called scorbutic paralysis. The spots often coalesce in large blotches, oi form ulcers, which discharge a thin, fetid, sanious fluid, mixed with blood ; and in the last stage blood is discharged from the viscera as in the former variety. Special Causes. — Stale food, salted provisions, an exclusive flesh- meat diet, and vitiated air, are the ordinary producing causes ; they are almost always associated with inattention to personal cleanliness. Either one of these causes alone may produce a modified form of scurvy, but all operating together generate the most aggravated cases. Treatmcni, — The proximate condition upon which this disease de- pends is a putrescent state of the blood. The indication of cure is, therefore, simply, to purify the blood ; and a moderate course of gen- eral bathing, with a liberal sujiply of fresh vegetable and farinaceous food, and plenty of good ripe fruit, will answer the indication. On ac- count of the extreme laxity and debility, the tepid half-bath, and drip- ping-sheet, or towel-wash, are the preferable water appliances SmaU CACHEXIES. 173 quantities of very cold water should be frequently taken into the stom- ach, and when the disposition to hemorrhage is gi'eat, cold water enema should be occasionally employed. Brown bread, wheaten grits, mealy potatoes, and good apples, are the best antiscorbutics known. < Plethora. — The condition of the body to which nosologists have applied this term, is that of general engorgement or over-fullness ; it is the result a^ excessive alimentation, or defective depuration, or both. Full-feeding and inactivity are the producing causes. The sanguine, or enionic variety, is distinguished by florid skin, full strong pulse, turgid veins, with firm and vigorous muscular fibres ; and the serous, or atonic, is denoted by a full but frequent and feeble pulse, smooth and soft skin, plump but inexpressive figure, and general lan- guor or debility of the vital functions Treatment. — The remedial measure of first importance is active out- door exercise. This may be commenced gently, and gi'adually in- creased ; but it should always be to the utmost extent of the patient's capacity to endure, short of excessive fatigue. It is of little consequence what the kind of exercise is, if it is sufficient in constancy and degree. The next matter requiring attention is the food; this must be plain and coarse in quality, and in quantity no more than actual nutrition demands. A moderate course of the "starvation regimen" for a few weeks would accelerate the process of throwing off the superfluity, liardening the structures, and invigorating the general system. Lastly, the whole surface of the body should have one or two daily washings in cold water, followed by thorough friction with a coarse towel or the flesh brush. Scrofula — Struma — Struma Vulgaris — Scorbutus — King's Evil. — The terra scrofula — derived from scrofus, a sow — literally im- ports swine-swellings, swine-evil, or morbid tumors to which swine are subject. Scrofula has long been recognized as a disease common among svv'ine, and it is doubtful if any of the domesticated swine are exempt from it. It is well known that all hogs fattened in the ordinary method are extensively diseased, and a source of disease to those who eat them. In this country the general employment of this filth}'^ animal as food, is the cause of many morbid affections, manifested under a great variety of scrofulous, erysipelatous, putrid, glandular, and skin diseases. The Scrofulous Diathesis. — A scrofulous constitution means simply, a frail, delicate, infirm, lax organization, a habit of body possessing a pre- disposition to the affection callel scrofula, and pecul arly liable to develap glandular swellings chronic ulcerations, tubercula' foiiiiations, and vis 174 PATHOLOGY AND THERAPEUTICS. ceral enlargements, whenever the exciting causes of disease are applied with ordinary intensity. The predisposition, however, under fiivorabJo hygienic influences, luay lay dormant through life, and only be called into activity in the succeeding generation. The scrofulous constitution is said to be characterized by relaxed fibres, smooth and soft skin, fair and fine hair, a peculiar fullness and rosy appearance of the fice, full upper lip, tumid alae nasi, large eyes, long silky eyelashes, delicate complexion, large head, precocious brain, great sprightliness with feeble endurance. But it must be remembered that this description applies only to extreme cases, or an inherited diathesis. The most usual path- ological indications of the scrofulous habit are, strumous ophthalmia, chronic inflammation and suppuration of the glands of the neck, por- riginous affections of the scalp, enlarged tonsils, rickets, spinal diseases, tabes mesenterica, white swellings, inflammation of the membranes of the brain, and tubercular consumption. SijmjHoms. — The most common form of the disease — that form known as scrofula proper — appears in indolent glandular tumors, fre- quently in the lymphatics of the neck, but also often affecting the ex- ternal or internal conglobate glands, suppurating slowly and imperfectly, and healing with difificulty. In size these tumors usually range from that of a pea to that of a chestnut, but occasionally they are much larger. In some instances, scrofulous tumors appear in clusters about the neck, and armpit, and upon the breast. Usually the tumors which appear in infancy subside at the period of maturity. Scrofulous inflam- mation frequently attacks the external structures of the eye, the spongy, and sometimes the cylindrical bones, and the ligaments, cartilages, and membranes around the joints. Special Causes. — Whatever deteriorates the general health tends to bring the scrofulous predisposition into a state of activity. Various forms of scrofulous disease frequently follow severe febrile and obsti- nate cutaneous affections, as measles, small-pox, scarlatina, yaws, syphi- lis, etc., and are then usually ranked among the sequelce of those dis- eases. I think they are much oftener a result of the drug-medication. All mineral drugs, and particularly mercury and antimony, which are Bo freely prescribed in all the above diseases, have a powerful influence in exciting inflammatory action and tubercular depositions in scrofulous constitutions. Narcotic medicines, as opium, tobacco, alcohol, etc., are also efficient exciting causes. The depressing antiphlogistics — vege- table, eartliy, or saline — as digitalis, senna, polassa, niti'e, epsom salts, etc., and all debilitating processes, as bleeding, leeching, cauterization, profuse evacuations, etc., tend to produce a scrofulous diathesis "where it did not previously exist, and aggravate it when ah-eady existent. The CACHJiiXIES. .75 gcrofulous diathesis may therefore be either inherited or ingenerated. A combination of bad food, impm-e water, foul air, dark tenements, sedentary occupation, and poisonous drugs, is sufiicient to produce the scrofulous diathesis independent of any hereditary tamt. Treatment. — The disease before us being one of debility and obstruc- tion, invigoration and purification constitute the indications of cure. And first among the restorative resources of hygiene are abi»udance of pure fresh air, and plenty of clear sunlight. Sunshine itself is better than all the tonics of the allopathist's materia medlca. The food must be restricted to the best fi'uits, vegetables, and farinaceous preparations, but allowed in liberal abundance. For city children good country milk is essential. The distillery slop-milk, on which so many thousands of our infantile population are daily fed, is a fruitful and frightful source of scroflilous aflfections, as weU as other fatal diseases. Scrofulous patients should, as a general rule, drink water rather freely, especially in the fore part of the day. Generally one or two full baths — tepid, cool, or cold, according to the debility or inflammatory action existing — dail}' are sufficient. AVet compresses should be constantly applied to the tumors so long as they manifest preternatural heat, redness, or pain ; and the wet-sheet pack, followed by the dripping-sheet or half- bath, should be employed daily whenever the whole body is feverish, and once or twice a week during the whole CQurse of treatment ; a moderate douche may be occasionally applied along the spine to advant- age ; and when the body evinces symptoms of general obstruction, torpor, over-fullness, and turgescence, moderate sweating in the dry blanket will be serviceable. Critical boils, eruptions, and abscesses are very common under active treatment. Ca>xer — Carcinus — Carciisoma. — The Greek word, carcinus, means a crab ; and the disease is thus named from the crab-like rarai- tlcations of the dark distended veins of the cancerous tumor. Any part of the body may become the seat of this affection, although se- s.ernent glands are most frequently attacked. The breasts of females, uterus, testes, glans, penis, tongue, stomach, cheeks, l:})s, and angles of the mouth, are its chief localities. The cancerous diathesis, like the scrofulous, may be either inherited or acquired, and, notwithstanding many nosologists have regarded this disease as a purely local one, the majority now assent to the doctrine that the topical affection depends on a peculiar constitutional distemper, taint, or malassimila- tion. Symptoms. — A cancer commences with a hard, livid, knotty tumor, with dark, cancriform varices, intersected with firm, whitish, divergeat 176 PATHOLOGF AND THERAPEUTICS. bands ; it is attended with acute, burning, lancinating pains, and termi- nates in a fetid, ichorous ulcer, having thick, livid, distorted lips. In the breast, the first appearance of the disease is a small indolent tumor, which is attended with an itching feeling; this is followed, after a longer or shorter time, by a pricking sensation, and this is succeeded by a shooting or lancinating pain eventually a sfense of burning is ex- perienced, and the skin becomes livid and discolored. Adhesive bands are formed in the skin, which becomes puckered, and the nipple is drawn inward, sometimes entirel)' disappearing ; the tumor ere long becomes more elevated, and feels knotty to the finger ; at length the ulcerative process appears by the integument giving way at different points, through whick an ichorous, erosive fluid, sometimes tinged with blood, is thrown forth ; as the ulcerative action advances, a broad, deep excavation is made, which discharges a most offensive and fetid matter. Cancer of the uterus is knowm by darting pains in the part, shooting through the region of the pelvis, and usually indurations in the part, which are sensible to the touch ; a preceding and immoderate men- strual or leucorrheal discharge, or both; and as soon as ulceration occurs there is a sanious, bloody, or mixed discharge, characterized by the peculiar stench of the disease. In the vagina and rectum the disease can be ascertained by the touch, in connection with the other symptoms ; in the mouth, and on various parts of the external surfiice it is obvious to the sight. In the stomach it is with difficulty diagnosticated. An acute and burning pain, tenderness of the epigfistrium on pressure, nausea, rejec- tion of food, offensive fetor in the breath, are together su'ongly pre- sumptive, though not absolutely pathognomonic, of the disease. Sjjecial Causes. — "Of the remote causes of cancer," says Dr. Good, "we know nothing." Other authors confess the same ignorance of the proximate cause, and of the nature of the cancerous diathesis. The most common of the exciting causes are, external injuries, as blows, depressing passions, spirituous liquors, narcotic medicines, gross, high-seasoned food, etc. That our friends, the allopathists, regard the disease as in some way or other dependent on or connected with a specific viru-^, is evident from the remedies which are put most promi- nently forward in their books. These are, arsenic, lienbane, and nightsliade — the first, a powerfully corrosive poison, and the last two, deadly narcotics. The utter contusion which reigns in the brains of medical book-makers concerning the real nature, causes, and proper medication of cancer, is evident enough from the following paragi'aph in relation to its treatment, found in (Copland's Medical Dictionar>% Afte'' enumerating two or three hundred j-.ternal remedies, all of \vh\cb CACHEXIES. 177 have enjoj.-;d a high reputation, but which cannot noiv be depended on, comprising, lu fact, nearly all the strong, pungent, powerful, and pois- onous drugs and cnemicals of the apothecary shop, our author remarks : "Of the numerous external remedies recommended at various periods, the preparations of arsenic and quicksilver, charcoal and carrot poultices ; the mineral acids, particularly chlorine, hydro-chloric, and chloric acids; the clilorurets, and many of the metallic salts; camphor, the balsams, and the terebinthinate substances ; aminoniacum, galba- num, and myrrh; and the greater part of the asti'ingent, antiseptic, detergent, and stimulating vegetable medicines, have obtained a greater degree of reputation ; and when some of them are judiciously combined with one another, and with narcotics, they are deserving of notice us discutients in the early stage of the disease, and as palliatives in its ulcerating state." Treatment. — The constitutional treatment for cancer is essentially the same as for scrofula ; and all that has been recommended for scrofula, in the matter of diet and regimen, is applicable here, with this exception — cancer requires even a more rigidly simple and a very abstemious diet. In this disease the "hunger-cure" is an indispensable auxiliary, or rather, perhaps, the leading remedial measure. Several cases are on record of foul, fungous, and cancerous tumors, which had resisted caustics and the knife, being cured by a simple and strict dietary. jThe celebrated Dr. Twitchell, of New Hampshire, was cured, a few years ago, of a malignant tumor of the lip, which had been extirpated once, and repeatedly cauterized in vain, by restricting himself to a diet of bread and cream, the quantity being barely suffi- cient for necessary nutrition. Brown bread, parched corn, or other grain, with a moderate allowance of good fruit, and plenty of soft water for drink, constitute a dietary it would be difficult to improve upon. In all diseases connected with general depravity of the secretions, and in all cases where a strict diet is advisable, a good proportion of the food should be hard or solid, for the double purpose of insuring com- plete mastication and better guarding against excess in quantity. Med- ical authors of the old school are generally opposed to "low diet," in this disease ; but with them low diet means slop food, and high, or "generous" diet implies stimulating or animal food. I am opposed to both of these plans, not only in this disease, but in all others. Every measure which can in the least conduce to the general invig- oration of the system, must be unremittingly emploj^ed. Abundance of fresh and pure out-door air is indispensable, and, as in scrofulH, one, two, or three general baths may be employed daily. There is but jitt e to jhooso between the different kinds of baths : the dripping- 178 PATllOLOGy AND THE LI iPEU TICS sheer, half-bath, or plunge, as either t» most agi-eeable to the patient's feelings. It is generally, however, imj ortant to deterge the skin thor- ougiil}', and keep up a good degree of activity in the cutaneous excre- tory i)rocess, by occasional packings in the v/et sheet, so managed as to produce moderate but not debilitating sweating ; or, in very torpid in- valids, the dry-packing, followed by the dri])ping-sheet, with very active friction, may be substituted. The local treatment is a matter of more difficulty. Extirpation will genei-ally succeed, if resortel to in the early stages, provided the gen- eral health has been judiciously cared for; but it unfortunately happens that the operation is not often resolved upon until structural disorgani- zation has proceeded too far to render it available. There is no doubt that, in some cases in which the local affection is much more prom- inent than the constitutional, caustics, or rather, perhaps, chemical an- tidotes, have been successful. The matter of a cancerous growth, being an abnormal formation, can, without doubt, be acted upon and destroyed, and the peculiar action or secretion on which its existence depends arrested, by substances which will not act very injuriously on the healthy structures, nor materially interfere with the normal func- tions ; but as yet we are ignorant of any such specifics or antidotes. The "cancer quacks," it is well known, use arsenic as the principal corrosive to eat away the diseased structures ; but death often results from the absorption of the poison. Iodide of potassium, and niti'ate of silver are reported, on good authority, to have, in a few instances, destroyed the cancerous ulcer, which did not subsequently reappear. Some vegetable powders, as bloodroot and blue cohosh, have had a similar reputation. It is certain, however, that all these preparations fail in a majority of cases, and an anti-cancerous remedy is yet a de- sideratum, if indeed it is a possibility. My friend and former patient, Dr. Schell, late of New Orleans, assures me that he is in possession of an antidotal preparation which operates destructively on the diseased parts, and correctively on the morbid action, without sensibly injuring the sound structures. As he is about to put the matter to a practical test on an extensive scale in this city, I need not dwell longer on the subject in this place, save to remark that Dr. S. is not one of the numerous professionable adventurers who are swarming in all our great cities, but a scientific, candid, and honorable physician. It is due, how- ever, to him and to the subject to say, that he depends as much on constitutional as on local ti-eatment, deeming the latter useless without attention to the general health, tliis attention to be in all respects eti'ictly hydro})athic. I have not yet had ai opportu?:ity of testing refrigeration, or the CACHEXIES m application of extreme cold to a cancerous tumor ; but, judging theo- retically, I should expect much benefit from it. Tt is always advanta- geous to keep the diseased part covered with wet compresses of as cold temperature as can be borne without increased pain ; and I cannot help believing that actually freezing the part occasionally, by the application of refrigerating mixtures, is among our most promising topical appli- ances. Melanosis. — The disease called melanose, or hlack cancer, consists in the formation of a morbid product of secretion, of a dark color, more or less inspissated, and staining or studding the organ or structure af- fected. Every part of the body is liable to these discolorations or tu- bercles, and sometimes all the structures are loaded with them. In the areolar texture the melanotic matter often accumulates in the cells, and forms tumors of various sizes. Symptoms. — The color of melanosis varies from a dark yellow to brown, deep blue, approaching to black, and to complete black, which is the most common. The secretion is easily detected by its peculiar shades of color in any part or organ containing it, as the surrounding tissues are lighter colored, and form a remarkable contrast with it; it is usually of a pultaceous consistence, the tubercles pea-sized to walnut- sized, and scattered in groups ; they are sometimes situated upon the surface, but more generally below it ; an irritative fever, mostly of the hectic form, attends, and the patient experiences great debility. The seci-etion is nearly destitute of smell and taste ; and as no vessels or nerves have ever been in it, the matter appears to be an unorganized deposit. Prognosis. — Dr. Good remarks : " The cause, progress, and diag- nosis, are at present obscure and unsatisfactory, and the ti'eatment is yet to be learned." The majority of cases have thus far, under allo- pathic treatment, terminated fotally. Treatment. — This need not detain us. The cure depends on restor- ing the normal condition of the secernent system, and this presupposes the employment of all the means for invigorating the general system and purifying the circulating fluids, which have been detailed under preceding heads, more especially when treating of scurvy, scrofula, and cancer. Catac \usis. — This is a condition of general combustibility of the body, produ -ed by the use of alcoholic drinks. Examples of sponta- neous combustion as having occurred in persons long accustomed to the immoderate employment of spirituous liquors, are too well authep" 180 PATIIULOGY AND THERAPEUTICS. ticated to be longer doubted. The condition of body liable to this strange phenomenon may properly be called the alcoholic diathesis. In a major- ity of cases recorded, females advanced in life were the subjects of the malady. In some cases the self-consuming flame has arisen with- out any obvious exciting cause ; but in others, a fire, a lighted candle, the heat of a stove, or an electi'ic spark, has ignited the inebriate body. It is a remarkable fact tliat the flame which decomposes and re- duces every fi-agment of the bodily sti'uctuve to ashes, does not essentially injure the common fui'niture or bedding with which it comes in con- tact; and more marvelous still is the statement that water, instead of quenching the fire, seems rather to quicken it. As this is the only mor- bid condition known which renders the human body combustible, and the only morbid fire which hydropathy cannot extinguish, the subject need not be further prosecuted, save to point the obvious moral for the benefit of whom it may concern — that all spirit-drinkers burn, and mar, and disorganize their structures in an exact ratio to the amount of alco- hol they consume, even if the alcohol does not consume them by a spontaneous, ingenerated fire in return. CHAPTER VII. DISEASES OF THE EYE. The morbid conditions of the visual organ requiring attention in this place may be arranged as in the following table : Ophthalmia ' Structural Derange- ments afifccting the < Sight ■ Acute, Chronic, Purulent, Infantile, . Granulated. ' Nebulae, Ulcers, Pterygium, Stiiphyloraa, Closed Pupil, Cataract, Amaurosis, ^ Strabismus. ' Psorophthalmia, Trichiasis, Entropium, Structural Affections Ectropium, of the Eyelids "^ Hordeolum, Excrescences, Ptosis, Fistula Lachrymalif ' Asthenopia, Hemeralopia, V Nyctalopia, Myopia, , Presbyopia. Perverted States of Vision /•Ecchymosis, Injuries and Acciilcnts< Extraneous Substances, l Burst Eye. The most common morbd aflfection of the eye is inflammatioQ. Il DISEASES OF THE EYE. 181 may attack any of its structures, but is most frequently seen in the membrane covering tlie external coat constituting the ophthabnia proper, or ophthalmitis of authors. Sclerotitis, iritis, retinitis, etc , designate, in technical Latin, inflammatory states of the sclerotic, iris, retina, etc. As they should ail be treated precisely in the same man- ner as acute or chronic ophthalmia, as the violence or mildness of their symptoms approximates the character of either, they need not be sep- arately considered. Acute Ophthalmia. — This is the common form of active inflam- mation. It commences with a pricking sensation, as though dust was in the eye, soon followed by heat, redness, swelling, and extreme in- tolerance to light. Often there is severe headache, with more or less general fever. Treatment. — Keep the eye shaded from strong light, but not con- fined from the air by close bandaging. Apply linen cloths wet in cold water, changing them very frequently, until the temperature becomes natural, and the redness disappears. Wet the head often in cold wa- ter. If -there are irregular chills and heat, employ the wet pack sheet once or twice daily for an hour, followed by the cold ablution. Move the bowels fteely with tepid water injections. If the feet are cold, use warm foot-baths. The patient should eat nothing stronger than water-gruel, and but little of that, until the violence of the disease has very materially abated. Chronic Ophthalmia. — This condition of sore eyes often results from riotous living, bad air, bad food, liquor, tobacco, etc., and is very often a sequel of maltreated acute ophthalmia. Millions of eyes are rendered miserable to look upon, or from, by the drugifications of doc- toring, washes, lotions, leeching, blistering, bleeding, calomelizing, etc., to cure the acute form. Treatment. — Particular attention must be paid to the general health. A daily rubbing-sheet, and a daily hip-bath, should be part of the treat- ment. Walking foot-baths are excellent auxiliaries. The eyes should be bathed several times a day in moderately tepid water at first, and finally as cold as may be found consistent with comfortable sensations after the application. Purulent Ophthalmia — Egyptian Ophthalmia. — This form of inflammation is rapidl)-^ destructive, and requires prompt and energetic treatment. In addition to the pain, heat, and redness of acute oph- thalmia, it is charactei'ized by the enormous swelling of the eyelids, IS2 PATHOLOGY AND THERAPEUTICS. Boon followed by the discliaige of a large quantity of thick, yellowish, or greenish matter. Treatment. — If thero be much general heat of body, the wet-sheet packing should be employed two or three times a day, followed by washing the surfice in tepid water. If the body incline to chilliness, the sheet should be wrung out of warm w^ater. The eyes are to be very frequently washed with pure soft water, wai"m at first, then tepid, and then cold — never veiy cold. Attend to the bowels as above. Infantile Ophthalmia — Purulent Infantil^ Ophthalmia. — Children of a few days or weeks old are often attacked with this for- midable malady. The symptoms, however, usually come on with less violence, and progi'ess less rapidly. But the common lotions and po- tions, washes and swashes, are very apt to aggravate the disorder, de- form the eyelids, or destroy the sight. The treatment is the same as in the case of the adult, substituting the warm or tepid bath for the pack. Granulated Ophthalmia — Granular Eyelids. — In this affec- tion the conjunctival membrane, or white of the eye, is raised into little projections, presenting a rough, irregular appearance. It is a consequence of long-continued or maltreated inflammation. If not cured, it mny in time occasion opacities of the cornea, by the irritation it causes, followed by blindness. The only chance of cm*e hydropath- ically is by a persevering course of general and local treatment. Mod- erate bathing, say a daily rub-sheet and douche, the local application several times a day of veiy cold or iced water, or even pounded ice, with a strictly abstemious regimen, carefully avoiding all exciting con- diments, and all sorts of stimulants, constitute the outlines of the rem- edial plan. Nebula and Specks, or Opacities of the Cornea. — Nebulas are superficial deposits in the transpai-ent part of the eye, giving it a cloudy appearance ; opacit es are deeper seated, producing a dense and pearly appearance. They are caused by inflammation. Their treatment should be managed precisely as for granular eyelids, with the addition of means to excite powerful absorption. A strong douche and walking foot-baths are the best measures for this particular indication. Ulcers of the Cornea. — These occasionally result from long- standing indammation, and are also soni.itimes produced by mechani- cal and chemical irritants. The treatment is, in all respects, as the preceding. DISEASES OF THE EYE. 188 Pterygium. — A small reddish triangular tumor, gi'owing from the inner cornea of the eye, or from some portion of the eyelid. It can be readily removed by cutting, the operation being entirely painless. Staphyloma. — A pearly, conical, whitish tumor, formed by tne enlarged cornea projectmg between the lids. It is the consequence of severe ophthalmia, and of badly-managed eruptive fevers, as the small-pox. It can only be removed by a surgical extirpation ; though a rigidly abstemious and hygienic regimen might, in many instances, prevent the disease from proceeding to a dangerous extent. The sight is always desti"oyed. Closed Pupil. — Inflammation of the iris is sometimes followed by an obliteration of the pu* ' Vision is often partially restored by form- ing an artificial pupil. Cataract. — ^This is an opacity of the crystalline lens or its capsule. Its progi'ess is very slow, and it generally commences without any ap- parent cause. The first symptom of the approaching disease is indis- tinct vision. Objects seem enveloped in a mist before the eyes. A speck can then be observed in the center and behind the pupil. As the opacity increases, the sight grows dim, and vision is better in a moderate than a strong light. Treatment. — Surgeons have three operations for its cure. 1st. Breaking up the crystalline lens with needles, which is probably tho best. 2d. Depressing or pushing the lens aside from the angle of vision. 3d. Extracting the lens. When this affection is first discovered, its further progress may be arrested, and possibly a cure effected, by the management applicable tp nebulae, specks, etc. Amaurosis — Drop Serene. — A total or oartial loss of vision from paralysis of the optic nerve, or an affection of the nervous structure of the retina. It is produced by inflammation, severe exposure to in- tense light, intemperance, gluttony, tobacco, alcoholic liquors, excessive niglit labor, etc. Milton was a notable example of this affection. Th>e defect of vision comes on gradually ; letters and other objects at first look misty or confounded, or run into each other; sometimes objects seem double, and at other times portions of objects are undistinguish- able. Between the objects and the eye, numerous insects, cobwebs, or other substances seem to be interposed. The eye itself manifests little or no change to the obser'ar. Sometimes flashes of light appeui* 184 PATHOLOGY AND THERAPEUTICS. before the eyes, and the head is often aftected with vertigo, pain, and heaviness. Treatment. — Confirmed amaurosis is incm-able. If taken in its in- cipient stage, it may be arrested and generally cured. Being essen- tially a disease of exhaustion, the full hydropathic system should be thoroughly and perseveringly applied. The general or constitutional treatment is mainly to be relied on, the local applications being of sec- ondary importance. The simple and single indication is, to invigorate the whole system. The rubbing wet sheet, the pack followed by the shallow-bath or plunge, sifz, and foot baths, with occasional douches, should be adapted discriminatingly to the particular condition of each case. Every part of a hygienic regimen is important. In no disease is strict temperance in eating and drinking more indispensable. A lit- tle of the '' hunger cure" would be serviceable in all of these chronic maladies of the eyes. Strabismus. — Squinting, or cross-eyes, is sometimes congenital, and sometimes produced by diseases and accidents. Measles, dropsy in the head, worms, looking too much at objects obliquely, are exciting causes. More generally it results from a permanent conti'action of a particular muscle which holds the eye in a wrong direction. It is curable, by di- viding the obnoxious muscle, an operation scarcely painful or dangerous. PsoROPHTHALMiA. — A form of chronic inflammation of the eyelids, attended with itching, redness, watery discharge during the day, and a sticky, glutinous secretion durii>^- sleep. Its causes and treatment are the same as of chronic ophthalmia. Trichiasis. — Irritative soreness of the eye, from the eyelashes growing in toward the ball. Extract the inverted haii-s, and bathe often in cool water. Entropium. — The eyelid is sometimes inverted, or turned inward. It requires surgical ti-eatment, viz., the careful excision of the inverted edge of the lid. EcTROPiuM. — An eversion or turning outward of the eyelid. It cre- ates a hideous deformity, and the lid must be excised as for entropium. Hordeolum. — Commonly known as stess to Borae extent. Myopia. — Short-sightedness. The subject cannot read ordinary print well beyond the distance of fifteen or sixteen inches. In looking at distant objects, he half closes the eyelids. It is most common in young persons. The oculists remedy this defect by concave glasses. Manipulations have been found successful as the difficulty depends on too gi-eat convexity of the globe of tbe eye Flattening the eyeball by 186 PATHOLOGY AND TIIER4PEU TICS. pressing gently with the fingers across it, from within outwardly, tends to restore the proper focal point of vision. Presbyopia. — Far-sightedness. The subjects of this complaint read with the book or paper at the distance of t^vo feet or more. The corner is too fiat, the pupil is contracted, and the eyes have a more sunken appearance. It is most common to aged persons. Convex- glasses are prescribed by the oculists. The defect may be final!}" over- come in many j^ersons by manipulating from without toward the nose, so as to increase the roundness of the eyeball. Press the fingers gen- tly from the outer angle of the ey '» inward, and rather around than across the globe. EccHYMOsis. — "Rowdy's coat of arms." This is the common black eye of rowdy characters. Generally it comes from an unlucky blow, but a fall, sting of an insect, or leech bite, may produce it. Bathe freely in the coldest water. Substances in the Eye. — Foreign bodies often insinuate them- selves between the eyelids, causing great pain. Draw down the lower lid (fig. 183), and remove by a piece of moistened paper. If the sub- stance be under the upper hd, place a bodkin across the lid, and draw Fis. 184. DEPRESSING THE LOWER LIU INVERTING THE UPPER LID. back the lid so that it is completely inverted (fig. 184). Very minute pieces of iron are often driven with such violence that a surgeon is compelled to cut them out; but the operation should not be attempted by other parties, as they may destroy 4;he eye. fnfiammation is very apt to occur after these accidents, for which the eye should be well bathed with tepid or warm water frequently, until the pain abates; then follow with cool, auJ. finally cold apprm\':ions. 1 ISEASES OF THE EYE, 187 Lime and Roman cement are very destructive to the eyes. Wash repeatedly with a mixture of a table-spoonful of some vegetable acid in a tumbler of water, as vinegar or lemon juice. Burst Eve. — From severe blows the eye is sometimes burst. Do not attempt to touch it, as vision may be irremediably damaged by touching it with the finger. The careful surgeon will frequently be ena- bled to preserve sight. Place the patient at once in bed, darken the room, and treat the subsequent inflammation with cool compresses. CHAPTER VIII. DISEASES OF THE EAR. The various fi^^normal affections of the organ of hearing may be con- veniently grouped under tlie general heads of inflammation and deaf- ness ; the kinds of the inflammatory afiiection constituting the varieties of the former, and the causes of the malady forming the varieties of the latter. This arrangement, I confess, has nothing classic or sj-stem- atic to recommend it; nor will it embrace two of the diseases belonging to the chapter, which must, therefore, be placed under a third liead, thus : r External Acute Inflammation, Otitis-^ Internal Acute Inflammation, I Chronic Inflammation. f From Cold, " Hardened Ear-wax, " Excrescences, " Abscess, " Caries, Deafness ■{ " Altered Membrana Tympani, " Diseases of the Eustachian Tube " Extravasation, " Nervous Affections, " Dumbness, " Senility. ,, . , Earache, Promiscuous < , ^ F^'"eign Bodies and insects. 188 PATHOLOGY AND THERAPEUTICS. Inflammatory affections of the ear have usually been distinguished by nosologists into acute and chronic ; the former being termed olitis, the latter oiorrhcta. Otitis has been divided into external and internal^ as it affects chiefly the external or internal ear; and otorrhcea has been regarded as mucous or purulent, according to the character of the dis- charge. Other distinctions have been oredicated on the causes of the disease, as scrofulous, syphilitic, etc External Acute Otitis. — Acute inflammation of the external ear commences with slight pain, or sense of heat, or intense irritation, or itching, followed by more acute and distressing pain. The pain is augmented on pressure, by the motions of the lower jaw, and generally by the contact of very cold air, or very warm fluids. Hearing is con- fused, and unusual noises trouble the ear, and sometimes, within three or four days, a thin fluid is discharged from the m.eatus, which gener- ally soon becomes thicker and puriform. Sometimes it is greenish,, fetid, and extremely acrid. When the inflammation subsides, the mat- ter hardens into a caseous or cheesy consistence, which, unless removed, obstructs the passage, and occasions partial deafness. Treatment. — This is plain and simple. Fasting until the inflamma- tory stage materially subsides ; the constant application of several folds of cold wet cloths to the part; occasionally syringing the ear with cool but not very cold water ; and general bathing, once, twice, or thrice a day, by means of the dripping-sheet or wet-sheet pack, comprise all the needful plan of medication. Internal Acute Otitis. — Acute inflammation of the internal ear is attended with a distressing sense of distention, painful throbbing, and nervous distui-bance, consequent on the obstruction of the Eustachian tube, and the diflliculty of discharging the secreted matter externally. The pain is deep-seated ; there is often a feeling as though the ear would burst, and loud, clanging, or beating noises are heard, and the ear is painfully susceptible to scind. In some cases the face is flush- ed, the eyes are red and watei-} , the head delirious, and the attending fever of the typhoid character. If the disease is not speedily relieved, suppuration takes place, and the accumulated matters are discharged through an ulcerous perforation of the membrane of the drum, or into the throat by the Eustachian tube, or by a fistulous opening in the mastoid process of the temporal bone. The former is tlie usual termi- nation ; the second seldom occurs ; and the latter result .s extremely rare. St)"uctural changes sometimes result from internal otitis, whicb partially or totally destroy the sense of liearing. DISEASES OF THE EAR. 189 Treatment. — This disease should be met with prompt and vigorous treatment. In addition to the processes recommended for the preced- ing variety, cold water should be poured over the sides and back of the head, several times a day, and several minutes at a time, or until the preternatural heat of the head is thoroughly subdued. The wet sheet must be resorted to sufficiently to keep down the general fever; and the bowels should be kept well cleansed by tepid injections. In some cases the purulent matter becomes so inspissated that it makes its way through the opening in the membrana tympani with great difficulty, in which case its discharge may be facilitated by very frequent injections ot warm water into the external meatus. Sometimes the Eustachian tube is entirely obstructed ; this fact can be ascertained by causing the patient to make a forcible attempt at expiration with the mouth and nose closed ; if the tube be permeable, bubbles of air, mixed with the fluid secretions, will escape at the external meatus. If the early treat- ment is thorough, and thoroughly hydropathic, this affection will almost always terminate by resolution, leaving none of those deplorable results which are so common, as sequels, after a course of allopathic manage- ment. Indeed, under the ordinary drug-treatment the disease often continues with violence from three to six weeks, and not unfrequently results in a complete disorganization of the internal ear. Chru.xic Inflammation — Otorrhea. — A prolonged discharge, or running from the ear, is frequently the consequence of acute otitis, and often one of the sequelae of malti-eated eruptive fevers, particu- larly small-pox, scarlet fever, and erysipelas. The mucous form is the most common among delicate and scrofulous children, and frequently, under the popular system of treatment, continues for years. The purulent variety is often connected with caries, or ulceration of the surrounding bony sti'ucture. The patieat, in this case, complains of a dull pain in the ear, extending over the side of the head ; of impaired hearing; and exhibits a dullness and heaviness of expression. The mastoid process is oftentimes the seat of ulceration, the external parts being then swollen and cedematous. Treatment. — All forms of chronic abscesses, ulcerations, mucous or purulent discharges from the ear, should be treated on one and the same general plan. They always indicate depravity of fluids, or de- bility of functions, or both; hence the uniform indication is to cleanse, or strengthen, or both. First of all, the general health must be at- tended to. The coarse, plain, farinaceous, and frugivorous diet, a care- ful abstinence from all saline, alkaline, or greasy foods or condiments, with a persevering application of such forms of general bathing as the 190 PATHOLOGY AND THE^i, APEU TI C S. general constitution::! condition demands, \re ilie essentials of the plan The rubbing wet sheet, with frequent h>; and foot baths, as deiivalives, niake a good bathing arrangement. If t'xO iskin is obstructed or bilious, the pack sheet should be occasionally ve&oited to ; and it is more or less frequently useful in nearly all casej. After the general health liaa become substantially improved, warm, and ihen tepid, and then cool injections, should be thrown into the ear, '\t, as is usually the case, there is more or less deafness, and this should be persevered in for weeks and months, if necessary. Deafness. — The pathological conditions, stnictural and functional, of the various parts entering into the formation of the ear, which may produce a greater or less depravation of the sense of hearing, are very numerous ; and many of them are exceedingly difficult of diagnosis. Fortunately, the worst cases are of rare occurrence ; and those which are common are easily discriminated, and successfully treated. Deafness from Colds. — A state of atony, or sub-paralysis of th© auditory nerves, from "taking cold," frequently occasions deafness in one or both ears, for days, weeks, or months. It is cumble by perse- veiing tepid injections, with due attention to the general health. Deafness from Hardened Ear- Wax — An accumulation of hard ened wax, obstructing the function of hearing, is generally the resuU of an erythematic inflammation of the auditory passage. Persons of bad habit of body, torpid skin, deranged digestion, etc., are peculiarly liable to this affection. It is known by an increased sensibility or sore- ness in the meatus, a sense of itching, and often a burning or pricking sensation, confusion in the head, noises in the ear, with a tearing or dragging sort of pain about the ear and kead. It is curable in the same manner as the preceding; but due attention to the general health is the leading indication ; and among the most im- portant of the hygienic appliances is a rigidly plain and unconcentrated diet. Head-baths are useful when the inflammatory symptoms are prominent. Deafness from Excrescences. — Morbid excrescences, usually soft wart-like tumors, or spongy vesicular polypi, are sometimes found in the ear-passage. They are the result of chronic inflammation of the folli- cles of the meatus, or the membrana tympani. These excrescences are red, sensitive, and readily bleed when irritated, except in a few cases," when they are hard and indurated. To detect their character, DISEASES OF THE EAR. 1^1 the meatus must be examined with the ear speculum, oi a common tri- angular reflecting prism of flint glass, by which light can be sent to the bottom of the external ear-passage. Treatment. — In treating these conditions, the inflammatory action ghould be subdued, and the general health restored, as already mention- ed, and then the fungus growths extirpated, after which, both tepid and sold injections should be emploj'ed for a considerable length of time. The polypi and other tumor? can generally be eradicated by a pair of fine curved scissors, or a cur\ed double-edged knife, having a blunt and rounded extremity, or a pair of delicate forceps, with sharp points, or with a ligature passed around them, and occasionally tightened until they are cut off". Such excrescences as are incapable of removal by mechanical means, can generally be destroyed by caustics, for which purpose they may be repeatedly touched with nitrate of silver. Its employment demands great care, to prevent the sound parts from being cauterized also. Deafness from Abscess. — The abscess is a phlegmonous inflam- mation of the cellular tissue of the passage, usually caused by severe cold or exposure to strong currents of air. It should be treated pre- cisely like acute inflammation. Deafness from Caries. — Some persons are afl*ected with, and children of a scrofulous diathesis are very liable to, an inflammation of the periosteum, which generally results in inflammation of the bonj structure, and fi-equently terminates in exfoliation of the diseased bone, by which the passage is narrowed or obliterated. The inflammatory stage should be treated by the means previously recommended, and as the healing process goes on, the passage should be prevented from closing by caustic or metallic tubes. The hearing always remains dull in these cases. Deafness from an Altered Membrana Ttmpani. — Neglected or maltreated inflammatory aff'ections are occasionally followed by a thickening, opacity, fungous excrescence, or destruction of the mem- brane of the drun. Sometimes the membrane, examined by the speculum, appears as if covered by small projecting glands or follicles; at other times it is very red and vascular, the blood-vessels being dis- tinctly visible. The pain is accompanied by buzzings, as if something were fluttering in the ear, and by diminished hearing. The pain ia increased by loud sounds, by variations of temperature, and by press- ure upon the ear. 102 PATHOLOGY AND THERAPEUTICS. Treatment. — There is nothing peculiar in the treatment of this af- fection, as distinct from that of the other forms of inflammation and its consequences, sdreaJy described. It is woith remembering, that in many chronic diseases of the head, and particularly of the ears, deriva- tive, hip, and half-baths are among the best applications. They should be aa lengthy as the patient can bear them, without disagreeable feel- ings in the brain or lungs, generally thirty or forty minutes. Artificial perforation of the membrana tympani has been frequently performed in cases where it was so thickened as to nearly or quite destroy the hearing ; but it has seldom succeeded in restoring it. Deafness from Diseases of the Eustachian Tube. — The Eustachian tube is sometimes obstructed by the presence of tumors in its vicinity, by inflammation resulting in swelling of the mucous mem brane, effusion, constriction or obliteration of a portion of the canal These conditions cannot well be ascertained without explorations by ear forceps or catheters. Injections of warm water, and of air, have been employed to ascertain the nature and extent of any existing ob structiou ; but all these operations are attended with no small degree of danger. Several fatal accidents are recorded in medical journals, as having recently occurred in London, from the pumping of air from a press into the Eustachian tube. The wisest policy in these import- ant cases is to be content with the thojough employment of all meas- ures conducive to the general and local health. Catarrhal aflections, inflammation of the throat, and eruptive fevers, not unfrequently leave an accumulation of mucus in the Eustachian tube, obstructing it, and occasioning more or less deafness. In such cases cold water gargles are an excellent addition to the general plan of treatment. An inflananation principally confined to the mucous membrane of the Eustachian tube, which is often but the extension of a disease of me throat, frequently causes deafness. When this inflammation is confined If. the guttural part of the tube, the patient hears well at times, but only momentarily. His own voice sounds worse to him than the voices of others, and has sometimes a gurgling, crackling, or detonat-n-^ sensation. Th« pain is greatly increased on gaping, or by the act of mastication. Ice-cold gargles, with the whole general anti- inflammation treatment, should be perseveringly employed. Enlarged tonsils sometimes press upon the guttural extremity of the Eustachian tube, so as to produce deafness, as also do fungous excres- cences, polypi, and enlarged parotid glands. Those obstructions, of course, must be removed by ligature or excision ; though enlarged ton- DISEASES OF THE EAR. 193 siis can generally be reduced by cold gargles, and thorougli general treatment, with a rigidly abstemious diet. Deafness from Extravasation. — External injury, violbot sneez- ing, or severe constriction of the neck, may produce a lesion, causing an extravasation of blood in the cavity of the drum. Cold compresses, gargles, injections, and any other baths demanded by the state of the general system, will generally produce an absorption of the extrava- sated fluid, if it does not pass off b}' the Eustachian tube, and remove the deafness. Nervous Deafness. — The term nervous, in this sense, is very in- definite. It is applied by medical authors indiscriminately to all forms of impaired hearing, unconnected with apparent inflammatory pheno- mena or sti'uctural changes. The proximate causes of this form of deafness are numerous : it may arise fi-om simple atony, paralysis, or exhaustion of the nerves pertaining to the sense of hearing, or those nerves may be compressed by tumors, purulent formations, or ex- travasations, not manifested by any external symptoms ; or from organic afi^ections of the brain pressing on the origin of the nerves. The most prominent symptoms which indicate compression of the nerves are vertigo or dizziness, severe and constant headache, noise in the ears, weak sight, and defective memory. It is generally incurable, although the means applicable to the preservation of the general health may prevent the further progress of the condition producing the deaf- ness ; and in some cases the hearing may be greatly improved by the same sanatory measures. Palsy of the acoustic nerve arises from severe shocks, contusions of the brain, convulsions, apoplexy, fever, plethora, and still more fre- quently from sympathy with some chronic derangement of other parts or organs, generally the digestive. The reader need not, perhaps, be told that in all the afl'ections of this class, which, in fact, are many, the prospect of cure depends entirely upon the degi'ee of general health which can be reproduced. Dumb Deafness. — Deafness in infancy may arise from original constitutional malformation, or from structural diseases occurring in the early periods of life. When congenital, it is incurable ; but in many oases resulting from diseases in the first few years of existence, a cure may be effected by careful attention to the local condition and general health ; it is especially important to avoid all concentrated and stimulating articles of food in these cases. 11—17 IVl PATHOLOGY AND 1 If E R A P c) U TIC S. Senile Deafness. — Old age should not, in a natural development ttod decline of the bodily functions, be subject to deafness, blindness, noi other loss of external sensibility, only in the ratio that all the phy- siological functions cease to perform their otYices. But the usual habit* of living tend to thicken the fluids an ^ hasten these results premature- ly — the fine capilliiry vessels of the dehcate structure of the organs of sense become obstructed, and their functions impaired disproportion- ately to those of other and more vital organs. Hence the great fre- quency of deafness in old persons. We have no panacea to ofler ib this relation, of preventive or curative efficacy, save a life in conformity with tile laws of life. Earache — Otalgia. — This is usually symptomatic of inflammation. or of foreign bodies or insects in the meatus. But the affection, con- sidered as idiopathic, is of a nervous, neuralgic, or rheumatic charac- ter, coming on abruptly, and disappearing suddenly, and is unattecdej^ with febrile irritation. Noises in the eai*, and slight 4eafness, are fre quent accompaniments of otalgia. Treatment. — Fasting a day or two, syringing th-^ ear with warii> water, and a few tepid foct-batlis, will generally soon vemove the worst attacks. A warm or vapor bath, or a wet-sheet packJ^F, will often re- move the trouble at once. If the stomach is foul, a warm water eme- tic should be employed, and if the bowels are not enthely free, copious W!U-m water injections are advisable. Foreign Bodies and Insecil> — Children at play occasionally put beans, peas, small pebbles, and other substances into the enr-passage. These may remain an indefiuite time without trouble ; but frequently inflammation and ulceration ensue, w^ith a constant discharge of irr;- tating or fetid matter. They often produce the most intense agony, and are sometimes so surrounded by fungous growths as only to be de- tected by the most critical exa-nination with the speculum, forceps, oi probe. If the body be hard, as a stone or metallic substance, the grating of the probe will discover it. Their removal by mechanical means requires the most careful and dextrous mnnagement, to avoid injuring the adjacent structures. Insects and worms somptimes effect a lodgment in the meatus, pro- ducing nwfu\ suffering. Tiiere is little doubt that inattention to clean- liness, particularly in diseased or ulcerated states of tlie passage, attractP the animals to deposit their ova there, which in time are converted into worms ; and it is possible they may oe generated there as they are in a morbid condition of the secretions of the raucous membrane of the ERYTHEMATOUS INFLAMMATICXS. 196 Btoraach and bowels. In either case they are unprofitublti and danger- ous residents. When they can be seen, they should &e removed with the forceps. A pledget of lint, covered with some viscid substance, as oil and honey, to which worms when small and numerous will adhere, will often ena- ble us to remove them. They may be destroyed also by narcotic poisons Hs oil of almonds, or a strong infusion of gi'een tea, or tobacco. CHAPTER IX. ERYTHEMATOUS INFLAMMATIONS. In the loose, slip-shod medical literature of the day, the terms, ery- thematic, or erythematous, and erysipelatous, are indiscriminately ap- plied to a great variety of topical, eruptive, and symptomatic inflam- matory affections, some of which are actually exanthems, or eruptive fevers, and others mere rashes, attended with little or no constitutional febrile disturbance. In its strictest sense, erythema means inflamma- tory blush, and is applied to those external ma-nifestations of inflamma- tion which are not necessarily connected with fever; whereas ery- sipelas is usually limited to an eruptive fever. Again, therefore, I find it necessary to sacrifice uniformity of method to convenience — my limits precluding tlie idea of a perfect nosological arrangement — and comprise, in the present chapter, Edematous, Erysipelas, Gangrenous, Erythemas -{ Vesicular, Anatomical, Chilblain, Fret. m Rasii Exanthem — Nettlerash. S3 O S Icherous Exanthem ) ^ ' ' ^ ( remphigus. c a H Carbuncular Exanthem — Yaws. Erythemas. — All the varieties of erythema are characterized by red, tumid, fullness of the skin, disappearing on pressure, attended with a burning pain, and termii^ating generally in cuticular scales, or vesicles, sometimes in ulceration and more rarely in gangrene. In the cedematous variety the Bkin exhibits a bright scarlet color; the affection spreads widely ant deeply through the areolar tissue 196 PATHOLOGi' AND THERAPEUTICS. whicli ofteu suppurates imperfectly, and occasionally sloughs and be- comes gangrenous. The swelling is principally caused by extravasated serum; it is generally found iu dropsical constitutions, and usually de- nominated, "■ adematous injiammalion.^^ In erysipelatous erythema the color is of a deeper red, and super- ficial, with a determinate edge, usually in a serpentine or winding di- rection, the part fir^t attacked healing as the disease extends over the surfiice. This form is called '■'■erysipelatous inflammation'''' in many medical books. Sometimes, though rarely, it is attended with some degree of extravasation, producing a soft swelling, and attended with a shiniog surface. It often follows wounds, injuries, and surgical ope- rations. In some cases it extends beneath the skin, and runs into sup- puration and mortification, constituting the erysipelas phlegmonodes of Galen. Gangrenous erythema is characterized by a superficial dusky red color ; a bloody serum separates the cuticle from the true skin ; the cutis, when denuded, exhibits dark brown spots, which are disposed to blister and slough. It attacks chiefly the exti'emities. It ia always found in extremely relaxed and debilitated constitutions, and is most common in advanced age, especially when the vitality has been pre- maturely exhausted by narcotics and stimulants, as tobacco and alcohol. It is sometimes, however, seen in weakl}' intancj'. Either of the pre- ceding varieties may pass into the gangrenous form. In the vesicular variety- the color is pale red ; the surface is rough- ish, and covered with minute crowding vesicles, filled with acrid, often reddish fluid. Authors distinguish two sub-varieties: the first, benign, in which the vesicles advance without a breach of the cuticle; and the second, corrosive, in which the vesicles break in the part first afflected and the corrosive fluid produces tracts of sanious ulceration as the red ness advances. This and the preceding variety were called ignis saccr — holy fire — by the ancients, from the superstitious notion thai they were special inflictions of the Deity, or of His ministers. There are also sub-varieties of this form of erythema, produced by the me- dicinal administration of mercury and arsenic; the former has been called erythema mercuriale and hydrargyria in medical books. The anatomical variety is the erythematous inflammation, ^^hich arises from dissection. Unlike all the other forms of erythema, and, indeed, unlike most other inflammations originating from a local caflfee, it commences^ at least in the gi-eat majority of cases, with a constitution^] febrile disturbance ; the locnl aflection first ai)pearing about the shoul- der or axilla, while the injured part shows little or no inflammatory action Tlie characteristic symptoms, as well stated by Dr. Good, are ERYTHEMATOUS INFLAMMATIONS. 197 "Inf]airmiation, wiih lancinating pains about the axilla, shooting down the chest, ushered by severe rigors and anxiety, succeeding rapidly to the dissection of a fresh corpse, with a puncture or abrasion of the hand of the anatomist; blush, a deep crimson, with a spongy fullness, chiefly over the pectoral muscle ; fever, a typhus." Those few cases in which the local symptoms take the lead of the constitutional, are always the least dangerous ; and this remark probabl}^ holds true with every form of disease resulting from local injury or infection. The immediate cause of this affection has never been satisfactorily explained. It has been ascribed to a specific virus, to the irritation of a putrescent fluid, or to simple irritation or inflammation operating upon a peculiar idiosyncrasy, or constitutional habit. There is little doubt that a dead body, in the incip'-ent stage of putref.iction, may de- velop some chemical element, which, analogous to a ferment, is capable of inducing a process of transformation or decomposition in some of the elements of the blood, or other fluids of the body, not very dis- similiar to what happens in small-pox, measles, and other diseases dependent on a specific virus, or ti'ausformation of matter. To this view it has been objected that the disease is never taken from a corpse in the advanced stage of putrefaction; but I think' the objection itself furnishes a strong presumption of the coirectness of the opinion ; for, it v/ill readily be admitted, that all forms of matter which, in a particular stage of the process of decomposition develop an infectious or poisonous principle, must necessarily be changed into something different if the process of decomposition goes on. Thus yeast, the vaccine virus, and alcohol, all pi'oducts of decomposition or putrefaction, may be resolved into very different and comparatively inert compounds of elementary matters, by further decomposition. , The local inflammation and the accompanying fever resulting from the bite of venomous serpents — as the cobra do capello, and rattlesnake, from whose virus death often results within twenty-four hours — in all essential circumstances, resemble the erythema before us ; the chief difference being that the local and constitutional symptoms Loth com- mence and continue simultaneously, while the progress of the disease is much m.ore rapid, the vitality being, as it were, destroyed as by an electric shock, by the first impression of the poison. There are also two classes of insects which occasion more or less local inflammation of an ery thematic character, in some cases followed by a constitutional disturbance similar to that of anatomical erythema, Ind in a very few cases terminating in death. The first class — as bees, wasps, hornets, ichneumons, etc. — sting, and the second class — as the gnat, horsefly, flea, big, eto —pierce the skin and suck the 196 PATHOLOGY AXD l IT E li APEUTIC S. blood. Whether the injury results mainly from poison, or the rritation of a rough, ragged wound, is not, in nil cases, clear. The following cut exhibits tje instrumentality by which these insects pierce, cut, and tear the fine capillary network of blood-vessels and nerves : Fig. 185. STIXGIXG AND BITING INSECTS. In Fig. 185, a is a representation of the hornet; b, the gnat; c, lancets of horsefly ; d, eting of wasp ; . lancet of flea ; /, lancets of bug. The variety called cJiilhlain, or pernio, affects principally the hands and leet, and is occasioned by exposing the parts alternately to extreme cold and heat. In very cold climates the nose, ears, and lips are some- times destroyed by it. The skin is of a crimson color, suffused with blue, and is troubled with an excessive and obstinate itching. The remaining variety— -//e/, intertrigo, erosion of the skin — is gen- erally seen behind the ears of children, and about the groins and anus of children and adults. The inflamed part is of a brijiht red color, the cuticle is eroded, nnd the exposed skin oozes a limpid and acrimonious fluid; the di.scharge is often peculiarly offensive. The whole t.heoiy of its nature, advanced by Dr. Good, in his elaborate "Study of Med- icine," is In the following words: "It is an eiythema with weak vas- cular action, and often considerable irritability, in consequence of such weakness." The plain English of the matter is this. It is an erythema with filthy personal hal)its, and always considerable uncleanliness of the skin u3 a consequence of such habits. I have never known a man. ERYTHEMATOUS INFLAMMATIONS. 199 woman, or child who took a daily bath or wash over the whole surface, to be troubled with it. Treatment. — In the first four forms of erytheinatic inflammation, we have to deal with local irritation, in connection with great general debil- ity; in the fifth-named variety these conditions are coupled with the peculiar morbid action of a specific virus ; while in the last two varieties the only morbid condition is irritation. TJic indications of cure are, therefore, sufficiently obvious. QEdematous erythema is rarely found except as symptomatic of some primary malady; but when occurring idiopiithicaliy, the local wet compress, frequently alternated with gentle friction by means of soft flannel or the bare hand, and the general tepid or cool ablution, or half- bath, constitute the leading remedial measuies. Bandages of wet linen, when the absorbents are nearly powerless, and the accumulated fluid produces very painful distension, are frequently useful auxiliaries, pro- vided they are evenly and smoothly adjusted. From the fiicts that erysipelatous erythema, frequently attacks chil- dren soon after birth, and that children are sometimes bory with it, we mny reasonably infer that the malady is closely fillied to the voluntary h.ibits, especially the dietetic habits, of the j)atient, or, in case of infancy, the mother. Hence a strict and rigidly simple dietary is of first im- portance in the remedial course. The greater tendency to general fever requires more thorough general bathing, and frequently a resort to the wet-sheet pack. The gangrenous and vesicular forms require more particular atten- tiun to the local treatment. While the general treatment is regulated by the superficial heat and the feelings of the patient, the temperature of the water being as cool or cold, but no colder, than is compatible with a prompt and comfortable glow on the surface ; the local appli- cations should be veiy cold, so as to produce a tonic and constringing eflfect. If very cold applications are painful, they need not be contin- ued long at a time, but may be frequently repeated. Allopathic authorities have not yet settled the question whether the antiphlogistic plan — bleeding and reducing, or the stimulating plan — bark and wine — is the most proper; for neither claims to be successful. Messrs. Hutchinson and Lawrence, eminent European surgeons, rec- ommended making numerous and extensive incisions in the afilected parts, v/ith a view of arresting the disorganization of the structures ; a practice which has been copied by several American practitioners, though not, I believe, with such success as will commend its general repetition. I am lot aware that any hydropathist has had an opportunity of test-' 200 PATHOLOGY AND THERAPEUTICS. ing the new system in a case of erythema arising from dissection ; nor do I believe that all cases could be cured by hydropathic, or any other means. Some anatomists who become tt ns affected are among those wliose physiological habits, especially in the matter of eating and drinking, are gross and unhealthful; hence they may have that degi'ee of putres- cency of blood which can offer but slight resistance to the destructive action of the infectious principle ; aL attack, therefore, may be certain death. And the same remarks apply to the bites of venomous serpents. But the most hopeful plan of treatment is clear. The intensity and malignancy of the disorganizing inflammation should be opposed b)'' a succession of wet-sheet packs, sufficient to keep the morbid heat in check, and promote free perspiration, if possible. In a later stage of the disease, when the strength is much exhausted, and the extremities inclined to coldness, I v/ould employ the warm wet-sheet, and apply hoi bottles to the feet. Water-drinking should be insiated on to the full extent of the stomach's capacity to receive it without painful repletion. I am not aware that any advantage is pretended to have been derived from any of the numerous local applications which have been tried. In the erythema fi-om the virus of serpents, a ligature above the injury, if applied immediately after the bite, or the removal of the wounded part by excision, or the actual cautery, when resorted to inskintly, have no doubt many times materially abated the violence of the disease, or possibly have prevented it altogether. And in some instances it is said that sucking the poison from the wound ver}^ soon after the serpent's fang has been withdrawn, has prevented all injurious consequences — the mouth being defended by a wash of olive oil. It is exceedingly difficult to determine the value of these resources, for the reason that the majority who are bit are not poisoned at all ; hence a remedy per- fectly inert may acquire the reputation of a specific. It is worthy of remark, however, that the virus of the rattlesnake — and the same is true of the fetid secretion of the* skunk, and, indeed, of the venomous matter of most, if nut all, poisonous serpents, reptiles, and insects — is not dangerously noxious when taken into the mouth or even into the stomach in considerable quantities; indeed, it has been employed in one, two, and three deep doses as an antispasmodic, in difficult breath- ing, asthmatic affections, etc., its sensible operation being rather agree- able, nervine, and somewhat exhilarating, like the effect of castor, musk, and similar animal secretions. Compressing the vessels around the bitten part veiy soon after the accident by a cupping-glass or any similar instrument, by interrupting the process of absorption, may con- ti-ibute something to the safety of the patient. The general treatment •8, of course, precisely the same, whether the system is poisoned from ERYTHEMATOUS INFLAMMATIONS. 201 the ingenerated virus of a dead corpse, or the venomous secretion of the living reptile. The irritation or poison resulting from the stings or bites of insects is mos: promptly relieved by the coldest water, and the preferable mode of application is the constant stream or douche. The constitutional affection, should it supervene, requires the same manage- ment as the anatomical variety. Chilblain requires a daily general bath or ablution, and frequent local bathing in the coldest water. As a prophylactic, the patient should never suddenly approach a hot fire when the feet and hands are very cold. The last named variety, as already intimated, only requires that the skin be well washed all over once a day, or oftenei", with pure cold water. If there be any sufferers who cannot possibly be satisfied with- out some "medicated" wash, a small quantity of either bar or soft soap may be added to the water. Like all the empirical infallibles of the day, "it will do no harm, if it does no good." Nettle-Rash — Urticaria. — Some authors have treated of this disease as a variety of scarlet fever. The precursive fever is slight, although the &tomach usually manifests considerable disorder. The rash appears about the second day, attended with a peculiar itching, like the sensation produced by nettle-stinging ; the eruption wanders from part to part, and fades and revives irregularly. It terminates in a few days with cuticular desquamation. Special Causes. — Irritating, constipating, or indigestible food ; salt, vinegar, spices, narcotics, shell-fish, stale sausages, old cheese, frowzy butter, tainted animal flesh, etc. Treatment. — A warm water emetic, tepid injections daily to keep the bowels free, a daily dripping-sheet or half-bath, with plain and abstemious diet, are all that need be said on this subject. Aptha — Thrush. — This disease consists of minute vesicles, con- taining, when matured, a whitish or milky fluid. Authors distinguish three varieties: infantile, or ivJiile thrush, appearing in infants soon after birth, often extending from the mouth to the stomach, and even intestinal canal ; the vesicles granular, roundish, and pearl-colored, and terminating in curd-like sloughs ; malignant, or hlack thrush, is seen most frequently as a symptomatic affection in typhus and innlignant fevers ; but it is said to be sometimes found idiopathically in old age, and other exhausted states of the vital powers; the fever is a strongly- marked typhus, and the sloughs are dark-colored or 1 ack ; chronic ihrush is attended with gi'eat emaciation and hectic fever the eruption 202 PATHOLOGY AND THERAPEUTICS. extends through the whole length of tiie alimentary canal, the edges of the tongue are affected with piraplog, huperficial blisters appear within the mouth aivd fauces, and the stomach is at all times troubled with a sense of heat and soreness. Dian-hea often attends, and ulcer- ations of the bowels are frequent consequences. Special Causes. — Hot drinks; the excessive use of tea and coffee, especially the drug-colored green tea of commerce ; highly-seasoned food; confined air; repelled eruptions ; too concentrated food; rancid greasi^ of any kiti'l ; poi'k gi-avies ; retained animal putrefaction, from inattention to bathing the skin, etc. Treatment. — The abdominal bandage, the wet-sheet pack once or twice a week, cool injections daily when diarrhea attends, moderate drinking of cool, but not very cold water, a daily half-bath, ablution, or dripping-sheet; and the adoption of a bland, simple, sti'ictly vegetable diet, save the article of milk ; with a strict avoidance of all the producing causes, comprise the remedial plan. Pemphigus — Vesicular, or Bladdery Feafr. — This affection is generally symptomatic of visceral inflammation ; though several nosol- ogists of celebrity describe it as an idiopathic disease, and even distin- guish it into several varieties. Its diagnosis is, ti'ansparent vesicles scattered over the body; filbert-sized, with a red, inflamed edge, but without surrounding blush or tumefaction ; the vesicles contain a fluid which is pellucid or but slightly colored ; on breaking, the vesicles are disposed to ulcerate ; and the affection is accompanied with a fever of the typhoid type. In the variety called vulgaris — common vesicular fever — the vesicles appear from the second to the fifth day, in successive crops, often ex- tending over the n>outh and intestinal canal ; another variety, called glandular, is preceded by swelling of the neck and throat, and in Switz- erland, where it has been chiefly noticed, it is considered as highly contagious ; and a third form, termed infantile vesicular fever, attacks infants soon after birth. Treatment. — As this disease, in its essential nature and causes, is nearly allied to the preceding, the treatment need not be materially different. In many cases, frequent sponging with tepid water is suf- ficient. M. Langhaus, who has given us a description of the gland- ular pemphigus of Switzerland, and who ti-eated the disease by bleed- ing and sweating, tells us, with a self-stultification peculiar to the school to which he belonged, in one part of his narrative, that " it was so contagious as to spread with great rapidity through numerous families, and 80 malignant that al' persons affected b}- it diec " and yet, in allu- ERYTHEMATOUS INFLAMMATIONS. 203 sion to his bleeding and sweating, recommends it, " with the most san- guine hope that it will effect a speedy cure." Yaws. — Ruhula and frambo&sia are other terms by which this dis- ease is known. Some nosologists have classed it among the eruptive fevers, although the attending fever is merely adventitious ; while oth- ers have regarded it as properly belonging to the order of tumors. It resembles syphilis and other infectious diseases, in being communicable by contact; and the exanthems and contagious diseases in rendering the body nvulnerable to a second attack. Symptoms. — The disease consists of numerous and successive tu- mors, commencing with mere specks, and gradually increasing to the size of a raspberry, which they somewhat resemble ; some of the smaller papulae become real pustules, and discharge an opake, whitish fluid when broken, and concrete into dense scabs or crusts ; the larger ran into fungous excrescences, and in their granular surface, ns well as size and color, resemble the raspberry, from which their name is de- rived. These tumoi-s, one of which becomes, at length, much larger than any of the rest, have but little sensibility, suppurate very imper- fectly, and discharge a sordid, icherous matter. They originate in scattered groups over the bod}-, and their connection with personal un- cleanliness and infection is sufficiently evinced by the fact, that they are chiefly found in the groins, axillae, about the anus and pudenda, though they often disfigure the neck and face. This is one of the most unsightly diseases known ; and nothing car\ exceed the revolting spectacle of a West India yaw-house, where the slaves, suffering under this disease, are collected together. Dr. Good has distinguished the disease into two vaiieties — African and Ameri- can. The diversity of the symptoms, however, is slight, and attribut- able wholly to local circumstances. In duration the disease varies from one to three months. Sometimes callous tumors are formed on the soles of the feet, in consequence of the yaw-tubercles not being able to press through the thick skin ; these are called tuhha, or ci-ab-yaivs, and greatly impede the exercise of walking. Treatment. — One or two tepid or moderately cold general baths, either by the dripping-sheet, pack, or ablution, witii a strictly vegetable and rigidly simple and absteoiious diet, ai'e the pro;"er iherapeutw app'iauces 204 PATHOLOGY A .N D THERAPEUTICS. CHAPTER X. SPASMODIC DISEASES. Thkre nre n variety of disease?, whose most prominent phenomena are : irregular muscular conti'actions, in some cases amounting to a more or less permanent rigidity of particular muscles, and in others attended with convulsive agitation of some part or of the whole mus- cular system. These may be conveniently grouped in thi present chapter in the following manner : ^ ^ ( Convulsion, Comatose I Spasm ^^P'leP^y' Synclonic Spasm Suffocative Spasm I Hysterics, f Tremor, Delirium Tremens, Shaking Palsy, '] St. Vitus' Dance, Raphania, I Barbiers. ( Cough, Dyspnoea, Asthma, Laryngismus, Incubus, Bronchitis, Sternalgia, Pleuralgia, Clonic Spasm Consti'ictive Spasm '' Hiccough, Sneezing, Palpitation, Nictitation, Subsultus, ^ Stretching. ^ Hydrophobia. Acrotismus, Tetanus, Locked-Jaw Cramp, Muscular Spinal Distortion, Muscular Stiff- Joint. ^ Wry Neck. The generic distinctions in the above arrangement may be thus defined : The comatose spasm is attended with muscular agitation, diminished sensibility, inability of utterance, followed by a tendency to drowsiness; the synclonic spasm is characterized by a simultaneous trembling, or chronic agitation of various sets of muscles, especially when excited by the will; the suffocal'ive spasm disturbs, momentarily or permanently, the muscles of respiration alone ; the clonic spasm is the forcible excitation of one or more muscles in sudden and irregular enalche'? : and the constrictive spasm is an irregular form of muscular contraction producing rigidity. CovuLSiON. — Deaths from convulsion-fits, especially among th© SPASMODIC DISEASES. 206 infantile population of our country, are becoming alarmingly frequent In the city of New York its fatality ranks next to that from consump- tion, and is all the while increasing, and as far as I have been able to gather information on the subject, the same is true of nearly all parts of the United States. Why twenty or thirty children, all of them not far from two or three years of age, should die weekly the year round, in this city, from this disease, may well engage the earnest thoughts of philanthropists and physicians, and, above all, of mothers. Although convulsion occasionally attacks persons in all periods of life, the disease, as already intimatea is conspicuously frequent and tatal in infancy; pregnant women are also, after the sixth month, during labor, and immediately afterward, liabl*; to the disease then denominated puerperal convulsions. Symptoms. — The muscula* agitations are violent, and wilh very young children the spasmodic movements are extremely rapid ; the fingei-s work, and the eyelids quiver; the teeth gnash; sometimes the convulsive motions skip from one part to another; at other times the body is universally convulsed; occasionally the paroxysms intermit and recur at irregular intervals ; often they are accompanied with shrieks or yells. In infancy, the disease is usually preceded by twitchings and startings, and a companied with a blueness about the eyes and uppei lip. When it occurs in adults, the muscles are powerfully exercised, the mouth foams, the eyelids open and shut perpetually, or are stretched upon a full stare, while the protuberant eyeball rolls rapidly in every direction, and the whole face is hideously distorted. Special Causes. — In the course of this work I have more than once had occasion to allude to the unhealthful habits and fashions which prevail in fashionable, and, indeed, in nearly all civilized society, in the matter of rearing children. The disease before us is one of the many special evidences of the general bad feeding, bad dressing, bad doctor- ing, and bad management that rule in the nursery; and as especially prominent among the special causes may be named concentrated food and confections — baker's bread, sweet-cakes, candies, etc. — and the paregoric and purgatives which are given to silence the pain and remove the co»stipation which they produce. Treatment. — The first thing to be done in a convulsion-fit is to expose tlie patient to abundance of cool air and plenty of cold water. There is no danger from any amount of ventilation in the coldest of weather while the fit continues. The cold ablution, or dripping-sheet, will answer for bathing purposes, but the half-bath, during which the surface is actively rubbed with the bare hand, is the preferable mode. As the bowels are usually clogged with il -digested matters, or irritated 18 20C PATHOLOGY AND THERAPEUTICS. by acrimoJiious secretions, tepid injections should not be omitted. After the spasms are overcome, the prophylactics to employ in the intervals nre brown lioine-madc bread, and milk, potatoes, squashes, pumpkins, apples, etc., and a daily bath or universal vvash-down. Kpilepsy — Falling-S jkness. —Epileptic fits present all degrees of violence, from a slight general spasmodic agitation and distortion of the muscles of the face, with a momentary suspension of conscious- ness, succeeded by a sense of drowsiness or stupor scarcely apprecia- ble, to the most violent convulsive movemeiits of the face and chest, while the limbs are fixed and rigid, and followed by several hours of total unconsciousness. Symptoms. — In some instances the disease is ushered in by precursive Byraptoms, which warn the patient of the approaching attack. The most usual of these is a sensation of a cold creeping vapor from some particular part of the body, which has been called an aura ejnlejytica. But more generally the paroxysm comes on suddenly, and often com- mences with a startling scream ; the patient is instantly deprived of al. sense of perception and power of motion, and if standing, he falls, while the body is more or less convulsed ; the muscles of the tace and eyes are always much affected, and the countenance violently distorted ; the tongue generally protrudes from the mouth, which dis- charges a frothy saliva; the lower jaw is strongly convulsed, and the teeth, gnashing upon the tongue, often wound it severely; sometimes the urine and foeces are discharged involuntarily. A profound lethai'gic sleep succeeds the severer attacks, from which the patient at length awakes, unconscious of having suffered pain. When the disease is owing to an organic cause, the attack is more abrupt ; the patient suddenly falls prostrate : there is more rigidity and less spasmodic agitation of the muscles, and optical illusions are very common. This form of epilepsy has been called falling-sickness, or cerebral epilepsy. Special Causes. — Among the organic causes are various structural derangements, as misformation of the head, external injuries, interna) tumors or collections of matter. When the disease is functional, the causes which specially excite the paroxysm in the individual predisposed to it, are — strong mental emotions, especially of the depressing kind, as anger, grief, fright ; indigestible food, an overloaded stomach, or any source of gastric irritation, may prove an exciting cause ; repelled eruptions, and the sudden suppression of customary evacuations, have induced it; exhausting indulgences, either in the exercise of the lower anmial propens>tie9, or in the use of stimulants and narcotics, frequently SPASMODIC DISEASES 20/ occasion an attack ; confirmed drunkards are pecul arly liable to it ; in a few instances the disease }ia« arisen from worms. Prognosis. — The chance of cure will be favorable or unfavorable as the symptoms do or do not indicate functional derangement or local irritation as the cause. When connected with deficiency or malform- ation of brain, organic changes, or exhausted nervous power, it is gen erally, and probably always, incurable. Treatment. — During the fit very little can be done, on account of the muscular distortions. Cold water, however, should be freely applied to the head, cold compresses to the stomach, and warm appli- cations to the feet. In the intervals, the cure must be prosecuted by a careful attention to the general health ; and here we have another condition where the dietetic part of hydropathy is more important than the watery, although both are useful. So utterly powerless for good, if not mischievous, has the drug- treatment proved in this disease, that one of the most experienced of the old school authors, Dr. Armstrong, testifies that he has seen more benefit derived fi'om removing the excit- ing cause, than from any thing else. " As to diet," his language is, '■'■ simplicity in the kind of food, and moderation in its quantity, is the golden rule." In making the practical application of this golden rule, we should prescribe the dry diet as crusts of good brown bread, roasted potatoes, and good baked or boiled apples, as the leading articles. Caution must be exercised not to distend the stomach unduly with a variety at a meal, of even the blandest articles ; very little drink should be taken at meals, and the supper should be extremely light, or what is better, altogether omitted. Among the bathing processes, derivative appliances — shallow- baths, sitz-baths, and foot-baths — should take the lead. As a general rule, they should be of short duration, and fre- quently repeated, so as to guard against determination to the brain. If the skin evinces considerable torpor or obstruction, the patient should be thoroughly rubbed in the dripping-sheet, or packed occa- sionally. Hysterics — Hysteria. — This disease is commonly supposed to be peculiar to the female ; but some authors, having noticed all its charac- teristic symptoms 'occasionally in the male subject, have described two varieties — hysteria feminini, and hysteria masculini. It is certainly :nore frequent in the female, and most disposed to sho w itself during the menstrual period. Symptoms. — The precursive signs, which, however, do not always exist, are — a sense of nausea or sickness, flatulency, palpitation, de- Dression of spirits, weeping, crying, etc., without any assignable caus«- 208 PATHOLOGY AND THERAPEUTICS. The fit soon follows, indicated by a coldness or shivering over the whole body; quick, fluttering pulse; a feeling of acute pain in the head, as though a nail were driven into it: there is often an acute sense of pain in the left side, about the flexure of the colon, with a sense of disten- bion, giving the idea of n ball or globe rolling itself about in the abdo- men, and gradually advancing upward till it gets into the stomach, whence, rising to the throat, it occasions a sense of suffocation, as if a!i extraneous body were pressing thei'e ; this feeling has been called globus hystericus. The convulsive struggle now commences, which is sometimes extremely violent; the trunk of the body is twisted back- ward and forward, the limbs are variousl}^ agitated, the fists are firmly clenched, the breast is spasmodically beaten, the muscles of the chest ai-e agitated in every way, and the patient bursts into violent paroxysms of laughter, sobbing, or screaming, utters incoherent expressions, and is in a state of temporary deUrium. On the cessation of the si^asms, there are flatulent eructations, and a copious discharge of limpid urine, the patient usually lies stupid, and apparently almost lifeless, for a short time, but in an hour or so recovers the exercise of sense and motion, without retaining any distinct recollection of what has taken place, but feeling a severe pain in the head, and a general soreness over the whole body. Diagnosis. — Hysteria may be distinguished from epilepsy by the insensibility b;-ing only partial ; by the sighing and sobbing respiration ; by the globus hystericus; by a peculiar trembling of the eyelid; and by the absence of distortion of the features. In a milder and modified form, the paroxysm consists of sudden insensibility, laborious breathing, swollen neck, flushed cheeks, and a closed and trembling eyelid, and the patient comes out of the fit talking incoherently, or crying and sobbing. Special Causes. — Intense mental emotions, especially grief and anx- iety; constipated bowels; excessive evacuations; obstructed menses; plethora; hot, enervating drinks, as lea and coflfee. Treatment. — A hysterical paroxysm is almost the only disease in the treatment of which allopathic and hydropathic prfctitioners harmonize. It is true the books recommend smelling-salts, asafoetida, fetid spirits of ammonia, ether, castor, musk, valerian, skunk-cabbage, opium, etc., yet the same book-makei-s are kind enough to tell us they do no good ! Says Dr. Guy, author of a Medical Jurisprudence: ''Cold affusion is the only remed\- which can be relied on, and is worth a whole phar- macopoeia of antispasmodics." Drs. Hooper, Good, Cooper, Neill, Smith, and Copland — all accredited authors of the drug school — rec- ommend the cold-water practice. A^.d Dr- Alfred iSmee, F.R S.« SPASMODIC DISEASES. 20S Burgeon to the Bank of England, etc., gives the following directions, illustrated by a plate, both of which are worth copying : flHOfiLVtB TREATMENT OF KYSTEH'^ " Place the head over a basin, and pour water tVoni a jug over the head and chest till the patient becomes chilly and revives. Never use any thing but cold water for the hysterical fir, unless the party turn very cold, when you should discontinue it, and apply warmth to the feet. I once saw the cold applied for three hours, but the patient was quite well the next day." To correct the condition on which the hysterical paroxysms depend, we must, during their intervals, employ the abdominal bandage, fre- quent hip-baths, and occasional dripping-sheets or packs. In almost all cases the bow^els are more or less constipated, and the diet must be regulated accordingly. Tremqr — Trembling. — A tremulous agitation of the head, limbs, or both, especially on some voluntary exertion, often occurs in the pro- gress of acute and chronic diseases. But in some instances the affection appears disconnected, as fiu' as we can observe, with any dis- tinct primary disease, although it is manifestly in all cases symptomatic of nervous exhaustion. It is produced by violent exertion, vehement indulgence of the mental or sexual passions, by various poisons, as mer- cury, lead, opium, tea, tobacco, and is only to be cured by religiously and perseveringly abstaining from all the debilitating causes which con- duce to it ; in brief, all the voluntary habits must be thoroughly ortho- therapeutic. Delirium Tremens — Drf:?karl's Delirium.— " This disease/' m PATHOLOGY AND THERAPEUTICS. Bays Dr. Doane, "is unfortunately veiy frequent in the United States;" to which may be added, that hardly a day passes without some suicide or iiiu)der being chronicled in the newspapers as committed under its intluence ; nor can any different result be expected, so long as our law- making representatives authorize and commission by special license, one class of onr fellow citizens tc poison all the other classes by selling them intoxicating drinks. Symptoms. — Delirium, during which the jiatient recognizes those about him, answers questions rationally, and does hurriedly what he is told to do ; the hands, lips, and muscles generallj^ tremble more or less, especially when speaking, or making any voluntary effort; the patient is restless, sleepless, talks incessantly, and evinces a great anxiety to be doing something; he fancies that he is surrounded with enemies, or that he is in a strange place, from which he is constantly endeavoring to escape; or he thinks some great evil has befallen him, or is impend- ing; he is suspicious of those about him, and is tormented with fright- ful images or sounds ; and often appears to be searching earnestly in unlikel}' places after something on which his mind is intent. There is frequently profase perspiration, a frequent pulse, and a moist and slightly furred tongue. In the most dangerous attacks the patient is himself not violent ; but in more moderate cases, when the muscular energies are less prostrated, he is sometimes exti-emely furious. Special Causes. — The habitual employment of alcoholic beverages in most cases ; in a few instances the disease has arisen from the use of opium, tobacco, andt^ea. The immediate exciting cause is generally sudden abstinence from the accustomed stimulant, particularly if such abstinence has been preceded by an unusual debauch. Treatment. — When the patient is not ungovernable the wet-sheet pack is the most soothing process we can employ; in otlier cases we must rely mainly on the tepid shallow-bath, accompanied with active and persevering friction; the dripping-sheet is also one of the best ap- pliances when considerable feverish heat exists- When the stomach is ft)ul, evinced by bilious taste and fetid breath, a warm water emetic is useful, or even the copious drinking of warm water without emesis; and a daily tepid injection is almost always seiTiceable. Cold cloths should be applied to the head, and when there is the least indication to coldness of the feet, the warm foot-bath should be prescribed. Ei- ther of the general baths may be repeated two or three times daily, or nil of them may be alternated. When the patient is too irritable or restless to perm'.t any general l)ath to be em|)loyed in the ordinary Way, wet towels may be applied to the chest, abdomen, jind thighs, and frequently renewed; and copious cold water injections may be thrown SPASMODIC DISEASES. 211 up the bovvd 5. In all cases cold water may be di-ank to any extent the thirst deinands. In lelalion to drug-treatment in this disease, the allopathic school is about equally divided between large doses of opium and liberal draughts of brandy. Dr. Johnson, in his "Domestic Hydropathy," tells us that the only way to cure the disease is to procure sleep ; and that there is no way of procuring sleep but by means of large doses of opium ; but the doctor climaxes his own climax of absurdity when he adds that, although the opium induces a sleep, which cures the delirium tremens, the patients often die in the sleep which the opium induces ! Shaking Palsy. — Paralysis Agitans. — Tiie term palsy, is not strictly applicable to this disease, for the reason that, although there is a diminution of muscular strength and of voluntary power in the part atfected, there is no absolute loss of muscular motion, nor of sensation, one of which, or both Conditions, being alwajT present in genuine pa- .'alysis. Symptoms. — " Permanent agitjition of the head or lim.bs without vol- untary excitement ; body bent forward, with a propensity to run and fall headlong; usually appearing after maturity." The first symptoms usually noticed are a slight sense of weakness with a proneness to trem- bling, ommonly in the hands and arms, but sometimes in the head. These increase gradually and almost imperceptibly, until, in a few months, the legs begin to be similarly affected, and the body bends for- ward. As the disease progresses, the tremor becomes constant and universal; the muscles refuse to act in obedience to the v/ill ; and, should the tremulous agitation be stopped in one limb by a sudden change of posture, it soon makes its appearance in another. When he attempts to walk he is thrown on his toes and forepart of his feet, and thus compelled to adopt a running pace. In the advanced stages the tremulous motions also occur during sleep ; the bowels become tor- pid, mastication and deglutition are difficult, and the saliva continually dribbles from the mouth. Toward ine closing scene, the power of articulation is lost, the ordinary evacuations are involuntary, and coma wi^h siight delirium occurs. Special Causes. — Long exposure to damp, unwholesome vapors, nervine excitants, as ardent s})irits, strong tea or coffee, narcotic poi- sons, as tobacco, nightshade, etc.; metallic vapors, especially mercurial; drastic purgatives. Those who are emploj-ed in mines, and hence constantly exposed to the exhalations of mineral vapors, are the most frequent and severe sufferers from this disease. Treatment. — As the proximate cause is simple debility of the whole n-l PATHOLOGY AND THERAPEUTICS nervous system, the simple indication of c::re is to sti-engthen the sys- tem ; the only point of skill is in adapting the processes to the particu- lar condition of the patient. The best general plan is, a daily ablution, or thorough rubbing in the dripping sheet, early in the morning, one or two shallow or hip-baths in coui-se of the day, followed by active friction with the dry sheet or dry hand ; and where the system has been evidently poisoned with metallic emanations, moderate sweating, either in the wet or dry sheet, as often as t%Aic€^ a week. Cold water should be drank rather freely, and cold injections employed daily, just preceding the time when the bowels are or should be evacuated. The wet girdle to the abdomen is worth something. The food should be of the most bland and unconcentrated kind, as cracked wheat dry brown bread, hominy, potatoes, baked, boiled, or uncooked apples, etc. Nothing can be more obvious than the nature of this affection ; and nothing can be more ridiculous than the reasoning on the subject in medical books, nor more absurd than the practice recommended. Thus Bonet ascribes the affection to a diseased state of some portion of the cerebrum; and Mr. Parkinson fixes the seat of the disease in the cer- vical portion of the spinal marrow, from which he supposes it to shoot up hy degrees to the medulla oblongata I "The remedial process," says Dr. Good, "is not very plainly indicated;" yet he recommends vesicatories and other stimulants to the neck ; setons, cav.sties, and even the red hot iron applied to different parts of the spine ; and for internal remedies, prussic acid n.nd arsenic ! ! Dr. Elliotson ti'eated several cases with copious bleeding, blisters, mercury, setons, zinc, and sub-carbonate of iron ; but save in a single instance, no benefit whatever was experienced. Such is a fair specimen of the " medical science" of the day. CiioRKA — St. ViTus's Daxce — Chorea Saxcti Viti. — This dis- ease is characterized by "alternately tremulous and jerking motion of the face, legs, and arms, especially when voluntarily callrJ into action, resembling the grimaces and gestures of l)uffoons." The name of St. Vitus's Dance — in colloquial French, Dance de St. Guy — according to Horstius, was given to this affection, or some other resembling it, in consequence of the reputed cures produced on certain women of dis- ordered mind, upon their visiting the chapel of St. Vitus, near Ulm, and dancing from morning till night, or until completely exhausted. Many marvelous stories are related of these dancers by the old writers, some of whom, in their easy credulity, give the patients credit for hav ing danced a whole week or whole month together. Sympioms. — The disease appears most frequenth from the eighth to ^P^SMODIC DISEASES. 213 tlie fourteenth year; and attacks boys and girls indiscriminately, but chiefly those of weak or impaired constitutions. Its approaches are glow, and are marked by variable and often ravenous appetite, loss of usual vivacity, swelling and hardness of the lower belly, and, in gene- ral, constipated bowels, which symptom becomes aggravated as the disease advances; slight, irregular, involuntary motions of different" muscles, particularly those of the face, precede the more violent con- vulsive agitation. The convulsive motions present a great variety of appearances. The muscles of the extremities, of the face, those mov- ing the lower jaw, thfe head, and the trunk of the body, are each at different times, and in different degi'ees affected ; the patient walks un- steadily, his gait resembling startiugs or jumpings : and sometimes walk- ing is impossible. The agitation of the muscles is constant during the day, but ceases during sleep. The eye eventually loses its lustre, the complexion becomes pale, and the countenance is expressive of languor nnd vacancy, giving the patient afiituitous appearance. Special Causes. — Repelled eruptions ; lead; mercur}'; constipation; ncTrcotics ; worms. Dr. Good remarks, "The predisponent cause of this disease is an irritability of the nervous system, chiefly dependent upon debility, and particularly a debility of the stomach and its collati- tious organs." The passage is certainly very fine, but if it has any par- ticular meaning I am unable to discover it. Dr. Armstrong gives us a less eloquent but more practical view of the subject. "Chorea," saya he, " is always preceded by some disorder of the stomach, liver, or bowels ; and the affection which takes place in the brain and spinal cord- seems to be secondajy. You may always trace its rise to some im- proper diet." Treatment. — The whole plan of medication named in the preceding disease is applicable here. The gi^eat majority of cases, however, will be found in connection with torpid liver, costive bowels, and obstructed skin ; for which a thorough daily ablution, an injection every day, or every other day, and a diet of brown bread, wheaten grits, potatoes, and a moderate quantity of the best fruit, wiU • e sufficient. Raphania. — This disease was first descrrued by Linnaeus, and se named because he supposed it to arise from eating the seeds of a spe- cies of wild radish, the rapliania raphanistrum. Other writers have imputed it to spurred rye or ergot, and others to still other vegetable poisons. The symptoms indicate the operation of a narcotic ; and probably several plants, and perhaps also duTerent vegetables in a state of disease or decay, or in a pai'ticular stage of putrefaction, may gen- erate the poisonous element. 214 PATHOLOGY AND THERAPEUTICS. Symptoms. — The disease commences with cold cliills and lassituao, headache, and anxiety about the picECordia ; these are followed Ijy Bpasmodic twitching, and afterward rigid conti'action of the limbs or joints, with excruciating pains, often accompanied with fever, coma, or delirium, a sense of suffocation, and a difficulty of articulation. It con- tinues from one to four weeks, and when fatal, terminates with a diarrhea, or convulsive paroxysm. Treatment. — Moderate cold water-drinking, the free employment of cold water injections, the wet-sheet pack daily, or twice a day. when there is considerable feverishness, and at other times frequent tepid ablutions, constitute the leading measures of the curative plan. Note. — An anomalous disease has, during the last ten years, prevailed in different parts of this country, more frequently in our Western states, to Vv'hich the physicians have been unable to assign a name, and which strikingly resembles the disease before us. If it is not identical 60 far as its causes are concerned, it is sufficiently similar in character to be apprepriately ti'eated on the same plan. Barbiers — Beribery. — This affection is probably unknown in this country. It is common to various parts of India, and of very frequent occurrence in Ceylon, and on the Malabar coast. Symptofns. — General lassitude, painful numbness of the whole body, stiffness of the legs and thighs, and a spasmodic retraction of the knees, and inability to walk, are among the early symptoms. In some cases the limbs are paralytic, and spasmodic actions affect irregularly the muscles of the body, chest, and larynx. In a later period of the disease, the legs swell, and subsequently the whole body becomes bloated and cedematous, the internal cavities are filled with fluid, and, in fatal cases, extreme difficulty of breathing, great restlessness, intol- erable anxiety, constant vomiting, and general convulsions, close the scene. Special Causes. — Sudden ti-ansitions from a dry to a damp atmos- phere, and from sultry calms to chilling breezes, are assigned, by medical writers, as the principal causes. But as the subjects of its attack are almost invariably persons of weakly constitutions, irregular lives, debauched habits, or liquor and tobacco topers, and above twenty years of age, it is evident that the causes named are only exciting cir- cumstances, when the constitution is predisposed by debilitj', or the bad habits which cause the debility. Treatment. — A daily al lution and half-bath, plain food, regiilated exercise, according to the strength, and cold injections, would seem adapted to the therapeutic indication, which is essentially tonic SPASMODIC DISEASES. 215 Cough. — There are three kinds of cough which are ranked as id:o j)athic diseases by authors — comynon cough, dry cough, and hooping' cough. Tbey are all attended with a sonorous and violent expulsion of air from the lungs, from a spasmodic or convulsive action of the res^)!- ratory muscles ; the first and second varieties are often symptomatic of a multiplicity of other diseases. Symptoms. — Common cough, or humid cough, is accompanied with an expectoration of a mucous or serous fluid. The dry cough is so called because it is unattended with expectoration. In the hooping- cough — kin-cough, pertussis — it is accompanied with a shrill, reiterated hoop; vomiting is also a frequent incident. The last variety is conta- gious under certain circumstances, which are not very well ascertained. The disease comes on with rne usual symptoms of catarrh; the excre- tion is always viscid, though small in quantity at first. The hoop, or sonorous spasm, is frequently violent, the iiice becoming turgid and purple from suffusion, and th« eyeballs swollen and prominent. The paroxysms at first recur several times during the day, are most violent toward evening, and least so during the night. After the disease has continued some time, they return only in the morning and evening, and toward the end of the disease in the evening only. The violence of the disease varies from the slightest indisposition without feverish- jess, to the severest spasmodic agitruion, attended with high and dan- gerous fever. Its duration varies from one week to one year, the usual period ranging from three weeks to three months. The pathognomonic sign cf the hooping-cough is the noisy inspiration accompanied by a lengthened hibsing. It is generally a disease of children, and the danger is in the invei-se initio to the age. Special Causes. — The first and second varieties are produced by "colds," or the inhalation of irritating dust, vapors, or other extraneous particles. The third is the result of specific contagion. SequelcE. — Bronchial inflammation, consumption, and dropsy in the head, are commonly specified in medical books as among the sequelae of all forms of cough, but more especially of the hooping kind. They are more commonly the sequelae of the poisonous cough mixtures with which children are generally so liberally fed. Trealment. — All forms of idiopathic cough may be very easily man- aged. Cold water should be treely drank ; the diet must be plain and rather abstemious ; and one or two ablutions daily, followed by thorough friction or active exercise, are, in Jhe majority of cases, amply reme- dial. When the system is incline;! to feverishness, the pack, prolonged eufficiently to produce moderate SAveating, may bo necessary ; and when there is an inflammatory state or fixed soreness of any part off 218 PATHOLOGY AND THERAPEUTICS. the chest or lungs, the chest-wrapper should be applied. When the paroxysms of hooping-cough are veiy severe and sufifocative, a warm water emetic is advisable; and in bad cases a tepid half-bath and foot- bath should be added to the daii^^ processes. The allopathic treatment of cough affords a melancholy reflection for the intelligent philanthropist. How many little children are poisoned out of their constitutions by the multitudinous cough-medicines of the day! It is true the regular doctors declaim against the irregular nostrums, by which children are poisoned through the media of lozenges, medi- cated candies, and narcotic syrups ; but unfortunately their own pre- scriptions are not a whit less poisonous. The most deadly drugs of the materia medica are the active principles of nearly all the popular cough remedies, and chief among theiu all are tartar emetic and opium: while henbane, deadly nightshade, poison hemlock, and prussic acid, are in the next highest class of remedies! Dyspnea. — The generic symptoms of this disease — the anhelation of Dr. Good — are : permanent difficulty of breathing, with a sense of weight in the chest. Like cough, dyspnoea is symptomatic of an ex- tensive range of diseases. Symptoms. — Idiopathic difficulty of breathing is distinguished into •;wo varieties, c/iro^zc, and eracei-batins; — the orthoptKea of authors. In the former the breathing is uniformly short and heavy, and usually accompanied with a cough; in the latter it is deep, stertorous, and suf- focative, subject to sudden and irregular exacerbations, and relieved by an erect position. Diagnosis. — Dyspnoea is distinguished from usthma by the breathing being permanently yet irregularly affected ; >shereas in asthma the difficulty is recurrent with considei*able intervals of perfect ease. Special Causes. — Irritating dust, or pulverulent particles to which etone-hewers i^lass-cutters, china-manufacturers, workers upon metals, millers, starch-makers, horn and pearl-workers, weavers, wool-carders, and feather-dressers, etc.. are subject; the vapor of mineral acids, metallic exhalations, narcotic vapors, various structural derangements, ns corpulency or obesity, hydatids, tumors, indurations, adhesions, etc. In some instances, a condition of emphysema, or preternatural dilatation of the air-cells of the lungs, resulting from catarrh, has produced both dyspnoea and asthma. Treatment. — When the cause is organic, little more can he done than to mitigate the sufferings of the patient by a careful attention to the general health. When the disease depends on functional derange- ment, the general management is the same as for common cough. A SPASMODIC DISEASES 217 moderate douche to the spinal column would be of additional service in -nost cases by promoting absorption ; and where patients have been 3xposed to poisonous vapors or effluvia, moderate sweating is desirable Sauvages relates the case of a female who was bled three times a day, antil the venesections amounted to two thousand, without benefit ! By warm bathing and active friction, so a«3 to produce free perspiration ?he was cured in ten days. Asthma. — This affection is, too, much more frequently a symptom- atic than an idiopathic affection. Its pathognomonic characteristics are : recuiTent and temporary difficulty of breathing, accompanied with a wheezing sound, and sense of constriction in the throat, with cough and expectoration. Authors distinguish two varieties, dry, convulsive, or nervous — asthma siccum ; and humid, or common — asthma humidum. Symptoms. — In the first variety the attacks are sudden, violent, and of short duration; the sense of constriction is hard, dry, and spasmodic; cough slight, expectoration scanty, and only appearing toward the end of the paroxysm. In the second variety the paroxysm is gradual and protracted ; the consti-iction heavy, laborious, and humid ; cough vio- lent; the expectoration commences early, is at first scanty and viscid, but afterward copious, and affording great relief. In many cases the attack is in the night, and most frequently an hour or two after mid- night. Special Causes. — Neaiiy all the causes named in the preceding dis- ease may produce this. It is frequently caused by turgescence, or swelling of the liver or spleen, which impedes the motions of the dia- phragm, or interrupts the supply of nervous influence. Strong mental emotions, repelled eruptions, suppressed discharges, rank odors, foggy, misty, or damp weather, indigestible food, and other dietetic errors, are fi-equent exciting causes. The predisposition is sometimes occasioned by malformation of the chest, small size of the glottis, dyspepsia, all of which may be conditions of hereditary transmission. Dr. S. Cooper names among the occasional causes, "the influence of light and dark- ness" — an idea altogether too diffuse. Treatment. — Medical authors admit that asthma is seldom cui'ed drugopathically, yet console themselves with the reflection that patients seldom die of the disease, as such, or until it takes some other form ; hence an opportunity is afforded to try any kind of medication that fact or fancy can suggest. It is ti'ue that expectorants and nauseants, as squills and antimony, and relaxants and debilitants, as tobacco, coffee, gin, saltpetre, and bleeding, generally relieve the paroxysm for the time, at the expense, if frequently repeated, of the total ruin of the ri-19 218 PATHOLOGY AND THERAPEUTICS. digestive powers and nervous system ; and that emetics, especially of lobelia, have entirely suspended the symptoms of the disease in the humid variety, for a longer or shorter period, without any great injury to the constitution ; and this, I believe, is all that can be said in favor of the popular practice. The rubbing wet-sheet, pack, and douche, with the chest-wrapper, are the leading ])rocesses. Any of the other bathing appliances may be useful or necessary in particular cases, but these are applicable and important in the great majority. When the digestive organs are strongly implicated, the tepid shallow-bath is excellent, and then the abdominal bandage may be substituted for the chest-WTapper. Asth raatic patients can usually take three or four baths daily with advantage. The following combination I have employed successfully in several cases : Dripping-sheet five minutes, followed by the douche three min- utes, on rising; at ten to eleven a.m., wet-sheet pack forty-five to sixty minutes, followed by shallow-bath at 72°, ten minutes; at four p.m., sitz-bath at 65°, fifteen to twenty minutes, or shallow foot-bath at 65'^, five to ten minutes. Where there is a good degree of animal heat, a dripping-sheet at bed-time is very serviceable. The bowels must be kept free, by tepid or cool injections, if necessary, and the patient may generally drink six or eight tumblere of water in the forepart of the day. Equally important, and perhaps more so, is the diet. Here we have another opportunity to magnify "the hunger-cure." In all cases the diet should be simple and unconcentrated, and in those cases connected with or caused by diseased livers or spleens, or primary dysjjepsia, it must be rigidly abstemious; and even this should be com- posed principally of the articles named in a former part of this work under the head of dry diet, or something similar. During the pai'oxysm we should palliate and abbreviate the sufferings of the patient as much as possible, by exposing him freely to the cold air — which is, indeed, what his feelings most intensely desire, and which is always safe while the fit is violent — giving him warm water to drink, even to the extent of vomition, and applying the warm half or hip-bath ; or when the breathmg is so laborious that he is obliged to sit erect, the hot fomentation to the chest and abdomen. Laryngismus — Laryngismus Stridulus. — This complaint is known by the various synonyms of spasmodic croup, spasmodic asthma of children, child-crowing^ crowing inspiration, angina stridula. Symptoms. — The disease consists essentially of a sense of spasmodic suffocation in the larynx, which usually comes on suddenly in the night, attended with a struggle for breatli, ani a shrill, croaking sound of the SPASMODIC DISEASES 219 voice, or crowing inspiration, somewhat analogous to .'rjup ; the coun- tenance is flushed and swollen, and in the severest cases convulsions occur. Dr. Good names " troublesome cough," as among the pathog- nomonic symptoms, while Hooper says it is "unattended by cough." The symptom in controversy is merely incidental. This disease some- times, though rarely, attacks adults. Diagnosis. — It is distinguished from croup by the attack being more sudden, and the symptoms relaxing or intermitting ; the freedom of the breathing during the intervals ; the absence of febrile or catarrhal symptoms ; and usually the presence of hot swollen gums. Special Causes. — Repelled eruptions, especially of the head, face, or neck; intestinal irritation from worms ; indigestible aliment ; enlarge- ment of the glands of the neck and chest ; cold, and teething are some- times exciting causes. An (Edematous swelling of the mucous folds in the ventricles of the larynx, has been supposed by some authors to be the proximate condition on which this affection depends. Treatment. — The ordinary drug-treatment is, an antimonial emetic, a calomel cathartic, an opium anti-spasmodic, and a Spanish-fly vesica- tory — a plan of medication far more dangerous than the disease itself. Several folds of v/et-cloths well covered with dry to the throat, a tepid bath followed by the dry pack, or by putting the patient, in bed, well covered so as to promote perspiration, free warm water-drinking, and a tepid injection if the bowels are not entirely free, is the [ilan of a safe and successful treatment. Incubus. — Authors distinguisfi two varieties of incubus, one of which is called nightmare, and the other day ma" e. The ancient Anglo-Saxon name for this affection was elf-squatiing — eij sidenne — so denominated because of the imaginary resemblance of the sudden sense of an op- pressive and suffocative weight on the chest, to the feeling produced by some hideous monster lying on the chest. Symptoins. — Both varieties are attended with sighing, suffocative difficulty of breathing, intercepted utterance, or entire temporary ina- bility to speak or move, with a sensation of some external weight press- ing heavily o*- the chest, from which the patient awakens aftVighted. In the daymare, which occurs during wakefulness, the sense of pressure is severe, and is extended over the abdomen ; the respiration is fre- quent, laborious, and constricted ; the eyes are fixed ; the sighing is deep and violent; and the intellect is undisturbed. The nightmare i» the more common form ; it occurs during sleep, which is interrupted with a violent struggle and tremor ; the pressure on the chest seemi to be that of some hideous monster or phantom ; it is usually preceded 220 PATHOLOGY AND THERAPEUTICS. by a painful or troubled dream, during which the patient imagines some position of danger, as a high building, steeple, or precipice, from which he is about to fall ; or fancies some horrid accident or calamity, as mur- der or suicide, or conceives an attack from some enemy, hag, spectre, ghost, or goblin, whose grasp he is incapable of eluding. Special Causes. — It is generally occasioned by excessive fatigue, ex- haustion from want of sleep, an overloaded stomach, or some indigesti- ble irritant in the alimentary canal. Dyspeptics, and nervous females are very liable to it. All persons who eat heavy or late suppers are in a state of predisposition. Treatment. — Shaking, agitating, or awakening the patient will imjne- diately arrest the paroxysm, which, by the way, seldom lasts a fiill minute. The preventive management is found in alight evening meal, a hard bed, and sleeping on rather high pillows, with the body a little inclined on the side. The curative plan may be found in a daily bath, plain qualit}^ and moderate quantity of food, and a free daily action of the bowels, which should be promoted by injections if necessary. Bronchitis. — Although this disease is attended with more or less Butfocation and spasmodic respiration, it is really caused by, or rather is in fact, an inflammatory affection of the mucous membrane of the bronchial ramifications. It is frequently the precursive condition of consumption ; and not unfrequently the treatment pursued by the med- ical man, rapidly hastens on the fatal termination, by developing tuber- cles in the lungs It is comparatively a modern disease, and is alarm- ingly on the increase, owing to the luxurious and enervating habits of fashionable society. Authors distinguish the disease into the acute and the chronic forms ; but as the former is not essentially different from a severe catarrh, or mild pneumonia, either in its symptoms, progi'ess, or termination, it is only what is usually known as chronic bronchitis that concerns us here. Irritative and inflammatory affections of the mucous membrane of the throat, fauces, larynx, pharynx, and adjacent parts, are often confounded with bronchitis proper : and are described as and confounded with this disease under the various terms of pulmonic erysipelas, pituitous ca- tarrh., bronchial angina, suffocative catarrh, catarrhal bronchitis, bron- chial peripneumony, pulmoriary catarrh, catarrhal fever, acute mucous catarrh, acute suffocative catarrh, etc. Symptoms. — The disease commences with more or less cough, irri- tation about the throat, sense of tightness in the c^iest, and shortness of breath, which do not, fur a considemble time, attract much atten- tion. The first difllcul^y which is generally noticed as of importance. SPASMODIC DISEASES. 18 a sense of roughness, with frequent attempts to clear the throat, ac- companied with or followed by titillation of the larynx, exciting a dry, hard cough ; these are, after a longer or shorter period, succeeded by gome degree of hoarseness of voice, w^th a sense of tightness across the chest, and sometimes a slight pain or diffused soreness upon cough- ing, or inflating the lungs fully by a prolonged and deep inspiration. As the disease progresses dyspnoea comes on, which is increased by exer- tion, coughing, or exposure to cold, and some degree of expectoration occurs, at first scanty, then more copious and of a glairy appearance, like the white of an egg ; and in still more advanced stages it becomes muco-purulent or purulent and sometimes tinged with blood. In some cases all of the symptoms are abated every summer and exacerbated every winter for several years in succession. The constitutional dis- turbance is marked by lassitude, pains in the limbs and back, slight shiv- erings or chills, frequent and feeble pulse, feverishness after dinner or toward evening, and eventually night sweats. In some cases the prin- cipal local symptoms are, hoarseness or loss of voice, a hard, dry cough, with a sense of soreness, rawness, dryness, and heat under the ster- num ; in most cases the cough is always excited by a full inspiration ; m a few instances the breathing is sittiing or wheezing, owing to the air struggling through the viscid mucus accumulations in the bronchi ; and sometimes, though rarely, the voice is scarcely altered, while the breathing, on the slightest disturbing causes, becomes painfully spas- modic, in consequence of the tenacious, glaring secretion becoming con- creted upon the lining membrane of the bronchial tubes. Special Causes. — All the causes of consumption, may, under a mod- ified set of circumstances, produce this form of pulmonary disease. But there is no doubt that the increasing quantity of tea, coffee, and tobacco consumed by our people is a special uii*se of the increasing prevalence of this disease among us. Treatment. — Nearly all that has been said in relation to the man- agement for consumptives wnll apply here ; and to that the reader is referred. A majority of the patients come to us bundled up in flan- nels, extra silk, double stockings, India rubbers, and other contrivances for keeping off the cold, to which these very contrivances — usually per advice of the doctor — have rendered them extremely susceptible. All these worse than superfluities of dress must be removed by degrees, as the pa ient's skin becomes accustomed to the contact of cold air and vrater. The best processes to commence with are generally the sponge or towel-bath, or rubbing-sheet, accompanied with active though not severe friction. After a few days the chest-wrapper should be applied, and all the derivative appliances — half, hip and fcot-baths — employed. £22 PATHOLOGY AND THERAPEUTICS. as frequently atiJ as cold as the patient can bear without disagreea- ble or prolonged chilliness. Precaution is necessary also, to avoid greatly disturbing the circulation cr respiration, by too great a shock or too cold an in pression. When the general heat of the surface is equal to, or above the natui-al standard, the pack should be resorted to daily, or tri-weekly. Those patients who are particularly troubled with short brenth, and are easily fatigued by exercise, should walk regular!}' and perseveringly in the open air, within the bounds of much fatigue at first, and gradually increase the distance. At best bronchitis is a dangerous and most obstinate disease, and pa- tients ought to understand before commencing a course of water-treat- ment, that time and patience are important considerations. I have known a few cases recover in ten or twelve weeks, but a majority re- quire cai'eful ti'eatment from six to twelve months, vrhile many cases cannot be thoroughly cured in less time than from one to two years. This may seem like a long and discouraging process; but if the sufferer can draw any consolation from the fact that no other method ever cures at all, he will find abundant evidence of the fact if he will look over the long catalogue of remedies which are put forward in medical books ; a list whose formidable length is alone conclusive that no real confidence is felt in anyone of its ingi*edients, nor in all together. Perhaps a page or two of this work could not be more instructively occupied than in presenting a fair sample of the interminably experi- mental nature of drug-ti'eatmeut — as few unprofessional pei'sons have ever dreamed of the confusion which pervades medical books on the subject of prescribing remedies. As an illustration, therefore, I will copy in full, from one standard work — Copland's Medical Dictionary — all and singular the remedies and curative processes, commended for the ti'eatment of the different states, forms, stages, and complications of the disease under consideration. These may be conveniently collated under the heads of classes, processes, fumes and fumigations, inhala- tions, drugs and preparations, and regimenal directions. 1. Classes of Medicines. — Acids, alkalies, emetics, purgatives, expoctoruDts. laxatives, tonics, nfrigeri.nte, stimulants, antiphlogistics, dpmulcents, cathartics, emollients, rube- facients, mucilages, vesicatories, revulaants, counter-irritants, diaphoretics, diuretics, se- datives, bitters, alteratives, attenuants, antispasmodics, narcotics, diluents, enemata, ano- dynes, and narcotics. •2. Processes of Medication. — Gener&l bleeding by the lancet ; local bleeding by leeches ; topical depletion by cupping; Inncing the gums (in children) ; blisters applied to various parts; burning the skin by hot turpentine; cauterizing the#kin by moxa burnings; pus- tulating the Bkin by ointment ot'tartarized antimony ; leeches applied over the sternum, leeches applied behind the ears ; leeches applied below the occiput ; cupping on the nape of the nock ; issues ; sctons the warm-bath ; sponging thebDdy with warm water and vin- egar ; sponging with a wa"*! lotion of nitro n uriatic acid ; astringent gargles ; cooling I SPAS. IODIC DISEASES. 1523 gargles ; antiseptic gargles ; demulcent linctuses ; lotions of common salt and water ; semi- cupium , pedili.Tnviura ; poultices ; liniments ; and fomentations. 3. Fumes and Fumigations. — Of tar, camphor, benzoin, amber, frankincense, myrrh, etoras, cloves, sulphur, assafoetida, and various tarpentines and balsams ; also the smok- ing of balsam of tola. 4. Inhalations. — Of chlorine gas ; fumes of iodine ; watery vapor holding in solution various narcotics ; sulphuret of iodine ; liquor potassii iodidi concentratus ;■ tinctures and extracts of henbane and poison hemlock, with camphor; fumes of the various bal- sams, terebinthinates, and odoriferous resins ; also of vinegar. 5. Drugs and Drug preparations. — Antimony in full do.ses ; antimonial wine ; com- pound powder of antimony ; tartrate of antimony and potassa ; solution of potassio tar- trate of antimony ; James' powder ; blue pill ; calomel ; corrosive sublimate ; mercury with chalk and rhubarb, followed by castor oil and small doses of ipecacuanha ; Dover's powder ; wine of ipecacuanha ; opium ; camphorated tincture of opium ; syrup of pop- pies ; camphor ; camphor mixture ; ammonia ; carbonate of ammonia ; liquor of the ace- tate of ammonia ; conserve of roses ; capsicum ; oliv.e oil ; white willow bark ; Iceland moss ; Prussic acid ; aloes ; senna ; creasote ; preparations of steel ; carbonate of soda ; t^i-carbonate of soda ; bi-tartrate of potash ; compound tragacanth powder ; sulphur ; bal- sam of sulphur ; sulphuret of potassium ; sulphuric acid ; sulphuret of ammonia ; sul- phuret of copper ; sulphate of zinc ; sulphate of quinine ; sulphate of alumina ; flowers of sulphur ; sulphate of iron ; various preparations of iodine ; extract of dandelion ; extract of hops ; extract of conium ; extract of hyoscyamus ; extract of sarsaparilla ; extract of gentian ; extract of poppy ; extract of lettuce ; belladona ; trisniti'ate of bismuth ; salt- petre ; squills ; decoction of squills ; tincture of squills ; infusion of squills ; oxymel of squills ; tincture of hyoscyamus ; colchicum ; infusion of colchiciim seeds ; digitalis ; chlorate of potash ; tarh'ate of potash ; chlorate of lime ; columbo ; decoction of Peruvian bark ; infusion of marrabium ; chloride of calcium ; liquorice ; mezeron bark ; cinchona ; uva ursi; gum arable ; oil of turpentine ; myrrh ; vinegar; marsh mallows ; decoction of polygala ; linseed tea ; ammoniacum ; galbanum ; senega ; nitrous spirit of ether ; kermes mineral ; mixture of sweet almonds ; and syrup of tolu. Regimenal Directions. — Barley water; tamarind water; lemonade; vegetable acids ; sulphureous mineral waters ; Brandish's alkaline solution ; ale ; beer ; imperial ; red wines of Bordeaux and Burgundy ; decoction of Iceland moss ; jellies ; mucilaginous and emolient soups ; new-laid raw eggs ; shell-fish ; and white fish, dressed with olive oil, or the oil obtained by boiling their own livers. There, reader, you have the whole apothecary shop and most of its appurtenances before you. I submit whether these evidences of cure do not prove too much? Before dismissing this subject, I must advert to the cauterizing prac- tice which has lately become so popular in bronchial and throat affec- tions. Some physicians are doing an extensive business in the appli- cation of nitrate of silver to all sorts of affections of the mouth and throat; and some kind of machinery has recently been invented by which the dust of lunar caustic can be inhaled into the lungs. It is true that caustics will often cure ulcers in the mouth, or about the fauces or tonsils ; but they are very liable to reappear, and, moreover, they can be better cured without the caustic than with it. But where the lungs are seriously affected, or the bronchial ramifications in a state of actual inflammation, the application of the caustic very frequently aggravates the affection of the pulmonary tissues, as I havf3 known in '2-2'i PATHOLOGY AND THERAPEUTICS. ] very many cases. This practice may be safe in purely local affectionu of the throat, but it is certainly hazardous where the lungs are also : implicated. Sternalgia — SuFFocAxnE Breast-Pang. — This affection is de- scribed by various writers under the varied names of angina pectoris^ ' syncope anginosa, orthopncea cardiaca, arthritic, or dolorous asthma, I and stcrnocardia. ' Symptoms. — The disease is characterized by a violent pain about the ; sternum, or breast-bone, extending toward the arms, attended with anxiety, difficulty of breathing, and a sense of suffocation. Authors describe two varieties : acute, in which the attack comes on suddenly during exercise, with a tendency to faint, and which is relieved by I rest ; and chronic, in which the paroxysm is less violent, of longer I duration, recurring frequently, and excited by slight causes, attended with palpitation, and not relieved by rest. j Special Causes. — Corpulent, gouty, rheumatic, and debilitated per- sons are especially the subjects of its attacks; hence the usual causes ' of obstruction and nervous exhaustion may be regarded as its predis- posing influences, and, indeed, it is always symptomatic of some gen- eral morbid condition. Laennec regarded angina pectoris as a species i of neuralgia of the heart ; and some authoi-s have imputed it to ossifi- | cation of the coronary arteries of the heart — a supposition purely | fanciful. Treatment. — The paroxysms can be relieved by a warm water i emetic, a dripping-sheet or douche, or the pouring head-bath. The j cure depends on a well-regulated diet, and a dtiil}' cold-batli. ■ i Pleuralgia — Pleurodi'ne. — Both of tliese terms import pain in ] the side, and are employed to denote a pungent pain in the side, with | diflficulty of breathing, which difficulty is owing to an acute disti-ess or j ache produced by every attempt to inflate the lungs. It is distinguished i from pleurisy or pneumonia by being unattended with fever or inflam- i matory symjrtoms. \ Symptoms. — In the acute or severe form, which is called stitch in \ the side, the pain is sudden and temporary, supervening on exercise, I and being relieved by repose. In the chronic form the pain is per- J manent, augmented by pressure, and there is inability of lying on the side affected. ; Special Causes. — The first vaiietA- is generally occasioned by hard i running, jumping, lifting, or other violent exertion, but is sometimes symptomatic of flatulejice hysteria, hypochondriasis, etc. The second '• SPASMODIC DISEASES. 225 variety is in some cases symptomatic of structm-al derangements, as aneurism, malformations, adhesions, or other organic lesions ; more commonly it is caused by plethora, transferred gout or rheumatism, chronic inflammation of the liver or spleen ; and more frequently still it is produced by the barbarous custom of lacing the chest, and the m schievous habit of leaning against a hard desk, or bending the trunk of the body forward while writing, reading, sitting, sewing, etc. Treatment. — The stitch gradually subsides on moderating the exer- cise, or by resting. It may be prom.pth' relieved by a handkerchief, or light bandage, the hot fomentation, or warm douche. In the chronic term we must have regard to the producing cause, or the primary malady. The abdominal girdle is, however, always in order. HrDROPHOBiA — Canine Madness — Rabies — Entasia Ltssa. — Hydrophobia literally means water-dread, a symptom which generally, though not uniformly, attends the disease, and is, in some instances, found in other diseases. Symptoms. — The disease generally commences with pain, uneasi- ness, or some unusual sensation in the wound, o.r bitten part, followed by pains darting along the course of the nerves. But in some few cases these local symptoms do not appear. The first constitutional symptoms are, wandering pains in different parts of the body ; stiffness of the neck and throat; restlessness and irritability; the patient is drowsy or depressed; he is observed to sigh deeply and frequently; a principal feature among the early symptoms is a sudden and deep in- spiration with which the patient is fi-equently affected. He is also severely agitated by the impression of cold air, the glare of a mirror, the noise of a pump, the sound of water, etc. As the disease pro- gresses, its true nature becomes revealed by the difficulty of sw^allow- ing liquids, which increases until the sight or sound of water causes him to start with dread and horror ; the attempt at deglutition is hur- ried, accompanied with sobbing, and followed by convulsions. The countenance now expresses indescribable alarm, anxiety, and suspicion; the eyebrows are contracted ; the eyes are wild, staring, and glassy ; there are urgent thirst, hot and dry skin, painful efforts to vomit, and intolerance to light and sound. The sufferer spits out the frothy mucus and viscid saliva between his closed teeth, with vehement strainings, ^vllich occasion a singular sound ; talks in a loud, important, authoritative tone, and often screams violently. In some instances the intellect seems unaffected to the last, but in other cases he is wildly delirious, anJ ta]k-^ incoherently and incessantly. Toward the end, convulsions be ?on53 nnre fre^quent, ar.d the patien,' dies asphyxiated or exhausted 22G TATHOLOGY AND THERAPEUTICS. Tlie durntion of the disease is usually two or three days ; in some rare instances it has continued eight or nine days. The symptoms also manifest considerable diversity. Sometimes the wounded part exhibits nothing more than a slight lividity, and sometimes the cicatrix opens afresh, and oozes forth a little colored serum. In some cases the patient is furiously mad, I ^tes himself and others, also the bedclothes, and whatever else is withii reach. Special Causes. — This disease is usually communicated by the bite of a rabid animal ; but it may originate spontaneously. The nature and origin of the virus, or infecting principle, are unknown. But that putrid flesh and decomposing offal, on which so many dogs, cats, hogs, etc., are fed, are the chief producing causes, is attested by the fre- quency of its occurrence in those animals. But this cause alone does not seem capable of generating the poison. Some excitement, or feverish heat of the blood, must co-operate. It is well known that violent passions have, in the human being, and in various domestic animals, changed the saliva in a moment to an absolute virus, which has com- municated disease and death to others. Thus the bite of an enraged man, horse, hog, goose, duck, and hen, has been known to impart a deathful infection. And when a furious exercise of the passions, or an inflainmatory state of the blood by violent exercise, co-operates with putrescent food, the peculiar abnormal transformation of matter may take place, which, analogous to a ferment, as I have previously had occasion to intimate, may produce in the saliva a virus capable of propagating itself under favorable circumstances. This view is cor- roborated by all its historical and phenomenal data. Dogs, cats, and hogs are most exposed to these combined influences, and these animals are most subject to the disease, and in the order named. Wolves and foxes have been noticed as more frequently afl*ected than the herbivora — horses, oxen, cows, sheep, goats, etc., and the manner in which they are exercised and fed, still strengthens our position. Prognosis. — Hooper pronounces judgment in the following words : "Fatal. The disease has hitherto defied all remedies." Some few cases, however, have recovered under different and even opposite plans of treatment, owing probably to the enduring energies of a good constitution. Water-treatment has apparently succeeded in two or three instances. Latent Period. — The time which elapses between the bite of the rabid animal and the development of the symptoms, is usually from twenty to forty days ; but it may be less than a week, and has been Known to extend to three and four years. Treaifxcnt. — l^he indications arr* — 1 1 ; equa'ize the distribution of SPASMODIC DISEASES. 227 tervous influence , 2. To deterge the system of its virus. In the early stages the cold treatment may be applied in almost any form, provided it be powerful enough to produce a decided sedative influence upon the whole system, followed by the wet-sheet or dry blanket en- veloping, to promote perspiration. Probably the preferable processes are the douche and rubbing-sheet, followed by the wet-sheet pack when the temperature of the body is nearly at or above the nonnnl standard, and by the dry pack when the circulation is low, and there is an inclination to chilliness. These processes may be repeated and alternated as long as the spasmodic condition of the throat exists. Meanwhile, if the patient cannot swallow sip« of cold water, \ve may perhaps be able to chew or swallow bits of ice ; and he may be in- dulged to the extent of his inclination. Very cold compresses or pow- dered ice should also be applied to the thorax. Very cold water enemas I should decidedly recommend, although I am not aware that they have ever been tried. Hooper tells us that the irritation of the throat has never been removed except by the use of ice taken internally. Priessnitz has repeatedly cured rabid dogs by douching them perse- veringly in cold water. The following case, treated by Dr. Todd, at King's College Hospital, is instructive : The patient was a boy seven years of age, laboring under the v/orst form of the malady, and refus- ing, with horror and impatience, every thing offered him, of either a solid or liquid form. After having taken twenty drop doses of prussic acid without any effect on the spasms, he was offered a fragment of rough ice, which he seized and swallowed with avidity. Fresh pieces were constantly put into his mouth, which he seized and craunched Detween his teeth with remarkable eagerness, swallowing them with perfect ease. In half an hour he had taken a pound and a half of rough ice ; and at the same time a bladder containing a mixture of roughly-powdereJ ice and common salt was applied the whole length of the spine and around the throat. Under this treatment all the symptoms referable to the throat and chest, with the exception of oc- casional hackings, passed away, and nothing remained but extreme restlessness, violent excitement, and incoherence. In this condition, and in Dr. Todd's absence, the cold douche was unfortunately applied by the directions of some other physicians, "but the system," says the phj'siciau who prescribed the douche, " did not rally from the shock." Dr. Guy, author of a work on Medical Jurisprudence, remarks, in relation to the above case : "I am inclined to attribute more benefit to the internal than to the external use of ice in this case ; but the joint administration seems to be the Jaosl rational treatment yet recom- mended." * 228 PAJHOLOGY AND THERAPEUTICS. There was certainly a grave mistake in the application of the cold douche under the circumstances. On the first attack it would have been proper, but wh&n the violent symptoms are subdued by cold treatment, and the patient is in a state of partial collapse, a very cold shock is entirely out of place. But there is another very important consideration. The patien^- had taken enormous quantities of a pow- erful narcotic, and, although he did not manifest any symptoms of nar- cosis while the convulsive paroxj'sms continued, yet the deadly drug was in hira, and must have so paralyzed the nervous system that it could not possibly react or rally against such a shock, which, in an earlier stage, or without the prussic acid, might have been harmless and salutar}-. Patients will, in no diseases, and under no circumstances, bear cold sJwcks as well while under the influence of narcotics ; a fact I have repeatedly known to be verified in actual practice. The history before us sho^vs also the danger of occupying the system, and prostrat- ing its energies by a drug-poison, while we are making impressions on the system by another and very different set of agencies. They do not work well together. The cold water-treatment was in repute for hydrophobia even in the days of Celsus ; and Dr. Good, who, after an elaborate examination of all the methods of ti-eatment known to, or rather practiced by mod- ern physicians, confesses the utter inutility of all of them, adverts to the case of a patient who was cured by water, as though it was a wonderful escape from death by drowning. "Thus," says Dr. Good, "M. Morin relates the case of a joung woman, twenty yeai's of age, who, laboring under symptoms of hydrophobia, was plunged into a tub of water with a busliel of salt dissolved in it, and was harassed with repeated dippings until she became insensible, and was at the point of death, wlien she was still left in the tub, sitting against its sides. In this state, we are told, she was at length fortunate enough to recover her senses, when, nmch to her own astonishment, as well as to that of the bj'standers, fihe found herself capable of looking at the water, and even of drinking it without choking." The preventive treatment after the bite, as in all cases of poisoned wounds, is by excision of the part, if it can be done instantaueousl}" ; the ligature; cauterization; suction; and perhaps refrigeration. Prob- abh' the immediate application of a ligature above the bitten part, and the employment of a powerful cupping-glass over the wound, Avould niTest the process of absorption for an hour or two, after which excision or cauterization maybe resorted to, or both. In all cases, it would be a prudential measure, after the wound has been attended to, to undergo a thorough course of wet-sh ^et packings, with the view of cleansing SPASMODIC DISEASES. 229 i'lie body as much as possible from all morbid secretions or putrescent tic-cumulations upon which the virus could, as it were, feed and prop- agate itself, should any portion of it happen to pass into the circulation. AcROTiSMUs. — The affection called acrotism, pulselessness, and by some asphyxia, though improperly, is a failure or cessation of pulsation for a longer or shorter period, sometimes affecting only particular parts of the system, and sometimes extending over the whole body, often accompanied with paleness, chilliness, pain in the epigastrium, and a sense of spasmodic constriction in the respiratory muscles. It is often precursive of palsy and apoplexy, sometimes symptomatic of organic derangements ; but is sometimes puoduced by functional de- rangement of the stomach, liver, or spleen, or some obstruction to the equable radiation of the nervous energy. Some persons have possess- ed the ability to produce, by voluntary effort, a universal deficiency of pulsation, and of simulating natural death. Treatment. — The paroxysm may be relieved by thorough friction with cold wet cloths, followed by dry flannel or the dry hand ; the cure, BO far as practicable, depends on a strict compliance with all the laws of hygiene. Teta-Nus. — Several forms in which this disease presents itself, have been designated as varieties by many authors ; as emprosthotonos, when the body is bent rigidly forward ; pleurosthotonos, when it is rigidty bent.ljiterally ; episthotonos, when rigidly bent backward ; ertctus, when rigidly erect, etc. Symptoms. — The character of the disease is a permanent and rigid contraction of many or of all the voluntary muscles, with incurvation of the body, and difficulty of breathing. Generally the extremities are firmly extended, the abdominal muscles strongly retracted, the eyes fixed, the forehead drawn up into furrow^s, and the whole countenance is shockingly distorted ; the violent contractions are attended with ex- cruciating pain ; the pulse is accelerated ; the respiration is very la- borious, or almost suspended ; and the skin is covered with a profuse perspiration. The symptoms frequently remit partially, but are re- newed with aggravated torture by the slightest cause, as the least motion of the patient or slightest touch of an attendant. Sometimes the tongue is darted spasmodically out of the mouth, and the teeth, spasmodically snapping upon it, lacerate it severely, unless prevented by some in- tervening substance. In fatal cases, death is preceded by frothy or bloody mucus at the mouth, small and imperceptible pulse, and de- Urium. 20 £30 PATHOLOGY AND THERAPEUTICS. Special Causes. — Sudden exposure to damp and cold when the body- is overheated ; wounds, punctures, lacerations, or other local irritations of nerves; the bad air of crowded hospitals ; exti-eme terror, or violent passion ; sympathy ; long exposure to a very hot sun ; various narcot-. ics, as strychnine, or nux vomica ; intense galvanic excitement. Hoop- er names, among the predisposing causes, "the male sex, robust and vigorous constitutions, warm climates, the period of infancy !" It is a singular reflection on nature, or on natm-e's God, that one cannot be a male, nor have a good constitution, nor live in a warm climate, nor ex- ist during infancy, without being, from either of these circumstances, predisposed to tetanus. Duration.^-ln fatal cases the ordinary duration is from four to eight days. Favorable cases linger from one to eight or ten weeks. Prognosia. — When ai'isiug from wounds, the disease has in most cases proved fatal, and it is exceedingly dangerous when existing from any cause. Treatment. — Water-Cure has not yet been fairly tested in this for- midable affection, but the principle upon which the treatment should be regulated, seems very clear. The single indication is to abate the irri- tation ; and to do this the leading measures must be calculated to pro- duce and maintain a relaxant or sedative effect. Horses, and even Wounded soldiers, have been cured by an accidental exposure to a long and drenching rain ; from which fact we may derive a profitable hint* As the patient is excessively susceptible to impressions of all kinds, it would not »nswer to weaken him with very warm water, nor shock him with veiy cold. The wet-sheet envelop — and two or three thicknesses, are better than one, especially in the early stage, if the patient has taken little or no narcotic or depleting remedies — offers the best resource. As soon as the patient is comfortably warm, a part of the bedding should be removed or the bed-clothes loosed, so as to keep up a comfortable glow ffnd maintain a moist state of skin for a long time, even hours together. When the patient becomes too warm, or the wrapping-sheet too dry, it should be wet with cool or tepid water, 65° to 75°, without being re- moved, so that the patient may continue at perfect rest. There can be no danger in continuing this treatment for days, provided the tem- perature of the patient is carefully kept near the natural standard. When caused by a wound, the injured part should be covered with sev- eral folds of cold wet cloths — as cold as can be borne, without increas- ing the pain, which should be frequently changed. If able to swallow, tl.i.e patient should drink rather freely, and as much cold water should be occasionally thrown into the bowels by a pump-syringe as they can conveniently receive SPASMODIC DISEASES. 231 Locked-Jaw — Trismus. — This disease differs from tlie former in the spastic rigidity* of the muscles being chiefly confined to the lower jaw; from which circumstance many authors regard it as a mere form or variety of tetanus. It has also been designated as traumatic, when arising from wounds, surgical operations, or other local injuries ; and catarrhal, when produced by colds. Sometimes it attacks infants soon after birth, constituting the trismus nascentium of Dr. Good. Symptoms. — Sometimes the attack is sudden, but usually the symp- toms come on gi-adually: there is moi'e or less of an uneasy sensation at the root of the tongue, and some degree of difficulty of swallowing. The spasms sometimes extend to the muscles of the chest or back ; the breathing is nasal; articulation is interrupted and slow; the muscles of the nose, lips, mouth, and of the whole face are fixed and distorted, and the jaw bone is often so firmly set as to break before the muscles will yield to mechanical force. Sjyecial Causes. — Mechanical injuries, especially the wounding of nerves in bleeding and surgical operations ; gun-shot wounds, punc- tured wounds by nails, splinters, pieces of glass ; extreme vicissitudes of temperature, etc. Obstructed bowels is a frequent cause of the in- fantile variety. Treatment. — The general plan of medication is similar to that of the former variety. Derivative baths may be here employed, in addition, with advantage, of which the tepid shallow-bath, accompanied with active hand-rubbing, is the best. The bowels should be freely moved by warm water injections. Cramp. — This affection is often symptomatic, as in various species of colic, cholera, and other diseases. Pregnant women, whose habiti? are too sedentarjs or wlwse diet is too concentrated, are often troublet with fugitive cramps about the hips or in the muscles of the lower ex- tremities. Symjytoins. — The disease consists of a sudden contraction and convo- lution of one or more muscles, attended with extreme but temporary pain. The stomach, neck, calves of the legs, and toes, are the parts most frequently attacked. When the hollow viscera or membranous nmscles are affected, the pain is agonizing, a violent perspiration usu- ally breaks out, and the part feels as though it were puckered and drawn to a point. When the stomach is attacked, the breathing is short and distressing. Special Causes. — Sudden exposure to cold or damp wljen the body is relaxed; flatulence of the stomach or bowels ; long-continued pres- sure ; overstretching the muscles Acr'i bile is a frequent cause of £32 PATHOLOGY AND THERAPEUTICS. cramp in the stomach, and acrid drugs are a common cause of acrid bile ; hence we meet with the most obstinate cases among obstinate drug-takers. Treatment. — The paroxysm can be relieved in a variety of ways. The warm douche, followed by the cold dash ; hot fomentations ; the warm hip-bath and foot-bath are applicable to cramp in the stomach ; when seated in the external muscles or extremities, the hot or cold douche will each relieve it ; it can also be speedily overcome by forci- bly pressing the affected muscle against a hard, resisting body, as, for example, the ball of the toe, or the heel against the floor, foot-board, or upon the other foot. The cramping diathesis may be entirely erad- icated by daily bathing, plain, unconcenti'ated food, and regular and active exercise. Muscular Distortion of the Spine — Spinal Incurvation. — *' Spinal disease," " spinal weakness," " spinal irritation," etc., are among the rapidly-increasing diseases which tell of our enervating habits and consequent physiological degeneracy Spinal distortions may result from organic affections — caries oi injuries — of the vertebral col- umn, or from osseous malformation, as in rickets and scrofula; but the great majority owe their existence to simple muscular debility. There is no part of the great field of " medical science" in which a more blundering pathology, a more unfortunate diagnosis, and a more empirical practice prevail than that relating to spinal complaints. All through the country weakly females abound, whose backs have been blistered, burned, scarred, cauterized, leeched, cupped, scarified, pus- tulated, and otherwise tortured, with the view of counter-irritating a Bpinal disease, when in fact they have had no spinal disease at all ! Any form of indigestion, any morbid condition of the liver, kidnej-s, and any foi-ra of mismenstruation, may produce a sympathetic irritation of some portion of the spinal colunan; and in many of these diseases of the ab- dominal and pelvic viscera, a tenderness will be found by pressing firmly on that part of the spine from which the nerves are sent off to the organ or part really diseased. This symptomatic tenderness the doc- tor mistakes for an idiopathic disease, and plies his destructives accord- ingly. Again, when the whole body is debilitated by fine food, hot drinks, close rooms, sedentary habits, etc., the whole muscular system Id necessarily i-elaxed ; it has not sufficient firmness and elasticity to sustain the trunk of the body erect, and perform its varied motions with ease and energy ; hence, like the masts of a ship, when the ropes are weakened or destroyed, the vertebral column bends, leans, or tips back- wai-d, forward, or to ?ne side — usually the latter ; and again the med- SPASMODIC DISEASES. 233 ical man, again misapprehending the state of affairs, instead of attend- ing to the health in general, and strengthening the weak muscles in particular, administers his internal drugs and drastics, and puts on his external liniments and plasters, or endeavoi's to give support to the fall- ing frame by binding it up with a set of awkward and complicated ma- chinery. Thousands of females have had real diseases inflicted upon them by the physician's attempts to cure the imaginary one. The "small of the back" is the center of the whole muscular sys- tem ; it is the strong or weak point with every person, and no less than three hundred distinct muscles aro concerned in the com])licated move- ments of the vertebral colun u ; hence it is no* lifficult to understand how a relaxed or vreakly condition of the general s3-stem should be es- pecially manifested in a muscular distortion of the spine. Special Causes. — Under this head I am most happy to quote the fol- lowing sensible observations from a standard allopathic book, more espe- cially as I have so frequent occasion to dissent from the sense expressed in the works of that school. "In rustic life we have health and vigf, and a pretty free use of the limbs and the muscles, because all are left to the impulse of the moment to be exercised without restraint. The country girl rests when she is tired, and in whatever position she chooses or finds easi- est, and walks, hops, or runs, as her fancy may direct, when she has recovered herself; she bends her body and erects it as she lists, and the flexor and extensor muscles are called into equal and harmonious play. But instead of this, let the child of the opulent be compelled to sit bolt upright in a high, narrow chair with a straight back, that hardly allows of any flexion to the sitting muscles, or of any recurvation to the spine ; and let the whole of her exercise be, instead of irregular play and frolic gayety, be limited to the staid and measured march of Mel- ancholy in the Penseroso of Milton : " ' With even step and musing gait ;' to be regularly performed for an hour or two every day, and to consti- tute the whole of her corporeal relaxation from month to month, ghd- ed moreover, all the while, with the paraphernalia of braces, bodices, stays, and a spiked collar, and there can be no doubt that the young heiress will exhibit a shape as fine and a demeanor as elegant as fashion can communicate, but at the heavy expense of a languor and relaxa- tion of fiber that no stays or props can compensate, and no improve- ment in figure can atone for." Diagnosis. — In organic or structural derangements, the distortion ia fi'om within outvv'ard, forming a sharp projection of the bones, called 23i PATHOLOGY AND THERAPEUTICS angular curvature, in contradistinction to the disease before us, which is usually termed the lateral curvature ; and this may be right or left-, MS rlie muscles on the right or left side of the body are more debilita- ted from peculiar pei'soual habits, ordinary bodily positions, etc. The muscles of the back are more or less emaciated ; the soreness or ten- derness upon pressure is a very variable s3-mptom ; it may be constant or occasional, severe or slight, or entirely absent. Parah'sisof the low- er extremities is a common symptom of the organic or true spinal dis- ease, especially when the displaced vertebras press severely on the spi- nal cord, and when any portion of the cord or medulla oblongata is af- fected with a softening ■^amolUssement — or other abnormal transforma- tion. Some authors have imputed the lateral or muscular curvature to an over-action of some of the muscles of one side; but the exact con- ti'ary — want of action — is invariably the fact. Some authors regard the muscular distortion as the predisposing cause of the bony distortion ; while others regard the disease of the bones and a relaxation of their ligaments as the producing cause of the muscular depressions. Nei- ther hypothesis is correct: for both affections, as already intimated, oomme" ;o progress, and terminate independently of each other: one being strictly organic, and primarily affecting the bones ; the other purely functional, and primarily seated in the muscles. Sometimes the miscuiTation is double, forming a sigm.oid flexure ; and the contortion is said to be more frequently on the right side than on the left, prob- ably owing to the more fi-equent extension of the right hand, the body being thrown toward the left to preserve the central point of gravita- tion. Treatment. — First of all in iinportance is the general regimen. All superfluous clothing must be thrown off"; silks and flannels next the skin must be eschewed; all artificial support must be withdrawn, and every thing about the body or dress which iuterrapts in the least free and varied motion is to be removed. Exercise in the open air should be frequently tnken, and such gj'mnastics as call *^he muscles more es- pecially debility fed info action, should be indulged \vith moderation, and regularly persisted in. The bed should be easy but not heating. A good hair mattniss answei's very well, and a bed well filled with new oat straw is still better; the patient, during sleep, should recline as nearly on the horizontal posture as is consistent with quiet rest, but not put on an uncomfortable stretch, as some authors have advised. The dietetic plan should consist, to a large extent, of plain, unmixed, solid and (hy articles and jireparations. as brown bread, with baked apples; wheaten grits and sugar, with uncooked apples; wheat meal or Indian cakes, with milk ; roasted potatoes and milk, with dry crusts of good SPASMODIC DISEASES. 235 sweet bread; Graham crackers, with ordinary vegetal: les and fruits, etc. Cold water should be drank in the foi-epart of the day, especially soon after rising, as freely as the stomach will bear without decided discomfort; and if the bowels are in any degree torpid, a daily injec- tion should be employed. The bathing part of the treatment should be as strictly tonic as pos- sible. The dripping-sheet, followed by active and prolonged rubbing with the dry hand; or the tepid shallow-bath, followed by the pai. douche, and this, succeeded by hand friction, should be employed daily when practicable, and the towel-wash substituted when both are im practicable. The douche to the whole surface of the back may be em ployed once or twice daily. The stream should be of moderate force, and applied from two to five minutes. The hip-bath will also be highly serviceable, by constringing the relaxed muscles at the very point of their greatest relaxation. The air-bath is also worth recommending in this place, and its advantage would be gi^eatly enlianced by manipula- ting or shampooing the whole back, and especially in the immediate vicinit^ of the morbid curvature. I may add, in conclusion, that Dr. Jarrold, who once wrote an elab- orate ti-eatise on this complaint, limited his medication almost exclu- sively to burned sponge and the carbonate of soda, from which treat- ment he is said to have experienced remarkable success ; but it is worthy of note that his hygienic auxiliaries were, a recumbent posture, shampooing, friction, pure air, occasional exercise, and careful atten- tion to diet. I am of opinion his hygiene effected the cure, while the drugs were useless or nearly insignificant. Muscular Stiff Joint. — This aflfection, which consists of a per- manent and rigid contraction of one or more articular muscles or their tendons, may arise from spasmodic contraction or from simple atony : the former kind cften results from rheumatism, and the latter from long confinement or neglect of use ; colds, strains, and inflammations occasionally produce it. The douche, com.presses, active and prolonged friction with soft flannel or silk, or, better still, the bare warm hand, are the " methodus medendi.^^ Wry Neck. — A permane»t contraction of the flexor muscles of one side of the neck, or a loss of the balance of action between the flexors and extensors, by which the head is drawn obliquely to the right or left, may be occasioned by a natural disparity in the length of the op- posite muscles, and only curable, if at all, by a surgical operation ; or by a spasmodic fixation of one or more muscles on the contracted side: 236 PATHOLOGY AND THERAPEUTICS. or from debility of the muscles on the opposite or yielding side ; or from the two last conditions combined. The first variety is generally congenital, but sometimes results from burns and other injuries ; colds and strains are the usual causes of the last three varieties, the curative method for which is the same as for the preceding disease. Hiccough — Hiccup — Singultus. — The disease before us, and all others arranged under the head of chronic spasm, are frequently symp- tomatic affections. In rare instances, how^ever, they seem to occur idiopathically ; that is to say, without any other apparent and well-de- fined primary malady to which they can be imputed. S]imptoms. — Hiccough is defined, a convulsive catch of the respi- ratory muscles, with sonorous inspiration, iterated at short intervals. The spasmodic action, as in the case of \omting, is principally made by the diaphragm and external abdominal muscles. Special Causes. — Bile in the stomach, acidity, fiatiilence, indigesti- ble food, an overloaded stomach, external pressure, narcotics, intoxi- cating drinks. Treatment. — A draught of cold water, the foot-bath, cold compresses to the stomach. When occasioned by acrid bile, over-fullness of the stomach, or alcoholic liquors, warm water-drinking, thp cold abdom- inal bandage, and the cold injection. When the spasmodic action appears to be merely irritative, it can be checked at once by holding the breath as long as possible, and fixing the mind intently on some object ; violent sneezing, sudden fright, or almost any sudden and strong emotion of mind, will general- ly arrest it. Baron Dupuytren once cured an obstinate case by apply- ing a hot iron to the region of the diaphragm ; but whether the actual cautery or the actual fright actually cured the patient, medical gentle- men may differ; my opinion is in favor of the fright. Snekzing — Clonus Sternutatio. — Sneezing is a convulsive mo- tion of the resj)iratory muscles, by which air is driven violently and suddenly through the nostrils, producing a sonorous expiration. In the natural order of things the act is intended to eject from the mucous membrane nf the nostrils any irritant or offensive material which ef- fects a lodgment there. Snufl'-takers frequently so obstruct and para- lyze tlje nervous sensibility, that it is impossible to excite sneezing by nil the pulvui-ulent narcotic the nose is able to receive ; while the un- depraved instinct will raise a violent commotion against the smallest particle of obnoxious dust or mephitic vapor. Special Cawses. — Pungent dust vapors, gases, or other local irri- SPASMODIC DISEASES. 237 tai)ts ; indurated mucous and acrimonious secretions, as in catarrh and measles ; morbid sensibility of the Schneiderian membrane from acrid biie, and morbid secretions of the alimentary canal. Treatment.— -Sniffing cool or cold water frequently, taking care to draw the fluid into the nostril by means of a moderate but prolonged inspiration, rather than by a forcible, jerking motion; in severe cases* derivative baths — the hip and foot — are useful ; and in some cases of dyspeptic sneezing, the whole face requires "packing." I once had an inveterate dyspeptic under treatment, who was afflicted with an eruptive, erythmatic, or " cankerous" condition of the mouth, throat, stomach, and bowels ; and this occasioned such an excessively irritable state of tlie mucous membrane of the nose that the most trivial ex- citing causes would excite violent and painful attacks of sneezing ; these would continue, unless attended to, for hours, and until the whole face was greatly swollen, the eyes injected and tearful, and the sense of tickling and irritation incessantly annoying and intolerably distressing. The sneezing fit was several times stopped by placing several folds of wet cloths over the whole face, leaving a small aperture for breathing purposes, and covering these with dry flannel, so as to produce what has been called the "poultice" effect of the wet compress. Palpitation. — A subsultory vibrative motion may be limited to the lieart aione, or the trunks of some of the larger arteries alone, or affect their ramifications in the viscera, constituting palpitation of the heart, of the arteries, and complicated or visceral palpitation. Symptoms. — Palpitation of the heart is a vibratory and irregular ac- tion, sometimes sharp and strong, and then called throbbing of the heart, and sometimes soft and feeble, when it is termedi fluttering of the heart. In some instances the force of the heart's contraction has been so great as to shake the bed, be heard across the room, rupture the ventricles, and even fracture the ribs. In very nervous or irritable persons the palpitation often shoots from one arteiy to another, and sometimes a preternatural pulsation pervades every part of the body, the raoibid sensibility being so acute that the patient not only feels the universal throbbing, but actually hears it. The temporal and carotid arteries are particularly subject to a migratory throbbiig, which may be synchro- nous, or alternating with the beating of the heart. In dyspeptics, the descending aorta is often the seat of a most disagreeable throbbing, not unfrequently mistaken for aneurism. Special Causes. — Palpitation is always symptonyitic of some organic or functional difficulty, commonly the latter. All visceral obstructions, and every form of indigestion, are liable to be attended with this sym[> 238 PATHOLOGY AND THERAPEUTICS. torn. The use of tobacco, strong coffee, green tea, or ardent spirits very frequently produces the worst and most obstinate attacKS. Strong mental emotions, if frequently repeated, or continuous mental excite ments of any kind, tend to create a habitual, disorderly action of the heart and arteries. Probably constipation of the bowels is the cause of the most violent attacks on record. The most common structural derangements of which palpitation is symptomatic, are eulai'gement or induration of the heart ; aueurismal dilatation of its cavities ; ossification of its valves, or its connection with the aorta ; morbid accum.ulation of fat around the pericardium ; dropsical collections within the pericardi- um; adhesions of the pericardium. Diagnosis. — It is often exti-emely difficult to distinguish between functional and structural causes of palpitation. The following will serve as a general though not a universal rule : functional palpitations are i?i- lermittenU while those produced by organic affections are continuous ; and to this T may add, that in all abnormal pulsations from functional derangement or nervous irritability, the character of the pulse is ex ceeding variable; while in organic affections its abnormal character whatever that character may be, is nearly uniform. It may afforc? some consolation for invalids with this affliction to know that not mor^ than one in ten of those who are suspected, by themselves or bj' their physicians, of an organic cause, ever find more than a functional de- rangement. Treatment. — As the disease is merely secondary, all we have to do is to trace it to the primary malady, and treat that according to its character. Nictitation. — A rapid and vibratory motion, or twinkling of tlie eyelids is named as a distinct disease by some authors. When the eye has been frequently exposed to dust, or pungent gases, vapors, etc., a morbid sensibility sometimes remains after the cause of irritation has been removed, producing an irregular, convulsive, and unsightly wink- ing. It has been overcome by a powerful exertion of the will, and by employing only one eye at a time. Frequent cold bathing, followed by gentle manipulation, seems well adapted to restore the natural tone. SuBSDLTUS. — Sudden and irregular twitches or snatchings of the tendinous extremities, are generally indicative of extreme debility, and are hence common in low fevers, and the latter stages of many fatal disorders. But sometimes a feeble convuisive action is IoctiI and hab- itual. Nervous and imtabl^ persons, of otherwise fair health, some- times ai'e troubled with a jerking, spasmodic action of the muscles of DISEASES 3F GENERAL TORPITUDE. 239 the shoulders, hands, feet, etc. Such cases almost always depend on some obstruction of the skin, or bowels, or both, and are curable by a daily bath, coarse opening food, and cool injections. Stretching — PArfDicuLATiON. — It requires some stretch of imag- ination to regard what Dr. Good defines "transient elongation of the extensor muscles, usually with deep inspiration and a sense of lassi- tude," as a distinct disease. Yawning, gaping, and stretching are in- stinctive efforts to recover the balance between the flexor and exton- sor muscles ; and ai"e sometimes excited by misposition, and at others by certain morbid conditions, as nausea, the shivering stage of fever and ague. Most frequently, however, that kind of stretching which au- thors have dignified with the title of a malady, under the name of pan- diculation, is symptomatic of indolence ; hence it is rather peculiar tc loungers, who " cannot rise from the sofa without stretching their limbs, nor open their mouths to answer a plain question without gaping ii one's face." The remedy is occupation. CHAPTER XL DISEASES OF GENERAL TORPITUDE The diseases constituting the present chapter, are distinguished hy general muscular immobility, with mental or bodily stupor. They form a striking contrast with those of the preceding ( hapter, and em- brace the following species : Asphyxia — Suspended Animation Ecstasy — Spurious Catale^osy. ( Ilemiphlegia, Catalepsy — Trance. Palsy ) Paraplegia, Lethargy — Deep Sleep. ( PaHicular. Apoplexy. Asphyxia — Suspended ANIMATlo^--Ap^ arent Death. — The term asphyxia, or asphyxy, is often used in the limited sense of acro' iism or pulselessness, and is generally restricted to that suspension of all the powers of sensation anc voluntary motion which is immediately owing to non -arterial) zation of the blood from mterruoted r^wpirntion. 240 TATHOLOGYAND THERAPEUTICS But in a more comprehensive sense it has been, and in the present | sense is employed to denote all cases in which a total or partial suspen- i sion of the mental and corporeal functions chai'acterizes the access of j the disease. ' Symptoms. — These vary with the pi'oducing cause. In asphyxia ; from suffocation, as in hanging or drowning, the countenance is turgid, ; and suftused with livid blood ; the eyeballs are protruded, i •■ - turing full ghastly, like a strangled man ; j His hair upreared, his nostrils stretched vrith sti-uggling." ' i When the asphyxia is produced by inhaling carbonic acid — choke- j damp — or other irrespirable gas or mephitic exhalation, the countenance j is paJlid, the whole surface is also pale, and death oflen takes place in- j stantly, save when the deleterious aura is largely diluted with common j air, in which case the symptoms more or less resemble apoplexy. Of the ! gases positively pernicious to breathe, are the carbonic acid, often found ' in close rooms where charcoal has been burned, in the bottom of wells, or large beer-casks, and in natural caverns; the carburetted hydrogen, ' and various compound gaseous products evolved from decomposing an- imal and vegetable substances, and from the puti-efjiug corpses of cem etaries; and of the negatively injurious gases — those which do not sup port respiration — are hydrogen and nitrogen ; some of their com- j pounds, however, with sulphur, carbon, and phosphorus, are abso- j lately destructive. The fumes of mercury, lead, and various other I metnllic substances, when highly concentrated, operas vrith as sudden facility as the fumes of charcoal. ' In electrical asphyxia, which is produced by a sti'oke of electi'icity or lightning, the limbs are generally flexible, the countenance is pale, and the blood is incoagulable ; usually the limbs do not stiffen after death, | and the body becomes rapidly putrescent. Sometimes no external in- j jury whatever is observable ; but in other cases the skin is vesicated, I the hair is scorched, and the body more or less lacerated and torn. When the disease results from intense sold — frost-bitten asphyxia — the limbs are rigid, the countenance pale and shrivelled ; it comes on more gradually than the other forms ; there is a tendency to sleep, : which increases us the period of exposure is extended ; and when this is joined with fatigue, the torpor -and drowsiness often become irre- j eistible. Various narcotic poisons, as cicuta, tobacco, and Prussic acid, when taken in large quantities, and also the" anesthetic agents, as ether and chloroform, in exti'eme doses, will produce asphyxia, attended with | total insensibility and universal musr-ular relaxation. ! DISEASES OF GENERAL TORPITUDE. 241 Treatment. — This must vary with the cause. The variety produced by hanging is hardly a medicable case ; yet if the strangulation has not continued too long, nor the neck-joint been fractured or dislocated, there is a chance of restoring respiration by some of the means about to be mentioi ed. Death from submersion does not result, as is gen- erally supposed, by water entering and filling the lungs, but from suf- focation produced by a spasmodic constriction of the glottis — an instinct- ive effort to keep the surrounding water out of the lungs. How long life can be maintained under water is uncertain ; and the time probably depends partly on the natural capacity of the lungs, and partly on the extent to which they happen to be inflated when respiration ceases. Individuals can generally be resuscitated if not submerged more than five minutes ; very often after having been ten or fifteen minutes under water ; and in some instances persons have recovered after an hour's submersion. Recoveries have been reported after a much longer sub- mersion — several hours, and even several days ; but such reports seem to challenge human credulity rather severely. Be this as it may, our duty is plain ; it is to endeavor to resuscitate the patient so long as there are the least indications of a spark of remaining vitality. Instan- ces are well authenticated of patients having recovered after a perse- verance in the restorative means for eight or ten hours. The remedial plan comprises two distinct. indications ; 1. To restore warmth and circulation to the surface. 2. To inflate the lungs. In the first place, the patient should be wiped dry, wrapped in clean warm blankets, and conveyed in a recumbent posture on the back, with the head and breast raised, to a warm, dry, welj-ventilated room, and sur- rounded by no persons except the necessary attendants. Dry warm flannels, and bottles or bladders of warm water, or bags of warm grain or sand, are to be applied to the stomach, feet, and sides, and the sur- face should be thoroughly and perseveringly rubbed by the Avarm dry hands of the attendants. The mouth and nose should be promptly cleansed of the obstructing mucus, and the foul air may be sucked out by means of a tube, which may also be used for inflating the lungs, as in figure 187. The inflation of the lungs is the most important of all the curative processes. This may be done by repeatedly forcing into the patient's mouth — the nostrils, meanwhile, being held close — a full expiration of air from the lips of an attendant, or by means of the tube repre- sented in figure 187, alternating the expiration with moderate but firm pressure on the external abdominal muscles, so as to simulate all the motions of natural respiration. A common bellows, when well managed, is preferable, because it will convey pure, unrespired air to 11-21 242 PATHOLOGY AND T HE K APE U TICS. the lungs ; and if the bellows can be attached to a tube, and this in- troduced into the larynx, the effect will be better still. Fig. 187, INFLAIING THE LUNGS. It may excite the surprise of the non-professional reader to be told chat bleeding, even in the asphyxiated state, is an approved allopathic remedy in this disease. Many physicians of "high authority" recom- mend opening the jugular; while other high authorities oppose the practice, not on the gi'ound of its impropriety, but because the blood will seldom tiow if the jugular is opened. Samuel Cooper dissents in part. He says': "Bleeding ought never to be employed m this stage of the process, though it may become necessary when the circulation has returned, and reaction has taken place." This means, liberally interpreted, that after the patient is out of danger it will not kill him to lose a little blood, although it might have been the death of him while the danger existed! When the disease is caused by deleterious gases, narcotic or metal- lic fumes, etc., or the anaesthetic agents, the treatment chiefly consists in exposing the patient freely to the open air, dashing co-Id water in the face, pouring cold water over the head, and active friction with pulmona- ry inflation, as in the preceding variety. Injections of cold water are also serviceable ; sprinkling or dashing cold water over the surface, fol- lowing the application with active friction with the bare hand, has beer tried with evident advantage. In the case of apparent death from electricity, all the appliances just named may be called in requisition; but as far as experience can guide us, dashing cold water freely over the breast, face, and even the whole body, and the prolonged pouring b>ath to the head, are the most im- portant processes DISEASES OF GENERAL TORPITUDE. 243 Here again, mnny of the shining lights of allopathy insist that the pa- tient ought to lose a little of his blood, as well as all of his sensibility. M. Portal recommends opening the external jugular ; Dr. Doane thinks the absti'action of a few ounces has done good ; and Dr. A. H. Ste- vens, of this city, has recorded a case of injury by lightning successful- ly treated by copious venesection; that is to say, the amount of blood drawn within ten days was about one hundred and twenty ounces ! If a patient can survive a sti'oke of lightning long enough to go through a ten days course of venesection, it is conclusive evidence that he can live better without the remedy than with it. Dr. Stevens has afforded another demonstration of the old proverb, that many patients recover in spite of the disease and the doctor. In asphyxia from cold, the application of warmth must be cautiously managed. When a limb or part is frozen, the coldest water should be employed in the first instance, and the temperature gradually raised ; the patient, meanwhile, should be kept in a moderately cool atmosphere until the circulation is restored. Rubbing the frost-bitten part with snow until sensibility returns, and then with warm water, and after- ward the dry hand, is an excellent plan. In cases of extreme torpor from cold when no part is absolutely frozen, friction with wool, flannel, or the dry hand is appropriate. Ecstasy. — This affection is peculiar to those states of bodily de- rangement of which mental aberrations or extravagances are symptomat- ic ; hence it attacks chiefly melancholic, hypochondriac, visionary, and abstracted persons. Symp)toms. — The paroxysm consists of a sudden and total suspension of sensibility and voluntary motion, the pulsation and breathing contin- uing, with rigid muscles, and an erect and inflexible position of body. In most cases there is also a complete suspension of mental power. The dui'ation of the fit varies from two or three hours to as many days, at the end of which the patient rouses as from sleep. Special Causes. — A morbid state of the liver ; powerful menta excitement; long-continued meditation on a particular subject; pro- longed suspense of mind ; venereal excesses ; self-pollution or ona- nism. Treatment. — Out-door exercise by walking, riding, sailing ; varied scenery ; lively company ; cheerful convei-sation ; amusements of the laughable kind; regular employment or occupation, with a daily bath and plain food. Catalepsy.-— The only essential distinction authors make between 244 PATHOLOOr All D THER APEU TI DS. ecstasy and trance is that of the flexibility or inflexibility of the mus- cles ; in the disease under consideration the muscles are lax and yield- ing, and the body yields to and retains any given position. The eyes remain open, and are fixed intently upon some object, but usually no perception accompanies the apparent vision. The fit generally comes on without premonition, and in most cases closes w^ith singing. Its du- ration is from a few minutes to several days. This affection is some- times counterfeited, and the real disease has been sometimes mistaken for actual death, '^he causes and treatment are the same as those of the preceding disease. Lethargy. — Deep sleep does not perfectly express the leading char- acter of this disease, as it is sometimes wanting. Lethargy is distin- guished from asphyxia, ecstasy, and catalepsy, by the apparent general ease and quietude of the body ; and from apoplexy, by the eyelids be- ing closed and the limbs gently reclining, as in natural sleep. Symptoms. — Sometimes the sleep is profound, and without intervals of sensation, waking, or consciousness; sometimes the sleep is remis- sive, and the patient occasionally a^vakens and recovers sensation and speech, constituting the coma somnolentum of authors ; and in a third variety — the typliomania and coma vigil of pathologists — there is a perfect lethargy or insensibility of the body; while the mind is only imperfectly lethargic, manifesting confused and w^andering ideas, and, during sleep, possessing a behef of wakefulness. This form is fre- quently a symptom in various fevers. Special Causes. — Violent menta commotion, fright, furious anger, excessive mental labor, night- work, lepelled eruptions or exanthems, congestion or effusion in the brain. Treatment. — Essentially the same as in the preceding two diseases, save that the exercise must be of the recreative rather than laborious kind. The pouring head-bath is a promising measure during the paroxysm. ApT-r,EXY. — This disease is one of the results of a constipated, ob- *l. led, plethoric, and overburdened body. Excessive alimentation, with defective depuration, and some internal visceral obstructions or compressions, are the obvious conditions on which the apoplectic fit de- pends ; and hence we rarely witness the disease except among the full-fed, the corpulent or obese, and the gross or high livers : and eveu then we almost invariably find inattention to the functions of the ex- creting organs or outlets of the body among the predisposing circum stances. DISEASES OF GENERAL TORPITUDE. 245 This view is simple enough, and not difficult to understand. But in medical books we find a world of confusion on the whole subject. Every thing relating to its causes, seat, nature, and proper treatment, is there hypothetical, unsettled, contradictory — a mountain mass of sci- entific absurdity and erudite inconsistency. Some authors regard it as a disease of the sanguineous system ; others as an affection of the nervous system. Some writers contend that the immediate cause is always some effusion, extravasation, or other structural derangement in the brain; while others declare that such circumstances are never necessary conditions. Some pathologists argue that compression of the brain is the universal immediate cause; while others as ably theorise that the brain is incompressible. And in relation to treatment, some authors rely on copious bleedings and other depletory processes as the only hopeful treatment ; others condemn large bleedings as injurious, but gc for small ones ; whilfe others con- demn all bleeding and all depletion as bad, and advocate the very oppo- site treatment — brandy and general stimulants ; and yet others con- sider bleeding good in some cases and bad in others, the great point of skill in the physician being to determine when to employ and when to withhold the lancet. Symptoms. — The distinctions which authors make of this disease, into sanguineous and serous, entonic and atonic, simple and congestive, etc., are unimportant, as they relate only to the gi'eater or less debility of the patient at the time of attack. Sometimes the disease comes on suddeiriy without the least premonition ; sometimes the attack is pre- ceded by a sudden paralysis of one side of the body, and sometimes it is ushered in by acute headache, nausea, faintness, noises in the ears, confused vision, incoherence of ideas, loss of memory, and numbness of the extremities. The fit is characterized by complete insensibility ; slow, noisy, and usually stertorous or puffing breathing ; impeded deglutition; flushed and livid countenance ; prominent and motionless eye, and generally a fixed or contracted state of the pupil ; the limbs are rigid, motionless, or convulsed ; the bowels are obstinately consti- pated, or the faeces pass involuntarily ; the urine is passed uncon- sciously, or retained until the bladder is full, then dribbling away. The pulse is variable ; it may be full, hard, and quick, or weak and frequent. Diagnosis. — It rnay be distinguished from the stupor of drunkenness, by the alcoholic odor of the breath in intoxication, and from the narcosis produced by various poisons, by the capability of occasionally rousing the patient in the latter affection. T"eatment. — The fii'st thing to be done is to remove the patient to a 246 PATHOLOGY AND THERAPEUTICS. POSITION IN APOPLEXY. cool, spacious, well-ventilated apartment, hosen all the clothing about the chesty remove eve~y thing from around the neck, and place him iu ao easy and nearly uprght posture, as in fig. 188. Fig. 138. Follow the prepai'atoiy measures with the cura- tive processes, which con- sist mainly of the pouring head bath ; Ava^'m water and warm cloths to the feet, and occasionally hot fomentations to the n'oao- raen. If the fit continue, the cold stream may be applied to the head for a quarter to half an hour, several times a day ; the cold wet girdle to the ab- domen should succeed the hot fomentation, which may be resorted to eveiy two or three hours, for ten or fifteen minutes each time ; and friction to the lower ex- tremities with a cold wet cloth, followed by the warm flannel or dry hand rubbing, is a valuable auxiliary. No attempt should be made to give any thing by the mouth, until the breathing is materially relieved, and then only moderate draughts of cold water should be administered. The prophylaxis^ or preventive medication, consists in a daily cold bath, plain, simple, abstemious diet, regular hours for eating, laboring, and I'esting, and a careful avoidance of all violent exertion, strong men- tal excitements, depressing passions, etc. Palsy — Paralysis — Paresis. — The same general causes which tend to the production of apoplexy, are among the most efficient pre- disponents to palsy. The disease before us, however, is more fre quently dependent on organic changes; and when merely functional, is more generally connected with nervous exhaustion. The ancients regarded apoplexy and palsy as modifications of one essential disease ; " apoplexy leing a universal palsy, and palsy a partial apoplexy." SympLoms. — Paralysis mny be attended v*'ith a total or partial loss of sensation only in the part affected, or a loss of voluntary motion only, or of both. The precursive symptoms are sometimes the same as those of apoplexy, but more generally the disease comes on gradually, an ocrasional sense of weakness, and troublesome but transient feelings of numnness being the leading adtnouit ons ; and these ai'e often ob- DISEASES OF GENERAL TORPITUDK 2l7 servable in a single finger, in one eje, the tongue, or one side of the face alone. In the hemiplegic variety the disease is confined to one side of the body, which is affected from the top to the bottom of the mesial line. This form is often a sequel of apoplexy. In the ]ia,raplegic variety the lower part of the body is paralyzed on both sides, or any part below the head. When not caused by some local injury, it is almost always preceded by costiveness. Particular or local palsy is confined to particular limbs, or to a par- ticular part of the body. Wiien it affects the face, the expression of countenance is peculiar, the features are drawn to one side, and of course the two sides are not symmetrical, and the deformity is in- creased when the patient attempts to whistle, speak, laugh, cry, sneeze, or cough. A variety of local paralysis, to w^iich those who work in quicksilver mines, at water-gilding, etc., are subject, called mercurial tremor, comes on with weakness and convulsive twitchings in the arms, gradually ex- . tending to the lower extremities, and finally to the whole body; and another variety, called lead palsy, or dropped hand, which attacks gla- ziers, plumbers, oil-painters, enamel card-makers, etc., begins by a feeling of weakness in the fingers, and extends to the wrist, but rare- ly beyond it , shooting pains affect the arm and shoulder ; the parts affected waste and emaciate, and the hand hangs loosely and uselessly at the wrist. Special Causes. — Most of the causes of apoplexy : enlarged or indurated liver or spleen ; constipation ; venereal excesses ; metallic fumes : narcotics ; alcohol ; pungent stimulants ; acrid medicines, as copavia, turpentine ; sudden and extreme alternations of temperature ; pressure upon the brain, spinal marrow, etc. ; fever tumors, injuries, extravasations, effusions ; loss of nervous communication from structu- ral degeneration ; intense mental emotion ; prolonged wakefulness, or excessive night-work. Treatment. — The prospect of cure must be predicated upon the prospect of the cause or causes being structural or fiinctional, which point, howevei-, is not always easy to determine. But in either case the plan of medication is obvious, and the same. Some few cases ar^ attended with a difficulty of respiration, and the indications of compres- Bion of the brain, resembling apoplexy, and require similar manage- ment. For bathing purposes, water should be employed as cold as can be borne without permanent disco-mfort; though, as a general rule, the baths should be of short duration. In paralysis of one side, the ablution or dripping-sheet may be the most convenient general bath ; the "«?ot- 248 PATHOLOGY AND THERAPEUTICS sheet pack, followed by the plunge, is still better when there is a good degree of remaining vitality. When the lower part of the body or low- er extremities are palsied, the shallow-bath is evidently the best lead- ing water process, and it may be aided by frequent hip and foot-baths. In all cases thorough friction by means of flannels, flesh-brushes, hand- rubbing, shampooing, etc., should follow the application of water. A moderate douche applied generally to the spine, and locally to the part allected is serviceable in most cases. When the superficial heat is too low, or the general torpor too great to admit of the full-sheet pack, the half-sheet may be beneficially employed. Whenever the extremities, or any portions of either of them are paralyzed, the wet compresses, well covered, should be constantly worn and frequently renewed. Careful attention must be paid to the diet ; and to the state of the bow- els. Cool injections are generally necessary daily; the patient should drink moderately of cold water, and the general regimen should be precisely on the plan adapted to, and recommended for, the cure of dyspepsia. CHAPTER XII. VISCERAL TURGESCENCE. A SWELLING, fiillness, or turgescence may exist in any part or organ in temporai-y obstructions, congestions, or inflammations; but the pres- ent chapter is limited to those afl^ections of the internal viscera in wdiich the enlargement is chronic or permanent. It includes the following varieties, which make the species of Dr. Good's genus parahysma : Hepatic — Enlargement of the Liver; Splenic, " " Spleen: Pancreatic, " ' Pancreas; Mesenteric, " " Mesentery; Intestinal, " " Intestines; Omental, " " Omentum; Complicated, " " Various Organs. Enlargement of thk Liver.— The sti-ucture and functions of the liver, as described in the physiological part of this work, explain the reasons why lh«^ liver is more snSject to chronic enlargement than anv VISCERAL TURGESCENCE. 24& other organ in the body. The morbid alterations of structure whicb constitute its intumescence are various, as simple swelling, tuberculai formations ; hydatid growths ; hardening, or induration ; softening, oi fatty degeneration ; and that result of bad living and putrescent blooo which pathologists have called black ramollissement, in which the or- gan is reduced to a dark-colored mass of very little consistence, etc. — conditions which are difficult of diagnosis during life. Another form of structural derangement has boen called gin-liver, in which the biliary portion of the liver is both hypertrophied and indui'ated, as well as dropsical, from the effect of the free use of ardent spirits. Symptoms. — With general derangement of health, and various symp toms of indigestion, particularly pale, yellow countenance, irregular and often whitish injections, a hard tumor may be found in the right hypo- chondrium, verging toward and often appearing at the pit of the stom- ach. In dropsical persons the swelling is sometimes enormous. An enlarged or indurated liver is common to persons who have suffered frequent or prolonged attacks of ague and fever, and has then been de- nominated ague cake. Special Causes. — All the common causes of vitiated blood and impure secretions tend to disease the liver ; but an obstructed skin, by which the decomposing and putrescent particles of the body are retained in the system, is the most efficient among them. Among the causes which operate indirectly in producing obstruction and enlargement of the liver, are concentrated food, animal oils, or greasy matters, swine- flesh, shell-fish, stale meats, old cheese, etc. ; and among those which operate more directly to produce functional disturbance, followed by organic changes, are alcohol, tobacco, hot drinks, violent passions, etc. Treatment. — The indications are, 1. To promote as vigorous absorp tion throughout the entire lymphatic system as possible. 2. To purify and invigorate the general system. For flilfilling the first indication, the "hunger-cure," moderately but perseveringly employed, and a moderate douche, frequently applied over the back, especially on its upper portion and over the shoulder-blades, are the leading measures ; and for the second, the wet-sheet nack, or shallov,'-bath, or both, where the external temperature is considerable, are the best among various useful processes. The abdominal compress should not be neglected ; and when there is pain or tenderness about the epigastric region, or in its vicinity, or when the bowels are habitually constipated, the warm stream douche to the whole abdomen, followed by the cold dash, AvilJ be advantageous. I may just observe, en passant, that there is some slight discrepancy in the opini ns of standard medical authors regarding the tr-eatment of 260 PATHOLOGY AND THERAPEUTICS. the .-nalady under consideratioi: Thus, Dr. Elliotson recommends iodFi e and mercury as the principal remedies; but Abercrombie says that the mercurial practice uniformly sinks the patient in a very rapid manner. Enlargewe^t or the Spleen. — Pathologists seem to be generally of the opinion that structural disorders of the spleen occasion but very little mischief to the organic economy. I think differently. It is ti-ue that the consequences are much less apparent; but if the opinion I have heretofore advocated respecting the functional office of the spleen is correct, a derangement of its function must be followed by a loss of power, to some extent, throughout the entire range of the organic or nutritive functions ; although such resul*" would not be manifested by any special local symptoms, as in the case of a similar morbid condition of the liver. Baron Dupuytren found that dogs maintained apparent good health after having their spleens extirpated ; but medical authors generally confess that " the more the spleen exceeds its natural size in the hu- man subject, and the longer it retains this abnormal condition, the more are the functions of respiration, digestion, etc., disturbed, and the great- er is the impairment of the general health." The key to an explana- tion of all these facts is within reach. The spleen is an appendage to the higher class, or brain-endowed class, of animals ; and its especial of- fice is to provide in part for the additional supply of organic nervous influence rendered necessary by the superstructure of the encephalic mass, while it performs a subordinate duty in supplying additional ner- vous influence to the general nutritive system. Hence the importance of the spleen in the animal kingdom has a direct relation to the size of the brain ; which fact accounts for the lesser disturbance its disease or removal should produce in the small-brained than in the large-brained animal. Sifmpfoms. — It is known by an indurated tumor in the left hypo- chonh'ium, verging toward the spine ; as with the preceding disease, there are symptoms of general ill health ; but while in enlargements of the liver these symptoms assume the forms of jaundice and dyspep- sia, they will, in induration of the spleen, appear in the shape usually termed nervous debility. The patient seldom complains of pain in the region of the organ affected ; his appetite is good, but he loses flesh and nmscular sti'ength ; his features have a dark, bilious, or mahogany hue ; the skm is dry, the lips are pale, and the patient is not infrequent- ly morose and desponding. Special Causes.- Thf disease often appears after obstinate intermit VISCERAL TURGESCENCE. 261 tent or remittent fevers ; scrofulous constitutions, and constitutions de- bilitated by intemperance are very liable to it; marshy situations and stagnant waters occasion it ; it has followed suppressed menstruation ; and medical authors name Peruvian bark, which is so immodei*ate]y administered in interm.ittent fevers, as a cause of enlarged spleen. This affection also called ague cake. Treatment. — The douche should be frequently applied, with as much force as the patient can comfortably bear, to the spine and left hj^^o- chondriac region; and in all other resp*^cts the plan recommended for enlarged liver is to be pursued. ^ Enlargement of the Pancreas — This is a rare disease, or at least, rarely detected in the living subject, but occasionally abscesses, ficirrhus indurations, tubercles, calculous depositions, etc., have been found to occupy a part or the whole of its structure. Symptoms. — These are obscure, except in extreme cases, when a hard, elongated tumor may be detected, extending transversely in the epigastric region, and accompanied with s^'mptoms of dyspepsia and general debility. Special Causes. — From the analogy existing between the functions of the salivary glands and pancreas, authors have judged the habitual excitement of the excretories of the former might be communicated sympathetically to the latter ; and that hence tobacco-users were pe- culiarly liable to the complaint ; in confirmation of which. Dr. Darwin relates a fatal case which occurred in a great consumer of the article — " chewing it all the morning, and smoking it all the afternoon." Treatment. — As in the preceding varieties. Enlargement of the Mesentery. — Enlargement of this struc- ture may be in^the form of hydatids, of tubercles, scirrhus induration ; fleshy, adipose, or fungus excrescences, or calculus deposits ; or sev- eral of these morbid alterations of structure may be coexistent. Symptoms. — The affection may be known by an indurated and irreg- ulai" mass of tumors below the stomach, yielding to the pressure of the hand ; the countenance is pale and bloated ; the appetite is irregular, often voracious ; and general atrophy or emaciation attends. The causes and treatment are similar to those of enlarged liver. Enlargement of the Intestines. — Tn some cases the induration IS confined to the coats of the intestines; and in others adhesions unite the intestines to the wals of the abdomen and to each other. Syniptom.s. — The int" noscence may be roimd or elongated, hard or 252 PATHOLOGY AJ^D THERAPEUTICS. circumscribed ; but is movable by pressure made with both hands ; the action of the bowels is irre^lar ; there is usually obstinate vomiting, and more or less fever and emaciation. Treatment. — In addition to the general remedial plan applicable to all varieties of visceral turgescence, the peculiar symptoms of the af- fection before us demand frequent sips of iced water, cold compresses to the stomach, and the free employment of tepid injections. Enlargement of the Omentum. — Turgescence of the omental portion of the peritoneum, is usually of a complicated character — indu- rated, scirrhus, cartilaginous, and tuberculated ; in some instances the struc-ture acquires almost a stony hardness. Symptoms. — The tumor is indurated and diffused, extending fre- quently over the entire abdomen; it is accompanied with general ema- ciation and difficulty of breathing. The treatment does not differ essentially from that appertaining to enlarged liver. Complicated Visceral Enlargement. — This is merely a con- joint existence of several of the diseases we have already considered. It is denoted by a hard, elevated, and distended abdomen, resembling that of pregnancy ; the belly is, however, more or less knott}' and un- equal ; the respiration is but slightly disturbed : but there is usually acute pain, thii-st, nausea, and vomiting. A diseased liver is the com- mon starting-point of these sti-uctural monsti-osities : and our only chance of cure is to employ assiduously, in the infancy of its malady, all the remedial appliances recommended under the head of enlargement of that organ. CHAPTER XIIL DROPSICAL DISEASES. The character of a dropsical affection may be dehned: a pale, indo- lent, and inelastic distention of some part or of the whole body, from accumulation of a watery fluid in the areolar tissue or other natuiTil cavities. There is, hijwevcr, one exception to this definition, in the case of. internal hydrocephalus, which, though usually regarded as a dropsical disease, is, ic reality, a strumons inflammation of the brain DROPSICAL DISEASES. :253 The principal forms of disease belonging to the chapter before us may be grouped : Cellular C General — Anasarca, Dropsy of ( External Hydrocephalus, Dropsy ( Local — CEdema. the Head ( Internal Hydrocephalus. Dropsy of the Spine — Spina Bifida. Dropsy of the Chest — Hydrothorax. Dropsy of the Abdomen — Ascites. Dropsy of the Ovaiy — Hydrops Ovarii. Dropsy of the Fallopian Tubes — Hydrops Tabalis. Dropsy of the Womb — Hydrops Uteri. Dropsy of the Scrotum — Hydrocele. ( Cellular, Wind Dropsy — Emphysema } Abdominal, f Uterine. < Puerperal Tumid Leg, Inflammatory Dropsy ^ ^^.^^.^^j ^^^.^ ^eg. It is amusing to read the lengthened discussions which have been carried on by medical theorists respecting the proximate cause or es- sential nature of dropsy ; one party regarding it as a disease depending on diminished absorption, and the other as ably contending that the fault consists in increased exhalation. The practice predicated on the former theory is stimulation, and on the latter, antiphlogistication. But as neither quinine nor bleeding eifected a cure, a third party has lately entered the field of conti'oversy, and cut the Gordian knot, by blending both doctrines in one ; and declaring that diminished absorption and in- creased exhalation produce the disease, the therapeutic indication be- ing to balance the action between the absorbents and exhalents. To this party we are indebted for the mercurial ti-eatment of dropsy, which has proved even worse than its bad predecessors. Cellular Dropsy. — This atfection is called anasarca when it ex- tends over the whole body, and oedema when limited to the areolar texture of the limbs. Symptoms.— Cold and diffusive swelling or puffmess of the skm, which pits beneath the pressure of the fingers ; the intumescence is greatest in depending situations ; and around the feet and ankles the accumulation increases toward evening, and decreases during the night The skin is paler than natural, and when the distention is great it as- sumes a shining appearance, which often becomes livid and discolored,, and not unfrequently bursts in extreme cases. 254 PATHOLOGY AND 1 HER APE U T ICS. Special Causes.— Ml the :auses of general debility predispose to dropsy. Intemperance, repe le'l eruptions, exhausting discharges, sup- pressed evacuations, and structural or functional obstructions of the kid- neys, skin, and liver, are among thi frequent causes. (Edematous swellings of the limbs are uften symptomatic in mismensti-uation, preg- nancy, etc., and frequently a result of mere debility, as in protracted fevers, etc. ; constitutions broken down by merjuvy, are very liable to this disease. Treatment. — In all dropsical affections of the cellular membrane, the indications are, 1. To promote the absorption of the effused fluid. 2. To prevent its re-accumulation. The first indication is accomplished by promoting the activity of the excretory organs generally ; and the sec- ond by strengthening the whole system ; and either indication must be made the leading one, as obsti'uction or debility is the leading proxi- mate condition. As a general lule, quite cold water is preferable for bath- ing purposes, but the duration of baths should be short, and succeeded by active and prolonged, yet gentle friction with silk or soft flannel, or bet- ter still, the bare hand. The moderate douche, followed by a thorough rubbing in the dry blanket, and the wet-sheet pack, with warm bottles to the feet, and, if need be, the armpits, are among the best general baths. But as no two cases present the same set of circumstances, the practitioner will always find a ^vide field for the exercise of judg- ment. The diet must be mostly of the dry and unconcentrated kind, and water should be drank only to the extent demanded by actual thirst. Tepid injections should be freely employed when there is the least tendency to constipation. Tlie warm douche, or spray-bath, followed by the cold dash or pail douche, is an excellent process when the swelling is tender and painful, and particularly serviceable if applied to the lower part of the abdomen when the kidneys are torpid or ob- structed, which will be known by scanty or difficult urination. A great deal of importance is attached, by most medical wi"iters on dropsy, to the chemical ingredients in the urine, and the changes this secretion undergoes in hydropic patients; and Dr. Johnson even ad- vises patients at a distance, when writing for advice, to send along a bottle of urine for the purpose of chemical analysis. Now people ought to know that, however amusing or interesting such experiments may be, they are of no utility whatever, as regards the cure of the disease ; for whether the urine is a little more or a little less alhumin- ous, or ammoniacal, or alkaline, or acid, or saline, it is all the same as fw as the treatment is concerned. J)Rovsr OF THE Hkaf — Htdi 3ps Capitis. — External dropsy of DROPSICAL DISEASES. 256 the head, commonly called chronic hydrocephalus, consists of an accu- mulation of watery fluid in the ventricles or convolutions of the brain, or between the membranes, or between the bones and dura mater ; and internal dropsy — acute hydrocephalus — is an inflammation of the membranes or substance of the lower part of the brain, which, in its pro- gress, runs into suppuration, and produces effusion into the ventricles. Symptoms. — In the first variety there is an oedematous intumescence of the head, while the sutures of the skull are usually separated ; the whole head appears preternaturally large, and the fontanelles are prominent: in its a\anced stages it is attended with languor, drowsi- ness, costiveness, vomiting, coma, frequently convulsions, and some- times sti'abismus. The second variety — the cephalitis prof unaa of Good's nosology — comes on gradually and insidiously ; the precursive disturb- ances are languor, inactivity, loss of appetite, feverishuess, etc. ; these are followed by darting pains in the head, great sensibility to light, contracted pupils, extreme restlessness, frequent sighing, disturbed sleep, from which the patient often starts with a scream ; in a later stage the bowels are irregular, the pulse small and frequent, and deli- rium and convulsions sometimes occur ; as the disease progresses the pupil dilates, the eyes usually present a squinting appearance, and a low moaning takes the place of the shrieks ; and near the fatal termina- tion, double vision or loss of sight, with lethargic stupoi, ^r violent convulsions occurs. Hydrocephalus is peculiar to infancy, an ' some- times commences in the fcetus. Special Causes. — Scrofulous, scorbutic, or syphilitic taint; re^ elled eruptions ; injury to the brain during labor ; bad dietetic habits ol the mother during pregnancy ; frequent exposure of the mother during pregnancy, or of the child soon after birth, to the powers of narcotic poisons, particularly tobacco. Treatment. — We can promise but little in either form of hydro- cephalus unless detected and treated in the early stages. The general plan of management is the same as for the preceding disease, save that a good part of the treatment should be derivative — half, hip, and foot-baths, and the wet girdle to the abdomen. The pouring head- bath is advisable in the chronic or internal variety. The external form has in some instances been relieved by evacuating the water with a lancet, couching-needle, or trochar. Dropsy of the Spine. — This affection is mostly congenital, it consists of a soft fluctuating tumor on the spine, from fluid accuiuu- Inted within the coats of the spinal cord, protruding externally in con- sequence of some portion of the vertebra! column being defective. Ii 256 PATHOLOGY AND THERAPEUTICS. is generally fatal, although a cure has taken place spontaneously in a few instances, and several cases have been reported as cured by re- peatedly puncturing the sac with a fine needle. With the exception of this surgery, if deemed advisable, the proper course is to attend to the general heallh, and " trust to nature." Dropsy of the Chkst — Hydrops Thoracis. — In this affection the fluid may accumulate in the cavity or cavities of the pleura on one or both sides, or in the mediastinum, or pericardium, or even the cel- lular texture of the lungs. These distinctions, however, are neither possible to ascertain during life, nor important practically. Sjjmptoms. — With a constant sense of oppressiou in the chest, there is difficult breathing on exercising or reclining ; the countenance is more or less livid ; the urine scanty and high colored ; the pulse is ir- regular; the extremities are oedematous; the patient is often troubled with startings and palpitations during sleep ; a distressing feeling of suf- focation frequently attends ; and the patient can get no rest but in the erect posture. It usually attacks persons in advanced life. Special Causes. — Hyperti'ophy of the heart, aneurism, scirrhus of the stomach and liver, and other organic derangements, frequently pro- duce hydrothorax. When idiopathic, if ever, it is produced by the common causes of dropsy. Treatment. — In a majority of cases our prognosis must be unfavora- ble ; the derivative baths, and the principles already adverted to as ap- plicable to the treatment of dropsy in geneml, are all our grounds of hope in the case before us. Some few cases are reported in medical works as having been caused by paracentesis thoracis — an operation which will be described in the surgical department of this work. Dropsy of the Abdomen. — Ascites, or dropsy of the belly, is called encysted, when the fluid is contained in a cyst or sac of adven- titious formation, instead of accumulating in the cavitj' of the abdomen itself. Symptoms. — It is known by an equal, tense, and heavy intumescence of the whole belly, which distinctly fluctuates to the hand, upon a slight stroke being given to the opposite side. Diagnosis. — In the enrysted form the size of the abdomen enlarges gradually and steadily, without experiencing any sudden increase, de- crease, or change in the swelling; where;is the distention is often tem- porarily diminished by treatment or accidental causes, when the accu- mulation is within the cavity of the abdomen: from ovarian dropsy, by the intumescence commencing lower down and on one side in the DROPSICAL DISEASES. 257 latter disease; from tympanites, by the dullness on percussion, and by the f.uctuation ; from retention of urine, by the dribbling of water in the lutter affection ; from 'pregnancy, by the fluctuation, and state of the menses and breasts ; and from cysts or hydatids of the liver, by the swelling in the latter case being more circumscribed, and commencing on one side of the upper part of the abdomen. Special Causes. — Repelled eruptions, or exanthems, very frequently produce this disease. Mercurial ointments, lead washes, and other discutient and repellent lotions and medicaments, have often changed the morbid action from an external skin disease to an internal dropsy.. Suppressed catamenia and metastatic gout are also frequent causes; and it is often symptomatic of diseased or disorganized liver, kidneys, and other organs. Treatment. — The encysted variety cannot be cured without the operation of tapping the abdomen. The general health should always be improved as much as possible before the operation is performed, for which purpose the packing, douche, and foot-baths are necessary. Surgeons are always apprehensive of danger from inflammation at- tacking the punctured part, but the danger chiefly arises from the in- flammatory or feverish state of the body, or the obsti'ucted condition of the excretories at the time of the operation. If the general sys- tem is put in good condition, the simple operation of drawing off the water by tapping can seldom be serious, much less dangerous. When the watery fluid is collected within the peritoneum an opera- tion is sometimes necessary; but fiequently it can be cured by the general plan of management applicable to cellular dropsy. The abdo- minal bandage, well covered and renewed five or six times a day, and a free use of injections, are specially desirable in this form of dropsy. Ovarian Dropsy. — Dropsy of the ovary is always of the encysted character, and the cysts are generally combined with enlargement of the ovary itself, which becomes converted into a hard, whitish, cartila ginous mass. Symptoms. — The tumor commences on one or both sides of the iliac region, and gradually spreads over the abdomen ; its surface ia unequal, and its fluctuation is obscure and feeble, and in some cases en- tirely imperceptible. The general health is at first but little impaired. The causes of ovarian dropsy are similar to those of ascites, and the remedial processes must be conducted on the same general plan. Tap- ping should never be resorted to until the increasing distention begins seriously ta affect the general health ; the operation cannot be relied on to offet a permaiien- cure, but with attention to the general health, 258 PATHOLOGY A ^" B THERAPEUTICS. mayH, and sick. Dr. Burder 566 PATHOLOGY A!TD THERAPEUTICS divides headache into muscular, periosteal, congestive, organic, dyspep- tic, and periodic. Dr. Weatherhead divides headache into dyspeptic^ nervous, plethoric, rheumatic, arthritic, and organic. Dr. Copland divides headache into nervous, congestive, plethoric and inflammatory, dyspeptic and bilious, cerebra% pericranial or neuralgic, rheumatic and arthritic, periodic, hypochondriacal, and the sympathetic. Dr. Hooper divides headache into internal and external ; the former being subdi- vided into congestive, sympathetic or dyspeptic, and organic ; and the latter into muscular, periosteal, and neuralgic etc., etc. The same confusion prevails among medica authors with respect to the pathology and treatment of this complaint. Treatment. — Whether idiopathic or symptomatic, all severe head- aches require prompt and special palliative medication, although the cure must be sought in the removal of the morbid condition on which they depend. The majority of cases can be relieved at once by put- ting the feet in warm water, and applying cold wet cloths to the head. The hot fomentation to the abdomen is often sufficient. When arising from suppressed menstruation the warm hip-bath is advisable. When the cause is a sudden oold, the wet-sheet pack should be employed. If the stomach is exceedingly irritable, and troubled with obstinate nausea and vomiting, warm waler-drinking and the pouring head -bath constitute the most efficacious practice. When arising from the sud- den abstraction of stimuli, as of wine, tea, coffee, tobacco, etc, the patient should keep very quiet for several days, and walk, sit, or lie down, as he finds most comfortable, and take frequent warm foot and cold head-baths, waiting patiently for nature to restore the natural sen- sibility and tone of the organism, so that its machinery can work again without the lash of artificial stimulation. Neuralwia — Nerve-ache. — Neuralgia is another of those dis- eases which are among the growing evils of the increasingly enervat- ing customs of civilized society. Until a very modern date, the only form of this disease known to medical men was the tic doloreux, or neuralgia of the face ; now, however, neuralgic pains, in almost all parts of the body, are very common afflictions. The face, jaws, feet, and breast, are, however, most frequently the parts afiTected. Symptoms. — The disease is recognized by acute lancinating pains, along the course of one or more nervous branches of the organ or part affected, which recur in short pRrox>sms, with irregular intervals ; usually there is more or less twitching or irregular convulsive motion of the adjoining muscles. In facial neuralgia the pain shoots from the region of the mouth to the eyes, ears, cheek, palate., fauces, and teeth. DISEASES OF SENSATION. 267 sound teeth have sometimes been extracted on the suj3f osition that some concealed ulcer or caries occasioned the pain. When the foot is attacked, there are racking pains about the heel, darting toward the ankle and bones of the tarsus. In nerve-ache of the breast the sharp darting pains usually divaricate from a fixed point in tho breast, and shoot down the course of the ribs and arm to the elbow. When other parts, organs, or particular muscles are attacked, the disease is easily recognized by the sharp, darting, cutting, and intermitting char- acter of the pain. Special Causes. — All the causes of dyspepsia, and every thing con- ducive to nervous debility, are among the causes also of neuralgia. Those enervating influences which more especially predispose to this disease are tea, coifoe, alcohol, tobacco, excessive brain labor, and de- pressing emotions, as grief, fear, anxiety, suspense, disappointment, etc Treatment. — I know not upon what principle our allopathic friend propose all the most virulent poisons of their materia medica for the treatment of neuralgia, unless it is that the more powerful the pain the more potent should be the poison ; or in other words, the more a pa- tient suffers from disease, the more he should be made to suffer from drugs. Arsenic, beiladona, Prussic acid, henbane, strychnme, opium, quinine, etc., etc., in terrific doses, are put forward as the most prom- ising remedies, while surgery comes in and kindly offers to interrupt the morbid sensibility by dividing the affected nerves between their point of disti'ibution and the common sensorium. The disease before us appears under so many complications that the most experienced hydropath will have to feel his way in the majority of cases. Every circumstance affecting the general health must first be inquired into and placed under organic law. Usually some one of the excretories will have been for a long time toi-pid, and frequently the bowels, skin, kidne3's, and liver are all obstructed. The majority of patients we meet with, too, will be worn down with suffering, and poisoned through and through with drugs, or farther reduced by de- pletions, as bleedings and blisterings ; hence they will generally be ex- ceedingly tender and susceptible. The treatment should generally begin with gentle bathing in tepid or warm water, followed by moderate friction or hand-rubhing. The temperature of the water should be reduced as fast as possible — taking care, however, to avoid aggi'avating the pain by a sudden chill — consist- ently with securing a comfortable glow after each application. In some few cases, where the external heat and capillary circulation are not materially deficient, cold, and even very cold water, is more sedative and agreeable than tepid or wai*m. Local baths, as compresses, half, hip, 76S PATHOLOGY AND THER A P£ CJTICS. nnd foot-barlis, should be first employed, followed by the half or full pack, dripping-sheet, plunge, and douche, as the morbid sensibility diminishes and the sti-ength improves. In many cases there is a kind of sub-paralysis of the limbs, or a rheumatic lameness and rigidity of the muscles of the affected part ; in these cases the warm douche, fol- lowed by the cold dash, is excellent. Sleeplessness. — This affection, which is characterized by a dififi- culty or inability of sleeping, is, when not symptomatic, produced by some mental* excitement or bodily disquiet. In the former case the mind is listless to surrounding objects ; and in the latter the attention is alive to them. Severe study, intense attention to business, and pro- tracted watching, are common causes of the former variety, and cold feet, eating near bed-time, taking stimulating drink in the evening wtieo unaccustomed to it, or abstaining after having been habituated to it, are the ordinary causes of the latter. The remedies are a hip- bath or dripping-sheet at bedtime, when the trouble arises from men- tal causes ; and the warm foot-bath, abdominal girdle, active out-door walkmg, and exercising in a cold room while in a state of nudity — a form of air-bath — when the causes are corporeal. Restlessness. — There are two states of general bodily disquietude, which authors have regarded as distinct diseases. One is familiarly called fidgets, and distinguished by a perpetual desire to change the bodily position; and the other, called anxiety, is known by an equally restless desire of perpetual locomotion. The common cause of the fidget}'' variety is too long confinement of the whole body, or any part of it, in a nearly motionless position. Children at school, writers at the desk, females with the needle, especially those of active brains and iiTitable temperament, often suffer severely for want of free and fre- quent exercise of the whole muscular system. Worms and some kinds of jkin diseases sometimes produce this complaint. The anxious form of restlessness is peculiar to persons of a highly nervous temperament, and is attended with a distressing or uneasy sensation, particular!}' about the praecordia. Constipation is a frequent cause in acutely irritable persons, and difficult, local, or pecuniary cir- cumstances, or projects in relation to the future, on which the mind dwells intensely, are among the most frequent of the mental causes ; and our medicjition must be directed to the removal of the existing cause, whatever that may chance to be. Antipathy. — A feeling of internr- repugnance or horror at the T)ISEASES C5 SENSATION. 269 presence of particular objects, or the introduction of particular sub- jects, constitutes one of the many singular infirmities of our fallen na- ture. Some persons will sicken at the sight or taste of cutter or cheese ; some find the smell of roses and mint, or the sound of music, painfully disagreeable ; some will detect the presence of a cat in the room with- out the use of the external senses ; some are ready to faint at the sight of blood, wounds, sores, crabs, lobsters, toads, vipers, and other un sightly animals ; and some will scream frightfully at the appearance of a mouse or spider. Probably these peculiar traits of idiosyncrasy may be produced by frights or other accidents in early life, or by some pow- erful and perhaps forgotten mental impression of the mothei- during the period of gestation. The only chance of cure seems to be, in gradually accustoming the patient to the object of antipathy. Vertigo. — Different forms of vertigo are known by thf* terms diz- ziness, swimming of the head, blind headache, niid nervous Jd.nting Jit ; it is a frequent accompaniment of headache, and is owing tj the same exciting and predisponent causes. Symptoyns. — The patient, while at rest, experiences an illusory gy- ration, or objects around him seem affected with a whirling motion ; there is also a sense or fear of fiilling, with some degree of mental con- fusion. In some instances the dizziness is combined with illusory Bounds, as whispering, murmuring, ringing of bells, beating of drums, roar of cannon, etc. Special Causes. — The immediate cause or proximate condition is a preternatural pressure of blood upon the nervous substance of the brain ; and this is owing in most cases to a morbid viscidity of the blood from retained bile, perspirable matter, or other effete material. Extreme debility, whether from hard labor, starvation, hemorrhage, or protracted diseases, favors the condition of the brain from which ver- tigo results, for the reason that the. action of the heart being weakened and the capillaries contracted or paralyzed, the blood is pressed with disproportionate force upon the brain. The exciting causes are usually Budden exertion or hurried motion, as raising the head, stooping, etc. Any considerable motion to which the bod)- has never been accustomed, AS sailing, swinging, walking circularly, sitting backward in a carriage, etc., may occasion vertiginous sensations in healthy persons. Intoxica- tion, narcosis, and violent fear also produce dizziness, which is experi- enced on every attempt at motion. Treatment. — When the body is full and plethoric, or there are evi- dences of biliary accumulations, a warm water emetic is advisable. In all cases the bowels must be kept entirely free by plain, coarse food. 270 PATHOLOGY AND THERAPEUTICS. Biid injections if necessary ; and the skin kept open by one or two thorough daily ablutions. In other respects regard must be had to the idiopathic condition. When connected with great debility, emaciation, Joss of blood, or inanition, quiet and ?leep are among the leading reme- dial agencies. Syncope. — Sivooning and fain ling -Jit are the princiir,il varieties of the malady before us, which is distinguished by diminished sensibility, inability of utterance, with feeble or imperfect motion of the heart and lungs. The general causes are the same as those of the preceding disease, although to the exciting causes may be added extreme pain, violent passions, sympathy, sudden fright, sudden abstraction of blood, rapid evacuation of fluid accumulated in the cavities of the body, as in dropsy, sudden discharge of the matter of extensive abscesses, retro- cession of arthritic and eruptive diseases, excessive fatigue, etc. The treatment consists of a free current of cold air ; sprinkling cold water in the face ; and if the syncope is prolonged, pouring cold water over the head, and applying the cold compress to the stomach; to which may be added the recumbent position, fig. 189, and warm water with friction to the lower extremities. As soon as the patient can swallow a draught of cold water should be administered. Fig. 189. POSTURE IN SYNCOPE. Dr. Good says — T quote to contrast, not to commend his h-eatment : *' As soon as the patient is capable of swallowing, some spirituous cor- dial, a glass of wine, brandy and water, fetid tincture, or the aromatic ppirit of ammonia, or of ether, should be administered." The reader need not be told that a half gill of pure soft water is an ample substi- tute for i*^ of the above allopathic notions. MoRBin Sight. — Ingenious nosologists have certainly displayed more analytical than philosophical talent in giving us a list of nearly six hundred jisoases of the ove I Dr. G )od has reduced the formida- DISEASES OF SENSATION. 271 b.' -ist to twelve ; but I think one will answer just as well for all the forms of depraved vision which do not properly belong to the special chapter on diseases of the e\'e. Symptoms. — In false sight or illusory vision — the only species com- ing within our generic definition — imaginary objects float before the eye, or real objects appear with imaginarj' qualities, constituting the ocular specters and the 771usccb volitantes of authors. In many cases of false sight, objects appear of unusually large or small sizes, or multi- plied in number ; one color is mistaken for another; sparks and flashes of light appear before the eyes. etc. Special Causes. — Excess of light, plethora, local injuries, as blows, bruises, congenital malformations. Treatment. — But Uttle can be done therapeutically beyond attention to the general health. Gentle friction and manipulation, frequently holding the eyes in cold water, etc., as in the case of weak eyes, or sore eyes from debility, are occasionally serviceable. It is especially important in all cases of depravity of the speci-al senses, that grease, salt, and all earthy or saline matters be excluded from the food and drink. Morbid Hearing. — Preternatural acuteness or obtuseness, or dis- ordered perception of sound, results from a variety of inflammatory states or structural changes of the ear. But in some instances the hearing has been so keen as to render the ordinary whispering, and even the respiration of persons present highly distressing, and to render real, imaginary, or illusory noises exceedingly troublesome, or so dull as to disable the patient from taking part in common conversation, without any apparent local aff'ection of the auditory apparatus ; although in most cases it is presumable that a deficiency of the ceruminous secre- tion, or an unnatural irritability or torpor, resulting from powerful noises, violent passions, etc., are the conditions on which the depravity of the function depends. In some cases of semi-paresis, or partial palsy of the auditory nerve, the ear is only sensible of articulate sounds, when excited by louder sounds intermixed with them ; and in some cases particular sounds, as the beating of a drum, the rattling of carriage wheels, the tones of a shrill pipe, the ringing of bells, etc., will excite the function and enable ordinary conversation to be recognized. Treatment. — Remedially, we can only attend to the secretion of the external ear, and to the general health. Frequently syringing the ex- ternal meatus with warm or tepid water, followed by cool or cold, and the occasional employmertt of the head-bath, with a moderate douche to the upper portion of the spine, are the appropriate local measures- PATHOLOGY AND TIIERAPEUTICS Morbid Smell. — Acrid, obtuse, and absence of smell are, like analogous conditions of the other senses, usually among the symptoms of fevers and local affections. But with some an exti'eme and painful keeness or total deprivation of the sense exists from birth. Some per- sons find the smell of roses, and various odors and perfumes which are agreeable to the majority, intolerably offensive and sickening. A tern porary loss of smell may result from a slight cold ; and a permanent depravation or depi-ivation of the sense is often produced by irritantS; pungents, eirhines, and poisonous vapore, as "cephalic snuffs," tobacco dust, cigar smoke, etc. Catarrhal affections, when long continued, always deteriorate the sense, and all high-seasoned dishes and compli- cateu preparations of animal food, are especially injurious. Treatment. — The head-bath, and the frequent sniffing of cold water up the nostrils, with a rigidly simple diet, constitute the special thera- peutic measures. Morbid Taste. — The tongue and palate, which in the norma state distinguish the chemical and gustatory qualities of substances, as sour, sweet, bitter, rough, aromatic, saline, etc., are sotnetimes so malformed originally, or so perverted by disease or bad dietetic habits, as to be j;)ainfully acute or morbidly obtuse; to remedy which nothing is more appropriate than fi*equently holding cold water in the mouth, and employing ;;n exclusively farinaceous and fruit diet, tl^e farinaceous part to be as simple and dry as possible, of which unleavened brown bread is the best specimen. Morbid Touch. — The hand, and especially the extremities of the fingers, possess the nicest power of discriminating the tangible proper- ties of bodies, although the whole skin belongs to the organ of feeling, or sense of touch; and this sense, like all the others, may be preter- naturaily acute, or insensible, or illusory. Its principal deviations from the normal condition are known as soreness, itching, heat, and coldness. The first vanity is usually the result of a cold, or a symptom of fever or inflammation ; the second is dependent on irritation in the stomach, bile in the blood, or imperfect depuration from the skin; and the third and fourth are caused by exercise, and alternations of, or exposures to, extreme temperature. Beyond a daily cold-bath, and attention to any particular local derangement that may chance to exist, we have nothing to say remedially, except advise a regulation ;f all the voluntary habit» according to the laws of health. MENTAL DISEASES. 27S CHAPTER XVI. MENTAL DISEASES. Thk I elation between mina and body is so intricate and intimate that a morbific impression upon either may produce a manifestation of mor- bid ])henomena in the other. The majority of cases of insanity, luna- cy, hallucination, or mental aberration, have their origin in bodily dis- ease ; yet there are some cases in which the producing cause is pure- ly mental. The present chapter comprises a group of maladies whose most prominent symptoms are abnormal manifestations of the mental operations, irrespective of the nature of the predisponent, proximate, or exciting causes. They may be arranged in tabular form as follows : < Melancholy, Insanity J badness. Ungovernable \ ^ ^' , Passion < Despondency, r Absent-Mindedness, Revery } Mental Abstraction, ( Brown Study. Hallucination ( Hair-Brained. < Sentimentalisra, ( Hypochondriacism. Sleep Dis- turbance Fatuity Somnambulism, Sleep-Talking. Irrationality, Imbecilit3^ Insanity — Craziness. — Nothing in the whole range of pathology is more difficult than a nosological arrangement of the abnormal states of mind ; for the vast diversity of human intellect, and the varied cir- cumstances of excitement, depression, and mis-direction to which it is subjected by individual and social uses and abuses, make it sometimes impossible to say where sanity ends and insanity begins; while among the unquestionably insane we ^nd every conceivable shade and degree of mental peculiarity, from a disproportionate activity of a single fac- ulty or propensity, constituting a one-ideaism or an all-ahsorhijig 2^cls- sion, whose possessor is merely a monomaniac, to the most violent and extreme derangement of several or of all the mental powers, consti- tuting ci'aziness, lunacy, or idiocy. The malady before us presents two distinct features, which authors have ranked as species of disease : melancholy, in which there is u to- tal or partial hallucination, accompanied with extreme dejection, fear, and filse apprehensions, while the will is way A'ard and domineering* 274 PATHOLOGY AND THERAPEUTICS. and mania or madness, in which all the mental powers are greatly ex- cited, and the discrepance between perception and judgment general. Melancholy is subdivided into many varieties, as gloomy melancholy, when the patient is mute and retiring ; errallc, when he v& roving and restless ; malevolent, when he is morose or mischievous, and disposed to injure himself or others ; and complacent, when he is quiet, affable, and visionary. Madness is characterized as furious, when the patient is violent, runs, jumps, mutters, cries, shrieks, etc. ; elevated, when he is gay, lively, hurried, exulting in his own imaginary importance, which may make bim a president, king, prophet, or the Messiah; despond- ent^ when he is abjected and depressed; and demented or chaotic, when the mind sinKs into insensibility and forgetfulness, with an entire abolition of the faculty of judgment, yet possessed of unconnected and evanescent emotions, and perpetually active in acts of extravagance without object or design. Special Causes. — It is natural enough that physicians, considering how few are the sound physiological prmciples known in the schools of medicine, should suspect some morbid condition of the brain or its ap- pendages as the special cause of all diseases which are characterized by disorderly manifestations of the mental functions. But says Dr. Goiod : " Concerning therefore the remote or even proximate cause of the disease, we have yet much to learn. From the view we have taken in the proem of the close connection between the mind and the brain, it seems reasonable to conceive that the remote cause is ordina- rily dependent upon some misconstruction or misaffection of the cere- bral organs ; and hence every part of them has been scrutinized for proofs of so plausible an hypothesis, but litherto to no pui-jiose what- ever. The form of the cranium, its thickness, and other qualities ; the meninges, the substance of the brain, the ventricles, the pineal gland, the commissures, the cerebellum, have all been analyzed in turn by the most dexterous and prying anatomists of England. France, Germa- ny, and Italy, but with no satisfactory result." As well might we expect to find the proximate cause of a disorderly communication or action of the telegraphic macliinery, by a chemical analysis of the wire between the batteries or at the stations, as to seek the cause of diseased mental manifestation in an analysis of the anatom- ical character of the brain. The nervous influence and the electi'ic fluid will probably forever elude all attempts at material analysis. That the phenomena of insanity immediately depend on some excess or defect, or mal-distribution of nervous influence, is sufficiently obvi- ous ; nor is it difficult to ascertain the ordinary, remote, or disturbing causes; thpse are generally strong menta en otions. operating in con- MENTAL DISEASES. 275 nectiou with an organism physiologically unsound. Intemperance is the most fi-equent cause. Gluttony, self-abuse, powerful stimulants, religious excitement, grief, fear, disappointment in objects of love, am- bition, or property, reverse of fortune, etc., are named by authors among the ordinary causes. Treatment.- — The moral management will be readily suggested by the circumstances of each case. Undoubtedly a well-ordered public asylum is the proper place for the majority of becrazed invalids. But there the medical part of the management could be vastly improved. Instead of bleeding and drastic purgatives, which, as the late Dr. Brig- ham, of the Utica Asylum, testified, only serve to fasten the insanity upon the patient, he should be put upon a bland and simple diet, and a plan of derivative and soothing bathing. In all the appliances of water, es- pecial pains must be taken to keep the feet warm, the head cool, and to avoid all sudden shocks or strong impressions which would produce cerebral excitement. The tepid, shallow, hip, and foot-baths are the leading processes. When the patient is manageable, the wet-sheet pack, followed by tlie dripping-sheet, is appropriate ; but when these or any other general cold bath is employed, care must be taken to have the feet warm ; if they are in the least inclined to coldness, they should be put in warm w^ater both before and after the bath. In our public institutions, insane persons are allowed flesh-meat, cof- fee, tea, condiments, and sometimes ardent spirits and tobacco — all of which is clearly wrong. Ungovernable Passion. — This affection, in which the judgment is overpowered by some predominant or ruling passion, accompanied with a marked change of the features and countenance, is seen under tlie forms of excited, depressed, and fitful or eccentric passion. The divisions of the first are innumerable, as ungovernable joy, self-love or self-conceit, 2^'ride, ambition, anger, jealousy, etc., all of which are marked by a lively, quick, daring eye, and a flushed, tumid face. In the second variety the patient is anxious, pensive, inclines to solitude, and his countenance is pale and furrowed ; the ruling passion is mani- fested in ungovernable love, avarice, anxiety, longing, heartache, des- pair, etc. The third variety is commonly called hair-brained passion^ and is characterized by wayward and unmeaning passion, indiscriminate acts of violence, and a hurried and tumultuous manner ; it is usually the result of an ill-directed education. SjJecial Causes. — Ail the causes of insanity may be among the pre- disposing or exciting causes of the species of mental pravity under con- sideration ; to wdiich may be added debauchery, gambling, ingratitude, 176 PATHOLOGY AND THERAPEUTICS. domestic trouble, loss of friends, crushed hopes, love-sickness, home- sickness, impending calamities, successive misfortunes, social disgrace, incurable secret diseases, bodily imperfection or deformity, contumely, imprisonment, banishment, remorse, etc. Treatment. — To all the remedial measures named as applicable to insanit)% should bea dded as far as practicable, recreation, occupation, and society. Probably nothing is more reforming to the mind or renovating to the body, in all forms of the malady before us, than regular,. steady employment in some useful calling. Hallucinatio> — Illusion — Alusia. — la this affection the imag- ination overpowers the judgment. It embraces two varieties, one of which is called sentimcntalisra, or mental extravagance ; and the other is termed hypochondriacism, or low spirits. The former is character- ized by romantic or fantastic ideas of real life, ardent fancy, excited and pleasurable feelings, and animated countenance; it embraces those forms of mental illusion, called heroic or chivalrous, facetious^ ecstatic, and fanatic; in other words, romantic gallantry, crack-brained wit, false inspiration, and fanaticism. The hypochondriac variety is distin- guished by gloomy ideas of real life, dejected spirits, anxiety, indispo- sition to exercise, an oblique and scowling eye, sad and sullen counte- nance, with a languid pulse, and prominent dyspeptic symptoms; it comprehends the mental states known as vapors, weariness of life, and misanthropy, or spleen. Symptoms. — Morbid sentiraentalism manifests eveiy conceivable form of extravagant mis-judgment, as uncalled-for acts of gallantry, rampant and uurestrainable jesting, ecstasy, visions, belief in appari- tions, or in some preternatural endowment, etc. Hypochondriacism perceives a thousand evils and accidents which have no existence, and imagines the most whimsical and groundless causes of disquiet, as personal danger, poverty, frogs or geese or other animals in the stomach; all sorts of diseases; one perceives himself transformed into a giant; another into a dwarf; one is as heavy as lead, and the other as light as a feather; some suspect their friends of an intention to nmrder them, and others suspect themselves of having murdered their friends ; they are peevish, pleased and displeased with the veriest trifles, and are often unwilling either to live or die. Special Causes. — The first variety is often, if not generally, attributa- ble to a superficial and ornamental instead of a substantial and useful education. Novel reading is, perhaps, the most potent and most com- mon cause. " Periloi.s adventures, love-lorn catastrophes, the stories of magicians, knights, enchanted castles, imprisoned damsels, melting MENTAL DISEASES. 277 minstrelsy, tilts and tournaments, and all the magnificent imagery of the same kind that so peculiarly distinguished the reign of Elizabeth, became a very frequent source of permanent hallucination." Thf> second variety is 'Inore especially connected with indigestion and dis- ease of the liver ; and among the common causes are alcohol, tobacco and intemperance and stimulation generally. Treatment. — In addition to the measures requisite to recover and maintain general bodily health, the moral or mental medication should consist of pleasant, cheerful, and. sensible company, with a light and easy, yet regular and steady business occupation, occasionally diversi- fied by reading sound, scientific, useful, and practical books and news- papers. Note. — Some authors name displacement of the transverse colon as a cause of various forms of insanity ; and the French pathologists are said to have frequently found this condition to exist, on post-orbit dis- sections, more especially in subjects who have died of the varieties of hallucination called weariness of life and misanthropy. I am of opinion some kind of sti'uctural derangement of some portion of the intestinal tube is a much more frequent cause of mental aberration than is gen- erally supposed. I have very often noticed a less degree of the same misaffections of mind, and also many extreme cases of those forms of hallucination termed fidgets, anxiety, vapors, etc., in persons suffering from a displacement of the lower bowel — prolapsus of the fundament. This is generally induced by piles ; piles are uniformly caused by cos- tiveness, and the ordinary dietetic habits of civilized society are exactly calculated to produce this diseased condition. Hence there is good reason to apprehend that a great proportion of those cases of menta! disorder coming under the present head, are owing to diseases or dis- placement of some portion of the digestive canal. But I have noticed another still more frequent cause of still severer forms of "a mind diseased," and I wish to give it particular prominence here, for the reason that it is scarcely alluded to in any medical work with which I am acquainted, in connection with the general subject of insanity. I mean displacement of the uterus. The reasons already assigned show us why this malady should be of frequent occurrence among females. They are more sedentary and in-door in their habits and occupations, and hence more liable to constipation, piles, prolapsed bowels, etc., and the general debility and relaxntion of fibre often ex- tends to the uterus and its appendages, producing prolapsus, antever- sion, retroversion, and a variety of other local complaints. Theso cases require the special treatment which will be mentioned here- after. 24 278 PATHOLOGY AND THERAPEUTICS. Revert. — Absence of inind^ mental abstraction, and brown study^ are the usual forms in which the misaffection of mind, termed revery, is exhibited. They are sometimes induc&d by bodily infirmity, but are more frequently the acquired habits, resulting from a loose, uTegular, and superficial education — an education in which the mind is stufted with words instead of being taught to think and form ideas for itself. This, combined with corporeal inactivity or indolence, is the principal renson why so manj- college-bred sons of distinguished men, after re- ceiving the highest finish of a formal education, and being " put through" a learned profession — law, physic, or divinity — in the ofifices of the most eminent professors, turn out wordy blockheads or profes- sional automatons, instead of thinking men and intelligent citizens. These remarks apply mainly to the first variet}'^ of revery. It should be remarked, however, that some overwhelming passion, and intense study, especially upon the principles of mathematics and other abstruse subjects, are not unfrequently causes of mental abstraction, while these causes, coupled with the pursuit of some object of ambi- tion or emulation, in whicli the mind is kept for some time in a state of distraction between hope and fear, frequently induce the variety called brown study — the studium inam, of Darwin. The treatment will be readily inferred from the general principles of cure indicated in the preceding remarks. Sleep-Disturbance. — Sleep-walking, somnambulijm, and sleep- talJcing are terms which denote the forms, and sufficiently express the nature of the chief varieties of mental disorder connected with sleep. There is in all cases an imperfect and disquiet rest, in which some of the mental powers are but partially asleep. The usual, and perhaps only causes, are an irritated or overloaded stomach, and an overexcited bniin. Profound or natural sleep is never accompanied with walking, talking, or even dreaming ; hence all the phenomena resulting from disturbed sleep are so many symptoms of abnormal bodily or mental irritation. Worms in the alimentary canal, and diseases of the brain, are peculiarly distinguished by somnarabulific manifestations. In some cases of somnambulism, which have been clearly ti-aced to morbid, di- gestive, or cerebral excitement, and cured by appropriate remedies ; the mental powers have been wrought up to high intensity of power, and have solved problems too difficult for the waking state ; and per- sons in such conditions have even been known to exer<;ise clairvoyant powers, as in reading with the eyes shut and closely bandaged, hear- ing and conversing coherently while entirely unconscious, etc., while (he voluntary muscles unaided by the external senses, have performed MENTAL DISEASES. 279 r.irious feats of locomotion, as climbing, walking secm'ely in the most dangerous places, etc., which could scarcely have been accomplished unless the "interior sense" had predominated over the special senses. Our success in medicating these affections will depend entirely on our skill in tracing each individual case of disturbed sleep to its particu- lar cause or causes, and applying our remedial measures according to the principles already explained. Fatuity. — The defkiition of this affection by Dr. Good, "defect or hebetude of the understanding," is rather too diffuse ; for some people are considerably prone to regard all others as in some way or other de- fective or foolish in judgment, who happen to feel, think, or act other- wise than according to their own standard of a sound understanding. That form of mental hebetude which is known as imhecility, is divided by authors into various forms, the chief of which are stupidity, for getf allies s, credulity, and feebleness ; wliile irrationality or witless- ness comprehends those manifestations of defective reasoning faculties we call folly or silliness, dotage or superannuation, and idiotism. Of course we must all humbly and modestly confess to some degree of some one or more of these " hebetudes ;" but it is only when they are found to form a very prominent feature of a very small minoiity, that we are to name them as leaves or branches of the great arhor morborum. Stupidity may arise from ignorance, from gross food or gluttony, from idleness, from intoxicating drink, from tobacco, etc. A celebra- ted author remarks, "Idleness in conjunction with wine and fermented liquors, has a proverbial power in besotting the understanding." For- getfulness affords many curious examples of oblivious reminiscence. Some forget the place or street they live in ; others cannot always pro- nounce then" own name at the post-office ; and instances are recorded m which individuals have forgotten their mother tongue, and been obliged to re-learn the language from the alphabet. Credulity may re- sult from misdirection or original malformation ; and it exhibits all de- grees of imbecility, from a trifling gullibility to a disposition to take hold of subjects with a fervency of faith proportioned to their intrinsic ab- surdity. Silliness is sometimes a natural infirmity, and frequently the fruit of bad company and low associates in early life. Dotage is usual- ly considered as a mere consequence of old age, but is generally hast- ened on and aggravated by riotous living or excessive labor, or the hab- itual indulgence of violent passions. Idiotism generally results from defective organization, or a want of that portion of the brain which man- ifests the reflective faculties It may, however, be induced by a V3- eao PATHOLOGY AND THERAPEUTICS. riety of accidental circunisrances or voluntary habits, as habitual drunk- enness, excessive indulgence in enervnting pleasures, onanism, or self- iwilulion violent and protracted emotions of mind, external injury of the brain, loss of blood, etc. It has been produced by the excessive ns.^ of the lancet in females after delivery, in brain diseases, and in va- rio 8 fi)nns of insanity. . Treatment. — So far as moral treatment can be of any avail, the prin- ciples which should regulate it have already been indicated. In rela- tion to the medical, much may be done to alleviate or cure those cases not depending on congenital or organic causes. In general terms, the treatment should be rather of the rousing, stirring, animating kind ; as the dripi)ing-sheet, douche, shower, plunge, spray, or fountain, cata- rart-baths, etc., combined with active out-door exercise, or regular oc- cupation. The diet should always be simple, bland, rather abstemi- ous, and strictly vegetable. An irrational mind, or one predisposed by organization, accident, or bad habits, to imbecility in any form, should avoid flesh -meat as if it were a very bohon upas. CHAPTER XVII. DISEASES OF THE VOCAL AVENUES. All the diseases which make up the present chapter, have, as their most prominent symptom, some misaffection of the voice or speech, although some of them differ very greatly in every other particular. Thoy may be thus grouped : . I Acute, (/hronic i ,,, \ Cinonic, ( atarrh I ,^ { U/.irna. Polypud Dissonant Voice Jv ii'Miciins Compressible, Cartilaginous. Snoring, Wheezing. Di«su"ant Speech ( Elingual, Speecftlessness } Atonic, ( Deaf-Dumbness. Whispering, Immelodious, Of Puberty. Stammering, Misenunciation. (mtarrh— r-iRYZA.— When this affeition is confined to that part DISEASES OF THE VOCAL AVENUES. 281 of the mucous membrane which lines the nasal cavities, it is called cold in the head ; and when the inflammation fixes permanently upon the same membrane in the cavities of the frontal bones, it is called ca- tarrh in the head Symptoms. — In the acute form there is a defluxion of acrid, pellucid, mucous, or ropy matter from the nostrils, with a sense of irritation, and some degree of general fever. In the chronic variety the discharge is limpid, without acrimony or irritation, and unattended with febrile dis- turbance. The third variety, which is produced by an ozcena, or na- sal ulcer^ is denoted by an offensive, purulent, or ichorous defluxion; it is often connected with caries of the spongy bones. Special Causes. — Sudden exposures to cold and damp, hot drinks, ir- ritant dust or vapors, snuff", smelling salts, strong aromatics, mercurial salivation, often induce this disease. Some authors give us a senile variety, owing to " the natural paresis of old age ;" but I hold that any local palsy before death is entirely unnatural. Treatment. — ^The acute form requires a few packs to reduce the general feverishness, which, if the diet is rigidly abstemious, and the patient kept in a moderately warm room of uniform temperature, will effect a cure in a very few days. The chronic variety — as also does the nasal ulcer — requires a persevering employment of derivative as well as local treatment. The pack occasionally, frequently sniflfing cold water up the nostrils, the hip-bath, and one or two foot-baths daily, with as much exercise in the open air — avoiding, however, chilling and damp winds — as the patient can comfortably bear, comprise the reme- dial course. Polypus. — Polypus tumors in the nostrils are of two kinds ; the soft, or compressible, and the hard, or cartilaginous. Both are proba- bly morbid growths of the mucous membrane, although the latter va- riety is generally connected with caries of the ethmoid or inferior tur- binated bones. Symptoms. — Nasal polypi present the appearance of fleshy, elongj ted excrescences, attached by a slender neck to some part of the Schnei- derian membrane, extending in different directions, and affecting the speech by obstructing the nasal cavities. The soft kind is unattended with pain ; its color is a pale red, having some resemblance to a com- mon oyster; and it generally shrivels in dry and enlai-ges in weX weather. The hard polypus, is firm, of a highly red or dark color, progresses gradually without alternate diminution and enlargement, and causes pain, with a very disagreeable sensation in the nostril and forehead, on coughing, sneezing, blowing the nose, etc. 282 PATHOLOGY AND THERAPEUTICS. Treatment. — In the eaily stage frequent sniffing ot the coldest wa- ter Will often urre^t the tumor. When it becomes troublesome fron: bulk, extirpation is necessary. The soft kind may be retnoved with the ligature or forcei>s ; the lat- ter is getierullv the most convenient method. The hard polypus can- not always be meddled with without endangering the life of the pa- tient. When attached to or connected with the si:ougy bones, these may be removed by a skillfu surgeon. J^„„^^n,>. — Rattling in the Throat. — Snoring o^ndi wheezing, which are the chief varieties of this affection, are symptomatic of other diseases, as a|X)plexy and asthma, or of gross feeding, a plethoric habit, en ■ . or obesity, or of an obstructed skin, by which the lungs are oj'; with vicarious duty, or of atony or debility of the abdom- inal muscles, which are important agents in the respinitory movements. The cure will be found in a restoration of that equilibrium in the bulk and action of the bodily organs and functions which is correctly termed liealth. Dr. Good recommends "taking off the obesity," in fat per- sons, " by repeated venesections, active purgatives, vigorous exercise, and a low diet." I will guaranty a perfect cure in everj' case of obe- sity on earth, by proper exercise and diet, sans all the bleedings and the purgatives. Speechlessness — Aphoxta — Dumbness. — Inability of speech may result from destitution of tongue — and this may be congenital or accident- al — constituting the clingual variety : or from paralysis of the nen'es of the tongue or glottis, in consequence of some violent injur}' or shock, form- ing the atonic variety ; or from congenital deafness, or deafness ac- quirer! in early life, making the variety called deaf-dumbness. Sjxrial Causes. — When the inability is not organic, its most fre- quent causes are severe and proti-acted colds; violent shocks, as of lightning or electricity ; vehement emotions, as of terror, anger, fright; narcotics ; mephitic exhalations ; ix)isoning from eating mushrooms, and sometimes shell-fish; metallic vapoi-s; mercurial medicines, etc. There are also many cases of partial or complete loss of voice, the cause of which is almost always overlooked or unthought of by the at- tending physician : I mean cases of weak voice resulting from mere debil- ity of the nui8cles of the loins and abdomen. In these cases there maybe a moeai"nnce and the most deplorable in their consequences that af- flict degraded and erring mortals. Symptoms. Venereal affections appear in two distinct forms, syphi- lis, or poi, and gonorrhaa, or clapp. The first is a constitutional dis- ease or. rather, may become so ; the second is always a local disease, never extending beyond the genital organs or glands of the groin. Both diseases, however, may coexist in the same individual, and be commu- nicHted at the same time. Gleet is simply a urethral mnning ; and, tliou"h often a sequel of gonorrhcea, may exist from irritation uncon- nected with venereal taint, and be excited by stone in the bladder, leu- corrhcea, and various other causes. These distinctions are important to keep in mind, for thousands have their constitutions ruined by a long mercurial course for gonorrhoea, on the mistaken notion that the dis- ease was in the blood or general system. It should be remarked, too, that syphilis never affects the constitution until after the formation of an ulcer and the absorption of its matter. Si/philis commences with one or several small pimples, or chancres^ on same part of the genitals, which gradually fester, and finally termi- nii;<' in spreading or deepening ulcei-s, filled with an exceedingly acrid niil corroding matter. If this matter is allowed to be absorbed, the glands of the gi'oin swell into hard tumors, called buboes, and often ul- cerate. Eventually the whole body becomes contaminated with the virus absorbed from the chancres, and what are called constitutional or secondary symptoms appear, as foul ulcers in the throat and palate, livid and copper-colored spots on the skin, or ulcerating scabs, inflamed eyes, pains, swellings, and caries of the bones, etc. Gonorrhea — blenorrhcea luodes — consists in a muculent and virulent discharge from the urethra or vagina, attended with a burning pain in passing the water, and considerable, sometimes violent pain, heat, and swelling of the part affected ; in some instances the inflammation ex- tends to the glands of the groin, producing buboes. Special Causes. — Venereal diseases may be generated by promis- cuous sexual intercourse, and when produced, the peculiar virus thus developed is capable of propagating the same disease by contact. Trralmcn'. — The ulcer or chancre should be destroyed by fire or caustic as soon as it makes its appearance. Aqua fortis or lunar caustic may be employed for this purpose. When the ulcer has already spread over a large surface or corroded deeply into the flesh, its virus may be destroyed by repeated applications of a strong solution of the caustic or diluted aqua fortis— one part to si\ of water. In all other re- spects both forms are tcf be treated as ordinary local inflammations. The proper temperature of the water for sitz-baths, which should be fre DISEASES OF THE SEXUAL FUNCTION. 293 quently employed, will vary greatly in different cases ; but in all cases that temperature is to be preferred which produces the most sedative or soothing effect. In some cases the morbid irritability is so extreme that cold water aggravates, wliile warm or very warm quiets the irri- tation, and relieves the pain and irritation at once. Inordinate Lust — We need not dwell long on this affection. Authors have applied tlie term satyriasis to an ungovernable sexual passion in the male ; and the term nympJiomania to a similar propensi- ty in the female. They are both produced by some local irritation, which may have its origin in the general mental or physiological habits of the individual. The most frequent combination of causes which op- erate to produce a state of lascivious /aror is, gross, high-seasoned food, intoxicating drinks, indolence, and personal uncleanliness — in other words, inattention to bathing. These views of the causation of the disease, are supported by the fact that it is more common in advanced life, even beyond the "three score and ten'* peiiod, than in youth or middle age. The cure will readilybe found in frequent general cold baths, copious water-drink- ing, active exercise or occupation, warm relaxing hip-baths, and a sim- ple vegetable diet. Genital DisrLACEMENTS. — ^The true pathology or proximate con* dition of these affections is but little understood by the medical {U'ofes- sion, as is apparent from the general ill-success attending the ordinary treatment. The term prolapsus is used indiscriminately for all degrees of simple descent, ov falling of the ivomb ; but in some books the term relaxation is applied when the descent is only to the middle of the vagina; procidentia, when the utei'us descends to the labia; and p/o- lapsus, when it protrudes externally. Retroversion is that form of dis- placement in which tlie fundus uteri descends toward the saci-um, tlio OS utei-i or mouth of the womb inclining toward the pubes. Antever- sion is the reverse of the preceding, the fundus falling forward and the OS uteri inclining backward. In inversion the organ is turned inside out Vvhile in a state of prolapse. In some cases the upper part of the vagina protrudes into the lower, constituting what is called prolapsus of the vagina. Symptoms. — Prolapsus of the uterus is attended with a heavy, dis- agreeable, or painful dragging-down sensation at the lower part of iho abdomen, aching or weakness about the small of the back, and when severe, great difficulty or inability in walking At first there is in- 294 PATHOLCGV AND THERAPEUTICS. creased mucous secretion, which increases by degrees until it acquires the chunictcr of an obstinate JeucoiThoea. When the I'^erus is rclroierled the bowels are irregular or consti- pated, and from the pressure of the displaced organ on the rectum be- hind and the urethra in front, there is more or less difficulty experi- CDced in expelling the contents of the bowels and bladder. In this situation the womb often becomes congested, inflammatory, and en- larged, and every attempt at walking is exceedingly painful or ex- hausting, lu bad cases the patient can only endure a fixed, quiet, almost motionless position in her chair or bed. There is, too, usually, considerable tenderness and tension of the whole abdomen. Anteversion is a less frequent occurrence; it is denoted by difficulty in w»lkit)i£, sense of weight or fullness in the pelvis, with man}' of the symptoms of prolapsus, and is attended with much less difficulty in evacuating the urine and faeces than retroversion. Inversion is known by the organ hanging down externally; it is usu- ally tlie result of violt^nce in extracting the placenta, but may occur from an adhesion of the placenta, or from polypus tumors. In some instances the falling down of the uterus or vagina drags along the bladder with it, constituting what is called complicated irro- lapse. In this case the bladder, being deprived of the expulsory aid of tlie abdominal muscles, is incapable of evacuating its contents with- out artificial assistance. Genital excrescence consists in polypus or other tumors, issuing from the surface of the uterus or vagina. They are of all sizes and of various degrees of consistence, from the softness of sponge to the firmness of leather. Special Causes. — Although medical authors and professors of mid- wifeiy are continually talking about "relaxation of the ligaments" which hold the uterus in position, as the main cause of its displace- ment, it is quite clear that this relaxation has nothing whatever to do with it; tlie yielding or elongation of the ligament being itself an efecl of the displacement. The natural supports of the uterus are the vagina and the abdominal muscles ; if the former is gi'eatly relaxed the uterus will descend, and the ligaments, being kept constantly on the btretch, will finally elongate more or less ; and if the abdominal mus- cles are greatJy debilitated, they do not contract vigorously, so as to keep uj) equable and uniform compression in all the various positions of the body, liencc the uterus is liable to fall forward or backward, or incline laterally; and when both are badly rehixed and debilitated, we find both con.litions of disjilacement — falling down and tipping transversely across the pelvis. In corroboratior of thi^ view of the subject, I mav DISEASES OF THE SEXUAL FUNCTION. 2% advert to the fact, that ail the cases of uterine displacement we meet vvirli in practice, with the single and rare exception of such as are produced by violence, occur in females who suffer from the very cir- cumstances which are most efficient in inducing muscular relaxation of these parts, as constipation, piles, dyspepsia, nervous debility, mis- menstruation, abortions or miscarriages, preternatural labors, etc. Treatment. — How impotent for good, and how potent for evil, are all the common chirurgical and drug-shop appliances for the manage- ment of these cases, may be inferred from the preceding explanation of their nature and proximate cause. Pessaries innumerable have been invented, trusses, braces, and supporters of all sorts and shapes have been contrived, and blisters, issues, and caustics, of every kind, have been resorted to, while many times the miserable sufferer has been kept confined to a fixed position in bed for six months or a year, all intended to aid, force, and sting the " relaxed ligaments" into contrac- tion, but which have, in nearly all cases, operated greatly to the disad- vantage of the relaxed muscles, and thereby greatly aggravated the difficulty. A rational medication will abjure all these " evidences of mechanical and chirurgical skill," and regard, first of all, the general health. All the resciirces of hygiene must be discriminatingly adapted to each in- dividual case. No class of patients require a more rigidly simple and abstemious diet. I have had many patients confine themselves for weeks to brown bread, boiled potatoes, and baked apples, or some plan as simple, and always with the best results. Nothing will conduce more to bring about a firm, energetic, contractile state of the whole muscular system. If a strict diet is adopted, very little water-drinking is necessary. The bathing part of the treatment must in general be moderate, for the reason that most patients can take but little exercise. A daily tepid dripping-sheet or halt-bath, with one or two tepid hip- baths, a foot-bath in the evening, with two or three vaginal injections daily, of as cold water as can be borne without disquiet, is the usual combination of baths whicli are most serviceable in these cases. To these I would always add occasional packs when the patient has a good degree of reactive power or superficial heat and circulation. As in all other cases, the patient should exercise according to ability ; but in bad displacements very little can be done in this way until the uterus is restored to its natural position. This must be done mechanically, when the ordinary external means fail. The os uteri must be found and elevated, or drawn backward or forward, according to the kind of displacement. "While the uterus is in position, the abdominal muscles must be strengthened by active yet gentle manipulations, and the re- 296 PATHOLOGY AND THERAPEUTICS. b.\e»ed for its removal the ligature is the best. CHAPTER XIX. DISEASES OF THE URINARY ORGANS. The various foin.s of mismicturition, which consist in morbid secre* tions or discharges of urine, are : Destitution of Urine — Suppression. Retention of Urine — Ischuria. Painful Urination — Stranguiy — Dysuria. Saccharine Urine — Diabetis. Incontinence of Urine — Eneuresis. Uuassimilated Urine — Urinary Diarrhoea. Eiratic Urination — Vicarious Urination. TT • /-111 ( Gravel, Unnarv Calcnlas ^ ^ ( Stone. Destitution of Urine. — In this affection tho urine is not secretet. oy the kidneys ; there is no sensation of fullness or uneasiness in tho bladder, nor any desire to urinate. The excrcmentitious elements of the ronal secretion are more oi less thi~Dwn off by ihe other emun^^- DISEASES OF THE URINARY ORGANS. 297 tories, but not sufficiently to prevent great constitutional suffering, evinced by general torpitude, apepleptic symptoms, etc. Most of thg subjects of this complaint are fat, corpulent persons, considerably ad- vanced in life, and the disease generally proves fatal in a very few days. Treatment. — To relieve the blood as fast as possible of its urinous accu- mulations, the wet-sheet pack and dripping-sheet should be employed ; while the action of the kidneys should be excited by the alternate hot and cold hip and foot-baths, or better still, perhaps, the warm douche followed by the celd to the loins and abdomen. The bowels should also be m.oved by copious injecti ns. Hetkntion of Urine. — In this disease the urine is duly secreted, but its flow is interrupted by spasm, inflammation, calculi, tumor, stricture, abscess, concretions in the rectum, distention of the vagina, or debility or palsy of the bladder itself. A frequent cause is over-disten- tion of the bladder in consequence of holding the water too long, when it has been inconvenient to void it. This condition is always attended with pain, protuberance, and a frequent desire to urinate. Treatment. — In most cases a hot hip-bath, or hot fomentations to the abdomen, followed by a dash of cold water, will relieve ; but if they fail, the catheter must be promptly employed. Painful Urination. — Strangury, or a painful and dribbling dis- charge of urine, may result from several of the causes of the preceding malady ; but generally it is excited by acrid food, drinks, or medicines, particularly cantharides, or Spanish flies, and is attended with a scald- ing sensation. It is also occasioned hy a stricture, or callous thickening of the lining membrane of the urethra, in which case the micturition is extremely troublesome and distressing, the straining often causing the bowels to deject their contents at the same time. Treatment. — These cases are generally relieved by copious water- drinking, and warm hip-baths ; in severe cases the full warm-bath may be necessary. Saccharine Urine. — Diabetis, termed water-Jlux, or urinal dropsy, by the authors, consists in a free or profuse discharge of urine, ot ft violet smell, and generally of a sweet taste, attended with great thirst and general debility. Medical writings are full of speculations as to the nature and proximate cause of the saccharine matter or sugar which is sometimes found in very large quantities in the urine of diabetic pa- tients; but as they shed no light o'.. the subject, they are hardly worth 298 PATHOLOGY AND THERAPEUTICS. our attention and limited space. The most important facL they have miide us acquainted with is, that the skin is always in a condition of ex- Iremo turpitude. 7V<:rt/mc^^— This disease has terminated fatally, with very few ex- ceptions, under allopathic treatment. Instead of dosing the kidneys or «toinncli, as has been and yet is the custom of the drug-doctors, we BhoulJ direct our main efforts to restore the cutaneous function, which is, in fact, the only way to take off the excessive determination to, and irritation of, the kidneys. When the skin is cola pale, and bloodless, tlie tepid dripping-sheet, followed by the dry pack so as to produce moderate perspiration, and the half or shallow-bath, followed by the dry rubbing-sheet, with thorough friction to the whole surface, are the leading meiisures of treatment. Water may always be drank to the extent of thirst, and the diet should be mainly farinaceous, and the arti- cles principally dry or solid, as wheat-meal biscuits, brown bread, roast- ed potatoes, Graham crackers, etc. Incontinence of Urine. — Eneuresis, as the present form of mor- bid urination is generally called, is a frequent or perpetual discharge, with difficulty of retaining the urine. It is variously occasioned by an acrid quality of the urme, local irritation, atony or debilitj* of the sphincter of the bladder, and a superabundant secretion. The remote causes are chiefly hot drinks, diuretic drinks or medicines, intoxicating liquors, etc. The plan of cure is the same as for the preceding dis- ease, especial care being taken to avoid, correct, or remove the ex- citing causes. UNAssI^^LATED Urine. — In this affection the urine is impregnated or colored with various alimentary or medicinal articles which have been taken into and have found their way to the kidneys, and through the bladder, unchanged. Rhubarb, prussiate of potash, and other drugs pass rapidly to the kidneys without updergoing decomposition; and those articles which are called diuretics are carried to the kidneys di- rectly without going the rounds of the circulation. In some cases ot imi>aired di-estion, the urine is impregnated with a matter resembling chyle. This affectum is but an " effort of nature" to rid the body of extraneous ingredients ; and hence copious water-drinking, a strict diet, and a daily bath are all the remedial measures which seem to be indi- cated. Erratic Urine.— A vicarious discharge of urine at some foreign outlet is not an unfroquent oncurrence. It is an evidence of the vis vied- DISEASES OF THE URINARY ORGANS. 299 icat.rix natures, to deterge the blood of its urinous elements when some obstacle prevents their expulsion at the natural emunctory, or when from atony or disease of the kidneys it is not secreted at all. In such cases a urinous fluid has been evacuated by the stomach, bowels, skin, salivary glands, ears, eyes, nostrils, breasts, nave , and at ulcerous sur- fiices and fistulous openings. The medication is the same as in the preceding diseases. Urinary Calculus. — Accumulations of calculous matter in the urinary cavities, are eithei re7ial or vesical, as they are found in the kidneys or bladder. Renal calculi comprehend the various forms of urinary sand or gravel ; and vesical calculi constitute the various kinds of stone. The chemical elements of these concretions are urea, uric acid, lac- tic acid, sulphates, hydrochlorates, and phosphates of potash, soda, and ammonia, and various other occasicoal ingredients. The most common form of urinary calculus is that called the lithic or uric acid. consisting of urea with some free acid and ammonia. The oxalate of lime, called also mulberry calculus, is the next in fre- quency ; and the other most frequent varieties are the phosphate of lime and ammonia, and phosphate of magnesia calculi. They vary in size from fine particles of sand to lumps of several ounces. Symptoms. — Calculous matter in the kidneys is attended with a fixed pain in the loins, shooting downward toward the thighs, which are af- fected with numbness; the pain is increased by exercise ; the urine often deposits a sandy sediment, which may be either of a white or red color ; the pain often alternates with a sense of weight. The passage of a large gravel or sandy particle through the ureters is often intensely agonizing, and accompanied with nausea, fainting, and generally retraction and inflammation of one of the testes. The pulse, however, is not affected, from which circumstance this affection may be distinguished from inflammation of the kidneys or bladder. If the calculus is stopped in the ureter, heat, thirst, and fever come on, and the retained urine being thrown back into the blood, soon oc • casions intermitting pulse, coma, convulsions, and death. Stone in the bladder produces a frequent desire of inaking water, with a difficulty of discharging it ; there is acute pain at the extremity of tlie urethra, and on sounding the bladder the instrument meets with a sonorous resistance. After horseback-riding, or any hard, jolting ex- ercise, the urine is bloody; in some cases it is voided by drops, and sometimes the stream is suddenly stopped before urination is corn- oleted. Wiien the stiine becomes large there is a dull j^ain about tlm 300 PATHOLOGY AND THEK AP ED TIC S. neck of tho bladder, and the rectum is affected with a troublesome te Special Causes. — Hard water, the free use of salt, alkalies, especial* ly the ordinaiy employment of saleratus ; sti-oog acids, as vinegar, vi- nous and fermented liquors, and flesh-meats, are the most common and most efficient causes. The general connection of the calculous or lithic acid diathesis with the gouty — both being almost always manifested in the same person — points with unerring certainty to animal food and wine as among tho leading causes. Ttiore is no doubt in my mind that the salts and magnesia with which nursing mothers and sucking infants are so frequently dosed "for me- dicinal pnrposes," occjision many of the cases of gravel and stone we meet with in young children. Treatment. — ^To alleviate the suffering, the warm hip-bath, aud in extreme cases the full warm or hot-bath is necessary; and if the pain is prolonged, the wet-sheet pack, of two or three thicknesses, will be the best sedative. The curative treatment consists in freeing the whole system from all extraneous ingredients as rapidly as possible, for which purpose the diet must be strictly vegetable ; the drink nothing but pure soft water, and frequent packing and rubbing wet-sheets, with such additional ap- pliances as the general health may demand. Our old-school friends have a variety of chemical tests to determine the acid or alkaline predominance of the calculus; if acidity prevails, alkalies are administered ; and if alkalies are most abundant, acids are the remedies. This is like putting out a fire by throwing on green or wet wood ; it dampens the flame for a moment, but increases the com- bustion in the end. These acids and alkalies are all the while filling the system with the very ingredients which afford the material for cal- culous formations. The surgical operation for stone will be considered hcrrnfter. I\'ote. — Tlie success which has attended the diuretic treatment of calculous affections, in the hands of some physicians who have made this branch of tho profession an exclusive business, is corroborative of the pathological and therapeutical views above advanced. The treatment of tljese "gi-Hvel doctors" consists mainly in the free use of vegetable diuretic drin44s — decoctions of dandelion, milk-weed, queen of the mead- ow, etc These drinks are continued for several months, and by in- creasing the amount of fluid which passes through the kidneys and bladder, assist to wash away the superfluous earthy particles. DISEASES OF THE SKIN. 801 CHAPTER XX. DISEASES OF THE SKIN. Some three hundred abnormal appearances of the skin have been de- scribed as distinct diseases by authors; and I know not why a sufficient amount of ingenious but useless analytical skill, by elevating every pe- culiar mark, spot, blotch, patch, or pimple, to the rank of a specific malady, might not extend the list to three thousand. The follow- ing tabular arrangement comprehends all that are important to distin- guish, for either theoretical or practical purposes : Cutaneous Rashes < Rose Rash, Gum Rash, Lichenous Rash, Pruriginous Rash, [ Millet Rash. r Water-Blebs, . J Herpes, BlamsS -o, • Rhypia, , Eczema. ( Veal Skin, Mole, Freckles, Sunburn, Orange Skin, Piebald Skin, Albino Skin, k. Cyanosis. ^ ^ -rr . ( Lousiness, Cutaneous Vermi- I _ _,. ' J insect Bites, (^ Worms. f Dandruff, Scaly Eruptions < ^^ ^^ : ' I Psoriasis, \ Ichthyi Morbid Sweat Macular Skin < lasis. r Impetigo, Humid Scans •j^"™?"' j Ecthyma, \ Scabies. ' Profuse, Bloody, " Colored, Scented, ^ Sandy. ' Bristled, Matted, Extraneous, Forky, Morbid Hair<( Gray, Baldness, Areated, Discolored, Sensitive. Cutaneous Rashes. —i^ose Rash — ro5eoZ<2 of authors — is an efBor- eeuence which appears in blushing patches on the cheeks, neck, or 26 802 PATHOLOGY AND THERAPEUTICS. oriius often fading and reviving ; usually appearing in the spring or au- tuiMfi. Gum Rash— strophulous— IS peculiar to early infancy, and con- eists in an eruption of red or whitish pimples about the face, neck, and arn)!<, inlenui)ted by irregular patches of inflammatory blush, and man- ifesting sev«M-al sub- varieties, called red gum, white gum, tooth rash, tcilJ-fire rash, etc. The lichenous rash is characterized by a diffuse eruption of red pimples, with a troublesome and sometimes intolerable sense of itching or pricking it is subdivided into simple lichen, summer rash, or prickly heat, wild lichen, nettle lichen, hair lichen, clustering lich- en, livid lichen, according to its varying and unimportant appearances. Pruriginous rash is known by a diffuse eruption, with pimples of nearly the same color as the cuticle, itching acutely, and when abraded or broken by the nails, emitting a fluid that concretes into minute black scabs. The millet rash is distinguished by very minute, tubercular, distinct, milk-white, hard, and glabrous pimples, which are confined to the face. Special Causes. — Roseola is often symptomatic of other diseases. Wlien idiopathic, it is produced by sudden and extreme alternations of temperature, drinking very cold water after violent exercise, etc. Gum rash is produced by coai'se woolen clothing, jncleanliness, greasy and highly-salted food, and various other bad dietetic habits of either moth- er or child. Lichenous rash is more frequently attributable to morbid bile than to any othersingle cause; and when a torpid liver is connected with an obstructed skin, and both of these conditions with a high sum- mer temj)ei-ature, we have the causes of its worst forms. Dr. Good remarks : "So for as I have seen, the varieties of this disease depend upon n peculiar irrilahility of the skin as its remote, and some acci- dental stimulus, as its exciting cause." If there is any thing but "su- perfluous nonsense" in such a flourish of words, I am no judge of the article. Pruriginous rash is more especially attributable to retained perspirable matters, and these have their cause in cutaneous uncleanli- ness. Some authors have imputed this form of skin disease to a fish diet. Millet rash, Dr. Good imputes to "a torpid state of the cutane- ous oxcretories, or rather of their mouths or extremities, which are ob ptructed by hardened mucus." This is a roundabout but very delicate way of representing the idea of a dirtj^ skin. Treatment. — I have many times in the course of this work had oc- casion to characterize the popular practice in relation to certain dis- eases HS barbarous, unphilosophical, absurd, pernicious, etc. I have used these terms deliberatelj-, conscientiously, and, in my own estima- tion at least, understandingly. But if I were to express an honest opin- hm of the ordinary drug-medicatior in the whole range of skin dis- DISEASES OF THE SKIN. 803 eases, I should apply to it all the preceding epithets, and add to them the little word silly. The ridiculous was never at a remoter distance from the sublime, than is the prevailing drug-treatment in aftections of the skin, from true science. The common, every -day remedies in the majority of skin diseases, are mercury in its most potent forms of corrosive sublimate and red precipitate, arsenic, antimony, iodine, preparations of lead, copper, zinc, and other minerals, with a formidable list of irritating and narcotic oint ments, all of which tend to repel the disease tc the internal farts, besides poisoning the system with the drug-remedy. Many an adult has been indebted for a fatal disease, and many a child for a ruined constitution, to the medication of a skin disease. For a single illustration — and thousands like it might be quoted from standarc. medical books — Dr. Good, who ascribes millet rash to an obstructed skin, instead of telling us how to clear out the obstruction, prescribes " lotions of brandy, spirit of wine, tincture of myrrh, a solution of sulphate of zinc with a little brandy added to it." The hydropathic management is intended to answer two indications ; I. To allay the local irritation; 2. To purify the blood and all the secre- tions. In almost all cases of excessive irritation of the. skin, unaccom- panied with fever, tepid water is preferable to very cold for bathing pur- poses. The pack, followed by the half-bath at about 72", with moderate rubbing or friction, is one of the best leading processes. Tlie half-bath alone, if accompanied with a rigidly plain and abstemious diet, will generally very soon effect a cure; and the same may be said of the dripping-sheet ; in fact almost any kind of washing, if sufficiently fre- quent, with a plain diet, will cure in due time. There are no diseases in which stale meats, highly-salted or highly seasoned foods, greasy mixtures, and excessive alimentiveness, have a more pernicious influ- ence than in the affections under consideration. It is also of some importance td preserve a uniform temperature of body, avoiding all extremes of heat or cold, and especially damp, chilly winds. When the itching or pricking is unendurable, the full warm-bath may be ad- vantageously employed as an occasional sedative. Scaly Eruptions. — The first variety, dandruff, consists in patches of fine branny scales, easily separated from the cuticle, which is not irritable or tender. It may affect the head, trunk, or whole body ; in the latter case the scaliness is red, brown, or yellow. Lcjmjsy — lepra— lefriasis — presents patches of smooth laminated scales, of a circular form, and of different sizes, surrounded by a red- dish prominent circle, with a central depregsior scattered generally ao4 PATHOLOGY AND THERAPEUTICS. over the surface. Its principal sub-varieties are the common or whiii leprosy, nud the black leprosy; so called from the color of the scales, which varies from a bright white to a dusky brown. In some cases the scales exist in scattered patches and in others in confluent clusters. It has generally been regarded as contagious, although some authors dispute its contagiousness altogether. Psorlaais — dry scall — rough scabies — consists in bright patches of continuous scales, of indeterminate outline, generally appearing in ser- pentine or tortuous stripes and found chiefly on the back and face, out sometimes extending over the whole body. In children it is con- sidered contagious. The surface is often chapped and excoriated, and itches or burns whenever exposed to unusual heat. A sub-varietj' of this alVeclion has been called grocer's itch, baker's itch, etc. It fre- quently affects the hands of grocers, bakers, bricklayers, washerwomen, and bleachei-s, especially in the spring and fall. Ichth-jiasis—fish skin — is a harsh, papulated, M-atery rind, or horny incrustation, of a dusky, brown, or yellow color, sometimes covering the whole body, except the head and face, palms of the hand, and soles of the feet; and sometimes the entire body, including the face and tongue. In some cases horn-like excrescences sprout out of the incmstations, and occasionally grow to the extent of several inches. It is regarded by authors as a morbid development of the cuticle, and is generally congenital. Special Causes. — Gross food, personal uncleanliness, and sudden al- ternations of temperature, are the ordlnaiy causes. Dandruff" in the head is often produced by too much head apparel, greasing or oiling the hair, confining it too closely on the head, and excessive brain labor. That leprosy was regarded as emphatically a disease of bodily impu- rity, when it prevailed among the ancient Hebrews, is evident from the whole tenor of the code of the Jewish law-giver on the subject of personal cleanliness, especially as related to the food of his people, and the rigid measures of purification deemed necessary in the treat- ment of lepoi-9 under the Mosaic dispensation. Treatment. — The principal point of difference in the management of cutaneo'.in rashes and scaly eruptions is this : in the latter, on account of the less degree of irritability or tenderness of the skin, water of a colder tempei-ature may be employed, and considerable friction can generally follow the bath with advantage. Probably the most efficacious treat- ment in a majority of cases, would be the long pack, from one to tno hours — usin^ two or three thicknesses of the wet-sheet, followed by a thorough nibbing with the dripping-sheet. Of course, when there is no protoruatural or feverish heat, due precautions must be taken to DISEASES OF THE SKIN. 306 secure proper reliction or a comfortable glow after each pack. Dan- druff of the body can always be cured by a perseverhig employment of the wet towel; and when the head is badly affected, so that the hair is loose and easily falls out when the comb is used, the hair should be worn rather short, and the head batlied once or twice a day in very cold water. BiiAiNS. — These affections consist in roundish elevations of the cuticle, containing a watery fluid. In water-blebs — qiompholyx — the eruptions, which are mostly dis- tinct, and break and heal without scale or crust, contain a reddish transparent fluid. They appear successively in various parts of the body, of the sizes of peas, filberts, or walnuts, somotimes bursting and healing in three or four days, but occasionally fornJng an ulcerated surface. Tetter — herpes — is an eruption of vesicles in small distinct clusters, with a red margin; transparent at first, but soon becoming opaque; it is attended with tingling or itching, and the vesicles concrete into scabs, and desquamate in the course of two or three weeks. It presents several sub-varieties, as miliary, when the vesicles are millet-sized ; corrosive, when the vesicles are hard and discharge an acrid, corroding fluid, which spreads in serpentine trails; shingles, when the vesicles are pearl-sized, and spread in clusters around the body like a girdle : ringioorm, when the vesicles have a reddish base, and are united in rings; rainbow -worm, when the vesicles, which unite in small rings, are suiTounded by larger concentric rings of different hues, and local, when they are limited to a particular part. In rhypia — rhupia — sordid blain — the eruption consists in broad, distinct vesicles, having a slightly inflamed base, and filled with a sa- nious fluid, which often produces gangrenous and offensive eschars. The scabs are thin and superficial, and easily rubbed oft* and repro- duced. Eczema — heat eruption — consists in minute, distinct, but closely crowding vesicles, containing a transparent or milky fluid, attended with ti'oublesome itching or tingling, and terminating in thin scales or scabs. Special Causes. — Rayer, who has written an elaborate treatise on diseases of the skin, assigns " chronic vascular inflammation or irri- tation," as the nature, cause, sum and substance of nearly the whole catalogue, while Drs. Good, Cooper, and Thompson, equally eminent authors, dispose of this branch of the subject quite as conveniently by the phrase, " a peculiar irritability with debility, either general or local" — phrases which I an: sorry to saj I cannot divine the meaning 800 PATHOLOGY AND THERAPEUTICS of. Ijidigestible food nnd intoxicating liquors are the ordinary causes of w.'itcr-blebs. Tetter is generally owing to acrid bile, thrown upon the surface. Rhypia almost always aHects children who have been reduced by bad nui-sing and bad drugging. Heat eruption i? usually produced by violent exercise, exposure to hot air, or the direct rays of the sun, and not unfrequently by the use or abuse of mercurj. Treatment. — In addition to the general plan of treatment recom- mended thus far for skin diseases, the digestive fLinction, being more particularly implicated in the diseases before us, requires some special HiMitional attention. In all the varieties of tetter or herpes, free water- drinking, frequent liip-baths, and the abdominal girdle are appropriate. In the soixiid blain of children, the parts affected should be frequently washed in very cold water, except when the abraded surface is itchy and tender, when warm or tepid washing is the most soothing. Humid Scalls. — The present genus of scall or scale-skin diseases is characterized by an eiuption of small pustules, either distinct or confluent, which harden into crustular plates. Impetigo — running scall — appears in yellow, itching, clustering pus- tules, terminating in a yellow scaly crust, intersected with cracks. It is generally confined to the hands and fingers, but sometimes extends over the lower extremities, and occasionally affects the neck and face. A thin ichor or purulent matter often issues from the numerous cracks, which corrode the skin and cellular membrane; and in some cases tho aggregated scabs form a thick, rigid casing around the affected limb so as to impede its motion. Sometimes the disease commences with a pulTy swelling of the face, with oedema of the eyelids, very nmch re- sembling erysipelas, but without its smooth polish. Porngo — scabby scall — ti7}ca — consists of straw-colored pustules, which concrete into yellow scales. Its principal sub-varieties are, the milkif srtill, ()!• crusta lactea, which chiefly affects infants at the breast, the pustules commencing on the cheeks and foi'chead, and often cover- ing the whole face with a continuous incrustation; and the scalled head— tinea capitis— hxindi mostly in young children, marked by pus- tules which commence in the scalp in distinct patches, and gradually spread until the whole head is covered, and the roots of the hair de- stroyed. It is generally regarded as contagious. Other less important lorm.s have been c.dled lupine, honeijcomb, furfuraceous, ringworm, etc. Ectlnftiui—pitate and vermillion are most frequently the agents of accidental poisoning; while calomel and corrosive subli- mate are the common agents in medicinal and suicidal poisonings. It is a serious fiict, among the "curiosities of medical literature," that the standard books recognize Jifty-one distinct diseases resulting from the medicinal administration of the various preparations of mer- cury ! Symptoms. — When very large doses are taken, especially of the more powerful of the mercurials, there is violent pain in the stomach, intense thirst, vomiting, heat and fever. When corrosive sublimate has been given in large doses, or when small doses }i#\e been a long time 11-27 814 PATHOLOGY AND TH Ell APEUTICS. continued, there is a griping pain in the bowels, with a ten/lency to di- arrhcra. Whon the system is slowly and gi-adually saturated with the poison, the effects are distinguished by the general term salivation, the symptoms of which are general fever, tremors, f(Bted breath, brassy taste, Bore gums, loosened teeth, driveling at the mouth, swelled tongue, and often ulcerated bones. In some cases the tongue is enormously swollen, and protrudes hideously from the mouth, the poor poisoned patient being unable to articulate or swallow. Treatment. — When a large dose of corrosive sublimate has been swallowed, albumen or gluten will decompose the salt and prove an effectual antidote. The albumen may be found in the white of eggs, and the gluten in wheaten flour. Either may be given freely ; the white of eggs being previously beaten up with water or milk, and the flour may be administered in either water or milk. In the absence of either eggs or flour, milk is the next best antidote. To cure salivation, and remove mercury and its effects from the system, require a persevering employment of the packing-sheet, which may be warm, tepid, or cold, according to the susceptibility of the patient, and so managed as to produce moderate but frequent per- spiration. When paints, ointments, etc., which contain some form of mercury, are accidentally swallowed, the patient should drink copiously of warm milk made into a very thin batter with wheaten flour, and, if the acci- dent is soon discovered, the stomach-pump should be employed. Arsenic — Arskmcum. — The arsenical preparations from which poisoning occasionally results are, the protoxide, or Jiy-poivder ; arse- nious acid or white arsenic, commonly called ratsbane ; ar senile of cop- per or mineral green ; arsenite of ijotass, as in Fowler''s solution ; arseniusetted-hydrogen gas, which is evolved in various chemical opera- tions ; and several sulphurets of arsenic, as realgar, orpiment, and king's yellow. Symptt/ms. — In a great majority of cases there is violent irritation and inflammation of the whole alimentary canal ; a burning pain in the throat an(i stomach, which soon extends over the whole abdomen, with nausea, faintness, and extreme prostration of strength. In some cases, however, the pain is slight, the nausea and vomiting moderate, but the vital depression excessive and alarming, and often attended with con- Tulsions, paralysis, in?cnsibility or delirium. When arsenic has been given medicinally in small doses for some time, the first prominent symptom of its specific action on the system is a peculiar puffmess of tiie whole face, called in medical parlance c&dema arsenicalis, and POISONS. 816 attended with redness of the eyes, and followed by gripings, nausea, purgings, and a gradual sinking of the vital powers. Tieatment. — The stomach-pump should always be resorted to at once, if possible. If this is not at hand, the patient should drink co- piously of warm water, and have the throat tickled with the finger or a feather to excite vomiting. We have no antidote, in the chemical sense, and medical books recommend a variety of diluent and demul- cent liquids, to involve the poisonous matter and thus indirectly defend the coats of the stomach. Flour and water, and olive oil, are com- plete substitutes for the whole list. Some authors advise large quanti- ties of the hydraled sesquioxide of iron ; but its value is uncertain and far from being reliable. To remove the subsequent inflammation and counteract the effects of the poison. Dr. Pereira tells us; "Our principal reliance must be on the usual antiphlogistic measures, particularly blood-letting, both general and local, and blisters to the abdomen. One drawback to the success of this treatment is the great depression of the vascular sys- tem, so that the patient cannot svjyporf, large evacuations of blood" — the same as to say, the patient niust be bled on theory, although it will kill him in practice. A-NTiMONY — Antimonium. — Accidental poisonings with antimonial preparations are uncommon ; but medicinal poisonings are extremely frequent. Death very often results from an over-dose of tartar emetic ; and this deadly drug iss extensively diffused amonj' us, being a common ingredient in candies, lozenges, cough mixtures, drops, and eyrups, etc. The popular ]ireparations of the regular pi larmacopjeias, James'' poicder, and Plummers'' p?7/, are strongly charged with this dangerous drug. Besides tartar emetic, the oxide or sesquioxide of the metal, called jlowers of antimony, and the chloride, are sometimes the agents of accidental poisoning. Symj>toms. — Small doses produce scarcely any obvious effect save general debility. Large doses produce epigastric pain, voiniting, and often purging. In very large doses it occasions extreme muscular re- laxation, nausea, depression, vital exhaustion, sometimes convulsions and death. Applied to the skin, tartar emetic produces an eruption of painful pustules resembling small-pox. Death has resulted from the absorption of the drug, when it has been applied to an abraded surface. T reatmcnt. — Our main reliance must be on the warm water emetic, in the early stage, and the usual " antiphlogistic" water-treatment in the later stages. Persons who are severely poisoned with any form of antimony are always cold, torpid, sensitive, and debilitated, so that U6 PATUOLOGY AND THERAPEUTICS. oui bathing nppliances must be gentle and of moderate temperature. Tlio warm-bath is excellent to check excessive evacuations when a large dose of the drug h;is been taken. Medical books recommend astiiagent.s, as tea, nutgall, cinchona, etc., on the supposition that tannic acid is antidotal to tiirtar emetic. Bui the numerous experiments which have been tried do not establish its claim to this title. Lead — Plumbum. — All the preparations of this metal, except the Bulphurets, are energetic poisons. The acetate — sugar of lead — sac- charuin satunii, is the form in which it is usually given internally as a remedy. The preparations from which accidental poisonings chiefly result are, litharge — the protoxide of lead ; red lead — the red oxide, or dcutoxide : ichile lead — carbonate of lead; and Goulard's extract — the diacetate. Milk, molasses, and even pure water, may acquire a poi- Bonous property by standing in leaden vessels. Red earthen-ware ought never to be used for cooking fruit or pastry, on account of its lead glazing; indeed all colored crockery ought to be '"ruled out" on account of its metallic coloring matter. Symptoms. — Small doses check the secretions generally, and consti- pate the bowels. Large doses coustringe the circulating vessels, re- duce the pulse, diminish the temperature of the body, produce dry- ne^-s of the mouth and throat, and a general wasting of the body. In most cases of lead poisoning there is a narrow leaden-blue line border- ing the edges of the gums, attached to the necks of two or more teeth of either j iW; the saliva is often bluish. The exti'eme effects are lead-colic. Excessive doses produce more or less gastro-enteritis. Treatinenl — The warm water emetic must be given in the first instance, and the stomach-pump employed if practicable. The soluble alkaline or earthy sulphates, or the alkaline carbonates, will lessen the injurious effects of the preparations of lead, by changing them to sul- phates. For this purpose phosphate of soda, alum, Glauber or Epsom Baits are appropriate. These chemicals are unnecessary when the vomiting has been thorough or the stomach-pump introduced. The treatment for lead-colic has already been given. Coi'PKR— Cuprum.— The salts of copper have been much em- ployed in the manufacture of culinary vessels, and to color candies, sweetmeat.'', and preserves, from which frequent poisonings have re- sulted. The preparations in common use are mineral green—the •ixjdrated oxide ; blue vitriol— the sulphate ; natural verdigris— the fC'bonate; and artificial verdigris— the mixed acetates. Symptoms.— These are quite various. In small doses they are POISONS. sn manifested by cramps, paralysis, discolorations of the skin, slow fever, wasting of the body, chronic inflammation of the stomach and lungs, etc. In large doses, nausea, vomiting, coppery taste, eructations, gi'iping pains, and giddiness result. Very large doses produce convul- sions and insensibility, with the usual symptoms of gastro-onteric in- flammation. Treatment. — Wheaten flour, milk, and the white af eggs, are here our antidotes again. Vinegar has been a popular prescription, but it is actually injurious. Bismuth — Bismuthum. — There are two preparations of this metal m common use ; the first is the trisnitrate, which is extensively used m medicine, and known by the various names of oxide of bismuth^ suhnitrate of bismuth, and magi^^ery of bismuth ; the second is the tartrate of the metal, and is extensively used in the cosmetic art under the name of pearl icliite. They are both caustic poisons. Symptoms. — Small doses diminish the sensibility, but large ones cause pain, vomiting, giddiness, gastric disorder, cramps in the extremi- ties, etc. The cosmetic preparation has produced spasmodic trembling of the muscles of the face, terminating in paralysis. Treatment. — We have no chemical antidote, and must rely on warm water, the stomach-pump, etc. Tin — Stannum. — The chlorides of tin, used in color-making and * dyeing, and the oxide, which forms a part of the putty-powder for glass staining and silver plating, are the preparations of this metal which sometimes, though rarely, occasion poisoning. Powdered tin has been given in ounce doses to expel the tape-worm. The symp- toms of tin poisoning are similar, and the treatment the same as in the case of the preparations of bismuth. It ought to be known to housekeepers that acid, fatty, saline, and even albuminous substances, ma}^ occasion colic, vomiting, etc., after having remained for some time in tin vessels. Silver — Argentum. — Nitrate of silver — lunar caustic — though a powerfully corrosive poison, is extensively prescribed internally as a nervine, tonic, and astringent medicine. The chloride, oxide, and cyanide, are other preparations of the metal occasiondly misapplied to the human stomach. Symptoms. — Applied to the skin, hair, or nails, nitmte of silver stains them black ; to an ulcerous surface it produces a white film ; and to a raucous membrane, smarting pain, and inflammatior. which lasts 816 PATHOLOGY AND THERAPEUTICS. several hours. Taken into the stomach in small quantities, it produces no sensible inconvenience for some time ; but if large doses are given, or the small ones long continued, heartburn, nausea, and vomiting re- sult, and sometimes inflammation and mortification, especially when it has been taken medicinally for six months or longer. Its absorption into the system produces a blueness, slate color, or bronze hue of the ekiu, which is very difficult to remove. In some cases the whole body, internally and externally, has beet: blue-dyed by the medicinal operation of this drug. The discoloration results fi-om a chemica^ combination of the salt with the organic tissues. Treatment. — When the drug has been recently taken into the stom- ach, common table salt will decompose it and render it comparatively inert. When the body has been pretty well saturated with it, a long course of hydropathic bathing and dieting will be necessary, even to get rid of its effects partially. Gold — AuRUM. — The morbific and medicinal effects of the prepa- rations of the rex metallorum, as the alchemists termed gold, are similar to those of the mercurials, though they are generally more sudden and violent. Gold has been administered in the state of minute division — pul- vis auri — and in the forms of iodide, cyanide, and various chlorides. A preparation, called fulminating gold — aurate of ammonia — has been experimented with considerably; and writere on materia medica tell us with sufficient coolness, that " it has produced very serious and even fatal results." Treatment. — The antidotes are albumen, flour and milk, as in the ases of corrosive sublimate and the preparations of copper. Iron — Ferrum. — A very strange and general delusion pervades the •nedicnl profession respecting the medicinal virtues of this metal. Some chemists have detected, or imagined they have detected, a little of it in human blood; and, making a spring-board of this fact, haxe jumped to the conclusion that iron was a great remedy for a great many dis- eases. Even our " botanic," " eclectic," and " physopathic" co-reform- ers, who are so justly horrified at the idea of mercurial and antimonial poisoning, vejy freely mingle chalybeate waters and ferruginous salts and oxides in the preparation of their purifying syrups, alterative mix- tures, and tonic powders. If it be true that iron is in some form a nat- ural constituent of the human body, it does not by any means follow that the preparations of the metal which are found in" the pharmaco- poeifis are natural remedies, or remedies in any sense ; nor does it fol- low that because phosphate and carbonate? of lime are found in the POISONS 81^ bones, that common chalk, mason's mortar, or plaster of Paris are nat- ural foods ! As h'on was the first mineral introdaced into medicine, the his- tory — all we have on the subject — of its introduction may not be un- interesting : " Melampus, a shepherd, supposed to possess supernat- ural powers, being applied to by Iphicles, son of Philacus, for a rem- edy against impotence, slaughtered two bulls, the intestines of which he cut to pieces, in order to attract birds to an augury. Among the animals which came to the feast was a vulture, from whom Me- lampus pretended to learn that his patient, when a boy, had stuck a knife, wet with the blood of some rams, into a consecrated chestnut- tree, and the bark had subsequent]}'' enveloped it. The vulture also indicated the remedy, namely, to procure the knife, scrape off the rust, and drink it in wine for the space of ten days, by which time Iphicles would be lusty, and capable of begetting children. The ad- vice thus given by Melampus is said to have been followed by the young prince with the most perfect success !" Iron is employed medicinal!}^ in the forms of Jilings ; black oxide, or ethiops martial ; sesquioxide — the red oxide, peroxide, or crocus raarlis, various preparations of which are known as carbonate of iron. vitrioli, brown-red, rouge, etc. ; hydrated sesquioxide ; animonio-chlo- ride; iodide; sulphuret, or common iron pyrites ; ferro-sesquicyanide, or Prussian or Berlin blue ; ferro-cyanide of jjotassium, or Prussiate of potash ; sulphate — green vitriol — sal niartis — copperas ; ferro-tar- trate of potash ; acetate ; persulphate ; j^er nitrate ; ferro-tar Irate of am- monia ; lactate, and citrate. Symptoms. — The effects of the different preparations are exceeding- ly various, both in quality and degree. A few of them are violently irritating; but the majority are among the slow and insidious poisons. Small doses generally constringe and harden the fibres, constipate the bowels, arid blacken the stools, and even reduce the size and harden the structures of various glandular viscera, as the liver and spleen. Like nitrate of silver, they form compounds with the organic tissues. They increase for awhile the frequency and force of the pulse, augment the temperature of the body, and heighten the color of the cheeks : ef- fects indicative of fever and irritation, but which are usually regarded as remedial. Unfortunately the general and preternatural excitement is, ere long, followed by corrresponding sinking and depression. The suljihate and chlorate of iron, in large quantu^s, produce great heat, weight, pain and uneasiness in the stomach, with nausea, vomiting, and sometimes purging and hemorrhages. Treatment. — We have no chemica. antidote? except fhe alkalies, S20 PATHOLCGY VND THERAPEUTICS. chalk, magnesia, etc., when the sesquichloride has been swallowed. This is usually obtained at the apothecary shop, in the form and under the name of muriated tincture of iron. Against all the other prepai-a- tions we must trust to warm-water vomiting, the stomach-pump, and the usual means for counteracting inflammation. Zi.NC — Zi.NCUii. — The compounds of zinc ai'e analogous to those of jopper in their action on the system, though somewhat less violent. The preparations in common use are the oxide — jiowers of zinc ; im- pure oxide, or tutty ; chloride — muriate, or huttcr of zinc : sulphate, or ichite vitrix>l ; acetate ; carbonate, or calamine ; and cyanide. The ti*eat- ment is the same as in cases of copper poisoning Ma>ga>£sk — Manganesium. — The hinoxide of this metal has been sometimes used in medicine. It is employed by potters to color earth- en-ware ; by glass-makers to destroy the brown color produced by iron, and to give an amethystine tint to plate glass ; and by bleachers to pro- duce chlorine. It has also been used as a depilatory. Its effects on the human system are more severe than those of iron, bat less injuri- ous than lead, and they are to be counteracted like those of the pre- ceding poisons. Iodine — Iodi.num. — This is an intense and acrid irritant. In large doses or small doses long continued, it causes a burning pain in the stomach, a colliquative and exhausting diarrhea, with a rapid emacia- tion of the whole body, and extreme prosti'ation of the whole system. Its destructive action seems to be particularly determined to the glandular structures. In some cases the male testes, and in others the female breasts, have been nearly absorbed and entirely destroyed by its medicinal employment. Its principal preparations are the hydrio- date of potassa, which is extensively used m preparations called " sar- saparilla," and is a frequent cause of paralytic limbs and weak joints ; and various combinations with sulphur and mercury, which are vio- lently coiTOsive. Unfortunately we are without antidotes once more, and must trust to the principles of treatment ah-eady explained. Phosphorous. — This article is in less repute for medicinal purposes at the present day than it was some fifty years ago. It is a powerful initant, and its acid is corrosive. The antid )tes are demulcents and al- kalies — albumen, gluten, milk, magnesia, etc. Si LPnuR. — Various foims of this artic ? nre familiarly known afl POISONS. a21 brimstone, flower of sulphur, roll or cane sulphur^ balsam of sulphur, milk of sulphur, etc. Their action on the animal economy is weak in small doses, producing chiefly those effects which are called laxative and diaphoretic. Its principal celebrity in medicine has been obtained from its success in curing the itch. Very large doses of sulphur sometimes produce severe griping and purging, with great debility, the treatment for which is the same as for an ordinary diarrhea. Chrome — Chromium. — The chromate of potass, and some other salts of this metal, are extensively employed in dyeing. When taken into the stomach, they produce the usual vomiting, griping, and purging effects of other mineral poisons ; but they are peculiarly liable to be fol- lowed by a degree of debility and paralysis wholly disproportioned to the irritant effects. The treatment should be the same as for lead poisoning. Bromine — Brominum. — This substance has been employed medic- inally as a substitute for iodine, to which its operation is similar ; and when poisoning results from it, the treatment is the same. Alum — Alumen. — Taken internally, alum corrugates the fibres, diminishes the secretions, creates diyness and thirst; and when large quantities are swallowed, nausea, vomiting, gi'iping, and purging suc- ceed. The remedies are, warm water and the stomach-pump. Platina — Platinum. — Some preparations of this metal, as the bichloride and chloroplatinate of sodium, have been used in medicine and the arts. Their action on the human system resembles that of the preparations of gold ; and their antidotes are the same. Barytes — Barium. — The carbonate, chloride, and nitrate of this metal produce effects on the human system hardly distinguishable from those of arsenic. The clfloride has been administered in scrofulous cases. The antidotes are alum, and the sulphates of magnesia, lime, and soda, which form an insoluble salt or sulphate of baryta. Metallic Salts and Oxides. — Tliere are many preparations of metals which it would be tedious to enumerate, which are irritant and corrosive poisons of greater or less intensity ; their effects are analo- gous to those of arsenic, copper, and lead, and in all cases of poisoning from them, our main reliance must be on vomiting and the stcLViach- pnmp; the al'^'imen of pggf and gluten of wheat are always harmless. 822 PATHOLOGY AND THERAPEUTICS. niul in some cases might be serviceable; hence it would be at least pru- dent to employ them in all cases as auxiliaries. Among the mosi dan- gerous may be named the oxide of osmium and hydrochlorate of ^)alla- dium, which are nearly as active as arsenic; the hydrochlorates of rhodium and iridiuju are rather less violent; the salts of molybdenum are comparatively feeble ; uranium and cobalt are more active ; tung- stein, cadmium, nickel, cerium, and titanium, in their various prepara- tions, are among the weakest of the metallic poisons. Narcotics. — These may be medicinally and toxicologically divided into the pure, stimulant, and acrid. The jpure narcotics prociace stu- por, insensibility, nervous prostration, paralysis, convulsions, etc., di- rectly, and without previous excitement, as Prussic acid, henbane, bel- ladona, strammonium, conium, cicuta, ergot, narcotine, letMce, pink, cherry laurel. The stimulant narcotics produce at first more or less nervine excitement or exhilaration, with an increased action of the cir- culating system, followed by torpor, depression, debility, stupor, and all the symptoms of ultimate narcosis. To this division belong opium and and its various preparations of morphine, meconic acid, codeia, lauda- num, paregoric, black drop, Godfrey's cordial, and wine of opium ; al- cohol in all its forms of intoxicating malted, fermented, or distilled liquors ; tobacco, camp>hor, cocculus indicus, nux vomica, St. Ignati- us' bean, etc. The acrid narcotics produce violent irritiition and in- flammation in the stomach and bowels, followed by stupor, delirium prostration, etc. Among them may be named as prominent, mezereon, squills, serpentaria, cantharides, elaterium., colchicum, gamboge, jalap, scammony, colocynth, celandine, croton oil, bryony, savin, spurge lau- rel, aconite, bitter almonds, arnica, arum, rhus, cowhage, anemone, marsh-marigold,, daffodil, fools' parsley, seeds of the castor-oil tree, bitter-sweet, five-finger root, black, white, and green hellebore, meadow saffron, rue, ipecacuanha, yew, darnel-grass, creasote, etc. Treatment. — All cases of narcotic poisoning demand the stomach- pump or warm water emetic, or both, in the first instance ; the ulterior symptoms will be those of inflammation, partial apoplexy, or complete asphyxia, denoted by tremors, stupor, or insensibility, coma, delirium, convulsions, partial paralysis, etc. In this stage the treatment is nearly the same jis for apoplexy. The extremities must be kept warm with ho' bottles, gentle but persevering friction applied to the surfiice, and the cold poming-barh applied to the head ; this last is indeed the most important part of the treatment. Inflammatory symptoms are to be treated on general principles. When an exhausting diarrhea attends M from r.olchicrm or elaterium, the :.oK' andage and hot foment*- POISONS. 328 tions may be necessary, and may alternate with advantage, and small quantities of very cold water are to be frequently thrown up the rectum. AcRiDS. — There are many aromatic and pungent vegetable sub- stances not usually regarded as poisonous, but which, when taken in large quantities, produce severe irritation, and even fatal inflammation of the stomach and bowels. Of this class are the essential oils, as pej)~ jpermint, spearmint, cloves, cinnamon, and cajysicum ; various balsams, as Tola, copavia, Canada, and Peru ; many condiments, as pepper, mustard, horse-radish, cloves, und nutmegs; to which may be added turpentine, oil of tar, cubebs, and two or three hundred medicines be- longing to the classes of cathartics, diuretics, diaphoretics, vermifuges, emmenagogues, etc. The action of these articles on the system, or rather, the resistance of the vital powers to their action, is not accom- panied with the indications of nervous prostration or exhaustion pecu- liar to the narcotics proper ; hence our ti'eatment is limited to soothing irritation and combating inflammation, premising, however, that the offending material is in all cases to be got rid of by emesis, catharsis, etc., as speedily as possible. Mushrooms. — The fly agaric, pepper agaric, deadly agaric, bul- lous agaric, and champignon, are the kinds of mushrooms from which poisoning most frequently results. They produce nausea, heat, and pain in the stomach and bowels, thirst, vomiting, griping, and purging ; in severe cases, convulsions and faintings are frequent, with small and frequent pulse, delirium, dilated pupil, and stupor, followed by cold sweats and death. Treatment. — Here again the 5cie?i^z^c treatment of the books is emi- nently calculated to make a veiy bad matter very much worse : " emet- ics of tartar emetic, followed by large doses of Glauber or Epsom salts." As these drugs have no antidotal property in the chemical sense, and as their employment is powerfully debilitating, they are as injudicious a selection for puking or purging purposes as it is possible to make. Warm water and the stomach-pump, with copious tepid injections, are our more rational practice. Poisonous Fish. — The kinds of "sea-food" from which poisoning most frequently happens, are, tJie crawfish, mussel, old-wife, yelloiv- hilled sprat, land-crab, gray-snapper, dolphin, hyne, conger-eel, blue- parrot fish, smooth-bottle fish, grooper, rock-fish, barracuda, king-fish, Spanish mackerel, porgee. ioiietta, blonder, i).nny, etc. The symp- 324 PATHOLOGY AND THERAPEUTICS toms of poisoning usually appear in an hour or two after eating theur, but sometimes in a few minutes after the ineal is finished ; a weight at the stomach is at first felt, with slight vertigo or headache ; these are fuUowed by a sense of heat about the head and eyes, great thirst, and an eruption of the skin resembling urticaria, or nettle-rash. Treatment. — This has already been given under the head of eryth- ema. Serpents and Insects. — Those serpents and insects whose bites or stings fire poisonous, are, the copper-head, moccasin, viper^ black viper, water viper, rattlesnake, Spanish or blistering Jly, potato fiy, tarantula, scorpion, hornet, wasp, bee, gnct, and gad-Jly. All the 6ymj)toms are those of violent internal and external ery thematic in- flammation, and the treatment may be found also under that head. PART VII. SIRGERT. Davinitions. — Surgery is either medical, mechanical, or operative. Aocording to the old school system, medical sUi-gery comprehends the internal administration of drug-remedies, and the external application of lotions, liniments, poultices, plasters, etc. In the hydropathic sys- tem medical surgery is limited to the internal and external employment of water of every temperature, from steam to ice, as the indication is to induce relaxation or excite contraction ; the internal administration of chemical antidotes or correctives in cases of poisoning, and the local ap- plication of astringents, caustics, and emollients, for the purposes of constringing bleeding vessels, removing preternatural formations, or de- stroying infectious matter, and protecting abraded or ulcerated surfa- ces from atmospheric and thermal influences. Mechanical sugery is applied to the replacement of displaced parts. Operative surgery con- templates the removal of mechanical or chemical obstnictions, and mor- bid structures. CHAPTER I. SURGICAL APPLIANCES. It has been said that a good workman requires but few tools ; a good doctor needs but few medicines, and a good surgeon requires but a very small part of the multitudinous insti'umental machinery which the in- ventive genius and manufticturing interest of the age has brought into use. The common pocJcet-case of instruments, with tooth-forceps, liga- tures, lint, adhesive plaster, sponge, bandages, male and female cathe- 28 326 SURGERY. tcrs. the stomach-pump, and the pump-syringe, are all that emergen- cies deinnnd to be kept always in readiness. The necessary mechanical, medical, and chemical appliances — re- jecting all internal drug-medicines— are, the compress, ligature, sponge, adhesive plaster, lints and pledgets, dry-cupping, bandages, splints, caustics sutures, torsion, the tourniquet, refrigeration, fomentations, rniftics, anaesthesia, haemastasis, and transfusion. Tuf Compress. — This is employed to equalize pressure under a roller or bandage, or increase the pressure at a particular point. It is made of several folds of linen, formed into a kind of pad ; various shapes and thicknesses of compresses are employed, to suit the particular local- ity and circumstances. For applying around a sore, the iierforaitd compress is constructed with a hole in the centre to permit the escape of matter. In Water-Cure parlance a wet cloth is often called a com- press : but in the strictly surgical sense, a compress is connected with the idea of compression. Tin: Ligature. — Various kinds of strings or ligatures are em- ployed to aiTest the bleeding from wounded or divided blood-vessels, check the venous circulation so as to retard or prevent the absorption of poison, as in the case of bites of venomous animals, remove tu- mors, etc. Silk, linen, and animal membrane — cat-gut — are the ma- terials in use. The latter is preferable, especially for tying bleeding arteries or veins, as both ends may be cut off close to the wound, and the rest left to decomposition and absorption. In applying the ligature to wounded vessels^ the surgeorCs knot — the first knot having two turns — must be tied, as this prevents the firet knot from slipping while the second is being tied. The bleeding vessel should be genth* raised with the forceps or tenaculum, and the ligature drawn as tightly as may be without cutting through the coats of the vessel. Silver wire is some- times used in ligating polypus and other tumors. The Sponge. — For surgical purposes the finest and softest article is the best. It is used to absorb the blood and other fluids from wounds and ulcers, and to support temporai-ily prolapsed parts, as the uterus. Adhesive Plaster. — This is employed to retain divided parts in proximity ; to atTord meclianical support to relaxed and distended ves- sels, as varicose veins; to excite absorftion by compression, as in indo- lent ulcers, and protect abraded surfaces. In dressing wounds, it is ap- plied in narrow strips, with interspace?* for the discliarge of matter. Fo^ SURGICAL APPLIANCES. 327 small cuts nr abrasions, the collodion is the most convenient article, and for very small wounds or sores the gummed-silk or court-j^lasler is suf- ficient. Where adhesive plaster is to be applied, the hair should be shaved off. Tents and Pledgets. — These are conical or cylindrical masses of charj)ie, or prepared lint — best made by scraping the fine nap from old linen — or sponge, some sizes and forms of which are called meshes, rolls, and j)ledgets. They are employed to keep up a discharge from a fistulous or sinuous ulcer, so as to secure granulation from the bottom of the sore; to introduce caustics and irritants; to absorb matter, etc Tampons are large tents, for making pressure or applying distention to arrest hemorrhage. The sponge-tent is the most convenient when ab- sorption is desired ; the common puff-ball, or silk pocket handkerchief, are frequently employed in uterine hemorrhages. Dry-Cupping. — The application of any convenient vessel, as a com- mon tumbler, to the surface, in which a piece of cotton is burned to pro- duce a vacuum, is employed to diminish the circulation in the adjacent vessels, and to abstract the irritation of an inflamed part, on the princi- ple of counter-irritation. This process is preferable to local bleeding — wet-cupping — and generally produces momentary relief of pain. But I regard it as hardly worth retaining for such purposes, for the reason that cold applications to the part, with warm, if need be, at a remote part, is a better resource in nearly if not quite all local inflammations. Dry-cupping is a valuable resource in reducing inguinal and femoral hernia. Bandages. — The most common use of bandages is to maintain the fragments or parts of broken bones in juxtaposition during the healing or knitting process ; to give support to parts after recent dislocations ; to promote circulation, and prevent accumulation in chronic swellings of the lower extremities, as in oedema, varices, old, deep, indolent ulcers, etc. The best are made of firm, smooth, unbleached linen cloth, torn into narrow strips, and sewed together by overlapping the ends so as to avoid a seam. The bandage must always be sraootlily and evenly ap- plied, and great care must be exercised to avoid drawing it tighter above, or toward the heart, than below, as congestion and swelling wili result from obstructing the circulation. Figure 190 shows the manner of applying the roller to the lower extremity. It is about tw^o and a half inches wide ; and, commencing at the extremity of the great toe, takes in the second toe at the second 828 S 'J R G E R Y. turn, the third toe at tl^e third turn, and so an ; compresses are placed in the depressions around the ankle so as to preserve equal pressure , Fig. 190. APPLICATIOX OF THE ROLLER. each layer overlaps the preceding t^^o thirds or more of its width, and the whole is applied smoothly from the toes to the knee. Just above the ankle, where the Umb is tapering, it has to be folded over itself, and its direction frequently changed to preserve its evenness of appli- cation. Splints. — Tliese are employed in cases of fractures, and sometimes to correct deformities. They are made of thin pine or poplar, cedar or basswood boards ; or better still, by saturating woolen cloth with gum shellac. They must, of couree, be shaped to the part to which they are intended to be applied, and padded with hut, cotton, or lined with soft sheepskin or buckskin. Caustics. — The red-hot iron, called the actual cautery, is some- times resorted to for the destruction of morbid parts ; but more com- monly some chemical substance, called the potential cautery, is em- ployed. Caustic jjotash — potassa fusa — is in general use as a strong, and the sesqui-carhonate of potash as a mild caustic. Nitrate rf silver — lunar caustic — nitric acid, and sulphate of zinc, are frequently em- ployed. Pr*^parations of antimony, arsenic, and merc-ury, are favorite eschoratics and caustics with allopathic practitioners, but they have already done mischief enough to entitle them to future oblivion. Mild caustics will generally remove callous or fungous growths without de- stroying the healthy structure; and the strong is necessary when the healthy parts are so involved with the disease that some portion of sound structure must be sacrificed to get rid of the morbid. Fortu* nately this necessity is of rare occuirence. SURGICAL APPLIANCES. 829 Sutures. — Stitchmg divided parts together is much less practiced fiow than formerly — superior skill in the management of bandages and adhesive straps having superseded, in a great measure, its necessity. Sutures are mostly employed to restrain the mobility of parts, and prevent permanent contraction of the muscles, in situations where straps and bandages cannot bo well applied. The curved needle should always be passed from within the wound outward, and take up but little more than the skin. The ticisted suture is employed for the double purpose of adaptation and compression. After the needle or pin has transfixed the lips of the wound, the thread is applied in successive coils round under the point and head, as in fig. 191. The inter- rupted suture is made by passing the threaded needle through the edges of the wound, at short distances, and then removing the needle and tying the thread. In the dry suture the needle is passed through strong bands of adhesive plaster, which are placed above and below the wound. Fig. 191. TWISTED SUTURE. Torsion. — This process merely consists in getting hold of the extremity of the bleeding vessels with a pair of forceps, and twisting them. It stops the bleeding of small arteries, and is so far a sub- stitute for tying. The Tourniquet. — This instrument is a form of liga- ture, and is calculated to compress large and deep- seated arteries in amputations and other exigencies. The pad or compress is applied directly upon the artery above the injury or operation, and pressed upon the vesse until the pulsation of the artery beyond is suppressed^ by turning the screw. A Fig:. 192. TISr. TOURNIQUET. 880 SURGERY rood substitute foi' the common tourniquet may be made in a moment in various ways. A handkerchief, tied twice around the hmb, may be twisted with a stick until ^ [y the pressure stops the cuiTent of blood HANDKERCHIEF LIGATURE- in tlio artery against which the knot is applied, as in fig. 193. Congelation. — In deep-seated chronic inflammations, especially around the joints, absolutely freezing the part, by means of pounded ice 04- refrigerating mixtures, has been attended with the happiest con- sequences; the application should never be continued but for a few minutes at a time. It is also one of the means for restraining hemor- rhage. Severe cold has been employed to remove the sensibility", pre- paratory to surgical operations ; and the testimony is unanimous that, in every instance " the wound has appeared to heal more speedily than under the usual circumstances." Dr. Arnott has used frigorific mixtures as anaesthetic agents in nearly two hundred cases withoi^ any injurious consequences; and he reports that foul ulcers are often changed to healthy ones by their action. A piece of ice dipped in salt, and applied to the part, produces congelation in about half a minute. Pieces of ice mixed with common salt and nitrate of ammo- nia, make a still stronger frigorific. It should never be applied to a very large surface at once. Fomentations. — These are intended to abate morbid sensibility, and relax the whole or part of the muscular sj'stem, to overcome spasms, and facilitate the replacement of luxated joints, fractured bones, ruptures, etc. All the muscular relaxation which regular sur- geons endeavor to produce by profuse bleedings and deathly nauseants, Ciin 1)6 readily and harmlessly produced by the internal and external use of wai:n water. Emetics. — In many cases of rigid muscular contraction, to facilitate the reduction of a dislocation or the replacement of the fragments of fractured banes, powerful and injurious doses of tobacco or tartar emetic are administered to induce greater relaxation; or the patient is kept fur a long time in a state of excessive nausea, AVarm water, taken copiously into the stomach, assisted by tickling the throat occa- SURGICAL APPLIANCES. 831 sionally, will answer all the purposes for which so manydeathful drugs are employed, especially if conjoined with external fomentations or the warm-bath. Anesthesia. — Chloroform and ether are just now in common use to produce insensibility, and thus obviate the pain attending surgical operations; and many surgeon accouchers administer chloroform tn lessen or obviate the pain in nearly all cases of parturition. They are not without danger, and the introduction of these agents into ordinary obstetric practice is to be reprobated. When an operation is exceed- ingly dangerous, painful, or protracted, the employment of anaesthetic agents is certainly commendable; and, although we have accounts of some thirty deaths occurring from their direct effects since their intro- duction into surgical practice, yet I suspect that some of those deaths at least, were attributable to a want of the proper precautions, or rather an ignorance of the proper precautions on the part of the operator. The same rules should be observed in administering chloroform or et) .^r, as are enjoined by hydropaths in administering a full-bath. The Stomach should be empty ; the patient in his ordinarily quiet or com- posed state ; that is, without rush of blood to the head, or determina- tion to the brain ; the extremities must be warm, and a general glow upon the surface, etc. The ether is the safer article, but the chloro- form is the most powerful. In many cases magnetism will produce the desired insensibility, and when the patient is susceptible, this pro- cess is always to be preferred. HiEMASTASis. — This process has been employed in the treatment of local congestion and inflammation; but we have, in water of various temperatures, an ample and a better resource. It is a valuable expe- dient, however, in some cases of sudden and alarming hemorrhage, as it enables us to retain a greater proportion of blood within the body, and also to lessen its impetus at the bleeding point, thereby favoring the formation of a clot or coagulum. Dry-cupping an entire limb, for which purpose elongated cylinders of flexible material have been in- vented, is one method of holding back its blood. The common ligature round the limb is equally eflicacious. Transfusion. — In some cases of excessive loss of blood, life hag been preserved by opening the vein of a healthy person, or of a sheep, end transferring the blood immediately into the vein of the bleeding patient, a suitable vessel or funnel being connected with the latter for the purpose of receiving it. 3Sf SURGERY CHAPTER II. WOUNDS. Distinctions of Worrrp?. — The usual division of wounds is into incised, punctured, penetrating, contused, lacerated, gunshot, and poisoned. An incised wound is a simple cut, made, of course, !)y a eharp-edged instrument, as a knife, razor, axe. A punctured wound is made by a sharp-pointed instrument, as a needle, awl. A penetrating wound is a larger puncture, as by a bayonet. A contused wound is occflsioned by a blunt instmraent, as a stone, club, which injures the parts below the surflice, the skin remaining entire. A lacerated wound is inflicted bj' an instrument which is both blunt and rough, and which teal's the integument as well as injures the parts beneath it. Gunshot wounds include all injuries accniing from substance^%npelled by the explosive force of gunpowder, as leaden bullets, cannon balls, stones, etc. They partake of the character of both punctured and Incei-nted wounds. Poisoned wounds are the mjuries inflicted by in- sects, reptiles, rabid dogs, etc., whose stings or bites are accompanied witli the introduction of a specific virus. Genkkal Consequences of Wounds. — Bleeding is the only nlurming symptom in incised wounds, which can generally be healed by the "first intention," that is, without suppurating. All the other varieties are attended, save when very large arteries are torn, with but little hemorrhage, but always suppurate more or less. In gunshot wounds, the concussion of the air impelled by the ball often inflicts severe injuiy, without making any mark upon the skin. In most wounds there is more or less extravasation, or an infiltration of blood into the cellular membrane. The j^ain is generally in the inverse ratio to the danger, for the reason that the more destructive the injury, the less f)ower has nature to cive the alarm. The danger of wounds, other circumsr.inces being equal, depends on the actual health, or physiolog- ical state of the system at the time th^ound is received. The most triviiil scratch, or the simplest cut, has been followed by bad sores, loss of limb, and even lifr, in persons of extremely morbid blood, foul se- cretions, and reduced vitality ; while those of sound, pure bodies, re- cover from the most complicated injuries with comparatively little dlf- WOUJSDS. 338 ficulty. Spirit-diinkers and beer-bibbers are notoriously liable to ex- treme innamjnation, foul ulcers, mortification, etc., from injuries which water-drinkers might regard as trifles. Treatment of Wounds. — The first point, in all cases, is to control the hemorrhage. Arterial bleeding, which is always far the most dangerous, may be known by the bright scarlet color of the blood, and its issuing in jets. It may be stated as a general rule, probably an in- variable one, that all hemorrhage from blood-vessels below the wrist and ankle, can be arrested without ligating the arteries. The injured part should be freely exposed to the cold air, and washed in the coldest water. In many cases the bleeding from small vessels is kept up by the dressings — covering the wound with compresses, lint, etc., which keep up the heat, and prevent the formation of a coagulum. I have known a deep wound in the thigh, made by a piece of glass, bleed for several days in spite of lint, and sutures, and bandages, and cease entirely on being laid open with a scalpel with a view of tying the wounded artery, which, by the way, was not found. In some cases the wounded artery can be com- pressed by the finger, as the radial artery in fig. 194. If the pressure Fig. 194. must necessarily be kept up a long time, a piece of soft rag several times folded may be placed over the aperture, and secured by a piece of broad tape, bandage, or pocket handkerchief, as in fig. 195. When internal bleeding occurs, known by paleness, faintness, etc sips of the coldest water or bits of ice should be frequently swallowed' and absolute quiet enjoined. Bleed- compressing the radial artery. ing from large arteries must be controlled by the tourniquet, and the artery ligated. Wlien the bleeding is from the upper extremity, the brachial artery must be com pj„ ^95 pressed above the middle of the arm ; and if from the lower, the femoral artery Hi — . — ::^Y - should be compressed just below Poupart's ligament. The congestion and in- the common compress. Jlammation which may attend all wounds merely require frequent changes of the water-dressings ; and when the inflammation of a wound has extended to the neighboring glands, producing painful 334 SURGERY. Bwellin«^s, these should be kept well covered with several thicknesses of wet cloths. The lo(i<7inpnt of foreign substances in wounds is to be ascertained r»y introducing the finger or a probe, and extracted if possible ; not, •lowever, until a'! danger from hemorrhage is past; and when poison- ous substances are imbedded in the flesh, warm water or neutralizing solutions should be frequently injected. In suppurating wounds the edges must be kept apart, to allow free egress to all matter that may form within ; and if the granulations, in the healing process, arise above the surface, and become loose and flabby, constituting /a;2o-ou5 or proud Jlesh, straps of adhesive plaster or collodion should be applied to act as a compress. In bad cases caustic potash may be necessary. Secondary hemorrhage is liable to occur in lacerated wounds from the sloughing of large arteries ; and in bad cases, gangrene. They require the coldest water-dressings. The moderate douche is excel- lent in contused wounds ; and when they become irritai^.*^ and painful the part may be bathed in warm water, followed by the cold compress. The absorption of extravasated blood may be promoted by the cold streams and cold wet compress. The general treatment of poisoned wounds has been detailed in the preceding part of this work. CHAPTER III. INJURIES. Concussion. — A stunning, or concussion of the brain, is the result of blows upon the head, or of falls, which so shock the whole system as to occasion u temporary suspension of consciousness. The extent of the injury cannot bo known, nor is it material that it should be until the psitic-nt " comes to." It may be so severe as to produce instan- taneous death ; or so slight as to leave no apparent ill consequences. Treatment. — Perfect quiet, and a careful attention to keep up the general circulation and normal temperature, are the principal remedial resources. The extremities must be kept warm, cold cloths should be laid over the head, and if the concussion is prolonged, the bowels may need evacuating by means of injections, and the urine require to b** drawn otT by the catheter. NJURIES. B3L The old })ractice of bleeding, which I am sorry to know is also a common practice with modern allopaths, has no better effect than to lessen the patient's chance of recovery. Indeed, this has been the opinion of some of the best Em'opean surgeons for the last fifty years, and a majority of all modern authorities is against the practice ; be sides, it is in itself at variance with common sense ; yet our doctors con- tinue the killing practice of l«tting blood as though there was some sci- entific reason for it ! Compression. — This is usually the result of concussion, and its im mediate cause is an extravasation of blood within the cranium ; or some collection of other matter; or mechanical pressure from a depressed or broken part, of the skull bones. It is denoted by continued pain in the injured part of the brain, with cerebral disturbance ; or, in the absence of these, frequent faintings, spasms, disordered vision or hearing, with nausea and vomiting. The patient is often also comatose. Treatment. — When a portion of the cranium i« depressed it must be raised by a lever ; or if this is impracticable, the operation of trepliii uing will become necessary. The head should in all cases be kept thoroughly cooled with wet cloths or the j)ouring-bath, and derivative treatment, especially tepid, hip, and foot-baths should be frequently employed, caution being taken to secure prompt reaction. In ex- treme cases, hot foot and leg-baths are useful, especially when the pa- tient is affected with delirium or coma. In young persons very bad fractures of the cranial bones will often replace themselves if the gen- eral health is well attended to. Bruises. — These are only worth naming for the purpose of men- tioning that the cold douche, and the wet compress, are worth more than all the stimulating liniments and embrocations in the world, in their treatment. Strains. — These accidents usually happen to the smaller joints, as the wrist, fingers, ankle, and toes ; they are generally exquisitely pain- ful, and are very liable to be followed by painful and protracted inflam- mation. The part should be held in cold water, or the cold stream applied to it until the violence of the pain abates, and then ^vl'apped in wet compresses until all inflammatory excitement is passed. Burns and Scalds. — Burns are produced by the action of concen- trated heat upon the living tissue. Scalds are produced by the appli- cation of a boiling or hot fluid. The danger of these injuries is usually 830 SURGERY. measured by the extent of surface destroyed. Authoi"s make three, fuur, five, an(' sometimes six degrees of burns; but the smallest num- ber is sutTicieijt for all practical purposes. The first is rube/action, or redness ; the second, vesication, or blistering; and the third, disorgan- ization, in which the skiu is destroyed, and perhaps some structures beneath the skin. The pain is usually the severest in the second va- riety. Superficial burns or scalds are easily healed when not mal- treated ; but deep burns, as by a hot iron, usually leave an ugly scar. Many terrible burns are frequently taking plaeo by the clothes of women, children, and servants taking fire from Ccii-elessness in hand- liug camphene, burning fluid, tea-kettles, cofifee-pots, etc. Treatment. — When one's clothing is on fire, the first thing to be done is to extinguish the flame : and as the sufferer might burn to death before a supply of water could be obtained, the ^me should be suflb- cat«d by covering the patient with a blanket, cai-pet, or some similar Fig. 196. y^y \ article, as represented in fig. 196. The next point of treatment is to immerse the injured part in water, or cover it with wet cloths of the temperature which feels most agreeable to the patient. The coldest water will prove the most soothing at first; and in a longer or shorter time, according to the severity of the inflammation, tepid water will be found most sedative ; and finally w*arm water w^ill often feel the best. But the rule is invariable : follow the sensations of the patient. When the skin i? vesicated, it should be kept covered with soft linen. The blisters which form should not be punctured or torn until suppuration has taken place on the surface, as they form the best protection to the injured 'surface. As the contact of the atmosphere, or rather of a colder medium, is excessively painful to the raw surface after the skin or cuticle comes oC*. the roon^ a'lould be kept quite warm, and oil applications should INJURIES, 837 then be moderately warm. The best covering hi this condition is simple flour, dredged over the surface, allowed to remain until it becomes loose by the purulent matter beneath, then removed, the surface gently washed with warm water, and more flour applied. A soft cloth may be placed over the flour and kept continually wet with water ; and the flour-dressing may be continued until cicatrization is completed. I have seen very bad burns heal rapidly and admirably under this management : starch, and finely-pulverized slippery elm bark — elm flour — are favorite applications with some practitioners, but I know not that they have any advantage over the common flour. There is always a considerable degree of constitutional disturbance after a severe burn, as rigors, oppressed respiration, small, weak pulse, followed by more or less febrile reaction. This requires warm hip and foot-baths, when practicable, during the period of chilliness, and tepid ablutions during the febrile stage ; the room should always be kept con- siderably warmer than in cases of the same violence of fever from any other cause. The allopathic treatment of burns and scalds is a singular jumble of the " good, bad, and indifi'erent." Professor Parker, of this city, after telling us that "the treatment of scalds and burns seems to us to be eminently empirical in all our systematic works on surgery," gives us a rational basis of treatment. This is "the use of such agents as are calculated to meet the existing debility." "The most prominent of the local and constitutional symptoms is gi'eat nervous prostration^ On this basis the professor recommends ivarm brandy and tincture of ojnum to get up rea-ction ; and then antimony, Dover s poivder, calomel, and ipe- cacuanha, to get the reaction down again; or, in his language, " regu- late the reaction, that it may not run too high." " General bleeding," he continues, "is commonly indicated by the gi-eat tendency in such cases to a typhoid condition of the system." Bleeding indicated be- cause the nervous system is prostrated, and the whole system in a sink- ing condition ! Is not this pre-eminently empirical ? Among the sequela of burns and scalds, are contractions of the skiu and adhesions around the tendons, producing distortions and deformi- ties. These must be prevented, as far as possible, by maintaining the normal position of the parts during the healing process. Dr. Parker remarks : " When these scalds and burns are upon the trunk, and there has been a copious suppuration, unless we are guarded in our treatment, as cicatrization takes place and the secretion is diminishing, there will occur suddenly and unexpectedly, effusion upon the brain or lungs, and death." The way to " guard" against such disastrous re- sults is, by avoiding the drugging and bleeding part of the treatment. '11—29 338 SURGERY. Particular Wounds and Injuries. — Venesection-Phlebotomy— is a wound made by puncturing a blood-vessel with ihe point of a lan- cet, a ligature having been previously applied betvreen the contem- plated wound and the heart. Some one of the veins or the inner Bide of the fore-arm, near the elbow, is usually selected ; but occasion- allv the external jugular vein, the veins of the foot, and the temporal urtorv are opened. The consequences of this operation are, 1. Loss of blood, which is irremediable. 2. Eccliymosis — a livid, hard tumor, occasioned by an extravasation of blood into the cellular membrane, in consequence of the wound in the vein not exactly corresponding with that in the skin ; it requires the cold do^he and cold compresses. 3. Aneurism — an arterial swelling, produced by pricking through the vein into the adjacent artery, or missing the vein with the point of the lan- cet and hitting the artery ; this requires the operation of ligating the artery above the injury. 4. LocJc-jaiv — produced by pricking or di- viding some nerve in the vicinity of the venesected vein ; it requires the treatment heretofore mentioned under the head of Spasmodic Diseases. 5. Phlebitis — inflammation of the veins of the wounded part, of whicli the operation is the exciting cause ; this requires the wet-sheet pack, with wet cloths to the intiamed part. 6. Fainting — which results from the abstraction of a large quantity of blood, or from a less quantity sud- denly withdmwn by making a large orifice ; the treatment has been described under the head of Syncope. Leeching and scarifying are among the common injuries w«hich modern surgeons are fond of inflicting upon afflicted humanity. The usual morbid consequences are, inflammation of the skin and adjacent blood-vessels — erythema and^Wei/i!?.?— langerous hemorrhages, and un- seemly scars. For all these ' accidents," the coldest water is the best remrdy. Wounds nfthe throat, of which throat-cutbing is the most prominent example, present many degrees of severity and danger, from a mere incision through the integument, to a division of the jugular veins, wind- pil)e, and carotid arteries. The principal danger is from hemorrhage ; and all the vessels which bleed freely, whether arteries or veins, must be taken up and tied ; after which the lips of the wound are to be re- tained together with both sutures and adhesive straps. Wounds of the scalp are liable to be followed by erysipelatous in- flammation ; the hair must be shorn, and the divided parts brought in proximity by adhesive straps, and sutures when necessary. Wounds of the chest are apt to penetrate the substance of the lungs, in which case air and blood together will bubble oat of the wound, Rud tiio patient will manifest short breath and )looiy expectoration INJURIES. 389 The wound should be covered with a plaster, and cooling derivative baths — half and hip — employed. Dr. Hill, author of an excellent surgical work {Eclectic Surgery), makes the following pertinent remarks in relation to the bleeding prac- tice in this case. ^'•Venesection is recommended in the books 'to di- vert,' as they say, ' the blood from the lungs.' But surely it is as well to bleed to death through a wound in the chest as through one in the arm ! We are told that the bleeding ' can hardly be carried too far ; for if the patient be not relieved by this measure, no other can jjossihly sa'^e him.'' (Gibson, vol. i., p. 19.) The reason given for bleeding, in such cases, is as absurd as the process itself." Wounds of the abdomen are among the most dangerous. When the intestines are wounded, the patient is affected with nausea and vomit- ing, and the matters ejected or dejected will be bloody. When a por- tion of intestine protrudes, it must be replaced as soon as possible ; if this is not done within forty-eight hours, adhesions may form and ren- der it impossible. When the protruded bowel is distended with gases or faeces, by which its return is hindered, these may be pressed for- ward into a portion of intestine within the abdominal cavity; or, if this measure fails, the wound must be dilated. These wounds, when large, may require the suture ; a fine needle and thread only should be used. For several days after severe injuries of the bowels or lungs, the pa- tient should eat little or nothing, and the bowels be moved, when neces- sary, by warm injections. Wounds of the joints are liable to be followed by severe inflammation, terminating in adhesions and anchylosis, or stiff-joint. The limb should be kept in the easiest possible position, perfect quiet observed, and cold- water dressings be assiduously applied. The modern disease, called in some late books synovitis, is a chronic inflammation of the synovial membrane, and to some extent of other structures of the joint, and is produced by some external injury. I have seen several cases affecting the knee-joint, produced, most unquestionably, by wearing strapped pantaloons. Synovitis is known by a sense of weakness or lameness in the affected joint, always increased by any considerable motion, and frequently amounting to pain when the exercise is prolonged. There is usually none, or but slight, external redness, swelling, or heat. This affection requires a long time to cure ; the remedial plan consists of a very strict dietetic regimen, one or two general baths daily, with the constant application of local compresses, and occasional shalloio foot- baths. When the knee-joint is the seat of the disease, the cold leg- bath should be employed for half an hour once or twice a day 440 SURGERY. CHAPTER IV TUMORS. EvKRY tumor is a morbid swelling era new formation — ^an ncreased or p«'rverted development of organic substance. The common causes are injuries, as pressure, blows, bruises, etc, although it is seldom that we can trace any particular tumor to the particular accident from which it originated. They ma}- also arise from capillary obstruction, and this is induced by manj- of the unhealthful eating, drinking, and anti-bath- ing habits of society. A mechanical injury of the vessels of a part, or a long-continued inflammation or obstiuction, may produce a change in its nutritive function, by which an abnormal structure is developed ; and when once this perverted action commences, it may progress to an indefinite period or extent. In their incipient stages they can frequently be removed by strong douches, cold compresses, and continued com- pression. Tumors are distinguished into adipose, cellular, jihrous, carti- laginous, osseous, encysted, fungous, indurated, scrofulous, malignant, jyutsating, vascular, etc., according to the stmcture affected, and the form, character, and consistence of the swelling. The older surgeons divided tumors into sarcomatous ov fieshy — com- l>i"ehending those which are composed of ftitty, fibrous, medullary, fungous, or other substances softer than bone : osseous or bony ; osteo- sarcomatous — when involving both the bony and fleshy sti'uctures ; and encysted — containing a fatty or fluid substance within a globular cyst, as in the case of teens and hydatids. Adipose tumors are collections of fattrj matter inclosed in a cyst or Bac of condensed cellular membrane, which renders them also encysted tumois. When filled with a suefc-like matter, they are called steato- mous ; wlien containing a hone^like substance, melicerous ; and when their contents are a pap-like fluid, atheromatous They are not pain- ful, and only inconvenience the patient by their bulk, weight, or pres- sure. They are easily removed by making a T incision through the skin, and carefully dissecting around them to detach the cysts from the eurniunding structures. They maybe removed by the "eight-tailed ligature," fig. 197, two needles being drawn through the under side of the tumor, touching each other at right angles, and each carrying a double ligature; the loops are then cut, and the ends tied in four knots, by which the tumor is completely strangulated. These tiimorg do not rfnpprar after having been entirely removed. TUMORS. 341 Fig. ^97. LIGATURE FOK TUMORS Fibrous tumors are composed of capsules of gi'eater or less densi- ty, inclosing yellow or whitisli substances di- vided into lobes or septa by cellular substance ; their shape is irregular, and they have a doughy consistence. They are not painful, and are easi- ly removed by the liga- ture or knife, being al- most always situated in accessible places. The fibrinous contents of tl- ese tumors adhere so loosely to their capsules that they can readily be removed by the finger or forceps on making an incision through the skin. Cellular tumors are smooth, firm, and composed of compacted layers of areolar tissue, containing, in thin cells, albuminous, fibrinous, and se- baceous matter. They are never painful except when inflamed. The cutaneous veins involved in the tumors may become varicose, and when abrasion occurs, sloughing and fungous growths are apt to follow. Ex ■ cision with the knife is the best treatment; but when sloughing takes place the mild caustic is necessary; and the strong caustic when fun- gous appearances present. Vascular tumors are limited, in surgical technology, to those raorbi(J developments of erectile tissue called ncevi tnaterni, or aneurism hy anastomosis ; and these may be superficial or subcutaneous. The proper plan of treatment contemplates the destruction of the morbid congeries of blood-vessels in such a manner as to avoid hemorrhage. Repeatedly puncturing the prirt with hot needles, and the repeated ap- plications of caustic, a small part of the surface only being touched at once, with constant but moderate compression, have each succeeded in removing them. The character of the other varieties is sufficiently indicated by their name, and the treatment will be given under the head of particular tumors. Whelk — Ionthus. — This affection is a stationary, tubercular, un- s«ppurative tumor, generally found upon the face. It comprises the varieties called stone fotk, and carbuncle ^ J'ai e, or rosy drop — gufta 842 SURGERY. rosea. Stone pock is a pimply eruption of hard, red tumors, which are Bore to the touch, and ooze a little fluid at the tip, or a grub-like con- cretion of mucus. In the carbuncular variety the tumors are confluent, and mottled with purple, often disfiguring the nose with pendulous lobes, and marring the face, as Shakspeare has it, with " bubukles, and whelks, and knobs, and flames of fire." In Ireland, the common name for these protuberances is grog-blossoms; in this country they are known as rum-blossoms, grog-roses, cider-buds, beer-berries, etc., while their possessors are honored with the appellation of copper-noses, bot- tle-noses, etc. Special Causes. — Grease-eating and "haixl drinking." Treatment. — Few invalids, distinguished by the carbuncular variety of the whelky tumor, can be expected to submit to i^-aier-treatment ; and, moreover, these patients have the same reason to regard their '• rose^" and "blossoms" as badges of honorable distinction, that the Englishman has his gouty toes and stomach, or the Polynesian Islander his enormously misshapen leg. All alike can boast of " high living.'" But if we should be called upon to indicate a remedy, we might with all propriety suggest the details of a " sober and temperate life." Sycosis. — This term has been applied to a fig-shaped tumor, a fun- gous ulcer, and a horny excrescence about the eyelids ; but usually and here it is employed to denote an enaption of inflamed tubercles on the scalp, and on the bearded portion of the face. These tumors often ul- cerate and discharge an ichorous or glutinous matter. They are con- nected with uncleanliness in either the positive or negative sense — bad diet or drirjk, or the absence of wate*-, and may be cured by thorough local and general bathing. Warts — Verdcc^. — These are rather excrescences than tumors ; some are smooth and apparently filled with fattj^ matter; others, called seed-waits, are rough, hard, and insensible. Some warts secrete a fluid which is infectious, and will produce a crop on other persons or on other parts of the same person. They may be eflfectually removed by caustics— potassa, nitrate of silver, nitric acid, or niti-o- muriatic acid. The latter preparation is the best ; it may be applied by means of a pointed piece of wood to the centre, taking care not to let the acid come in contact with the surrounding structure. To prevent this, a piece of perforated adhesive or court-plaster may be placed around the wait. T.ie acid may be repeated until the troublesome and unsightly excrescence b entirely destroyed, which will usually require but a ft»w days. TUMORS. 842 Corns — Clam. — These well-known toe-tormentors are produced by tight shoes or boots. The first principle of cure is to give the feet a respectable area of freedom ; and the second is to soak them in warm water, and shave off the horny substance, and then touch them with the nitric or nitro-muriatic acid. When the corn is inflamed or highly irritable, the tepid foot-bath should be employed to remove this condi- tion before the acid is applied. The aqua regia — nitro-muriatic acid — is the ordinary secret remedy of the " corn-curers." When the corn is fully formed, or ripe, a membrane separates it from the ti*ue skin, so that it can be taken off without injuring that surface ; and this circumstance enables professional chiropodists to elevate the " grain" on the point of a pen-knife, after an application of the acid. Bunion. — This affection, though generally regarded as a variety of corn, is really an inflammation and swelling of the bursa mucosa, at the inside of the ball of the great toe ; it often produces a distortion of the metatarsal joint of the great toe, and is produced by the same causes as corns. The treatment is, warm foot-baths, when the part is very ten- der and irritable ; at other times, frequent cold-baths ; and when a horny substance resembling a corn appears externally, the application of caustic. I have known bad corns and bunions cease to be trouble- some after the patient had been a few months under hydropathic treat- ment for other complaints. Ontxis. — This distressing affection, sometimes known by the dis- tressing synonym of onychogryjjhosis, consists in an incurvation of the toe nail from a bruise or the pressure of a tight shoe, producing in- flamnirition and ulceration, and followed eventually by fungous growths, or proud flesh, which is exceedingly tender and painful. The cure is slow but certain. The foot must be frequently soaked in warm water until the soreness is so far abated that it can be handled Vv^ithout pain; then with a probe press pledgets of lint as firmly as can be borne under the most detached point of the toe nail, pressing them also between the nail and projecting portions of the flesh as far as possible. Cover these with the wet compress, and apply a moderately -tight bandage over the whole, frequently wetting the whole with waj-ni. tepid, or cool water, as either temperature is most agreeable. The tents are to be pressed further and further under the nail from time to time, and the foot should be soaked and dressed once or twice daily. When portions of the nail become free they may be cut off, and mild caustics may be employed to remove fungous or indurated growths, which do not yield tp the other measures of treatment. #jl SURGERY. Ga.nglio.ns.— These are encysted rumors, formed of a viscid, albu- minous fluid, resembling the white of an egg, and varying in size from II pea to that of an egg. They are hard, globular, and without discol- uralion of the skin. Sometimes the cyst is loose, but in most cases it commuuicatt' s by a narrow foot-stalk, with the sheath of a tendon, or the synovial capsule of a neighboring articulation. Ganglions are al- ways situated in thp course of a tendon, and usually appear on the wrist, hand, and top o( the foot. In their ti-eatment surgeons have re- sorted to compression, percussion, discutient applications, extirpation, and caustics. When the tumor is prominent and round, a simple in- cision will allow its contents to escape, and if dressed with a moderate- ly tight c(jmpress, the wound will heal readily. I have always re- moved them in this way, and never knew any injurious consequences to result from the operation. Oblong and diffused ganglions maj' be punctured with a lancet or couching needle, and the tluid pressed out. When the cyst is thin it may be ruptured by a blow or by pressing it firmly against the bone — in which event the fluid will be absorbed and a cure result ; but whether the sac can be ruptured with a safe degree of violence, can only be known by trial. Irritants or caustics, to ex- cite suppui'ation, is a method recommended by some authors ; it is applicable to cases attended with ulceration or induration. Ran u LA. — This is a small tumor under the tongue, resulting from obstruction of some one or ^nore of the excretoiy ducts of the sub- maxillary or sublingual glands. It may be cured by clipping off a small portion with a pair of sharp scissoi's ; and, if it does not disap- pear in a few days, touch it with niti-ate of silver or sesqui-carbonate of potash. Epulis. — A small tuueiv. e of the gums, which generally appears above or below the incisor teeth, sometimes becomes a serious malady. It commences with a small seed-like swelling, which gi'ows so slowly and painlessly as to attract little notice ; but at length it enlarges rapidly, becomes soft, bleeds on the slightest touch, fungous formations spread out, involving the gums displacing the teeth, and affecting the glands of the mouth and othe soft parts, until the patient is destroyed by hemorrhage or worn out with irritation. The best surgeons recom- mend the removnl of the tumor as soon as its character is ascertained. The adjoining teeth must bo iirst extracted. Sir Astley Cooper pre- fers the kuife ; but the cauterizing process as recommended by Dr. Hill is, I think, far preferable; it consists in destroying the tumor to t** )«:«p. with every portion of the diseased sti-ucture, bv means of TUMORS. 346 caustic potash, applied until disorganization and sloughing take place — the surrounding parts, lips, tongue, etc., being protected by cotton wet in vinegar, rolled up and pressed in around the portion to be cauterized- In all cases of malignant tumors and ulcers, let me here say once for all, a rigidly abstemious and exclusively vegetable diet is one of the most important, and frequently one of the indispensable measures of the remedial course. Bronchocele. — This tumor, commonly called goitre^ or swelled neck, is a preternatural enlargement or hypertrophy of the thyroid gland. In its early stage it is soft and elastic ; but as it advances in size it becomes firmer, and spreads toward the sides of the neck, at- taining sometimes a prodigious magnitude. In the valleys of Switzer- land, Savoy, the Tyrol, Derbyshire, and some other places, it is very prevalent ; most frequently, however, affecting young females. It is found in all parts of the United States, but more commonly in low, moist, marshy, or malarious situations. In this country the disease seldom increases to a dangerous extent, the deformity being the prin- cipal source of uneasiness. To treat this complaint successfully we must employ as powerful douches to the spine and to the tumor itself as the patient can conve- niently bear, with occasional packings in the wet-sheet, and a thorough course of derivative half, hip and foot-baths ; and to this course of bath- ing must be added a plain, abstemious, and rather dry diet. The drop-bath for half an hour or longer, followed by the wet compress, is among the promising remedial resources ; and if there is the least ten- dency to constipation, tepid injections should be fieely employed. It is but a few years since iodine was the vaunted specific for this disease throughout the medical world; but it was found at length that a great many more constitutions were killed than bronchoceles were cured by the remedy; hence, like every other specific which ever has or ever will' be got up on drug-medication principles, its destiny is — oblivion. Paronychia — Whitlow — Felon. — An acutely painful inflamma- tion, seated about the nails and ends of the fingers, has been called by these terms indiscriminately; the term paronychia is applied to all phlegmonous tumors of the fingers and toes. In some cases the in- flammation commences in the periosteum, and effusion takes place be- tween it and the bone, constituting tl\e worst or malignant form — the true felon; in the tendinous whitloiv the inflammation commences in the sheath of a tei 'on; and in a variety called cutaneous, tke effusion 546 SUR JERY. occurs in the subcutaueius areolar tissue, or between the skin and epi- dermis. Similar inflammations are sometimes found about the palms of the hands and soles of the feet. The severe and lancinating pain of paronychial tumors arises from tlie firmness and inelasticity of the skin and other sti'uctures where it \9 seated, wnich act upon the inflamed vessels like a tight bandage, pro- ducing- a most distressing sense of pressure ; and hence it is that when the skin opens the soft parts below are pushed out like a fungus, and become exquisitely tender. Treatment. — On its first appearance this affection may generally „. .gg be promptly cured by immersing the whole arm in very cold water. The arm-bath, fig. 198, should be frequent and prolonged. When discoloration of the skin indicates approaching suppuration, tepid, or even warm water to the in- flamed part, with the cold elbow- ARM-BATH IN WHITLOW. ^ath, wiU prove the most soothing treatment. In the felonious variety it will save the patient much time and suffering to cut with a scalpel down upon the bone, making a free incision one or two inches in length. SciRRHUS AND Cancer. — I have already treated of cancers medi- cally, but as many surgeons regard scirrhus and cancerous tumors as distinct diseases, while others treat of scirrhus as though it were the first stage or beginning of a cancer, it may be proper to consider both subjects connectedly in. this place. It is unquestionably true that all cancers are in their incipient stage hard, scirrhous, indurated tumors — occult cancers — and in their latter stage, open ulcers — carcinoma. But it is equally true that indm'ated or scirrhus tumors often remain for an indefinite period in a condition of cartilaginous and almost stony hardness, without evincing any tendency to cancerous ulceration; and not unfrequently, when irritated or in- jured, degenerating into other malignant tumors, very diflferent from true cancer. A scirrhus tumor, therefore, is not per se the proof of an approaching cancer. Indeed, some authors have grouped together scirrhus, medullanj sarcoma, fundus hcsmatodes, and carcinoma, as constituting species of the generic family of cancer. But it is enough for practical purposes, to know that a scirrhus tumor may become a cancer or some other malignant ulcer ; and when the surface of the scirrhus is uneven to the touch. tlTe pkin leaden and wrinkled, with ir- TUMORS 847 ^ regularly dilated veins, and twinging, gnawing, or lancinating pains, tha cancerous character is clear. Diagnosis. — Non-canceroid scirrhus, and all hardened but non-malig- nant tumors, are never preceded by nor attended with pain of tlie gnawing or lancinating kind. They present, also, a smooth and more rounded surface, w'ith a manifest swelling in instead of out of the part in which they are found; whereas, in canceroid scirrhus, the part affected is condensed and really diminished in bulk. Treatment. — Scirrhus or hardened tumors resulting from inflamma- tion may be dispersed by the plan of trwitment reconmiended for bronchocele. But the caHceroid tumor, in its early stage, may, per- haps, be treated with equal success by the knife or caustic; and in either case care must be taken to remove or destroy every vestige of discolored skin or affected flesh. Open cancers can be and frequently are cured by a free application of caustic potash, although the operation is a painful one. Dr. Hill advises, in the scirrhus stage, the application of a pencil of potassa, so as to surround completely as well as to open the cancerous mass, letting it penetrate into the very center from several different points; and if the patient cannot bear so extensive an application at once, the caustic may be applied to different parts from day to day. Between the cau- terizations the sore is to be covered with a poultice of slippery elm flour. In the open cancer the caustic potash is to be applied freely to the whole of the ulcerated surface ; burning to the bottom of the tu- mor by striking the pencil in from different directions. When the eschar sloughs ofl', any remaining portion of the morbid growth should be touched with the caustic ; and these applications are to be continued and repeated until all of the morbid structure is destroyed. During the healing process the sore is to be washed daily with the mild caus- tic — sesqui-carbonate of potash — to destroy the vitality of any rem- nant of cancerous virus that may exist, and prevent the development of new. The constant application also of floiir, starch, or slippery elm, absorbs the pus, and thus prevents its corrosive effect. When this or any other operation is resolved upon, the body must be prepared by a thorough course of hydropathic bathing and dieting. Fungus H^matodks. — This term means bloody fungus ; the dis- ease is sometimes called medullary sarcoma, spongoid inflammation^ mcephaloid tumor, and soft cancer. It commences with a small, elas- tic, movable, and nearly insensible tumor, under the skin, the integu- ment itself being unaffected. Sooner or later it becomes inflammatory, swells rapidly, the skin becomes discolored with purpl'gh or red spoJi? 348 SURGERY. and adheres firmly to the distended and lobulated mass. Ulceration soon comes on ; dark-colored fungous growths sprout out irregularly Hiid at severfil points beyond the surface ; the whole mass becomes exceedingly vascular, the top being ruuch larger than the base ; event- ually the adjacent glands are affected, when the patient's general health rapidly declines Treatment. When the lymphatic glands have become affected, the disease may be pronounced incurable. In its early stage, while the tumor is loose underneath the skin, and nearly free from active inflam- mation and tenderness on pressure, it may be destroyed by caustic or removed with the knife. The knife is preferable when the diseased mass is so situated that the whole can be removed at once. The ex- cision should include every particle of morbid structure ; and to make sure of this the dissection should extend some distance beyond all ap- peanmce of disease. When cauterization is resorted to it must be managed, as in the case of common cancer, except that it is more im- portant to destroy, if possible, every vestige of the diseased mass by the first application. Bone Cancer — Osteo-Sarcoma. — ^This disease, called spina ventosa by some authors, consists in the deposition of a flesh-like mat- ter in the structure of the bone, producing a morbid enlargement. As the disease progresses, the inteynal structure is changed to a brownish, fleshy mass. When the swelling opens on the surface, large quantities of pus, of a more or less ichorous or sanious character, are discharged. The affection is most frequently seen in the lower jaw bone. The early symptoms are, acute pain, followed by a hard elastic swelling, afler which the pain becomes more dull, and eventu- tually lancinating. Treatment. — The first thing to do — except when a part or limb is so far destroyed as to require amputation or forbid any attempt to cure — is to cauterize an opening into the center of the diseased mass, so as to allow the free escape of purulent matter and loose pieces of bone; the limb or part is then to be kept well covered with wet compresses, find, when practicable, the cold stream or pouring-bath should be fre- at night. The skin appears whiter than natural, becomes tense, shining, and marked with varicose veins, and there is a constant sensation of heat in the part. In tliis condition it may renmia fl)r years, but usually the swelling continues to increase until the soft parts become so hard as to appear like enlarged bone. As it progress- es tlie tibia is thrown backward, the condyles of the femur project for- ward, the whole limb emaciates, anchylosis takes place while the joint is flexed, and mutter collects, and is discharged at various sinuous open- ings. Extensive caries of the bone often ensues, with hectic fever, soon terminating in death. Sjyecial Causes. — Repelled eruptions, local injury mercurial and antimonial medicines, syphilitic taint. Treatment. — This is one of the maladies which the popiilar "heal- ing art" does not pretend to heal. When the joint is \evy painful, it should be bathed in w'arm water or fomented until this is relieved, and then dressed with several folds of wet cloth, except when the inflam- mation is acute, in which event cold applications are most appropri- ate, the rule being, as in all similar cases, to regard the sensation of the affected part. The cold pouring-bath, douche, or leg-bath, or even moderate congelation, may be employed with advantage when the sensibility of the part is such that they can be administered without pain. Indeed, in most cases they will each and all have a soothing and sedative influence- Callous edges of the ulcerated sur&ces, sinuses, and fungous growths, will require the application of the mild or strong caus- tic. The limb should be kept as extended as possible, and as much compression employed during the suppurative stage as can be borne without pain. To these local measures must be added thorough con- Ptitutional treatment, in which the packing-sheet should be the leading process. The regimen must be such as has been heretofore recom« mended for scrofula. ilvDROPS Articdli. — This is usually regarded as a result of rheu- matic disease, and hence called rheumatic white swelling. It consists in a distention of the synovial membrane and capsular ligament by serous effusion, which renders the limb lame and stifl", though not very painful except from exercise. Sonietimes the eflHision extends along the tendons of the muscles. The warm or cold douche, wet bandages. TUMORS 368 the pack-sheet, copious water-drinking, and frequent injections to keeo the bowels entirely free, are the remedial measures. Varicocele — Circouele — Spermatocele. — A varicose dilata- tion of the veins of the scrotum and spermatic cord, is called indiscrim- inately by these terms. When the spermatic veins are affected, the tumor is soft, knotty, doughy, unequal, and compressible, increasing from below upward. The disease I'equires no special attention, save a careful regard to hygienic habits ; occasional sitz-baths, or the ascend- ing douche, with the use of a suspensory bandage. HiEMATOCELE. — Tliis is an extravasation of blood in the tunica vag- inalis, or an effusion into the cellular membrane of the scrotum. The external parts are often thick and dark, somewhat resembling gan- grene. The treatment is the same as for the preceding affection. Sometimes the disease is producevl by the wounding of some large vessel, in which case the scrotum may be laid open and the vessel tied. Sarcocele. — This term is variously applied to a scirrhus or can- cerous, encysted, or fibrous tumor of the testis, and to a simple enlarge- ment as a consequence of maltreated chronic inflammation. When the tumor is malignant, castration is the only sure remedy ; other- wise it may be reduced by the remedies recommended for the prece- ding maladies. Hernia Humoralis. — This technic is applied to a swelled testicle from common inflammation, or to a hardened tumor which is at first confined to the epididymis, the pain extending along the cord to the loins. The latter variety is frequently the result of a suddenly-sup- pressed gonorrhoeal discharge. I'he former variety requires cold, and the latter warm water-treatment at first, to be followed by cool, and finally cold applications. Cystic Sarcoma. — This is a hydatid disease of the testis. It oc- curs chiefly in middle life, and is sometimes mistaken for hydi'ocele • but the oval shape of the tumor will readily distinguish it from that af- fection which is pyriform. The morbid mass consists in pp.rt of a solid structure, and partly of cysts of various sizes, containing a thin, trans- parent, yellow serum, or a turbid fluid. The complaint had better be managed on the "lee alone" system, unless its bulk or malignancy cre- ates great inconvenience or suftering, in which case extirpation is the on'y reraeiy. II&4 SURGERY. Polypi. — The most common situations for polypus tumoi-s are the nose and vagina, although they may grow from any inti-overted mu- cous surface. For all practical purposes, it is sufficient to distinguish them into soft and hard, altliough sui-gicai writers have made several subdivisions of each, as mucous, vesicular, fibrous, fleshy, scirrhus, or cancerous, etc. The latter variety is probably a true cancer, instead of a cancerous polypus. Treatment. — In addition to what has been heretofore said in relation to the treatment of these morbid growths, it may be remarked, that the application of j)owdered caustic — either mild or strong, according to the firmness of the tumor — will frequently be sufficient to destroy them In many cases the caustic may be advantageously combined with me- chanical force, as squeezing, twisting, crushing, etc., tearing a\^y such jKirts as may be conveniently detached. The powder should be apj)lied with a camel's-hair pencil. This plan is particularly adapted to nasal polypi. The practitioner should also bear in mind that nasal polypi are very liable to grow again, after having been removed by me- chanical means, unless the surface fi-om which they are detached is thoroughly cauterized. Polypi in the vagina, whether originating from its sides or from the mucous surface of the uterus, usually present a pedunculated shape, which is favorable to the operation of removal by ligature. I have known cases connected with such a degree of prolapsus as to allow the application of a ligature without any instrumental assistance ; but gen- erally the ligature will have to be introduced by means of the polypus forceps, or the double canula, fig. 200, afte*-- which it is to be drawn Fig. 200. DOUBLE CANT7L>, WITH LIGATURE. tight enough to cut off the circulation and sti-angulate the tumor; the canula is to remain, and the ligature tightened from time to time, until the tumor comes away, which will usually be in five or six days. When the neck of the polypus cannot be reached by ligature, the tu- mor may be destroyed by a solution of the caustic potash, inti'oduced through a silver catheter; or the powdered caustic may be applied b} means of nieces of fine sponge, with threads attached to withdraw them. TUMORS 855 Nodes. — A majority of bone tumors are included under the terra exostosis, and the term 7iode is usually restricted to hard concretions or incrustations which form around rheumatic and gouty joints. It is em- ployed, however, by several writers, synonymously with exostosis ; and many authors apply it to tumors of the cylindrical bones resulting from the venereal taint. It is the opinion of some surgical authors that syphilitic nodes only occur in persons who have taken mercury, which, by the way, has inflicted vastly more mischief on the human constitu- tion than has the disease it is intended to cure. Samuel Cooper says {Coopers Surgery), "I believe that ti'ue nodes are rarely produced in syphilis, unless the patient has been using mer- cury." Dr. Hennen, who had an extensive experience in the treat- ment of syphilitic diseases, affirmed that he had never seen but two cases of nodes in patients who had not taken mercury ; and in relation to those two cases the question may be fairly raised, Whether the patients had not taken mercury on some previous occasion. Treatment. — This is mainly constitutional. Thorough general bath- ing, an abstemious diet, and local compresses, are the leading meas- ures. When the tumor becomes projecting and pointed, the soft parts may be laid open, and the tumor removed with a saw, chisel, or tre- phine ; when ulceration occurs, attended with callous edges or fungous excrescences, these require cauterization. Enlargement of the Prostate Gland. — In this affection the gland often attains manj^ times its ordinary size, and is much harder than natural. It produces but slight difficulty in urination, yet it pre- vents the bladder from being completely evacuated, and the urine is, in consequence, rendered constantly turbid. Total retention of urine, however, is liable to occur if the swelling is aggravated by any ex- cesses to which the patient is addicted. There is a sense of weight in the perineum, and the middle lobe of the gland usually projects into the bladder, altering the shape and direction of the urethra, and ren- dering the passage of a catheter or sound more or less difficult. The disease is usually caused by calculous concretions or venereal affec- tions. Treatment. — Frequent hip-baths, and a thorough employment of the ascending douche are the ordinary local appliances ; to which must be added some general daily bath, as the dripping-sheet, or pack and half-bath. When it is produced by repelling or suddenly drying up a gonorrheal discharge, warm hip and foot-baths must be assiduously employed until the discharge reappears or the irritation subsides ; after which the cold treatment may be employed as above. 85e SURGERY. CHAPTER ^ ULCERS. Ulcers ai-e purulent solutions of the continuity of the animal tex- ture. In a general sense, they are distinguished into the benign, or heaWiy, and the malignant, the indolent, and the irritable, etc. They are also subdivided into many varieties, according to their causes, na- ture, tendencies, consequences, etc., as simple, sinuous, fistulous, fun- gous, gangrenous, cancerous, scorbutic, syphilitic, sc'^fulous, inveterate, phagedenic, virulent, sordid, cacoethic, carious, varicose, etc. Many tumors, if not arrested in their early stage, become ulcers, as cancer cnrbuncle, etc. An ulcer is called healthy when its purulent matter is a normal se- cretion, unattended with the destruction of the surrounding parts. Its surface is florid; its granulations are small and of uniform size; it is without offensive smell ; and it heals regularly, leaving little or no scar. A common boil is an example. An irriiable ulcer is very tender to the touch ; exti'eraely liable to bleed ; its discharge is slight, and of a thin, ichorous, or sanious ap- peiirance ; its color is dark or purplish ; its granulations are imperfect and spongy ; its edges are ragged and everted ; the parts around are red, pwollen, and often oedematous. The indolent ulcer is the more frequent form of "running sore" we meet with ; its edges are inverted, rounded, thick, glossy, and regu- lar; the granulations are of a dull pale aspect, and insensible ; the pus b thick, of a dark yellow color, and adheres to the bottom of the ulcer. It is most frequently located on the lower extremities. Varicose ulcers may be either irritable or indolent ; they are con- nected with enlargements or varices of the adjacent veins. They are generally situate below the knee. Fistulous ulcers are sinuous cavities, having a narrow outlet, the dis- ease being kept up by an altered texture of the part. Specific ulcers result from the inflammation of specific diseases, as scrofula, salivation, syphilis, etc. Other distinctions, depending on mere varying appearances, or on common causes and terminations, are of no practical importance. Gfnkrai. Trkatment of Ul:ers.— The constitutional treatment ULCERS, 857 is n]^yays of primary importance in chronic ulcerations of every kind. In all matters of regimen the patient must be held to a strict accounta- biiity to physiological law. The whole skin must have, at least, one thorough daily ablution or packing. The local medication will vary ac- cording to the character of the ulcei*. The healthy u]cer needs nolhuig more than a cool wet cloth. When the irritable ulcer is very painful, the limb or surrounding part may be fomented with warm cloths until it becomes easy, and then " done up" with the ordinary " water-dress- ing." When exposure to the air aggravates the pain, the surface may be covered with flour. The indolent ulcer often requires the applica- tion of the mild caustic to remove fungous growths or callous edges. When the surrounding parts are hard, they should be occasionally fo- mented ; and if the sore is on the lower extremity, compression with the roller or by adhesive straps is useful. Varicose ulcers require etill stronger compression ; the roller bandage should be applied to the whole limb, and the sore treated in other respects according to its character. When the veins are extremely distended and knotty, ad- hesive straps may be advantageously applied over and adjacent to the ulcer ; and these may be covered by the roller. Cauterization of each distended vein with potassa fusa, one or two inches distant from the ulcer, so as to obliterate their cavities by adhesive inflammation, may be resorted to in bad cases with safety, and usually with success. Fis^ tulous ulcers generally require to be opened with the ligature, or ob- literated by caustic. FuRUNCULUS. — A boil, or hile, as some authorities have it, is a small phlegmon, seated in the dermoid texture, and tending to a pointed tumor which sooner or later breaks and discharges a white or yellowish pus, mixed with blood. Sometimes a small fibrous mass of dead but undis- solved areolar tissue appears, after it suppurates, called the core. The only medication demanded is the wet dressing; and, should the tumor not open spontaneously when matter has evidently formed, it should be punctured with a lancet and the matter pressed out. Parulis. — The common gum-boil is a small abscess which frequently forms in the gums. It is sometimes owing to carious teeth, but is gen- erally produced by bad dietetic habits. Those who eat coarse vegetable food, and use the tooth-bruslr daily, are seldom trouHed with such affections. Fever Sores. — The most common form of chronic ulcers are Known as '•'■fever sores,^^ '' brandj sores,^^ ^^ whisky sores,'^ etc., and some- 868 SURGERY times, in view of their usual locality, ''old sore legs'' They are gen- erally connected with and the penalty of intemperate habits. I have known several bad cases among the children of liquor-drinking parents. The ulcers are deep, the limb is swollen, in some cases nearly as hard as bone, and frequently purple or dark. The character of the sore may be irritable, or indolent, or of a mixed character, some portions being irritable and others indolent. Treatment. — These cases require a long course of treatment, but can generally be cured, provided the patient will sign and then keep the temperance pledge. When painful, they are to be soothed with Wiu-m water or the warm fomentation ; when hot and inflammatory, the cold douche should be applied to the whole limb daily. Callous or fiingous excrescences are to be destroyed by caustic. The roller ban- dage is also an indispensable part of the treatment. It must be ap- plied twice a day — every morning and evening is a good rule — ana thoroughly wetted with cold water aftcx it is applied: wet cloths should always be placed over the bandage when there is the least pre- ternatural heat or active inflammatory excitement. All these meas- ures, however, will fail, unless the whole surface is thoroughly attended to in the way of bathing ; and the stomach and bowels are kept unbur- dened and well cleansed by the appropriate quantity and quality of food. It is a prevailing opinion among drug-physicians, and a popular pre- judice with the people, that it is dangerous to cure old sores. Truth, "they say." lies between two extremes. The truth in this case, as in all others, is at one extremity. It is always dangerous to heal them drug-opathically, but nexer dangerous to cure hydropathically. Caries and Necrosis. — These terms are often employed synony- mously ; but in strict surgical parlance, caries is an idceration of the bony structure, analogous to gangrene of the soft parts ; while necrosis is the death of the bone, analogous to 'fortification. Caries usually attacks the spongy bones, as the vertebrae ; and necrosis as generally aifects the long or flat bones, as the tibia, humerus, and bones of the cranium. Necrosis in the leg or arm is generally called ''fever sore." The process by which dead portions of bone separate from the living — ■ :.vilogous to sloughing of the soft parts — is called exfoliation. Symptoms, — The bones, though insensible in their healthy state, be- come exceedingly painful when diseased. The swelling has no regnlar a|)ex or point, but is more distressing than ordinary inflammatory' 9%veirmgs, especially at night. The pait is hot, somewhat hvid, and •ometimes come* on suddenly and progresses rapidly to suppuration. ULCERS. 359 The pus is dark, sanious, and fcetid, and generally discharged through several fistulous openings or pipes ; and through these the rough, un- even surface of the bone can be felt by means of the finger or common probe. Sometimes the bones of the cranium are perforated at numer- ous points, constituting the worm-eaten caries of authors. There is more or less fever, which is of the hectic character. When necrosis occurs in the center or shaft of the long bones, it seldom or never ex- tends to their articular extremities ; but the exterior layers form a canal around the dead portion, which is called sequestrum ; and between these swollen layers and the sequestrum suppuration takes place. Special Causes. — Professor Parker disposes of the causes of necro- sis in the following summary manner : "So f^u' as any thing can be known, it seems to bo the result of sudden changes of temperature." But the fact that both caries and necrosis frequently follow local inju- ries, as blows and falls, and are also frequently connected with consti- tutional taints, as scrofula, scurvy, syphilis, mercurialization, etc., seems to indicate that something should be known beyond mere temperature. The greatest number, as well as the most malignant kinds of caries and necrosis owe their existence to the combined action of mercury and syphilis, or mercury and scrofula ; or, in the language of Samuel Cooper, " to the prejudicial influence of a badly conducted course of mercur3^" Treatment. — In its forming stage the disease can generally be "dis- cussed" by douching the part frequently with cold water, the constant application of wet cloths, and one or two packs daily. The late Pro- fessor Ntithan Smith recommended making a free incision down upon the bone, and even into its substance, if relief from pain did not follow the first incision, on the plan of treating a felon or whitlow ; and no doubt such a practice in a very early stage, would lessen tho extent of the inflammation: still if the cold-water measures are vigorously em- ployed it will be unnecessary. After ulceration has taken place, "the books" furnish us with any number of vinegar-and-meal, carrot-and- onion, bread-and-miik, soap-and-molasses, rum-and-sugar, scraped-po- tato, tobacco, strammoniutn, etc., poultices, to help "digest" the affiiir; but I know of nothing in theory or in experience which gives them any advantage over a few folds of old linen rags well wetted in pure soft water, provided the temperature is duly regulated. But when the disease proceeds to suppuration and exfoliation, it is important to get rid of the purulent matter and lead bone as fast as possible, yet all rough handling of the diseased part must be avoided. If any portion of bone becomes loose or projecting, or can be ascer- tained to be dead — in which case its color will be zvhiter or darker than ^tjO SURGERY. : Dntural — the cHUstic should be applied to it. "The mild caustic," saya j Di'. llill, "has ft peculiur ^JFect on diseased bone, ntid seems to exert \ a stronger inrtiietice thuu the bi-curbouule, or even the pure alkuh — \ caustic {>olu5h — williout nny injury to lieulthy parts." When there \ are several optMiiu;;s* they should bo converted into a single ulcer 'f | p<):««iible ; for which purpose the caustic, knife, or ligature may be em- i ;'!.tvt\l according to circumstances. Dead bone and fungous growths may be dissolvixl by passing tents, charged with the sesqui-carl)onate I of {K>tash, into llie sinuses, and pushing them against the morbid struc- ture. Sometimes uew bono is formed around the dead part, inclosing it in n shell, and producing a preternatural eukirgement of the part ; i:i .>(>ening, however, is usually left in the new formation, through \s rii purulent matter issues. This opening must be enlarged by* caustic sufficiently to allow of armed tents or caustic solutions to be 1 passed through a tube or syringe to the dead bone, to effect its disso- lution. After every vestige oi" disorganized matter has been removed from the ulcerated cavity the ulcer will heal kindly ; yet the bone will geuerully remain preteruaturally enlarged. j Fistula in Ano. — Any abscess about the rectum, opening either within or without the anus, or both, is known by tlie term, Jisfula in j ano. Fistulie are so common iu this situation, tiiat some physicians, I whose pnictice, "from being general is confuied to a particular bra;«ch i of their profession," have selected "diseases about tlie anus" as the j ' ' ir field which is to etu r " prof mud attentiDn." Fistulce ' e usually connected w ^ s and botii have habitual costive- ' ness as their common caus**, although the former is sometimes occa- ' V wouu'Ja and injuries. • 1 tiiere is an opeu communication between the rectum and the cutaneous surface, the fistula is called complete ; and incomplete or blind j when it comuumicates with but one ; the latter is called bUnd internal \ or blind external fistula, as it opens into the bowel, or Ufxxi the exter- ' iml »kin. In a majority of cases the fistulous pipe, or sinus, is tortu- j » t:> and branching, sevenil distinct openings being internally connected. ' " '^ lined with a semi-cartilaginous, or callous growth, having ^ property of mucous membrane, from which exudes ai Intl. yetk)wish pus; thin indurated surface is generally extremely ten- j • -nich. i . — The "standard authors" on surgery are surely not! wi II jKMsled in the matter of curing the disease under consideration. | 'l"tir pliiii ..flaying the ulct-r open with the knife i^ always barbarous, ! p.ruTnlly unsuccessful, and sometimes fatal. More than twenty yean ■ r L C E R 8 over ft ittfe womlHi Fif.nB.. tfo a •eifHCOMUMed relonn flrftmol of mmiikaam in the city dT 'Sem York. puUUbgd to dio WKirld {Dr. Bfusidh't Ame/rwam Pm,i %am€) « smcto&eiffml aiethod df ttvamieall ; rel \v tsraoltodie iafeeraaJ ohfioe^ die i !: r:Frri.A ,»Tir».B.. .laM -Stm 8^2 SURGERY. and he should keep very quiet, resting much of the time in the hori- zonrnl iwsition. Fistula in Perineo. — A sinuous ulceration in the perineum is generally the result of a stricture in the uiethra; the urine, thus ob* Btructed, acting upon the lax structures of the part, often occasions ex- tensive ulcerations, attended witn very offensive discharges of purulent or sanious matter. Treatment. — After the stricture has been removed, or the urethra dilated, as the case may be, a gutta percha catheter should be intro- duced into the bladder, and worn constantly ; the hard, callous edges of the ulcer are then to be disorganized by the repeated application of the mild caustic, or the pure potash, if necessary. Before applying the caustic, the parts should be soothed with warm fomentations ; and if the urethra is too irritable for the constant employment of the cathe- ter, the patient should keep on his back while it is withdrawn, taking care to have the instrument inti'oduced before he rises, so that the bladder may he emptied without allowing any urine to come in contact with the ulcerated parts. Strictures and Fissures. — Strictures and fissures of the urethra and rectum, though not in any sense ulcers, are so intimately con- nected with fistulse that they may as well be considered in this place. The membranous portion of the urethra, between the bulb and the prostate gland, is most frequently sti'ictured, although a stricture may occur at any part of its channel. The disease may be spasmodic or organic. In the former case obstruction is temporary, and is produced by a partial or total obliteration of the canal in consequence of its sides being pressed together by the contraction of the surrounding muscular fibres. In the latter form the obstruction is permanent, and results from a morbid thickening of the mucous membrane. A partial organ- ic stricture may become total by spasmodic action, superadded to the structural difficulty. The most frequent cause of stricture is gonor- rhea, or rather, the irritating drugs which are employed to cure it. In- juries from the passage of stone or gravel, and by surgical instruments, Eometimcp produce it. Sipnptoms. — The spasmodic stricture is known by the sudden stop- page of the sti-eam after it has reached the irritable spot ; there is alsc> H desire to urinate frequently and hurriedly. In the organic stricture the streain becomes crooUed, gradually diminishes, and at length di- vides, and finally passes only in drops. The excretion eventually be- comes yellow and purulent, evincing ulceration in the urethra or blad- ULCERS. 363 der. The constant habit of straining often induces hernia or piles ; and when extensive ulceration has taken place, rigors and hectic fever are the precursors of a fatal termination. Treatment. — The first measure is to relieve the bladder. When tne stoppage occasions a tense, round, painful distention above the pubes, the catheter must be employed ; the gonorrheal inflammntioHi or irritation, when it exists may be subdued by frequent warm hip-baths, followed by tepid, then cool, and finally cold ; the bowels must be kept free by a simple opening diet, with tepid injections when necessary; and cold water should be drank as copiously as the stomach can com- fortably bear. With the subsidence of the morbid irritation, the spas- modic stricture will usually disappear; but if not, the additional meas- ures are necessary, which pertain particularly to the treatment of per- manent stricture. These consist in dilating the urethra by means of gum elastic or gutta percha bougies^ or destroying the stricture, which is usually confined to a very small space, by the application of caustic, or both. The dilating process is managed by introducing a very small bougie at first, and after it has been worn as much of the time as pos- sible for a day or two, a larger one, and so on, until the constricted calibre is enlarged as much as possible. If sufficient relief is not ob- tained by dilatation, the caustic is the dernier resort. This is applied by means of a bougie armed with caustic Tiotash, or nitrate of silver, and passed to the strictured point, against which the caustic is pressed for about one minute at a time. If there are several strictures, each must be cauterized successively. Another method, called malaxation. which consists in introducing a bougie through the strictured portion, and retaining it as long as possible, during which time pressure is made against the stricture by an external compress and bandage, to excite absorption, has been frequently successful. During all or any of these operations, the irritation must be kept down and constant relaxation of the parts maintained by very frequent warm hip-baths or fomentations. Indeed, a majority of cases will yield to the medical part of the hy- drotherapeutic treatment, without any resort to mechanical surgery whatever ; and the cases are extremely rare which will require any mechanical operation except the dilating process, provided all the pa- tient's habits and management are thoroughly hydropathic. It should be generally known that, as a majority of stricture J, of both the spas- modic and permanent kind, are produced by astringent and irritating applications employed to check gonorrhefil or gleety discharges, so a majority will get well by reproducing the discharge ; and this may gen- erally be done by the persevsring employment of warm local baths and fomentations. 864 SURGERY. Stricture of the rectum is a thickening and hardening of the intes- tine, resulting from constipation ; it produces a serious difficulty in passing the faeces, which are evacuated in small, contracted, elongated, or flattened lumps, or in a fine stream. As in the case of fistulse, all callous formations must be removed by caustic; and the consti-icted intestine must be mechanically dilated. Apiece of ordinary wood, cov- ered with oiled silk, of a conical shape, about three inches in length, the smaller end just large enough to pass the stricture, and the other, about two inches in diameter, answers every purpose. It must be held by a T bandage, made of gum-elastic, and worn as long, and as fre- quently advanced as the patient can well bear ; the rectum should be well cleansed with a tepid injection previous to each application of the dilator. Fissures of the anus are ulcerous gtaoves in the rectum, extending upward from the orifice. The edges of the crack or fissure be«corae thickened and hardened, and constantly exude a sanious fluid. These should be removed by caustic, as in the case of fistulse, the patient kept quiet, the warm relaxant baths employed, and the general regimen strict- ly attended to. Salivary Fistula. — Wounds of the face, which sever some one of the excretory ducts of the salivary glands, are often followed by an ob- literation of the cavity of the duct, and the formation of a fistulous opening through which the saliva escapes upon the outside of the face. The difficulty may be remedied by making an opening with a small trochar, passed into the open end of the duct at the fistulous opening, and then inserting a gold or silver tube to guide the saliva into the mouth ; after which the fistula may be healed by adhesive straps, or these aid- ed by the mild caustic. When the injured parts ai"e entirely healed, tlie canula or tube may be removed. FisTUL-E Lachrymalis. — In the true lachrymal fistula the lachry- mal sac is distended to a tumor at the inner corner of the eye, which ulcerates and forms an opening through Nvhich the tears are discharged on the face, instead of passing to the nose. There is also a morbid se- cretion of the sac distinct from the tears, for which the mild caustic may be necessary ; and the nasal duct may be &D obstructed as to re- quire probing, and the application of a tent. ABSCESSES 366 CHAPTER VI. ABSCESSES. An abscess — aposteme — vnposthume — is a collection of purulent mat- ter in a cavity, or in the substance of an organ or part of the body. Sometimes the pus is contained in an orbicular cavity Jmed by a cyst; and sometimes it is infiltrated into the meshes of the areolar tissue. The formation of an abscess is often preceded by chills, or shivering fits, called rigors ; and just before suppuration takes place, the pain, tension, swelling, throbbing, etc., are increased. After matter is form- ad, a sensation of weight and throbbing continues in the pait, and a conical projection soon denotes the pointing of the abscess, preparatory to its bursting and discharging its contents. Some abscesses will point in a week ; others may not do so in several months. Generally aJZwc- tualion may be felt in the swelling previously to its pointing. In order to distinguish the fluctuation of an abscess to the best advantage, two or three fingers should be placed on one side of the swelling, and the op- posite side briskly tapped with the fingers of the other hand. Deep-seated abscesses, and those formed beneath fascias and dense fibrous tissues, do not readily point, but they are attended with greater constitutional disturbance ; and severer hectic symptoms, as shiverings, night-sweats, small, frequent pulse, etc. A sense of weight and cold- ness in the part will also succeed the acutely throbbing pain ; and not unfrequently the integument over the abscess will become oedematous. The general treatment of abscesses is precisely the same as that of inflammatory tumors and ulcers, preceding the formation of matter ; after which, as a general rule, they are to be opened by cutting or cau- terization — usually the former. Empyema. — This is a collection of matter in the cavity of the pleu- ra. Inflammations of the lungs or of their membranes occasionally re- sult in suppuration, producing .the abscess under consideration. It is known by a manifest enlargement of the side affected ; a dry, tickling cough ; laborious breathing, which is easiest in the erect posture ; fixed pain in t?he chest, with diflficulty of lying on the sound side. Treatment. — In a few instarces the matter has worked its way into the bronchial tubes and been expectorated, followed by recovery. 56C SURGERY. When any tiling is done surgically, it is the operation of paracentesis thoracis. An incision is made with the bistoury an inch and a half in length, through the integuments, usually at the upper edge, and a little behind the middle of the sixth rib; the intercostal muscles are care- fully separated, and the point of the instrument passed in through the pleura costalis ; a canula is then introduced, through which the matter escapes. Care must be taken that air does not pass in through the tn'je ; to prevent which, the patient may incline, after the introduction of the canula, on the affected side ; or a valvular instrument may be used. This operation has not been generally successful. Maxillary Abscess. — This disease is an ulceration of, and collec- tion of matter in the antrum of the upper maxillary bone. It is gen- erally produced by the irritation of decaying teeth, and may exist for years, passing for toothache. It may be known by severe and obsti- nate pain in the face just below the prominence of the malar bone; the fetor is also extremely offensive to the patient, and to others about hira. Sometimes there is a considerable discharge of offensive matter from the nose, and in some cases the face is much swelled and disfig- ured. Treatment. — The Inflammation and irritation should be allayed by derivative baths and local fomentations. The surgery proper in the case consists in extracting the second or third molar tooth, or both ; and if the pus does not find a ready exit, a hole is to be drilled through the alveolus into the antrum about the size of a goose-quill ; the cavity should then be repeatedly washed by injecting warm water ; and if the fetor does not soon subside, a few applications of the mild caustic, in solution, should be made. Mammary Abscess. — Abscess in the breast is sometimes the re- sult of injuries, as blows, pressure, etc. ; but generally it is the conse- quence of bad management or mal-treatment during the periods of ges- tation, childbirth, and lactation. The disease usually appears in four or five weeks after parturition ; in about ten days thereafter suppuration takes place, beginning in several distinct parts, and forming many sep- arate sinuses, all uf which, however, communicate. It opens at one or several points. Treatment. — This distressing affection is a standing disgrace to the doctor, the nurse, the patient, and all parties concerned. It is produced by the mi.st foolish stuffing, and slopping, and stimulating, and heat- ing, and drugging; nor is the usual method of doctoring the disease, after it has been artificially producet: half as well calculated to cure the ABSCESSES. 867 malady as to kill the patient. If promptly and properly treated, it can almost always be speedily resolved in its early stages. The constitu- tional treatment is more important than the local, and both should be managed on the plan heretofore recommended for visceral inflamma- tion. The wet-sheet pack, or frequent tepid ablutions, with hip and foot-baths, are the general measures ; and the constant application of several folds of wet linen, very frequently renewed and well covered, Is the local appliance. Water may be drank freely, but the diet should ie rather dry. Onyx. — A collection of purulent matter between the laminae of the cornea, having the shape of a nail, is so called in surgical technology. Its form, however, is nearly semilunar, like the white mark at the root of one of the finger nails. It usually occupies the lower edge of the cornea, and may be distinguished from hypopyum by its form and situa- tion remaining unchanged in all positions of the patient's head. This affection can generally be removed by the appropriate remedies to re- duce inflammation — on which its existence depends — and promote ab- sorption. The head and eye-baths, a moderate douche, and deriva- tive, hip, and foot-baths, are all serviceable. Lumbar Abscess — Psoas Abscess. — This is one of the most formidable and fatal of abscesses. It commences with a dull, heavy aching in the lumbar region ; pains shooting down the spine and thighs, and a lameness in one or both lower limbs, with a difficulty of standing erect; there is usually a drawing up of the testicle of the side more particularly affected ; the patient is easily fatigued by exercise, and when lying down is disposed to flex the thighs or the abdomen. At length the local pain becomes throbbing, chills and night-sweats occur, a fluctuating enlargement appears along the psoas muscle, and the apex of the tuinor presents itself immediately below the groin. The dis- ease usually occurs in scrofulous persons, and is often connected with caries of the spine, in which case curvature of the spine and paralysis of the lower extremities are apt to result. Treatment. — If detected in the early or forming stage, this disease requires thorough constitutional treatment, of which the pack-sheet daily is the leading process. The diet must be strict, the bowels kept open by injections, and wet cloths constantly applied to the painful part. If the treatment is not commenced early enough to prevent sup- puration, the abscess, as soon as fluctuation is clearly detected, should be punctured to let out the matter. When the pus lies very deep, an Dponing may bo made t/i it with caustic potash. After the abscess is 8G8 SURGERY opened, moderate compression should be kept up, and the water-dress ing cotitiiuied. jSute. — Sometimes the swelling of a lumbar abscess in the bend of the pom so nearly resembles that of a hernial protrusion, that great diffi- culty is experienced in the diagnosis ; and the difficulty is increased by the fact that the same impulse is communicated to the swelling when the patient coughs in either case. Usually, however, the swelling ia lumbar abscess is larger and more toward the ilium. In cases of ex- treme doubt, a needle may be introduced into the tumor to ascertain the character of its contents. Hip Disease — Coxarum Morbus. — This disease, like the prece- ding, is seldom cured in the regular way. It consists in an abscess originating from caries of the head of the os femoris ; it generally occa- sions a luxation of the hip joint and a permanent shortening of the limb. The symptoms come on insidiously. Generally a slight pain in the knee is the first thing noticed. On a close examination the limb will be found elongated, which causes the knee to be slightly bent, and the whole limb more or less disfigured. At this period the pain will atfect the groin, and may be severe. Extensive ulceration has generally taken place when purulent matter makes its appearance ; this may be dtschiu*ged at several points, although the abscess commonly opens in the groin. In some cases the head of the femur is not destroyed, and anchj'losis results ; but usually the head is dislocated upon the dorsum of the ilium, where it may form a new joint, and produce a deformed and shortened limb ; when the head is entirely destroj^ed, the limb will be shortened several inches. Treatment. — This does not differ essentially from that applicable to the preceding disease. When fistulous openings exist, their callous edges or fungous growths may require the caustic ; and when theyare connected, they should, if practicable, be converted into a single one by the ligature. In order to enable the patient, during the lengthy process of cure, to exercise in the open air, he should be supplied with crutches, and the limb should be dressed with gum-shellac, or other light splints, to keep the affected joint as motionless as possible. Prostatic Abscess.— Abscess of the prostate gland k a result of acute inflammation, and may be known by rigors, with swelling, heat, and redness of the perineum externally. As soon as matter has formed, the abscess must be opened at once, lest the matter work its way into the rectum o'- urethra HERNIA, OR RUPTURES. 8«9 CHAPTER VII. HERNIiE, OR RUPTURES. Tme terms hernia and rupture are commonly employed as syijony- mous ; but writers who are strict in the use of language, apply the former word to all pi'otrusions of the viscera of parts from their nat- ural cavities, while the latter term is limitea to abdominal protrusions. The word rupture, however, is always a misnomer, for it implies that something is burst or torn, which is not necessarily the case. Varieties of Hernia. — These are innumerable. They may in volve the brain, lungs, stomach, intestines, bladder, the different por tions of the peritoneum, and in rare cases, the liver, spleen, uterus, or ovaries. The parts commonly affected with hernia are the abdominal viscera; of these the intestines, or omentum, or both, are the portions usually protruded ; and the abdominal ring, the navel, and a point at the inner side of the femoral vein, just below Poupart's ligament, are ihe places where herniae most frequently appear. They are met with occasionally at all points of the linea alba, at \he foramen ovale, the ischiatic notch, in the perineum, and in the vagina. Technology of Hernije. — This is derived from their contents and locality. A protrusion of the brain is called encephalocele, or hernia cerebri ; of parts within the thorax, piieumatocele ; of the stomach, gastrocele ; of the intestine, enterocele ; of the omentum, epiplocele ; of both, entero-epiplocele ; of the liver, spleen, bladder, uterus, etc., hepatocele, splenocele, cystocele, hysterocele, etc. Abdominal hernias are distinguished according to the aperture from which they escape. A^ or near the navel they are called umbiliccd — exomphalos, or empha- locele; through the linea alba above the umbilicus, epigastric ; through the linea alba below the umbilicus, hypogastric, infra-wnbilical, or ceeliocele ; through the abdominal ring, inguinal, or supra-puhian, and this variety, when small, is called bubonocele, and in man, oscheocele, or scrotal hernia, when the intestine has descended into the scrotum, while in woman its extension to the libiae is called epiciocele, or vulvar^ pudendal, or labial hernia; through the crural cnnR\,fe77ioral, or mero- cele; through the opening which gives passage to the infra-pubian ves- sel?!, infra-pubian ; through the saci 5-ischiatic notch, ischiatic hernia, 870 SLRGERT. through the levator ani, and appearing at the perineum, mesosceloceU, or perineocele ; through the narietes of the vagina, coleocele, elytrocele ; and through the diaphragm, diaphragmatocele, etc. *' Ventral hernia'"' includes all forms of abdominal proti-usion, except those occurring at the umbilicus, abdominal ring, or femoral sheath. In inguinal hernia, the intestine may be arrested in the canal, after having passed through the internal abdominal ring, when it is called in- complete inguinal hernia ; when it passes through the canal and emerg- es at the external abdominal ring, it is called complete inguinal hernia Complete inguinal hernia is called direct, or veniro-inguinal hernia^ when the bowel passes through the space between Poupart's and Gim- bernat's ligaments, leaving the external ring and spermatic cord on the outside ; and in other cases it is termed oblique. Congenital hernia is the protrusion of some portion of the abdominal contents into the tunica vaginalis testis, owing to a want of adhesion ^(* tween its sides after the descent of the testicle. Pathological Distinctions. — In abdominal hernia the protruding part usually pushes along a portion of peritoneum, which forms a sort of pouch, and is called the hernial sac ; the narrow part of which ie the neck, and the expanded portion the body. The bladder and caecum, however, not being contained in the peritoneum, do not have -a complete sac ; and in cases of wounds and ulcerations, the sac may be absent; nor does it exist in internal herniee, in which there is really no protrusion at all. In complete or direct inguinal hernia, there are two necks, one at the internal and one at the external rmg. Hernia is culled reducible when the displaced part is attended with no disturbanc-e of the general health, and is susceptible of being easily replaced ; when incapable of replacement, from its size or from adhe- eions, it is called irreducible or incarcerated ; and when the incarce- rated part is constricted and inflamed, obstructing the passage of faeces, and causing violent pain and sickness, it is called strangulated. Special Causes of He rmje.— Surgeons tell us that blows, falls, violent exertions, us lifting, wounds, dropsy, abscesses, pregnancy, Btmining at stool, hard ridnig, and severe coughing, are the common exciting causes, while general debility is the general predisposing cause. All of these causes are favorable to these complaints, and some of them alone produce them ; but the general and special cause is cos- tiveness. Without this predisponent condition, most of the other causes named would be powerless. Many persons, perhaps a majority in re* HERNIA, OR RUPTURES. 371 fined society, scarcely ever go to stool without being obliged to strain dangerously, to respond to the "solicitation of natui'e." And when this straining has been kept u\: for years, it is not remarkable that very slight accidents should cause the "bowels to gush out" of their natural inclosures in the shape of hernial protrusions. Some have estimated the subjects of hernia to be one eighth of an entire population. Diagnosis of Hernia. — In a reducible hernia the tumor may ap- pear gi-adually or suddenly at some one of the points above named; its size is changeable, being larger when the patient stands, and smaller when he lies on his back ; compression Avill generally diminish it; it is usually more tense after a full meal, or when the patient is flatulent ; when the patient coughs, an impulse may be felt at the tumor, as if air were blown into the swelling. When the sac contains intestine only, the tumor is uniformly smooth and elastic, and also painful to pres- sure ; when it contains omentum only, the tumor is insensible, and has a more flabby, or doughy, and somewhat unequal feel; and when it contains both — enter o-cpiplocele — a part of the contents of the hernial tumor will slip up with a gurgling noise, leaving behind a portion less readily reduced. Irreducible hernias are distinguished by more or less difficulty in evacuating the bowels ; colic pains are frequent, with a variety of dys- peptic symptoms. They do not usually occasion great inability or in- convenience, but are liable to intussusception — a slipping of one portion of bowel into another — and this is a dangerous and often fatal ac- cident. Strangulated hernia presents, first, an irritable condition of the parts afl'ected, with a hectic flush externally, and a pain at the point of con- striction; the pain generally extends to the diaphragm, followed by nausea, vomiting, obstinate constipation, rapid pulse, and general fever- ishness. The peristaltic action is often inverted, and fcecal matters are ejected from the stomach. If reduction is not soon effected, the bow- els become distended with air, the abdomen hard and tense, the ex- tremities cold, while hiccough, clammy sweats, and a sinking pulse, with a sudden cessa^zW q/'i/iepam, denote the existence of mortifica- tion, and the approach of death. General Treatment of Herm^. — When the hernia is reduci- .ile, the protruded part is to be returned to its natural position, and maintained there by a truss, or other suitable contrivance. In some rare cases, however, the contents of the hernia are so bulky, or the paits so altered, that it is advisable mei'ely to support the tumor with a •72 SURGERY. suspensory bandage, unless an attempt at a radical cure should be deemed expedient. In irreducible cases the strictest attention must be paid to the diet, Avhich should be so managed as to obviate the least tendency to con- Btifmtion. With this precaution, the use of a truss or bandage, and the avoidance of all rough exercises, the patient may " live through life" very comfortably. But when the reducible variety sudden!}^ becomes incarcerated, and in all cases of strangulation, the first attempt at relief should be by the la.ris, or hand oj^eration. The taxis can almost alwaj^s be successfully performed by any one who has a clear idea of the mechanism of the l)art and the existing obstacles. The patient is to be placed in a horizontal posture on tlie sound side — these directions apj)Iy particularly to inguinal and femoral her- nia, otiier varieties not recjuii-ing specim instructions — with the hipg elevated, the chest inclined forward, the thigli of the affected side flexed upon the abdomen, and drawn toward tlie other — all of which is intend- ed to relax the muscles and integument at and around the protrusion. The sac is then to be gently grasped, and moderately elevated and coni- pressetl with one hand, while the forefinger of the other hand presses as much of the tumor as possii)le uj) to and within the point of protru- sion ; the returned portion is to be retained while the middle fingei pushes up another portiorj, when the forefinger may be again em- ployed for still another jmrtion; the middle finger holding the part it has brought up, or the ring finger may be used, while the odiers are both occupied in holding the advantage gained. In this way the whole tumor is to be lemoved. In tlie c.rlcrnal insrulnal hernia, the pressure must be directed up- nard and oulicard, along tlie course of the spermatic cord ; but m fem- oral hernia it is to be directed first doivmvard and then backivard. In vmhdicai and vcnlral hernia the pressure is to be made directly hack- icard. Violence must never be used, nor the parts handled so roughly as to occasion much pain. Several circumstances, however, may interfere with the operation of taxis, or defeat its successful result, as extreme distention of the pro- truded intestine, great pain and tenderness, active inflammation, severe «onstrictior. around the neck of the sac, etc. ; but these things should not discourage us. We have in cold icater or ice a suitable auxiliary for the first-named complication ; its assistance will often enatle us to suc- ceed at once. When the part is excessively tender and irritable, hot water must be brought in requisition. The full warm bath, or local fo- mentations, cr both, may be employed, and these mav be fohowed hy HERNI.E, OR BUPTURES. S73 a reapplication of the iold process. Our "old school" friends, on iheir characteristic principle, that when a patient is suffering locally, he ought also to be made to suffer constitutionally, recommend tartar emetic and bleeding to produce sickness and faintness, with a view of bi'inging about relaxation and quietude ; but warm water externally, and inter- nally by injection, may be made to produce any degi'ee of these effects which can be desired. After the employment of either of these water processes, the taxis is to be tried again. There is yet another resource in bad cases — dry-cupping — which Dr. Hill {Eclectic Surgery) significantly calls traction from tvithin, and which is not mentioned in any other work with which T am acquainted. A large cup, or any convenient vessel* may be applied to the abdomen, covei-ing the umbilical region, in which a piece of burning cotton is placed to exhaust the air; the "suction" thus established will pull upon the protruded intestine while we may be pushing from without. Holding the patient's heels up, and head down, and jouncing him in that condi- tion, has succeeded in " domestic practice," in reducing a rupture, of which Dr. Hill gives a notable instance. In extreme cases, when the strangulation with inflammation has ex- isted, despite the efforts to reduce it, for twelve or fifteen hours, the only chance for the patient is by the operation with the knife ; yet this does not afford him quite an equal chance to live. It consists in making an incision through the skin three or four inches in length, along the course of the tumor, cutting through the successive layers — described in the first part of this work under the head of " Anatomy of Hernia" — or coverings, by picking up a small bit at a time with the forceps and cut- ting horizontally through it under their points, until an opening into the sac — which can be distinguished by its bluish appearance — is made. "The sac" — I quote substantially from Dr. Hill — ^" is then opened in the same manner, and the small director, fig. 202, inserted, and an opening Fig. 202. THE SMALL DIRECTOR. made large enough to admit a finger. The forefinger of the left hand \e 32 874 SURGEKY. F,n irtftodured, fig. 203. and passed up to the neck of the sac to find Fig. 203. *^Vv. OPERATION FOR STRANGULATED HERNIA. ihe Stricture, which may be at the internal or external ring, or at both places: the stricture should be sufficiently dilated to permit the finger to enter the abdomen; this may be done by the probe-pointed bistoury, or similar knife, made for the purpose, not edged quite up to the point, nor but a short space below it, fig. 204. The blade is passed u])Jiat- Fig. 204. HERNIAL. BISTOURY. xois€j along the finger, and pushed on through the sti-icture. Its edge Fig. 205. CUTTING THE STRICTURE is then turned up- ward, cutting no more than necessary to ad- mit the finger, figure 205. The cut must always be made ^i- redly upward, paral- lel to the linea alba, to avoid the epigas- tric artery. After HERNIA, OR RUPTURES. 376 the sti'icture is thus relieved, the parts must be examined, and if firm adhesions have taken place, or fatty deposits accumulated largely, no attempt at reduction must be made, but the wound allowed to heal. When mortification has taken place, the only chance is by an artificia. anus. In femoral or crural hernia, the sac is usually very small, and embraces the bowel very tightly ; hence it must be opened with caution. Radical Cure of Herma. — Beyond the taxis for reducing dis- placement, and the operation for relieving strangulation, little or nothing has been done for this class of invalids in the way of regular surgery, while mechanical skill has generally been content to prevent further mischief by the constant application of a truss. But it has been no- ticed that in recent cases the pressure of a truss has sometimes excited adhesive inflammation in the parieties of the canal between the ab- dominal rings, or in the femoral sheath, and thus closed the passage against all future danger. Acting on this hint, others have succeeded in some recent cases, by keeping up as strong pressure as the patient could bear, by means of a truss with a large and hard pad, so applied as to compress the whole canal or sheath through which the viscera had passed. Others have succeeded in cases of long standing, by add- ing to the mechanical-pressure treatment, that of vital irritation, the combined effect of both being to produce the requisite degree of ad- hesive inflammation to obliterate the canal, slieatii, or cavity, where the rupture presents. Professors Morrow and Hill, of Ohio, employ an irritating-plaster — compounded of bloodroot, mandrake, wake- robbin, pokeroot, tar and rosin — large enough to cover the whole cenal or sheath — two to two and a half by three to three and a half inches — over which the truss is worn, the pad of which is nearly as large as the plaster. The part is first shaved, the plaster applied, and then the truss ia adjusted as tightly as the patient can bear, the compression being diminished as the parts grow tender. The truss is removed daily, and the plaster re-spread, during which the patient must keep perfectly still in the horizontal posture, with the thighs flexed upon the abdomen. When the truss cannot be longer borne on account of the pain, it is substituted by a compress and bandages ; and while these are worn the patient is recommended to keep on his back. A point of practice especially insisted on is, that no pi'otrusion must on any account be allowed to take place during the treatment. Should tlie pain and irritation become intolerable, the plaster is to be omitted for a few days, a slippery elm poultice taking its place ; and this the hydro- path could readily supersede by simple flour to the surface, over wliic^" TTp SUE, C- E P. T- wrm wet oiorhs ravrhr; oe- i"- -•:. ...: -^ ■-■: '-".r — y'ara:. bj ^.ijs puia oi cre:i*menr. no e:Tc.r " '. " ■ ■;- ■ •- 4 •-. ■ ^ ■ • r^ .^.- -y and a scnr «cor» ©f w tfa# irricania are^ pro'^Tjd^d! the; ^ precisety " ^ of arriCaEioa, ami do ooiC p: of a few (irefs Q'f 0%^ '/ tBiiOlBiiiirxl sSne emEpu". .3 maffiBeaC of beciamm. &r wMeii mrnhdical hemaia : tke BroGraaii: B too LoCS^. T....^ -. -i.--; i •---... protessioniiJ mea'3 n^ath' i», th • :t its JT3st what prodnGea nrie r' -». in is tfais nfaat tnake> — ■ -' ^ - ■ ■ - - - feifcle ic will be to iaave a rjt)tare- ic •• npoB ' . TwiatmenL — The pv ■ - - dr • • ■ - WU.- ._: - . ;„,- , ■ - - ■bdboBuea. A - ; de;a3re«' (irf ri' r iridted by --i iu* tb -^cieta, A m-;,., .■...._..-.- .j,;a8aaa w • xh^ ryrtrrritn^c^ aoii r * mrwi*. Ipjr wiuicli ti- be SO i • ■•iaare' wfl t'^- - " Tane a circulitr r* "i aoirr - ■■ -h ^ --.--,-. - -. .. ome an the IleachMv «> as to oitike ic re:§uJairi.y cocuuBvre. preasioQ bi= - : ■ — DEFORMITIES. 377 close the orifice, by pressing frora the sides, while the muscles are in this relaxed condition. The edges being thus kept in contact, apply, directly over the point of protrusion, a layer of raw cotton or soft lint, wet in a strong decoction of white-oak bark. This application should be just large and thick enough to fill the excavated sui^face in the leather, without causing any pressure. Apply your leather pad over it, and secure it by a bandage passed round the body, sufficiently tight to compress the muscles, and keep in contact the parieties of the aper- ture. It is better to fasten the pad to the bandage before it is applied. This should be kept on six or eight days without being removed, unlesa it produce too much irritation. It should be wet once or twice a day with the oak decoction, by applying it upon the surface and allowing it to soak thi'ough the pad and cotton." One or two weeks will often sufl5ce to produce adhesion in an infant, while an adult may require the treatment for one or two months. ' While removing the dressings the patient must be placed in the position before described, and the walls of the abdomen firmly held by an assistant, so that no motion be allowed to inteiTupt the adhesive process. CHAPTER VIII. DEFORMITIES. The deformities which result fromaccident, disease, or malcon forma- tion, are innumerable ; but an understanding of the principles which apply to the management of those which are common, will readily suggest the modifications applicable to unusual cases. Hare-Lip — Labium LEPORI^■UM. — This is a fissure in the upper lip, which lUJiy be single or double. In the Fig. 206. former case it is usually on one side of the mesial line; in the latter each fissure ex- tends downward and outward from one of the nostrils, as in fig. 206. In some cases the division extends backward through the palate bone, and often the front teeth pro- ject through the fissure, adding greatly to the deformity. docble hare-lip. Treat'ient. — ^The operation of tying by the twisted surare is the 378 SURGERY. only rtMiiedN . Tiio edges of the fissure are raised with the fingers (ir i forceps ; a flat piece of wood is placed between the lip and gum ; and I the edges are then pared olf fvoi'.? hoth sides upon the wood with a ; 8cali)el or bistoury, leaving the edges straight like the shape of the let- J ter V. Tiio bleeding ran be stopped by sponging with cold water, ; after which a thhi sewing needle is passed through and across the fis- i sure near its lower extremity ; t)ie needle must penetrate nearly to the \ inner surface of the lip, which will keep the inner edge together while i the ligature secures the outer edge. After this needle is secured by j the thread two others are to be introduced above at proper distances, j and the part dressed with wet lint, over which a bandage is applied, ' and kept constantly wet with cold water. Adhesion will take place in about a week, during which time the patient must be kept very quiet; after this time the needles may be removed and adhesive straps ap- j plied. When two fissures exist each is to be treated in the same way, | and both should be operated upon at the same time. When projecting , teeth are in the way they should be extracted. i I Tied Tongue. — Notwithstanding I have had some fifty applications , to cut babies' tongues, I have never yet seen a case of this kind. It is \ an extremely rare occurrence in reality, thougli very apt to exist in I the imagination of nurses. W^hen the frenum lingua is extended to | the tip of the tongue, firmly holding this "unruly" member to the j floor of the mouth, and preventing the child from sucking, it is a j tongue-tie ; and then the surgeon may elevate the member with one ' or two fingers, and snip the string across as near the floor of the mouth \ as possible, with a pair of scissors. The cut should rarely extend be- yond one eighth of an inch. Enlarged Tonsils and Uvula. — These are rather inconveniences i tlian dof(}nnities ; yet it is sometimes advisable to excise them. The i proper instrument for doing this, fig. 207, has an angular or rounded i Fijr. 207. I INSTUU-AIKNT FOR KXCISING THE TONTSILS AND UVULA. blade, which can be drawn back, leaving a ring to be passed over the part to be removed, after which the blade, armed with a needle to prevent the excised portion falling into the throat, is pushed forward against the tumor. BEFOKMITIES. S79 Squinting — Strabismus. — In the majority of cases of permanent e-'pinting, the difficulty is owing to a disproportionate contraction in the recti muscles, one being too much relaxed and the other preternatu- raiiy contracted. The remedy consists in a division of the contracted muscle, and this is usually the internal rectus. The eye is secured and held by the wire-spring speculum, fig. 208 ; a double-hook is then Fi> ''OS SPECULUM APPLIED TO THE EYE. hitched to the conjunctiva midway between the margin of the cornea anc' internal canthus, by which the ball is rolled outward, as represented in fig. 209, and the handle then held by an assistant. The operator next raises the conjunctiva with Fig. 209. fine hook-forceps, cuts into it per- pendicularly with the curved scis- sors, and continues to raise and di- vide the cellular tissue until he reaches the muscle, when he sev- ers it with the scissors. If the muscle has been com- pletely divided, the patient, on hav- ing the eye released, will be able to turn it in all directions, except directly inward. Aftei" the opera- tion, the eye requires to be kept operation for strabismus. covered for a day or two with a wet cloth. Superfluous Fingers and Toes. — Supernumerary appendages to the hands and feet are not of much consequence ; but as they are not usually attached by a regular joint, they may readily be got rid of by means of the ligature or knife. "Wkb Fingers. — These only require division by the scalpel, and to 880 SURGERY be prevented from reuniting by a piece of oiled silk kept between the i fingers until cicatrization takes place. i Wry Nkck. — If this deformity is so great as to render an operation [ desirable, the constricting muscular tendon or fascia is to be divided ' with the knife. The incision should be as superficial as possible; when j the muscle luis been completely divided, it will snaj) back. The hemor- I vhnge can be prevented by the ordinary compress. i Spina Bifida — Hydro-Raciiitis. — There is a jJossibility of curing ■ some cases in which the membranous covering is rather thick and firm ^ b}- means of a linen compress and bandage, applied moderately tight, and so adjusted as to press the tumor down to a level v/ith the surface. If ■ inflammation exists, the cold water-dressings must be added. Spinal Curvatures. — These deformities, which have been con- ! sidered in the preceding part of this work, are rather medical than sur- | gical maladies ; and the subject is only introduced here to add an ocular demonstration of the theory advanced in relation to their pre isposing ,! and proximate causes. Fig. 210 is a representation of a singlo cuiTa- Fig. 21L Fig. 210. UISPOSIVION AT WORK. IVJtTBLE CURVATURR. DEFORMITIES. 381 ture in its forming stage, occasioned by a habitually-improper position at a work-table, which is raised too high. Those who have a clear idea of the manner in which these ailments originate, will at once appreciate the absurdity of the ordinary treatment with mechanical machinery and surgical cauterization, by which many poor backs have been cruelly tortured and many bodies permanently crippled. An extreme result of the same cause is seen in the curvature, fig. 211. Scrofulous persons, from their greater frailty or laxity of organiza- tion, are peculiarly liable to lateral curvatures, when exposed to any causes which debilitate the muscular system, or throw the different Bets of muscles out of balance. In double curvatures the mispo&ition of body is generally connected with causes which tend especially to debilitate the abdominal muscles, as constipation, hot drinks, feather beds, etc. Mercurialized Tongue. — This is both a cruel disease and a hor- rid deformity, as the accompanying representation will bear witness, fig. 212, and I introduce the subject in this place for the especia' pur- Fig. 213. ■ALIVATIOJ* 882 SURGERY. poses of protesting against its cause, and against tlie treatment whicb those physicians whose "healing art" creates the disease, recom- mended to cure it. This treatment consists in making long and deep incisions into the tongue with a scalpel. ^ It is not strange that those practioners, whose " remedies" produce such consequences, should be the poorest doctors in the world when those consequences themselves require medication. Nothing will reduce this violent mercurial inflam- mation equal to the wet-sheet pack, so managed as to produce mod- erate but frequent perspiration. At the same time the bowels must be kept very free with tepid injections, the wet compress applied to the neck, the mouth frequently rinsed with cool but not very cold water, and sips of cool or cold water — as either is most agreeable to the patient — swallowed whenever the patient has the ability to swallow. When the body is extremely sensitive to cold, a tepid ablution, followed by the dry pack, is the best way to promote a perspirable condition of the skin, and this may be frequently repeated. Professor Chapman, in a text-book for medical schools {Materia Medico), tells us that " Occasionally mercury, from some unaccounta- ble cause, instead of operating as a remedy, acts as a poison ;'' and Dr. Thacher, author of two standard works {American Practice of Medi- cine, and American New Dispensatory), informs us that " no rules can be given or regarded to regulate its administi'ation" or obviate the un- certainty always attending its introduction into the human stomach; and surely such authorities sufficiently sustain the protest here entered against destroying any more tongues, teeth, gums, palates, jaws, and lips — I have seen one case in which both lips were eaten off by a mer- curial action — and ruining any more constitutions by this Paracelsian quackery. PsEUDARTHROsis. — This is an unnatural or false joint, resulting from a failure of the portions of a fractured bone to unite by ossification or callus ; it may be caused by morbid habit of body, or the fault may arise from the fractured bones not being properly brought into contact. A ligamentous capsule forms around the extremities of the broken bones, which finally become smooth and round ; and in some cases a regular ball-and-socket joint is formed. The most hopeful plan of treatment is to pass a seaton-needle, armed with a skein of silk, through the limb between the ends of the bones, by means of which a running sore may be kept up for six or twelve months, and possibly adhesive in- flammation excited and a re-union produced. Club-Foot— Talipes.- Surgeons distinguish four varieties of this DEFORMITIES. 583 deformity. In the first — talipes varus — fig. 213, the foot is turned Fig. 213. Fig. 214. TALIPES VARUS. TALIPES EQUINAS. Inward, the patient walking on the outside of it, the heel being el- evated. In the second variety Pi^. 215 — talipes equinas — fig. 214, the heel is more or less elevated, the patient walking on the ball of the foot oronthe toes, and pres- sing equally on all the toes, or principally on the side of the lit- tle, or that of the great toe. In the third — talipes valgus — the foot is turned out so that the patient walks on the inner sur- face, the external edge being raised from the ground, and the sole standing outward ; and in the fourth — talipes calcaneus — fig. 215, the toes and foot are elevated to an acute angle with the leg, the heel resting on the ground. Causes. — The first variety is produced by a conti'action of the TALIPE3 CALCANEUS g84 SURGERY. muscles of the calf of the leg and the adductors of the foot; the sec- ond variety is usually owing to a contraction of the gastrecnemii mus- cles alone, but sometimes the flexors of the toes are also contracted ; the third variety is caused by the contraction of the adductor muscles, and also those of the calf of the leg ; and the fourth vaiiety is owing to the contraction of the tibialis anticus and the extensor muscles. These deformities are usually congenital, but may result from acci- dents. Treatment. — The majority of cases can be remedied b}^ proper me- chanical apparatus, if it is applied early — say before three years of age. A. variety of machines are in use, and the skill of the surgeon is re- quired to adapt one to each particular case. They consist essentially [/fa stiff shoe or sole, fixed to an upright shaft, to which springs are so attached as to make gentle but constant extension against the contracted muscles. Where machinery fails, or is not applicable, the operation of tenotomy — a division of the conti*acted tendon or tendons — is the only chance. A division of the tendo achillis is sufficient in a majority of cases of the first vai'iety. The skin is drawn tense so that it will cover the wound when it contracts, and a long, narrow-bladed knife is passed through the skin flatwise between the tendon and the bone, near the anterior surface of the tendon, one or two inches above the internal malleolus, and carried through to the skin on the opposite side ; the edge is then turned upon the tendon, and while an assistant bends the foot 80 to put the tendon firmly on the stretch, this is cut through, v/hen it will separate with a crackling noise. The limb is kept in an easy po- sition for three or four days, and then placed in a suitable machine to keep up extension and fix it in its proper situation. The posterior tibial muscle can be most readily divided about two inches behind and above the internal malleolus ; the anterior tibial, where it passes over the ankle joint ; and the flexor of the great toe on the sole of the foot, where it may be seen and felt projecting like a strong cord. Contracted Sinews. — A contraction of the flexors of any part of the body is so termed. It is most frequently seen in the fingera or toes over-riding each other. The fingers are also contracted from in- flammation, and a "club-hand" is sometimes met with. Some of the cases may be relieved by an incision through the skin ; but others re- quire the operation of dividing the tendon or muscle affected — tenotomy or myotomy. DISLOCATIONS. 886 CHAPTER IX. DISLOCATIONS. Technology. — A displacement of one bone from its natural articu- lation with another is called a simple dislocation, when unaccompanied with external laceration or fracture ; and compound and complicaLed, when those conditions co-exist. Its readjustment is termed reduction. The mechanical means employed in reduction are extension — the force applied by the surgeon on the luxated part; and counter-extension — the force employed to fix the body in position, which may be by machinery, such as pulleys, or by the hands of assistants. Dislocations are called partial when the bone is moved out of position in its socket, or on its articular surface, without being thrown completely out or off. Syinptoms. — A dislocation is known by a change in the external form of the joint; an alteration in the length of the limb; the altered axis or position of the limb. The patient ma}^ have the power to move the limb immediately after the accident. When considerable swelling has taken place, it is often extremely difficult to distinguish between a dislocation and a fracture near the joint. When muscles are ruptured, there is gi'eat effusion and inflammation in the part. Treatment. — The principal obstacle in the way of reduction is the contraction of the muscles; and this difficulty increases with the length of time the part has been displaced. When luxation has existed for several weeks, adhesions are apt to occur, forming a new joint or an anchylosis, and rendering reduction impossible without a new disloca- tion, and doubtful with. Very soon after the accident the displaced bone can generally be replaced with very little force. But when the muscular contraction is strong, we must employ, in addition to extension and counter-extension, warm water to the part to relax the muscles particularly implicated ; and in severe cases, the full warm-bath, to relax the whole muscular system ; and in extreme cases, the patient must also drink plentifully of warm water, and have the throat frequently tickled, to excite and maintain considerable nausea. The extending force should always be- gin gently, and be gradually increased, while the counter-extension should, of course, be fixed and uniform. The limb should be slightly flexed, so as to favor relaxation. In dislocations of the shoulder, the n— 33 g^ BURSERY. extension bandage should be applied to the forearm ; and in disloca- tions of the hip, above the knee. As the patient's mind, directed tc the injury or operation, increases the contractility of the muscles, adroit surgeons often conti'ive some way of diverting it, at the moment when extension has been carried U a sufficient extent, as by smashing a window, communicating tidings of some awful accident, etc. When the bone returns to its socket, a " snap," like that of a lock when the key is turned, can be heard, and generally felt. The after-treatment is 5imj)ly a bandage wet with cold water for a few days. There is a general plan by which many, perhaps a majority', of dis locations, can be replaced by persons entirely ignorant of anatomy This consists m drawing the limh oid of place as much as possible, iu (he first place — that is, extending it, and then, while the patient's mind is diverted to something else, making a sudden rotary motion, during which the bone generally slips into its place. Many marvelous stories have been told of Dr, Sweet and other " natural bone-setters," who have frequently succeeded by this method, after the scientific surgeon liad failed; they were called natural bone-setters, because they were not professionally educated. The following remarks of Mr. Skey, on "The Reduction of Disloca- tions Generally," are exceedingly valuable : "In the endeavor to reduce a dislocation, the line of traction should hold reference less to that of the socket, or surface from which the ^one has been displaced, than to the more important purpose of easing it from the surface, on which it has lodged. For example, the rim of the glenoid cavity, in dislocation of the humerus, presents an obstacle to the extension of the bone in the immediate line of that cavity; but if the bone be drawn oflfit by extension made in any oblique direction, the instant this ridge is passed, the head will rush back into its natural cavity. So, also, in dislocation of'the femur on the doi-sum illi, we do not attempt to draw the bone in a direct line wnth the acetabulum, but we carry it below, round its back and elevated margin, and no sooner does it rr^ach the lower part of the rim, which is much less prominent than the upper and back part, than the muscles immediately restore it to its socket. The same rule holds in dislocation of the ulna and radius backward at the elbow -ji int. I believe the exact line of extension to be much more readily determined, and, in truth, a less important sub- ject of consideration, than it is generally deemed. I believe that if we liring the bone suflficiently downward, and place it in the neighborhood of the articulation, the muscles will replace it with as much ease fis that whicli originally dislocated it. "The bone appears, as it were, sucked violenth into the socket, even DISLGC AT] JNS. 38T at the instant of its sustaining the gi-eatest force of extension. Then is it that the muscles, acting with one accord, set at naught the extend- ing power, and complete the work of reduction, in defiance of all the agents employed at the moment to prevent it. I consider that the muscles are the immediate agents of reduction, and not the surgeon, whose entire duty consists in placing the bone in a position to give them the opportunity of displaying this harmony of action, and of exercising a power, even beyond that of the mechanical agents of extension. It is this power that succeeds in forcibly drawing backward the head of the femur into its cavity, when it has fairly reached the rim of the ace- tabulum, notwithstanding the force employed at that instant in extend- ing it. In the examples of the larger dislocations, I place no reliance on any of the above-mentioned efforts of manipulation, but depend almost entirely on the act of simple extension, in the fullest confidence of the disposition of the joint to right itself if the obstacles be removed." Dislocation of the Jaw. — This accident arises from yawning Of gapine;, or from a blow on the . Fijr. 216. chin when the mouth is wide open. It may affect one or both sides. Fig. 216 represents the appearance of the mouth in a dislocation of both articulations. The mouth remains wide open, the saliva runs constantly, and there is often alarming but not dangerous pain. Treatment. — The reduction is easily affected. Place two pieces of soft wood, or large corks, as far back between the teeth as possible, to act i\s fulcrums ; then, while the head is held by an as- sistant, press the chin steadily upward and backward. Another method is : place the thumbs on the back teeth, and the palms of the hands and fin- gers on the sides and under sur- face of the jaw; then press downward with the thumbs, and forward and upward with the hands ; the thumbs must be removed as the joint slips in its place. DISLOCATION OF THE JAW. 888 5URGERY. Fig. 217. DiSLOCATiOxN OF THE Clavicle. — The collar-bone may be dis- placed at its sternal or scapular extremity ; in the former case it -- ^-= 't-; is pushed fonvard or backward, ■^:??=^?ii\ and in the latter generally up- ward. Fi^. 217 shows its situa- tion when dislocated at the breast- bone. In thin persons the nature of the injury is obvious at a glance ; but with very fleshy individuals the diagnosis is sometimes diffi- cult. Moving the shoulder, how- ever, occasions great pain ; and it is with much difficulty that the patient can move it at all. Treatment. — By pulling tho shoulder backward and slightly Fig. 219. CLAVICtTLO-STERNAL DISLOCATION. outward, the collar-bone is drawn down to a level with the breast- bone, when the head will readily fall into its proper place. To retain it in position, sur- Fig. 218. CLAVICLE BANDAGE BEHIND. CLAVICLE BANDAGE ANTERIORLY. geons have a clavicle bandage, which is buckled round the body and found the shoulders with a soft pad in each armpit, and another on DISLOCATIONS. 389 each shoulder. It is applied in dilterent modes by surgeons, and in- closes the arm, as it were, in a sling. A back view of it is seen in fig, 218, and a front view in fig. 219, which will enable any person of ordi- nar}' tact to adjust it successfully. The arm is previously supported in a sling. When the scapular end is dislocated, the shoulder on the injured side is depressed, as compared with the other, and also draion btivard toward the sternum. In reducing it, the surgeon, standing behind the patient, places his knee betw^een the shoulders, and draws them both backward, until the clavicle sinks into its place. The arm-sling and clavicle bandage are so applied as to keep the arm pressing slightly up- ward, and backward. Some degree of deformity will always exist after these accidents. Fig 320. Dislocations at the Shoulder-Joint. — The head of the hu- merus may be displaced downward into the axilla, forward under the clavicle, backward upon the dorsum of the scapula, and partially luxated upward against the outer side of the coracoid process. Symptoms. — In the downward luxation, fig. 220, the head of the bone is readily found in the axilla, or resting on the lower side of the in- ferior costa of the scapula; there is a tumor-like projection in the armpit, and a corresponding hol- low below the acromion process. The whole form of the shoulder is changed, the muscles being flat- tened, and the arm seemingly elon- gated ; the elbow cannot be brought to the patient's side without great pain, and the patient inclines to sep- arate his arm from the body and sui)port it with the other hand. When the accident has existed for a considerable time, an effusion of lymph into the joint may occasion a crepitus on moving the arm, something like the grating sound of a fracture. In the forward luxa^ tion, fig. 221, the head of the humerus can be plainly felt, and gen- erally seen upon the pectoral muscle below the clavicle. The point of the acromion process is very distinct, and beneath it is a considera- ble ho low. The coracoid process is on *^he outside of the displaced DOWNWARD LUXATION. 890 SURGERY. head, which, when the arm is rotated, can be observed to move. The elbow is thrown further back tlian in the downward luxation, the arm is much siiortened, and tliere is gi-eat difficulty in moving the arm in any direction. In the backward luxation, fig. 222, the projection of the head of the Fig. 221. Fig. 22" FORWARD LUXATION. BACKWARD lA^KTlOTH. bone is apparent at first sight, and when the elbow is rotated it is seen to move. It may also be felt by app'ying the finger just below the Fig. 223. -^=2^^ REDUCTIO OF AXILLARI I.UXATIOKS. D I S L C A T 1 X S. 391 spine of the scapula, and the change in the axis of the limb is quite ob- vious. This variety of dislocation is extremely rare- T'reatment. — The general plan of reducing luxations at the shoulder joint, adopted by modern surgeons, is represented in fig. 223. The patient is placed in a recumbent position, and tlie surgeon, sitting be- fore him, puts his unshod heel on the head of the bone in tlio axilla, Rnd presses it upward, while he pulls steadily and lirmly on the arm until the head of the bone slips into the glenoid cavity. By this simplo management, almost any person, although entirely ignorant of anat- omy, may reduce nearly all the luxations that occur* at this joint, by taking the case very soon after the accident. If greater force is re- quired than one person can exert, he may be assisted by others pulling behind him, by means of additional straps or bandages placed upon the arm. If this plan fails, greater force can be brought to bear by the method represented in fig. 224. The patient is seated in a chair, and Fig. 2'2A. EXTENSION' AND COITNTER-EXTENSION. C07infer-cxte7iding bandages so applied as to let the arm pass through them. For the extendi n, a bandage, a wetted roller, placed around the arm above the elbow, with straps or slips of cloth attached, will answer The arm is then raised so that the elbow is a little above the horizon- tal line with the shoulder, and, while in this position, two or more as- sistants make gradua' and steady extension upon it, an equal amount 892 SI KG Ell T. of* force being emplavetl in prfxlucing counter-extension at tlie some time. After tljs slniin ujx>n the muscles hns been continued for some Time, the surgeon, resting his foot on tlie chair, pushes his knee 'imo the HxillJi and presses up the he;jd of the bone, wliije he presses down on the ncroinion with one hand ; making also slight rotation upon the There is another methc J by which a majority of recent dislocations can be easily repkiced without waiting for the regular sui-geon. Plac» the patient in a chair, fig. 225, extend the luxated arm as far as possi Fig. 225. REDUCTION OK RECENT LUXATIONS. , ble from the side, then, .vith tlie kuee in the axilla — the foot being sup ptjrted on a chair, and the heel raised so as to press the knee upward — grnsp the humerus above the elbow with the hand, pressing down \i\xm the shoulder at the same time. The pulley and counter-extend- ing bandage, seen in the cut, may also be employed if necessary. In the forward luralicm, the extension is to be made obliquely down- ward !ind slightly b.ickward. The resistance is usually stronger tJian in axillary dislocatioiw ; hence extension must be kept up somewhat longer. When the head of the bone is observed to move, the surgeon should place his knee or heel against it, and press it backward into ita cavity. Tn other respects the management is the same as for the pre- ceding variety. D 1 S L C A T I C N S. 393 In the backward luxation the reduction is easy. After the shoulder is fixed, gradual extension is made directly outward, the head of the bone being thus moved slowlv forward into the glenoid cavity. This dislocation has been replaced by merely raising the arm, and turning the hand to the back of the head. After reduction, the arm should be carried in a sling for several dijys, and all motion at the joint prevented by suitable bandages. Dislocations at the Elbow. — Injuries at this joint are very fre- quently complications of dislocation, fracture, aad laceration. Sur- geons distinguish five varieties of dislocation. Both bones of the fore- arm ma}' be pushed backtvard, or to one side ; the radius may be dis- placed forward ; the ulna alone may slip backward over the cond^yle of the humerus; and the radius alone may slip from its connection at the elbow joint. Symptoms. — When the radius and ulna are both dislocated backward^ Fig. 226. Fig. 227. KLBOW LUXATION BACKWARD. fig. 22C, the posterior pi'ojection k very prominent. The olecranon process is above the external con- dyle, and a deep hollow may be felt on each side of it; while in front, under the tend^s, the con- dyles appear like hard tumors. The hand and forearm are supine, and cannot be entirely turned. In the lateral dislocations of both bones, whether inward or outward, they are driven more or less backicard. In the outivard dislocation, fig. 227, the projection of the ulna is still greater; the co- ronoid process is fixed at the external condyle; an^f the flat head of the radius forms a projection outside and behind the elbow, with an abrupt cavity above lateral eisloca* it. In the nm-cri luxation, fig. 228, the head of tion outward. t..e ulna is displaced behind or )ver the internal condyle, projecting ic ^94 SURGERY, ■\ ^ tliat direction, while the external Condyle is miule equally prominetit on its side by the radius occuyping the place of the ulna. When the idna is dislocated backward, the olecranon can be easily felt behind the humerus ; the arm cannot be straightened, nor can it be flexed to more than a right angle ; the forearm nnd hand are also tw'*?ted inward. In dislocations of the radius forward, fig. •2-29, the forearn: is more or less bent, but in Tempting to flex it further, it is suddenly stop- ped before k gets to a right angle ; the elevated head of the radius bears against the fore part of the humerus, where, if a finger be pressed into the bend of the arm, it may be felt moving. The hand is also in a state of pronation. In the backward dislocation of the radius, fig. 230, the head of the bone may be seen and felt behind the external condyle of the hu- merus ; the arm is nearly straight, and cannot be flexed ; the liand is pronate, and cannot be LATERAL DISLOCATION tumed. i-NWARD. Treatment. — The first variety is easily re- Fig. 229. FORWARD LUXAllu.N Fig. 230. U! FHE RADIUS. BACK-WARD LUXATI.X OJ THE R.^DIVi duced. The sur- geon places his knee on the inner side of the elbow, pressing chiefly on the displaced bones so as to keep them from bearing on the end of the hu D I S L C A r 1 N S. merus. and to bring the coronoid process out of the posterior fossa, so that it can pass over the condyles, while the arm is hent slowly and steadily with considerable force. This fnriit of luxation can generally be reduced with tlie aid of suitable hot water relaxant processes, a loiyy time after the accident. The second variety is mainly reduced by bending the arm over the surgeon's knee, as in the preceding case ; less pressure, however, is usually required, as the bones do not require the same separation from the humerus. The third variety is replaced still more readily by the same general plan. Here the bending of the arm is the principal pait of the oper- ation, the fixed radius acting like a levei- to push the humerus back ink< its place on the ulna. * To reduce the fourth variety, the surgeon takes the patient's hand, as in "shaking hands," and makes steady extension, while his other hand is pressed strongly on the ulnar side of the head of the radius, pushing it outward and wpicard. It will facilitate the reduction to have the arm slightly bent. In the fifth variety ei'tension is to be made upon the radius, and counter-extensio7i upon the humerus, while firm pressure is made on the head of the bone, until it slips into its place. One assistant may make the extension, another the counter-extension, and the surgeon make the pressure and direct the movements of the bone. Dislocations at the Wrist. — Six varieties of luxation occur at this joint. The radius and ulna may together be displaced forward or backward, or either of them separately in either direction. Symptoms. — When hoth hones are displaced forward., their projec- tion is seen and felt under the^^carpus. This accident is caused by falling on the palm of the hand. When hoth. hones are displaced haclc- it^arrof, they project oyer the carpus ; the carpal bones are thrown for- Flar. 2^51. BACKWARD LUXATION AT THK WRIST. ward and upward under the flexor tendons, in front of the forearm This luxation is represented ir. fig 231. TMiosic luxations may be dis- 396 SURGERY. tinguished from sprains, or strains, by the more sudden occurrence and more uneven appearance of the swelling. Wlieii the radius alone is displaced, the external or thumb side of llie hand is backward, and the opposite side inward or forward, the ex- tremity of the radius may also be seen to form a prominence in the front of thf> wrist. When the ulna alone is detached, which more fre- queiilly liappens, the connecting ligament is necessarily ruptured: iho liand is twisted, tlie bone projects at its back, from where it may be easily jiressed down; but when the j)ressure is removed, the deformity wif reappear. Treatment. — The process of reduction is similar when both bones are displaced either forward or backward. The surgeon holds the hand of the patient in one of his, and with the other supports the fore- arm, while an assistant holds the arm at the elbow, and keeps that joiiri slightly flexed. When sufficient extending and counter-extending force is applied, the bones are drawn into place by the contraction of the muscles. Compresses should then be placed upon the wrist, and secured by a roller which should inclose the limb from the tips of the fingers to the elbow ; after which a splint should be added, and the fore- arm suspended in a sling. The same ti'eatment precisely is required when the radius alone is dislocated. To reduce the dislocated ulna, it is only necessary to press the ulna down in its proper cavity at the side of the radius, and retain it there by compresses, bandages, and splints. The spiint3 should be well padded, extend along the forearm in a line with the back of the hand, and be well secured with a roller. Carpal and Mktacarpal Dislocations. — Displacements of the bones of the wrist are extremely rare ; but when they do occur, the hand is to be extended, and the bone pressed down into its place, and then secured by proper compresses and bandages. Luxations may occur at any of the phalangeal joints, and the smaller bone may project over or under the larger, constituting the post erixvr Fig. 232. POSTERIOR PHALANGEAL LUXATIOW. D I S L C A r I N s. 897 luxation, fig. 232, or the anterior, fig. 233 The nature of the accident will be readily distinguished at the first sight. Treatment — The general plan of reducing dislocated fingers and Fig. 233. ANTERIOR PHALANGEAL LUXATION. toes is as follows : The surgeon places his thumb at one of the divided extremities, and his finger at the other, fig. 234, then makes extension, while the joint is moderately flexed. The reduction will usually be Fig 234. Fig. 235. REDUCTION OF DISLOCATED FINGERS AND TOES. easily affected; but if a long time has elapsed since the accident, the extension may require to be kept up perseveringly for a considerable length of time. In such cases, a piece of tape is usually employed ; it is fixed to the finger by what is called the "clove- hitch," fig. 235, and to this the extending force is applied. The thumb, which is seldom dis- located, is with more difficulty re- duced. It 1 inquires great extending force, during which i* should be flex- ed toward the pahr of the hand. It should also be wp i covered with wet tape before the clove-hitch tape is applied. Dislocations at the Hip-Joint. clove-hitch. — ^I'he head of the femur may be displaced upward ov the dorsupt? of 34 398 SURGERY the ilium, fig. 236, or downward, into the foramen ovale, fig. 237, Fi- 236. Fig. 237. or \ UPWARD LTJXATIC "«r. Fig. 238. BACKWARP LUXATXOJf OOWITWAHD LUXATIOjr. Fig. 239. »VRWARD LVXAWOW, DISLOCATIONS. backward, into the iscliiatic notch, fig. 238, or forwc^d, on to the pubes, fig. 239, in which case it is Also thrown upward. The first va- riety is the most frequent, being the result of violence in an upward and outward direction. Syinptoms. — In the j^? 67. variety Xh.& femur rests on the concave side of the pelvis ; the limb is shortened from an inch and a half to two inches; the knee closely approximates, yet does not touch that of the other leg ; the foot is turned inward ; the thigh can be bent over the opposite one, and the round head of the bone can be felt moving upon the ilium. Fig. 240 represents the appearance of the limb while the patient is in the standing position. In the downward dislocation, the head of the bone can be felt by ex- amining the inside of the thigh, especially in thin persons ; the leg oi* the affected side is about two inches longer than the other ; the tro- chanter is less prominent than on the sound side; the body is bent for- ward; and when the patient stands erect, the knee projects in ad- vance of its fellow, and is kept wide apart from it; the foot, though separated, is turned neither in nor out, fig. 241. Fig. 240. Fig. 241. VPWARD J.TJXATIOX. JIOTVNWART LUXATION iOO 5 U R G E R Y In the back'-ard luxation, the head of the femur can rarely be felt; flio trochanter will be found further back than natural ; the foot and knee are turned inward ; the knee is slightly flexed and advanced for- ward ; the heel is raised, and the ball of the great toe rests on the base of the other grea»- toe, and the limb is shortened from half an inch to an inch, fig. 24'2. In the forward and upward luxcation, the head of the bone is at once discovered in front, and a little above the level of Poupart's ligament, which circumstance distinguishes the case from a fracture of the neck of the femur ; the limb is shortened from one to one and a half inches; the knee is everted ; the foot and knee cannot be rotated inward, bat the thigh can be flexed, bringing them forward. In the erect position this patient, fig. 243, contrasts strikingly with the preceding one. Treatment. — As the muscles concerned in this articulation are large. and their resistance powerful, it is always prudent to relax the whole Fig. 242. Fi?.243. BACKWARl -.UXATION. !■ R\V.4:RD LUXATI01» DISLOCATIONS. 401 musculai system before atteinpting reduction. An admu'able and very pleasant method of doing this is to envelop the patient in the warm wet-sheet pack, placing hot bottles to his feet and sides, and covering him well with bedding, the affected limb being sustained in an easy po- sifcon by pillows ; while in the pack the patient should drink abundant- ly of wai-m water, and after being sufficiently relaxed for the opera- tion, he should be kept well covei-ed in flannel blankets to retfiin the heat and moisture, and prolong the relaxation. All of these hip dislo- cations can frequently be reduced by the rotary, or "Sweet plan;" but surgeons have a specific and surer method for each variety. In the vjpward displacement the patient is laid on a table, or placed Fi£. 244 REDUCTION OF UPWARD LUXATION. on a board, fig. 244, covered with a quilt or blanket ; a strong counter- extending strap is passed between the legs — a sheet split in two, and folded into the width of four or five inches, will answer; this is passed up before and behind the hip; so placed as to press upward on the perineum, at the inside of the dislocated limb, and listened to some unyielding point. A wet bandage, of eight or ten turns, is applied around the limb, above the knee, and to this the extendh^g straps are attached. These are to be draw^n upon by the assistants in the direct line of the limb ; or, what is better, attached to a pulley, so stationed ^bat the extension may draw in a direct line with the fastening of the rounter-extension. The force is to be steadily increased as long as tlie patient can well bear it, then held stationary for a few moments, until he ceases to complain, then again increased, and so continued until the bead of the bone reaches the edge of the socket, when the surgeou rotates the limb a little, and elevates the head until it entei's the aceta- bulum. The snapping noise, as the head of the femur slips into its socket, when the extension is made by rr»a aual force, is not always 402 SURGEPa he:ird when the force is more steadily and gradually- apphed by the piilif'Vs; honce it is sometimes necessary to ascertain the fact of its repliujenient by actual measurement; and until this point is settled the ejwtension should not be abated. In some cases the head of the bone is held fast over the edge of the socket; to prevent this a towel or handkerchief may be placed round the thigh, as high up as possible, and the bone lifted by it at the proper moment. The above is the plan approved and recommended by the best "standard authorities;" but, after all, it is probably neither the best method, nor founded on true mechanical nor physiological principles. A very different and much more easy plan for both surgeon and pa- tient, which dispenses with the torture of traction entirely, was prac- ticed successfully many years ago by the late N. Smith, of Yale Col- lege, and has since been adopted by Dr. Cartwright, of Natchez, and recently explained by Dr. Reid, of Rochester. It is as follows : Place the patient on his back, without fastenings of any Jdnd, the leg flexed on the thigh, and then strongly adducted — carried inward; in this con- dition the adduction is continued by flexing the thigh on the pelvis, until the knee is as high as the umbilicus. This plan is predicated — correctly, I think — on the idea that the distention of the small muscles constitutes the main obstacle to reduction, instead of the contraction and resistance of the large ones. The reduction of the downward luxation is much easier than that Qf the upward. The patient is placed on the back, the thighs sep- Fig. 245. REDUCTION OF DOWNWARD LUXATION. ] arated, f\ gether, or either of them singly. Fig. 262 repre- sents a fracture of both bones, with a view of the in- terosseous muscles, whose contraction tends to draw the bones together, so as to prevent the circular movement of the radius round the ulna. Wlien the radius alone is fractured, fig. 263, the depression and crepitus readily points out the place of injury; and the same symptoms on the opposite side of the arm denote a fractured ulna, fig. 264. The surgeon, in all these accidents, has only to ti-ace the bones up from the wrist, until the finger comes- to the divided part, when a depression will be felt ; and by fixing the elbow, and rotating the wrist, the crepitus will be experienced. The lower end of the radius is sometimes frac- tured near the wrist, where the hand is distorted, and appeai-s very much like a dislocation, fig. 265; Fig. 263. >*• > ■ — i \ FRACTURE OF THE ULNA AND RADIUS. FRACTURE OF THE RADIUS. but, on moving the hand, the styloid process of the radius moves with 't, which is not the case when the bone is dislocated. Fig. 264. F3 .^.CTURE OF THE ULNA. 410 SCJRGERT. Treatment. — In the fust vni'iety— fracture of both hones — the most important point in the tieatment is to keep the bones apart. After ad- Fig. 265. FRACTURE OF LOWER END OF THE RADIUS justing the bones, by making the necessary extension at the wrist ^le arm sliould be bent at a right angle, with the thumb midway bet- een pronation and supination ; the loose roller is to be applied, and thVs, fo' lowed by two splints, one on the inside, and the other opposite, which should be convex on the side next the arm, and well padded with cot- ton ; the splints are, lastly, to be secured by a roller extending from the hand to the elbow. When the radius alone is fractured the hand may hang k)ose, and thus exert some degree of extending force on the bone. When the ulna alone is broken the hand and forearm should be kept in the same line, and the splint and bandage should extend to the ends of the fingers. The s])lints should in all these cases, as a general rule, be worn ten or twelve days ; but the compress and bandage should be continued a week or two longer. The only point of difference in the treatment of a fi-acture at the lower end of the radius, is in so adjusting the pads and compresses that they may aid in keeping the two bones apart and the fractured portions together at the same time. Though passive motion may be employed ]n Shree or four weeks to prevent anchylosis, no great exer- tion should be made by the hand for several months. FnACTURKS OF THE Wrist, Hand, AND FiNGERS. — These acci- dents require a broad splint fitted to the front of the wrist and hand, with the ends slit for the fingers, the parts being well padded to secure equal pressure, and the splints fastened by the roller. Splints may also be adjusted to the sides and back of the fingers. A single finger bone may be fixed with four small splints secured by tape. Fractures of the Thigh. — The neck of the ftmur may be frac« tured irillii?' or without the cavsulcr ligament; the trochanter majo' FRACTURES. 417 FRACTURE WITHIN THE CAPSULE. Fig. 267. may be broken obliquely; and the shaft at or near the tro- chanters, in its middle, or near the condyles. Symptoms. — The fi'acture icithin the ligament, as repre- sented in fig. 266, generally unites by a ligamentous sub- stance, or a double joint is formed, and the limb perma- nently shortened. The accident is known by the inability to stand on the leg, the limb being shortened one or two inches, the knee and foot turned out, and the heel inclining to rest on the other limb above and behind the malleolus, fig. 267. Severe pain is felt on moving the limb, and a crepitus will be recognized on rotating it. Sometimes, however, the shortening of the limb does not occur until seveml hours after the accident ; and in some rare cases it is said the foot turns in in- stead of being everted. In fracture outside the ligament, the pain and swelling are greater — often extreme ; the limb is not materially shortened nor everted, and crepitus is more easily felt. When the bone is fractured obliquely through die trochanter major, the leg is everted, a little shortened, and a fissure can be felt between the shaft and ti'ochanter. When the shaft is broken just below or near the trochanters, the psoas and internal iliac mus- cles draw the superior fragment of bone upward and forward, causing great pain and deformity. When the shaft is broken betiveen the tro- chanters and condyles, the deformity, crepitus on extension or rotation, and inability to bear weight upon the limb, determine the nature of the case. If the fracture be oblique, the limb will be much shortened by che broken parts slip- FRACTURED NECK OF THK FICMirH. 418 SUR3ERY. ping by each other; and this mmj be the case also in transverse frac- tures. * The condyles of the femur are seldom bi'okeu except in old per- sons, and the accident is not unfrequently fatal. Treatmoit. — Sir Astley Cooper, in speaking of the various methods for treating fracture of the neck of the femur ivithin the capsular liga- ment, says: " Baftled in all our attempts at curing these cases, and finding the life of the patient occasionally sacrificed under the trials made to unite them, I should, if I sustained this accident in my own person, direct that a pillow should be placed under the limb throughout its lent^rh; that another should be rolled up under the knee, and that the limb should be thus extended until the pain and inflammation had subsided. I should then daily rise and sit in a high chair, in order to prevent a degi'ee of flexion which would be painful ; and, walking with crutches, bear gently on the foot at first, then gradually more and more, until the ligament became thickened, and the muscles increased in their powei". A high-heeled shoe should be next employed, by which the halt would be much diminished. Our hospital patients, treated Eifter this manner, are allowed in a few weeks to walk with crutches ; after a time a stick is substituted for the cixitches ; and in a few months they ai'e able to use the limb without any adventitious support." Fracture of the neck outside the capsular ligament, admits of ossific union, though this does not always result. Sir Astley's plan of adjust- ment, as simple and practical as an}^ is thus described : " In the treat- ment of this injury, the principles are to keep the bones in approxima- tion, by pressing the trochanter toward the acetabulum, and to pre- serve the length of the limb. The foot and ankle of the injured side should be firmly bound with a roller to the foot and ankle of the other leg [which is to be kept straight], and thus the uninjured side will serve as a splint to that which is fractured, giving it a continued sup- port, and keeping it extended to the proper length. A broad leatherc strap should also be buckled around the pelvis, including the ti'ochan- ter major, to press the fractured portions of the bone firmly together ; and the best position of the limb is to keep it in a straight line with the body." Mr. Listen's jilan, applicable to all cases, as detailed in his own lan- guage, is as follows : " Whethor the fractjire is suspected to be within or without the joint, either entire!- or partiaiiy, the biOKen surfaces are to be brought in contact and retained immovably in apposition for a time sufficient to admit of union. The limb is put up in apparatus not requiring removal, and but little adjustment. This can be effected only in the extended position. Many splints, with foot-boards, straps, and screws, are intended for this purpose, soma to be attached to the in- 7KACTURES. 419 juved iimb, others to the sound one; but the apparatus which is most simple, easily to be procured at all times and in all circumstances, is at once the best and most efficient. This is a straight wooden bo-ird, not so thick as to feel cumbrous, and not so thin as to be pliable or easily broken ; in breadth, corresponding to the dimensions of tlie limb ; in length, sufficient to extend from two, three, or four inches beyond the heel, to near the axilla ; deeply notched at two places at its lower end, and perforated by two holes at the upper. The splint, well padded, is applied to the extended limb, the ankles being protected by proper ad- •ustment of the pads. The apparatus is retained by bandagmg, fig. 268, a common roller is applied round the limb, from the toes to n-ear the knee, so as to prevent infiltration, which would otherwise follow Fig. 268. ADJUSTMENT OF FRACTURED NECK OF THE FEMUR. pressure above by the rest of the apparatus. The splint is then attach- ed to the rest of the limb by involving both in a roller from the foot to above the knee ; and, in doing this, the bandage, after having been turned round the ankle, should be passed through the notches, so as io be firmly attached to the end of the splint, thereby preventing the foot from shifting. A broad bandage is applied round the pelvis, over the groin and down the thigh, investing all that part of the limb left uncov- ered by the previous bandaging. A broad band, like a riding-belt, is fastened round the pelvis, so as to bind the splint to the trunk, and thereby keep the broken surfaces of the bone in contact. A large handkerchief or shawl is brought under the perineum, and its ends se- cured through the openings at the top of the board. It is evident that the splint, being thus securely fixed, and made as part of the limb, tight- ening of the perineal band will extend the member and preserve it of its proper length. By care and attention in applying the apparatus, and in adjusting the cushions about the ankle and perineum, there is lit- tle or no risk of the skin giving way. The bandages will require to bft reapplied once or twice durmg the cure ; and the perineal band should be tightened frequently. The apparatus is retained for six or eigh^ weeks, the time necessary for union varying according to circumstan- ces Afte' its removal great care must be t^iken a first in moving the 120 SURGERY. limb mid putting weight upon it; it should be accustomed to its formeif functions very gradually." Another convenient mode of fixing the thigh bone, is the concave duuble-inclined splint, recommended by Dr. Beach, with the foot- board added by Dr. Hill, fig. 269. The manner of using it must be ob- vious at a glauce. Fiff. 269. DOUBLE-INCLINED CONCAVE SPLINT. The ohliqiLC fracture of the trochanter major is managed precisely like the preceding case. When the shaft is fractured, the most important point in surgery ia to prevent the shortening of the limb. The patient is placed in a sit- ting position, by which the psoas and iliacus muscles are relaxed, and the ends of the bones approximated. Extension is then made until the two limbs correspond ; the roller is next applied, from the toes to the hip ; three splints are then placed over the first bandage ; one in front from the patella to the pelvis ; one from external condyle to the tro- chanter major ; and one from the internal condyle to the perineum. Dr. Hill — I think judiciously, too — recommends a fourth splint of stout gum-shellac cloth to be applied on the inferior surface, from the tube- rosity of the ischium to the hollow of the knee, wide enough to cover one third of the thigh, and perfectl}^ adapted to the surface. All the splints are to be firmly fastened with a roller, when the limb should bo placed on the inclined splint, or supported by some similar appara- tus. Three separate rollers are commonly employed ; the first is so applied about the knee as to admit of its being bent. The patient should not lie down for ten or twelve days, as that posture is exceed- ingly liable to displace the broken bones. When one or both condyles are fractured, the limb is to be straight- ened so that the hfad of the tibia will press upon the condyles, and se cured with rollers and splints. Fracture of the Patella. — This bone is generally broken transversely ; the upper fragment is drawn up by the rectus femoris* FRACTURES. 421 the patient cannot straighten the limb ; and the fissure between the brolien portions can Le seen and felt, fig. 270. Treatment. — The usual method of adjustment is to secure the limb in a perfectly straight position by a stiff splint extending down the back of the thigh to the calf of the leg, around which a roller is applied. The divided parts may be brought together by straps buckled around the limb above and below them, and drawn together by other straps attached to them, which pull the circular ones up and down un- til coaptation is complete. When the broken parts ai-e not accurately adjust- ed, the union will be ligamentous in- stead of osseous. When fractured longitudinally, the leg is to be extended, the parts brought together, and secured by bandage, compresses, and paste-board splints. Fiar. 270, FRACTURED PATELLA. Fig. 271, Fractures of the Tibia and Fibula. — These accidents are readily detected by the de- formity, pain, crepitus, etc. Treatment. — When the head of the tibia is fractured, the management is the same as for fractured condyles of the femur. What is com- monly termed "broken leg," is a fracture of one or both bones between the knee and ankle. The double-inclined splint apparatus, or some similar contrivance, is here necessary. The application of the roller, fig. 271, which is the first part of the dressing, need not begin at the toes, as in the case of ulcers, nor be as firmly bound. This bandage is applied before the bones are ftilly ad- justed, and not so tight as to prevent further ex- tension. In all fractures the great toe is to be kept in a line v/ith the inner edge of the patella. In oblique fi-actures, after the provisional appli- cation of the roller, the limb should be placed on the inclined splints, and extended until the two limbs compare exactly ; the f>ot is then to be 2G THE ROLLER 422 SURGERY fixed (o the foot-board by straps that will not stretch ; and after the ad- justment of the bones is completed, two or three splints are to be ap- plied and bound with a roller, which is also to extend around the in- clined or supporting sj)lints. Any ingenious mechanic can make a ma- chine in ill! hour or two which will serve as an inclined plane, and an- swer as a substitute for the double concave splints before mentioned. Fractures about the Ankles. — By twisting the foot outward, the Jib III a is sometimes broken about three inches above the ankle, ac- companied with i)artial or complete dislocation of the ankle, fig. 272. I'he internal malleolus, by projecting, forms a tumor, and when the foot is moved, crepitus can be felt just above the external malleolus. Fig- 272. Fig. 273L FRACTURE OF THE FIBULA. FRACTURED TIBIA. The tibia is sometimes fractured near its lower end; i6 may be transverse, extending through the fibula ; but is generally oblique with the internal malleolus also broken, fig. 273. The foot is turned in- ward, .'uul the crepitus is felt on the inside. Treatment. — In the first variety the dislocation must be reduced be- fore the frnctui-p is adjusted. The fractured parts are to be kept in PARTICULAR OPERATIONS. 423 place by one splint at the back of the leg, another along the fibula, the foot-board, and the usual bandages. In the second variety a splint is to be applied on the side of the tibia. Fractures of the Foot. — Nearly all of these cases are connected with severe contusions and lacerations. The medical treatment is as important as the surgical. The cold water-dressings and bandages must be employed with a vigor proportioned to the intensity of the inflam- mation; and the fractured bones kept in their places by pasteboard or shellac splints, compresses, and bandages applied to meet the indica- tions of each case. Note. — There are some iiircumstances which the practitioner should always bear in mind, although they have not always been specified in treating of particular fractures and dislocations. In the first place, any injury of the kind, and especially those about the wrist, knee, and an- kle, as well as complicated cases generally, are liable to severe inflapi- mation. When fractured or dislocated parts are very painful or badly swelled from inflammation, this must be subdued before adjustment or reduction is attempted. In the second place, adjustment or reduction is always greatly facilitated by previously bathing the part in as warm water as can well be borne. Thirdly, in all cases of fracture or dislo- cations involving the sti'ucture of a ioint, very gentle or passive motion should be made at the joint as eari) is is consistent with safety, to pre- vent anchylosis, or stiff joint. If made too soon, however, there is dan- ger of re-displacement. The time and extent of this motion must be determined by the nature and place of the injured, the age and health of the patient, ect. CHAPTER XI. PARTICULAR OPERATIONS. Trephining. — When performed for a fracture of the skull, a small opening is sufficient; but when the object is to evacuate matter, it should be larger. The requisite instruments are, a large and small trephine, a Hay's saw, an elevator, a scalpel, with the common pocket- case. A flap is made through the scalp in the shape of the letter D, the circular side of which is raised, when loose fragments of bone, if 424 SURGERY. present, are to be removed. The lining membrane of the bones — per- icranium — is next to be separated, or a circular incision made through it for the edge of the instrument. The trephine is to be applied so that the centre-pin will rest on a sound portion of the skull ; the instru- ment is then turned steadily forward and backward, gentle pressure being made upon it at the same time, removing it frequently-, and clearing the teeth with a brush ; the groove must also be examined frequently, and the dust and blood removed with a piece of wetted sponge. When the groove is deep enough to steady the instrumeni:, the centre-pin is to be withdrawn; and as soon as any point of the bone is cut through, an attempt should be made to raise the piece of bone within the circle ; but if it does not succeed, the sawing should be very cautiously continued until the bone is nearly cut through all round, when it may be detached with ease. After purulent matter or ex- travasated blood is removed, or the depressed portion of bone elevated, the' scalp is to be replaced and secured with the wet compress. The trephine should not be applied over a suture, nor over the course of the middle meningeal arteries. Paracentesis Capitis. — The operation of puncturing the head has been resorted to in some cases of external dropsy. One of the fonta- nelles is the point usually opened ; the fluid is drawn alf very gradual!}-, 80 as to avoid fainting. The wound heals readily, but the operation seldom succeeds in effecting a cure. Paracentesis Oculi. — Tapping the eye to let out the humors is among the regular resources of chirurgery, w-hen the inflammation is 80 intense that the "ordinary means" fail; but as the hydropath has ample and e.r^raordinary means to subdue inflammation, /te will have no occasion to "operate" in this way. In dropsical affections of the eye, attended with a gradual and per- manent enlargement of the globe, protuberant eyeball, and excessive pain, the eye may be properly punctured. A common lancet, or couching needle, may be introduced "behind the junction of the cornea with the sclerotic coat, into the posterior chamber. Some surgeons puncture the anterior chamber through the cornea. Fistula Lachrymalis. — A small, sharp-pointed bistoury, or cata- ract knife, is held perpendicularly to the eyebrows, the point directed to the lower margin of the internal tendon of the eyelids, wdiich may be seen on drawing the lids outwai-d, the patient sitting erect, and the surgeon standing behind. Tlie point of the instrument is pressed di- PARTICULAR CPERATIONS. 425 rectly downward, fig. 274, until it enters the sac, which will be denoted Fig. 274. by a flow of tears and mucus. The opening should be slightly enlarged out- wardly as the knife is withdrawn. A probe, curved a little forward and in- ward, is then inti'oduced, and, if necea sary, pushed through into the nostril when a tube, style, or tent is inserted. Entropium and Ectropium. — The inverted lid can often be restored by cauterizing the outside of the lid, or by incising the mucous membrane. Emer- sion is often cured by a removal or divi- sion of the tarsus. LACHRjfMAL F'STULA. Anchyloblepharon and Symblepharon. — The first of these terms is applied to a growing together of the eyelids, whi "h may be remedied by the use of olive oil, or any bland cerate ; and the second, when the lids adhere to the eyeball. They are sometimes dissected apart, but the operation is not often successful. Ptosis and Lagophthalmos. — The former case — elongation or drooping of the eyelids — may generally be remedied in the same way as entropium; and the latter — a shortening of the eyelids — nay be treated as ectropium. Blepharidoplastice and Rhinorrhape. — In relation to these formidable words, I can only inform the curious reader that the first ap- plies to the formation of new eyelids and eyelashes from the adjacent integument; and the second, to new lids, or parts of lids, from the in- tegument taken from the back of the nose. New eyelids have also been formed of the integument of the temple. Rhinoplastice. — This operation, sometimes called taliacotian, con sists in the formation of an artifio^al nose from the integument of the forehead or temple. In this and all similar cases, the particular circum- stance of each case must determine the kind of operation required. ScHLESEKTOMY — Keratoplastice. — Thesc terms have been lately applied to an operation for the formation of an artificiaV pupil. Expe- rience dl^es not justify it except in cases of complete blindness. 420 SURGERY. Fig. 275. HARD LENTICULAR CATARACT. Fiff. 276. Otoplastice.— One of Talmcozzi's operations for forming a new e^r out of the scalp of the oack pjirt of the head is so called. Cheilo and Gznio-Plastice. — These are still other taliacotiaa operations, either performed or proposed, to restore lost parts of the lips and chin by taking the integument adjacent. Couching. — This is one of the operations for curing blindness caused by cataract. The disease con- sists in an opacity of the crys- talline lens, or its capsule, or both. The eye presents very ?:. different appearances in dif- M ferent forms of the disease. ^:^ Fig. 275 represents a hard cataract ; it has a radiated ap- pearance, with an amber-col- ored center and gray circum- ference. Fig. 276 shows the appearance of the eye when the lens is in a soft pulpy or creamy state. Liston says, "the darker the color, the harder the cataract." Opacity in the anterior part of the capsule is usually indi- cated by a whitish spot in the center of the pupil, with a dark blue circle around it ; and when the opacity is in the posterior portion, it ap- pears concave, striated, and yellowish, and at a distance behind the iris, fig. 277. In the majority of cases, how- ever, the affection is of a mix- ed character. For a day or two before operating, surgeons usually keep the pupil dilated by the frequent application of some sti'onff narcotic to the lida SOFT LENTICULAR CATARACT. Fi«r. 277. CAPSULAR CATARAPT PARTICULAR OPERATIONS. 427 and balls of the eye, as extract of belladonna, stramonium, etc. The head of the patient is steadied by an assistant, who also holds the eye fast with the speculum; the upper lid may also be held by the fingers of the assistant, and the under lid by the operator, who is obliged to prevent the eye from rolling with one hand, while the other handles the instruments. The usual position of the patient is a low chair, in a well- lighted room, and that of t'ie surgeon, seated on a high chair in front, with a foot-stool to steady his elbow on his knee. The couching nee- dle is introduced through the sclerotic, about two lines from the cornea, and a little below the horizontal axis of the eye, and its point carried slightly backward to avoid the iris ; when the point of the needle ia seen in front of the lens — by looking through the pupil — the capsule is to be detached from the lens with the sharp edges of the needle, and then pushed down out of sight. But if the lens itself, or its posterior capsule, then appear opaque, the edge of the needle is to be moved round its margin to separate the lens from the tunica liyoloidea, and then the lens pushed down by placing the flat surface of the needle on top of it, fig. 278, below the pu- pil, and slightly backward into the vitreous humor ; or it may be drawn down by thrusting the needle into it. If the lens rise on raising the needle, it is to be held down until it will remain stationary, when the operation is finished and the needle may be withdrawn. The patient should be kept in a dark room, and the eye closed and covered with a cold wet cloth for several weeks, until all danger of inflammation is passed. I ii. 273. COUClilXG. Extraction. — This is the operation for removing the opaque lens. The upper eyeUd is supported by the retractor, or by an assistflni instead of a speculum, and the lower one by the fingers of the sur- geon. Resting his little finger on the patient's cheek, the point of the cornea-knife is passed edge downward through the transparenfc cornea, a little within its outer margin and above its center, and passing straight across, parallel to the iris, emerges at the opposite margin. The wedge-shaped edge of the knife advances in two directions round the cornea, making a semicircular section, fig. 279. On removing the knife, the lids are instantly closed, the operator giving the assistant a signal ft)r the purpose. In a short time the eye is again opened, fthe (28 5URGERT Fi? 079 3ornenl flap raised, a needle inserted, and the capsule lacerated with it. Slight pressure is then made upon the ball, unless the lens passes out at the opening without. After examining the eye to ascertain if the iris is prolapsed — in which event the eye has to be exposed to a sti'ong light> to cause contraction and retraction, or the iris pushed back — the cornea is adjusted, and the eye dressed with the com- press and bandage. EXTRACTIOX OF CATARACT. Absorption, or Solutio'. — This is another and the easiest meth- od of disposing of an opaque lens, but it frequently has to be repeated. It is best adapted, however, to congenital and soft cataracts. Surgeons have an anterior and posterior operation ; but the latter is preferable. The couching needle is introduced as for depression or coucliing, the capsule broken up, and the lens cut in several directions. If this does not soon effect its absorption, the needle is again introduced, and the lens broken into minute fi-a^ments. Teeth Drawing. — The turnkey has long been in use for extracting teeth, especially the back teeth ; but forceps are becoming more and more in favor in all cases. When the turnkey is employed, the gum should be cut cleanly from the neck of the tooth with the point of a sharp penknife, the hook of the instrument fastened upon the tooth as low down or near the jaw-bone as possible, and the fulcrum resting on, and not against the side of the jaw. This manner of adjustment will raise the tooth as nearly perpendicular as possible, and to that extent diminish the danger of breaking the jaw-bone. In some cases the neck or fangs of the tooth are firmly adherent to the jaw when a great- er or less fracture is inevitable. The severe bleeding which some- times follows the operatioii, can be readily checked by washing the mouth with the coldest wat6r, and exposing it freely to the cool, open air. When ybrcrp.? are used, of which several sizes and shapes are man- ufactured to suit the different teeth, figs. 280, 281, and 282, the blades are to be pressed firmly down to the jaw, and while the tooth is raised by a steady force, slight lateral motions are to be made to loosen the fangs in tb<^ sofket. In the extraction of incisoi teeth, circular motior PARTICULAR OPERATIONS. 429 should be made. The cuspids may be extracted witli the incisor, and the bicuspids >vith the molar forceps. In extracting fangs or spags," Fia:. 280. MOLAR FORCEPS OF DR. HILL. Fig. 281. COMMON INCISOR FORCKPS. Fig. 282. POINTED FORCEPS FOR EXTRACTING FANGS. the gums are to be completely detached, and the sharp points of the forceps pressed as far down as possible, M^hen the fragment is to be seized, raised, and rotated at the same time. Pumping the Stomach. — The introduction of the common stom- ach-pump requires no special directions ; but in emergencies, as in rases of poisoning, the stomach can be emptied by introducing the elas- tic tube of the common injecting syringe, using the syringe itself as the pump. When it is withdrawn, the outer end should be closed, so that whatever liquid it might contain would not run back into the stomach. Catheterism. — This term applies to the clearing and enlarging of various canals in the body, but is usually understood as pertaining sole- ly to the passage of the catheter through the urethra into the bladder. Either a sti-aight or curved tube can be inserted by any one ftimiliar with tlie anatomy of the parts. 480 SURGE R Y. To introduce tho male catheter most conveniently, the patient lies on the back with the shoulders somewhat elevated ; the catheter is held at n right angle to the body until its point reaches the arch of the pubes, and then depressed to a level with the thighs, when the point of the in- strument will slip over the triangular ligament and enter the bladder. The female catheter is easily introduced, as the thickened edge of the urethra can readily be felt about an inch behind the symphisis pubis, at the upper edge of the vagina. Conunon catheters for the urethra are made of silver or gum-elas- tic. When the latter is introduced, a wire is contained within the tube to prevent its bending on meeting with resistance in its passage. A catheter is sometimes passed into the Eustachian tube to clean or enlarge it; the orifice of the tube is about a quarter of an inch behind the soft palate, and is large enough for the insertion of the little finger. The instrument is passed through the nostril with its convexity up- ward, until the patient gags, when, by turning the point further to- ward the affected side, it will slip into the tube, or the point may be directed into it by the finger introduced through the mouth. Inoculation. — This operation has thus far been confined to vacci- nation — the introduction of the kine-pox virus as a preventive of small- pox. The cuticle is raised with the point of a sharp lancet or needle, and the vaccine lymph, previously moistened, rubbed on the abraded surface. Three or four punctures are usually made near each other, on the outside of the arm above the elbow. But the French surgeons are threatening us with another kind of in- oculation, that of syphilis itself! It is announced in the late medical journals, that the wonderful discovery has been made that, by repeat- edly inoculating the system with this virus until the system is saturated so that it will take no more, the system will thenceforward be proof against any further action of syphilitic poison. What use "the pro- fession" in Paris or New York intend to make of this "discovery," is not stated; and I mention the subject for the especial purpose of rep- robating the gross immorality as well as arrant quackery of the whole affair. CEsopHAGOTOMY. — The gullet has sometimes been opened to ex- tract foreign bodies, and to introduce food into the stomach. An inci- sion is made between the trachea and sterno-cleido mastoid muscle ; and the dissection made chiefly with the fingers, to avoid the recurrent nerve, the fascia being cut with the protection of a director. The op- eration may prolong, but seldom saves life. PARTICULAR OPERATIONS. 13i Choking is generally produced by some substance lodging just above the cricoid cartilage, from which it is in most cases soon pushed for- ward toward the stomach, or raised a little, sticking fost in the pharynx, where it may produce suffocation by pressing upon the lurynx and ex- citing spasm of the glottis. By opening wide tlie mouth, the article can generally be loosened with the finger, a fork, teas^poon, spoon-han- dle,, or curved forceps. If it has passed below reach in this way, it may bo pushed into the stomach with H^rrobang, a piece of whalebone, hav- ing a rounded end, and covered with silk ; or withdrawn by means of an air-pump. Laryngotomt. — This operation is sometimes necessary to remove foreign bodies. An incision is made through the skin from the lower side of the pomum adami to the lower border of the cricoid cartilage. The skin is then separated, and the cellular membrane ruptured with the handle of the scalpel, between the sterno-hyoid muscles down to the crico-thyroid membrane, v/hen the point of the scalpel h r>assed sud- de-tiiy through this membrane. Tracheotomy. — The trachea or windpipe is sometimes opened ia order to extract foreign substances. The place selected is the median line, extending from near the upper end of the sternum to the cricoid cartilage. It requires a skillful anatomist. Paracentesis Abdominis. — "Tapping," as this operation is usual- ly called, is performed in ascites, or dropsy of the abdomen ; it is justi- fiable whenever the fluid is contained in a cyst, and when all the usual means for promoting the absorption of the fluid have failed. The pa- tient sits in a chair; a bandage is made of a sheet folded about half a yard wide ; this is placed around the abdomen, with a hole in front through which to operate, and crossed behind the back, where the ends are lield by two assistants, who are to tighten it as the fluid es- capes. The surgeon then makes an incision in the Unea alba, tv/o or three inches below the umbilicus, fig. 283, with a sharp lancet or bis- toury, through which a blunt tube or canula is introduced to carry oflf the fluid. If faintness occur, the flow must be lessened or even dis- continued for a time and if excessive fainting supervene, the patient may be placed in a horizontal position, and the completion of the ope- ration deferred for several hours, or even a day or two. The only dressing required is the adhesive strap and bandage ; the patient must keep very quiet for several days, and then revsume habits of exercise very gradually. 482 SURGERY Paracentesis Vesica. — The bladder may e "tapped" above the Fig. 283. PARACENTESIS ABDOMINIS. front of the pubes, or punctured through the rectum in males, or vagi- na in femcles, in obstructions which admit of no other method of relief. Imperforate Anus. — Children are sometimes born with the in- teiiument closed over the rectum, which can be observed swelling be- neath. A simple incision will remedy the difficulty. When the rec- tum cannot be reached, and in cases of its closure in the adult in con- sequence of disease, the only remedy is an artificial anus. This is usually made by cutting in the loins to the descending colon, and at- biching the bowel by two ligatures to the lips of the wound; an inci- sion is then made into it, and the lips of this wound more closel}' united with those of the first. Imperforate Urethra. — When this is a congenital malformation, a round trochar is to be inserted, followed by a cauula, and then by a catheter, and this is retained until the orifice \ieals. Lithgntripsy and Lithotomy. — Each of these modes are resort- ed to for stone in the bladder. The former operation consists in cnishing it in the bladder with an instrument called the lUhontriptor, and is only apj)]icQble to adults when the stone is soft and small ; and the latter consists in cutting into the bladder with the gorget or knife. The operation of lithontripsy is more frequently applicable to the fe- male, by reason of the larger diameter of the urethra; and for the «ame reason, even this is very rarely necessary. PARTICULAR OPERATIONS. 438 For the operation of lithontripsy, the urethra must be dilated by Dougies until the lithontriptor will pass. This instrument, fig. 284, w Fi-. 284. LITHO?,-TRIPTOR INCLOSING A CALCULUS. then oiled and passed into the bladder, while closed, as a common bougie. When it comes in contact with the stone, the movable half is pushed in, by which the blades are opened at the several joints; it is then rotated from side to side, tightened occasionally, etc., so as to grasp the stone ; when fixed between the blades — which fact is known by the inability to draw the sliding part back — the arms of the screw are turned gradually, by which the slide is withdrawn and the blades brought slowly and with great force together. After the stone has given way and the instrument closed, it is to be reopened and man- aged in the same wa}' for any large fragments which remain. During the operation the patient is placed on a table, with the hips elevated and the bladder full, or nearly so ; or it may be filled by injection through the catheter. After the ci'ushing process is completed, the lithontriptor is withdrawn, the patient turned ftice downward, and di- rected to urinate as rapidly as possible ; after which the bladder may be repeatedly injected and the powdered stone washed out. In cuttino; for the stone, the lateral operation is now generally pre- ferred, and always adopted by some of the most eminent living sur- geons. But as no one will attempt it without special education in the dissecting-room, its description, which is somewhat tedious, need not be detailed here. AmputatiOxN. — The Water-Cure method of treating injuries, tu- mors, ulcers, and inflamiiatiwns is destined to diminish very greatly the 11—37 434 SURGERY demaod for this operation, which, however, is much more simple t;han is generally supposed, and can be performed by almost any person who combines a good mechanical tact in the use of tools, with a sufficient amount of anatomical knowledge to enable him to compress he main artery. The operation may be performed with nearly equal advantage in two ways, one of which is called the circular, and the other ihefiap ope- ration. The latter, however, is applicable to a greater number of places. The usual instruments employed, in addition to the pocket-case, are, the tourniquet, large knife, saw, and bone-forceps. For the circular operation, a blunt, round-pointed knife is used ; and for the flap opera- tion, two sharp-pointed ones for different parts. Of course, the thorough, practical surgeon is to be pi"eferred in all cases requiring amputation, but emergencies do sometimes exist in w^hich immediate amputation is the only chance for the patient's life ; and to meet this exigency, the following explanations are given : The patient is seated in a chair, or placed on a bed or table ; the pad of the tourniquet is fixed on the artery at a convenient distance above the place of operation. In the circular operation upon the arm, one assistant supports the forearm, and another grasps the ai'm above with both hands, and pulls back the integument as much as possible. The surgeon passes his hand under the arm, bringing the knife corn- Fig. 285. CiaCULAR AMPUTATION OF THE ARM. oietely over it on his own side, with the point downward, fig. 285, and makes the firs', incision by drawing the b'ade backward from hilt to PARTICULAR OPERATIONS 4*55 point, rutting through the skin ana superficial fascia, entirely round the limb. The skin is then loosened from the muscles beneath, by sep- arating the areolar tissue with a scalpel or bistoury ; the skin is next re- tracted further up, and then another incision made as high up as the skin will allow, dividing all the flesh down to the bone- Some sur- geons give an elliptical direction to both incisions, leaving the muscles longer before and behind than at the sides. The muscles are next separated from the bone an inch or two with the point of a knife or scalpel, and a strip of muslin, a yard long and three inches wide, made into a "two-tailed retractor," by slitting it to its middle, applied, tho broader end being placed on the under side, the two tails passing up on each side of the naked bone, and crossing them at the top; by this the flesh is pulled upward as far as possible, and held by an assistant. The periosteum is then separated from the bone by a circular cut, and then the bone is sawed ofl", the splints, if any, remain, being smoothed olf by the bone-forceps or nippers. The retractor is then removed, and the brachial artery tied. If the artery is not readily found, the tour- niquet is loosened, when a jet of blood discovers it. All other arteries which bleed on loosening the tourniquet, are to be also taken up and tied. When the veins cease bleeding, the stump is to be washed clean and dressed by bringing the edges of the flesh together in an exact hor- izontal line across the middle of the stump, and there fastened by strips of adhesive plaster, three fourths of an inch wide and eight or ten inches in length, placing the first over the center of the seam, and the others laterally at about a quarter of an inch distance. Other straps may be laid obliquely over these, and narrow straps in any direction necessary to secure every part of the wound firmly ; and a strap around the whole arm to secure all the others is also advisable. The stump is then cov- ered with lint, retained by a light, easy bandage ; and the dressings are to be kept constantly w^et with cold water, if there is the least tendency to inflammation. When animal membrane is used for tying the arteries, it may be cut off close to the knot and left to itself; but if linen or silk is employed, one end of the ligature must be left long enough to hang out between the straps. The dressing does not usuall}' require removing under sev- eral days ; and when they are removed or readjusted, the parts must be carefully supported by an assistant ; the ligature must be taken away whenever it can be done by^ ^ntle pulling ; but its removal should not be attempted within one week. When it is necessary to amputa ^ the arm high up, the subclavian artery should be compressed where it passes over the first rib, by the thumb of an assistant. 436 S U R E R Y. In the fiap operaiior^ for the forearm, fig. 236 shows the proper posi« Fig. 286. tion of the arm. The pos- terior flap is made first ; and when the point of the knife reaches the bone, the hand is to be rotated a little inward, and the point pushed on close over both bones, taking care that it does not pass between them ; when the blade passes over the ulna, the hand is to be rotated a lit- tle outward, to bring its point further down under that bone ; the incision is then pursued downward and outward, so that the edge of the knife may emerge at about an inch and a half below, and at equal distance from, the points of entrance and emergence. The exter- nal flap is then raised a little, the knife entered at the former point, pushed through close in front of the bones, and brought obliquely downward, thus making a second flap to corresp*.Tid with the first. The remain- der of the operation and the dressings are similar to those of the former operation. Amputation of the fingers, though occasionally desirable at either joint, is most frequently per- formed at ihe base — the phalangeo-metacarpal ar- ticulation, fig. 237. An incision is made upon the knuckle in an ell'ptical form around the finger, extending down upon the AMPUTATi 'N or THf: FixtjER. palmar surface of the fir»- FLAP OPERATION. Fi?. 287. PARTICULAR OPERATIONS. 487 ger about an inch, to make a flap large enough to cover the joint ; after which the tendons and ligaments are cut through, and the joir.t dislo- cated by carryiig the knife through it. LiQATiNG AND CoMPRESSiNG Ap^TERiES. — Tliese Operations will usually be performed by the experienced surgeon ; but emergencies will frequently'- exist in which it is indispensable to cut down upon and tie, or make compression on a large artery, in order to arrest a dan- gerous flow of blood, or prevent hemorrhage while removing tumora or other morbid parts. Hjw and where to do these things, ought, therefore, to be matters of general information. In ligating arteries, the main points to be observea are, to make an oblique iyicision over it, and to avoid taking up the nerve, which is frequently inclosed in the same sheath with the artery. And in compressing arteries, a hand kerchief or the thumb may be employed, making the pad or pressure to bear directly on the vessel. When the thumb is employed, the beating of the artery will dii'ect the exact point for the pressure to be made, which is to be increased until the pulsation ceases. The subclavian aileiy may be compressed by the thumb, and with difficulty in any other way, where it passes over the first rib, in the space between the first rib and clavicle, thus controlling the circula- tion of the entire arm. The brachial artery can be easily compressed on the inner side of the arm, about midway between the elbow and axilla, as it hes near the surftce. The circulation of the lower limb may be efl*ectually controlled by compressing the femoral artery at the groin just above Poupart's ligament; the pulsation of the artery can be felt immediately below the concavity of tlie groin ; the thumb is here the most effectual instrument for compression, although a piece of cork, or the handle of a door-key, wrapped in several folds of linen, will answer. The large arteries .of the neck seldom require compression, except when large tumors are to be dissected out. The common, carotids may be considered as resting on the transverse processes of the cervical ver- tebrae, and their circulation may be controlled by pressing them against those processes. Note. — There are a few instruments required in some of the prece- ding operations which are found at nearly all the manufacturing shops; but an ocular view may enable the operator to have either of them n:ade to order, should it prove necessary or more convenient. Fig. 288 represents the double hook employed in tne operation for sti-abis- mus. Fig. 289 is the curette or director used in the same operation. Fig 290 is a pair q{ fine Jiook forcep?, Fig. 291 is a pair of curved 438 SURGERY. scissors. Fig. 292 represents the silver tube inserted in cases of fistula lachrymalis. Fig. 293 is the style sometimes employed in the treat- ment of the same disease. Fig. 294 is the ordinary curved couching- needle, and fig. 295 is called Hay's couching-needle. The former nee- dle is sometimes called Scarpa's, and is generally preferred. Figs. 288. 289. 290. 29L Fli 295 PART VIII. MIDWIFERY. CHAPTER I. HISTORY OF MIDWIFERY JirfCiEPTT Midwifery. — All history, sacred and profane, attests that the general practice of midwifery has been in the hands of females un- til a veiy modern date. It is true Hippocrates theorizes on obstetrics, but we have no evidence of his possessing any experimental knowledge on the subject. Historians tell us that in Greece, Rome, Persia, Egypt, Arabia, and Chaldea, woman was woman's physician. The Old Testament informs us \hi\t female midwifery was an honorable calhng among the ancient Hebrews. "Since the beginning of history," says Mrs. C. M. Dall, " the lives of eighty-seven women, eminent not only for obstetrical skill, but capable of extended practice, have been writ- ten." So far as the world has had experience in this matter, the success of female accouchers has been at least as gi-eat as that of male accouch- ers; and the statistics of all ages show that the attendance of woman has been accompanied with fewer accidents and a less number of fatal cases than the i^Tdcticc of man. Since it has been as fashionable as it is foolish to drug and bleed pregnant females occasionally, on the ab- surd notion that there are a great many natural "diseases of pregnan- cy," the success of our mosi eminent professional men-midwives com pares rather unflivorably with that of many professional female mid wives, who lived in happy ignorance of the whole of the modern drug and bleeding art. Modern Midwifery. — Save in most parts of Great Britain and the United States, the general practice of midwifery still is in the hands of woman. In several European countries, the business is divided be- tween male and female practitioners ; but in the greater number of 440 MIDWIFERy. countries on earth, civilized and uncivilized, woman officiates in all or- dinary cases. Throughout Russia, at this day, educated female? at- tend all classes of society, from the royal family to the meanest serf. The Chinese employ midwives in all ordinary cases, obsteti-ical sur- geons Deing called upon only when instrumental assistance is necessary. 'J'he American Indians, the Otaheitians, the New Zealanders, and many other nations and tribes, wlio employ female midwives or none, are celebrated for easy births and exemption from accidents. In France, the sage femme, wise woman, is the principal accoucher. In Germa- ny, the xrocdvromc, skillful woman, officiates. In Denmark her title is iordcrmoder, earth-mother. In Sweden and Norway she is called iord-gumma. In Spain and Portugal, the co-madre — literally, with motlier — attends. All of these terms are equivalent to midwife in our language. Fkmale Authors and Practitioners. — Soon after the institution of ti>e first medical school in Greece, the exclusive sj)irit of tlie faculty obtained the enactment of a statute prohibiting the practice of this art by " women and slaves." The tsrannical act spread dismay among the women of Athens ; and so tumultaously did they rebel against the out- rage upon "woman rights," tliat a new act was soon after passed al- lowing free-born women to learn midwifeiy. No other attempt was made by the profession to wrest this practice from its rightful owners until after the accession of Henry IV. Among those who have attained eminence in this tlieir peculiar de- partment of the healing art, tlie following names may be mentioned in this place: Agnodike, the daughter of Hieroj)hilus ; she practiced suc- cessfully at Athens in defiance of the medical clique. Artemesia, the queen who assisted Xerxes at the battle of Salamis. Kli)indike. of Greece, daughter of Cimon, and sister of Miltiados. Yroutata, of Sa- lermo, who practiced in the latter part of the lliirteenth century, and wrote several books. Mad. Peirette, wlio was sworn into the office of midwife, in Paris, in 1408, and bv^came famous throughout France. Mad. Gancourt, later in the fifteenth century, became equally cele- brated. Mad. Francoise, the midwife of Catherine de Medicis, was t\n approved lecturer on obstetrics near the middle of the sixteenth century. Olympia Morata, born in Ferrara in 1G.2G, wrote the lec tures which her hu^^lmnd, a young physician, delivered at Heidelberg. Mad. Perronne had the reputation of contributing all the obstetrical matter which was published in the works of the eminent French sur- geon, .Tames Guillemeau. Louise Bonrsin Bourgeois, born in 1580, man-'^d ? surgeon, was appointed to attend the Queen of France, and HISTORY OF MIDWIFERY. 441 published many valuable works. Mad. La Marclie, boni in 1638, was an accomplished literary scholar, as well as extensive obstetrical writer and practitioner. Justine Dieterich Siegmunden, born in Silesia in 1650, was one of the most accurate anatomists of her day, an extensive practi- tioner of midwifery, and the authoress of several obstetrical works. Mad. Breton, in the eighteenth ce>ntury, invented a plan for the artificial nourishment of babes. Elizabeth Blackwell, born in England in 1712, was the authoress of the first illustrated work on medical botany ever published. Mad. Ducondray, born at Paris in 1712, was the first per- son who lectured with a manikin, which she invented herself. Mo- randi, born at Bologna in 1716, was among the first to invent and per- fect wax preparations. Mademoiselle Biheron, born at Paris in 1730, made still greater improvements in wax figures illustrative of obstet- rical knowledge. Saridi Stone, of Eiigliind, was the fmthoress of a" work published in 1737, called the "Complete Practice." Elizabeth Nihell, of London, was distinguished for successfully opposing a distinguished physician on one hand, and a notorious quack on the other. In l'?60 she wrote a treatise on midwifery, in which she exposed the use of instruments, which the male accouchers were becoming too fond of employing; ad- vocated the employment of women, and strongly protested against the interference of men. She declared that a curse followed their inter- meddling, in evidence of which she adduced the increasing number of difficult and fatal labors. Mad. Refilatin, born in 1720, was the author of a work on " Delayed Accouchments." Margaret Stevens was the author- ess of the "Domestic Midwife," published in London in 1795. Mad.Lu nel published a work in Paris in 1750. Mad. La Chapelle, who officiated in over twenty-two thousand cases at the Maternite Hospital in Paris, ranks among th-e standard authorities on midwifery. Mad. Bovin, anoth- er standard authoress of several works, attended over twenty thousand cases, and performed nearly all the manual and instrumental operations known to the art as successfully as any male accoucher has ever done. Mad.Lesebourswas the authoress ofawork published in 1770. Anirish midwife, named Dunally, performed the C cesarean operation success- fully with a common razor. Mad. Rondet, born in 1800, perfected a tube for the restoration of children born asphyxiated. Mad. Dian was practicing reputably in 1821. Mad. Wittembaciv was consulted in re- lation to obstetrics by the most experienced physicians. In the United States the following names occur in this connection : Old Mrs. Wiat, who died at Dorchester, Mass., in 1705, aged ninetj'- four years, assisted as midv/ fe in more than eleven hundred cases. Mrs. Whittemore. who diet ir Marlboro', Vermont, at the age of 442 MIDWIFERY, eighty-seven often traveled through the woods on snow-shoes to at- tend her patients, and of more than two thousand cases of births, she never lost a patient. Mrs. Elizabeth Phillips, who was born at West- minster, England, and commissioned to act as midwife by the Lord Bishop of London in 1718, removed to Charlestown, Mass., the follow- ing year, where her gravestone now records the honorable story that she assisted in successfully bringing into the world above three thou- sand children. Mrs. Jane^ Alexander, whc iied at Boston in 1845, aged sixty-one years, studied mid^^if6»•y witii Dr. James Hamilton, of Edinburgh, and pi-acticed in this countiy twenty-five years without losing a patient. Mrs. Stebbins, who died at Westfield, Mass., in 1844, at the age of seventy-five, was an extensive and successful practitioner for many years. Similar facts could be greatly multiplied, but I have al- ready enough for my purpose. Man-Midwifery. — According to the best authorities we can find, man-midwifery, as a regular part of the physician's duties, dates back precisely one hundred and eighty-eight years, and then it originated with a court prostitute of Louis XIV., the Duchess de Villiers, who, under arrangements of the utmost secrecy, submitted to be attended by Julian Clement, an eminent surgeon. Clement was soon after ap- pointed to the new and lucrative office of midwife to the Princess of France. Until that event the ordinary practice was entirely in the hands of female midwives, surgeons being called upon only as surgeons in cases of unnatural labors. In the most uncivilized and unenlightened portions of the globe, a male midwife has never been heard of. A male accoucher was not known among the " Puritans" until this country Imd been settled more than a century. In 1723, Dr. John Maubray, the first male lecturer iu England on this subject, wrote a book against the abuse of instru- ments, which the male accouchers were becoming too fond of employ- ing. In fact, at that time the use of instruments was considered such an improvement on nature that, in the language of Dr. Gregory {Man- midwifery Exposed), " Almost eveiy doctor, old or young, was for try- ing his hand at it." So notorious, indeed, was the rage for instrument- al operations, that Sterne, in 1757, satirized it in "The Life and Times of Tristram Shandy, Gent." Dr. Shippen, of Philadelphia, was the first lecturer on midwifery in the United States — 176-2. Dr. Alwood, of this city, in the same year, was the first to advertise himself as a man-midwife. And no longer ago than 1820, a Boston physician jjublished and circulated a pamphlet advocating t^ie exclusion o^ females fi-om the practice, and the substitu- REPRODUCTION. 443 tion of males. At the present time, nearly every allopathic medical journal in the world is vehemontly opposed to relinquishing this prac- tice into the hands of females, while every progressive and reform pe- riodical I am acquainted with as earnestly advocates the restoration. Who Should be Midwives ? — I confess to be of that number who advocate a restoration of the practice o^ midwifery to educated fe- males ; but I am very far from desiring tv. see it taken from the hands of educated physicians and entrusted to ignorant nurses. I hold, how- ever, that all females should be sufficiently intelligent on this subject to manage an ordinary labor, and certainly the education required for this purpose is exceedingly simple — so much so that the majority of females could and would acquire it without any teacher whatever, if they were entirely left to themselves, and thereby compelled to be- come self-instructed. It is very true, moreover, that the multitudi- nous disorders and deformities existing in artificial society, do now, and will for a long time to come, render surgical assistance necessary in certain cases ; and for this purpose the practical surgeon-accoucher should be retained for accidents, complications, and emergencies. His services would be rarely called in requisition if we had properly-edu- cated females to take the entire management of the ordinary practice ; and surely no one will pretend that young men can be taught the sim- ple yet delicate duties of a companion and attendant during childbirth, more readily than young women can, or be more efficient in the dis- charge of the responsible duties devolving. The reason young women are not so educated, or are but imperfectly educated, is because the 'immense influence of an interested profession is arrayed against them. CHAPTER II. REPRODUCTION. Theories of Reproduction. — No subject has engi'ossed a greater share of the attention of philosophers and physiologists in all ages of the world than the mysterious function by which the great command, " in- crease and multiply," is fulfilled. All the theories which ingenious minds have fabricated may be resolved into three, and perhaps two ; although no less than two hundred and sixty-thre.e modifications of those theories have been proposei. Without wasting any time upon thes« 4ii MIDWIFERY fanciful speculations, it is enough for all practical purposes, to under- stand that sexual association is necessary to the propagation of our race; and that the female furnishes the ovum or germ of the future being, while the male communicates the vivifying principle. Both, however, equally concur in supplying the actual elements of its organ- ization originally ; but the mother has the greater modifying power over the development of those elements, on account of the constantly commingling of the circulating lluids of mother and child until birth, and the nourishment of the child being derived directly from the moth- er during the period of early infancy. Transmission of Organization. — Nothing is better established tlian the fact that the character and quality of the organization of the child are dependent on that of both parents; and this fact is of im- mence importance in its bearings on the well-being of the family of mankind. Though this principle is pretty well understood in the man- agement of cattle and in improving the breed of horses, it is very gen- erally overlooked in theory or disregarded in practice as relates to the human being ; and it is to me a matter of astonishment that the stand- ard works on physiology and obstetrics in our medical schools never elucidate the subject, and seldom allude to it. But surely all who con- template the matrimonial relation, as well as all who are alread}'^ in that relation, ought to know that precisely according to the development, purity, and vigor — in a word, health — of their own bodily and mental constitution, will be the physiological integrity and mental character of theu- offspring. It should be universally known, too, that the passion which impels to j)rocreation, lying at the very foundation of existence, is of necessity one of the most powerful of the propensities ; and that, while its rational and legitimate exercise is conducive to health, moral purity, and intellectual vigor, its excessive indulgence or abuse is as conducive to physiological enervation and moral degradation. It is the common consent of the medical world that libertines, drunk- ards, and gluttons, cannot have healthy children ; but we ought to be able to trace the sources of infirmity beyond their grosser manifesta- tions. Neither the father whose nerves are shattered by tobacco, whose digestion is disordered by improper food, whose constitution is impaired by drug medicines, or whose blood is often inflammatory with the violence of ungoverned passion ; nor the mother whose mus- cular system is enfeebled, whose nerves are debilitated, or whose ab- dominal organs are contracted and rigid, and whose brain is constantly h-ritated by indolence, novel reading, constipating food, strong coffee, green tea. or the ^vequent indulgence of the p'lssionate or fretful n\ood, KEPEODUCTiON. 445 can do justice to the rising generation. If in any of these ways they "eat sour grapes," the children's teeth will certainly be "set on edge." In this way, too, do the sins of the fathers and mothers curse their own offspring through many generations. The extremes of excessive toil and absolute indolence alike dispose to a vitiated organization; and we see the lamentable evidence-* equally among the wretched millions who toil incessantly for less than a sutil- ciency of food and raiment, and the profligate idlers of a more luxuri- ous but scarcely better fortune. Nature never intended that constant labor should agree with the constitutions of a part of mankind, and con- stant idleness or dissipation be compatible with the rest. Those whose muscles are perpetually worked down to the point of absolute ex- haustion, require all the rest and sleep they can get to replenish the muscular system; and the brains being but little exei'cised, will nat- urally degenerate, and they will propagate a race comparatively idiot- ic. Those who exert the brain intemperately, and sufifer the bodily functions to decline, will subject their offspring to feeble constitutions and unbalanced minds; and those whose life is a dull round of indolent repose, or dissipation, will entail the bodily and mental qualities of grossness, vulgarity, debauchery, and selfishness. A very common source of debility on the part of parents, and hence imperfect organization on the part of offspring, is the abuse of ama- tiveness. No false delicacy can excuse those who assume to be teach- ers, for refusing to speak plainly on a matter which so much concerns human health and happiness; and I cannot better acquit myself in this duty than by making the following quotation from a recent work {Or- ganic Laics), by J. Bradford Sax : " The various organs and f iculties of the parents are transmitted to the child with all their peculiarities and conditions. The perfection with which they are transmitted depends upon their degree of activity at the time of parentage ; the more active they are at the time the more perfectly will they be inherited. Hence, in order to secure per- fect offspring, it was provided that during the act of parentage all the organs and faculties of the body and mind in both parents, but espe- cially in the father, should be stimulated to the highest possible degree of activity. Of course a corresponding reaction must afterward take place. "Now it is impossible that such violent or intense vital stimulations and reactions should occur without an immense expenditure of nervous or vital energy on the fund of life. In point of fact, no act or function is so exhausting to the whole system as this. If indulged in to ex- cess, no practice can possibly be so debilitating, depraving, and de- 446 MIDWIFERY. Btructive to all the organs and faculties. Probably more of the nervous fluid or influence is expended in a single sexual crisis than would suf- fice to carry on all the ordinary vital operations, perhaps for days. If it is indulged in daily, or even weekly, the deluded subject need not hope for heijlth or happiness." In a recent and very exi •s'Uent work {Popular Education) bv Ira Mayhew, A.M., late Superintendent of Public Instruction in Michigan, the author remarks: "Physiologists in general coincide in the belief that a vigorous and healthy physical and mental constitution in the pa- rents, communicates existence in the most perfect state to their off- spring ; while impaired constitutions, from whatever cause, are trans- mitted to posterity. In this sense, all who are competent to judge are ngi'eed that the Giver of life is a jealous God, visiting the iniquity of the fathers upon the children unto the third and fourth generation of thera that hate Him or violate His laws. Sti'ictly speaking, it is not disease which is transmitted, but organs of such imperfect structure that they are unable to perform their functions properly, and so weak as to be easily put into a morbid state or abnormal condition by causes unim- paired organs are unable to resist." The Marriageable Age. — Ample statistical data have settled the question that the first children of those who marry very young are more animal and less moral and intellectual than those born nearer the middle period of the life of the parents. Extensive observation has also established the position, that the great majorit}' of men and women, morally and intellectually eminent, have been among the younger chil- dren of the family. The elevation and improvement of the race, there- fore, seems to be adversely affected by early maiTiages. The sound- est physiologists and phrenologists regard twenty-two to twenty-five for the female, and twenty-five to tliu'ty for the male, as the most appro- priate ages for assuming the serious duties as well as participating in tlie pleasures of m.atrimonial life. Physiological Law of Marriage. — Physiologists are divided on the question, whether organizations similar or unlike are most condu- cive to vigorous oflTspring. Phrenologists generally maintain that tem- peraments decidedly different, provided those differences are not ex- treme, make the most fortunate alliances for the offspring; and the same principle is held in relation to the mental organs. This proposi- tion is strongly corroborated by the favorable results of cross-breeding in the l()wer animals, and even from the cross-marriages of the people of different nations, sc far as observations have been recorded. I ap PHYSIOLOGY OF THE FCETUS. 447 pi'phend, however, that this law, if it be a law, derives its principal im- portance from the erroneous habits and customs of society. People who "live, move, and have their being" under one dull, monotonous routine of surrounding circumstances, will become mentally stupid, and physiologically indolent and sensual, for want of suitable external cir- cumstances to call out the mind and exercise the body; and here cross- breeding, or the union of different temperaments, tastes, habits, fash- ions, and differently-developed faculties, will tend to excite and culti- vate the powers of both parties. But when both parties are health- fully developed in body and mind, actively yet not drudgingly engaged in some occupation which gives free exercise to all the functioi^ and faculties, the voluntary habits being at the same time physiologically correct, there is not, certainly, an equal reason, if, indeed, there is any, to seek for aught save the most congenial tempers. CHAPTER III. PHYSIOLOGY OF THE FCETUS. FffiTAL Development. — About two weeks after impregnation, the new organization becomes about as large as a pea, and its two envelopes, or membranous coverings, called chorion and amnion, with a gelatinous substance inclosed between them, are distinctly visible. A thin mem- brane is also formed over the whole internal surface of the uterus, call- ed the decidua. Soon after a small white thread-like substance ap- pears, which is the commencement of the brain and spinal marrow ; before the twentieth day the eyes are visible ; and before the first month is completed a cartilaginous or grisly substance indicates the fu- ture bones. In the second month the cartilage begins to harden into bone, the ru- diments of the teeth are visible, the general form is developed, and it is about an inch in length. During the third month the heart is de- veloped, and, although without blood, has a slight degree of motion. At the end of three months, the eyelids are distinct, the lips perfect, the fingers and toes apparent, the heart beats forcibly, and all parts aro well defined, the weight being tsvo or three ounces, and the length four or five inches. In the fourth month the muscles become distinct- the brain and spinal marrow firmer, the abdomen covered with integu- ment; a large portion z^ the bony structure is ossified, tho rudiments 448 MIDWIFERY. Fig. 296. of the second set of teeth are seen under the first, and tire substanca called meconium, begins to collect in the bowels. Near the middle of the fourth month, the uterus rises above the pel- vis into the cavity of the abdomen, when the mother becomes remark- ably sensible of the mohons of the foetus. This period has been called quickening, upon the erroneous supposition that the foetus then first be- came endowed with life; but it is truly alive from the moment of con- ception. Sickness at the stomach, tendency to faintness, etc., denote The disturbance occasioned by the sudden change of position. From four to nine months the general development is more rapid. [n the fifth month the situation of the nails can be discerned, the weight is about one pound, (md the length about nine inche.?. In the sixth month the head be- comes downy, and the nails niark- ed : the weight increases to one and a half or two pounds, and the length to twelve inches. During the seventh mouth the hair is per- fected, the nails fully formed, the bones are comparatively firm, the meconium collects lower down in the large intestines; weight about thi'ee pounds ; length about four- teen inches. Many children are capable of being raised if prema- turely born at this period, and even in some cases if born a month or two earlier. During the eighth and ninth months, no new phe- nomena present, but every part acquires a firmer consistence, and all the functions become mor*..» active. FffiTAL Circulation. — Until quite recently the opinion pre- vailed that the blood of the mother circulated direc.ly through the vessels of the foetus ; but it is now known that the foetus has a sort of independent exi3teDce,although \J \J roTAX riRCUI.ATION PHYSIOLOGY OF THE F(ETUS. 449 its nutrient materials are of course derived from the mother. Tho mother secretes the substances of nutrition, which, by coming in con- tact with the foetus, are absorbed ; and, after being mo^-fied in their passage through the placenta, are digested and assimilated. Fig. 296 is a representation of the foptal circulation. 1. The umbilical cord, consisting of the umbilical vein and two umbilical arteries; pro- ceeding from the placenta (2.) 3 Umbilical vein, dividing into three branches ; two (1. 4>, to be distributed to the liver; and one (5), the ductus venosus, whicu enters the in- ferior vena cava (6). 7. Portal vein, returning the blood from the intestines, and uniting with the right hepatic branch. 8. Right auricle; the course of the blo-^ft is denoted by the arrow, proceeding from 8 to 9, the left auricle ]0. Left ventricle; the blood follow- ing the arrow to the arch of the aorta (11), to be v'-'stributed through the branches given otf by the arch to the head and upper extremities. The arrows, 12 and 13, represent the return of the blood from the head and upper extremities through the jugular and subcla- vian veins, to the superior vena cava (14), to the right auricle (8), and in the course of the arrow through the right ventricle (1.5), to the pulmonary artery {16). 17. Ductus arterio- sus, which appears to be a proper continuation of the pulmonary artery ; the offsets at each side are the right and leit pulmonary artery cut oft"; these are of extremely small size as compared with the ductus arteriosu.?. The ductus arteriosus loins the descend- ing aorta (18, 18), which divides into the common iliacs, and these into tiie internal iliacs, which become the hypogastric arteries (19), and return the blood along tht; umbilical cord to the placenta ; while the other divisions, the external iliacs (20), are contlnuei into the lower extremities. The arrows at the terminations of these vessels mark the return of the venous blood by the veins to the inferior cava. The pure blood is brought from the placenta by the umbilical vein; this vein passes through the umbilicus, and enters the liver, where it divides into several branches, two or thuee of which are distributed to the left lobe of the liver; one branch communicates with the portal vein in the transverse fissure, supplying the right lobe ; and a large branch, the ductus venosus, which, passing backward, joins the inferior cava. In the inferior cava the pure blood is mixed with that which is returning from the abdominal viscera and lower extremities, and is car- ried along through the right auricle, guided by the Eustachian valve, and through the foramen ovale, into the left auricle. From tlie left auricle it passes into the left ventricle, thence into the aort.), and, by means of the carotid and subclavian arteries, is distributed to the head and upper extremities. The impure blood is returned from the head and upper ext)-emities by the superior vena cava to the right auricle ; from this Jt is propelled into the right ventricle, and thence into the pulmonary artery. As the lungs are solid and impervious, only a small quantity can pass into them, and hence the grenter portion pusses tliroui:;h the ductus arteriosus into the commencement of the descend- ing aorta, where it is mingled with that portion of the pure blood which IS not sent throngli the carotid and subclavian arteries. Passing along the aorta, a small quantity of this mixed blood is distributed by the ex- ternal iliac arteries to the lower extremities; the greater part is con- i50 MIDWIFERi^ veyed by the internal iliac, hypogastric, and umbilical arteries to the ])lacenta ; the hypogastric arteries proceeding from the internal iliacs, and passing by the side of the fundus of the bladder, and upward alonp the anterior wall of the abdomen to the umbilicus, where they become the umbilical arteries. "From a careful consideration of this circulation," says Dr. V/ilson (Human Analoiny), " we perceive, 1st. That the pure blood from the placenta is disti'ibuted in considerable quantities to the liver before en tering the general circulation. Hence arises the abundant nutrition of that organ, and its enormous size in comparison with other viscera. "2dly. That the right auricle is the scene of meeting of a double current, the one coming from the inferior cava, the other from the su- perior, and that they must cross each other in their respective course. How this crossing is effected, the theorist will wonder ; not so the practical anatomist ; for a cursory examination of the foetal heart will show. 1. That the direction of entrance of the two vessels is so oppo- site, that they may discharge their currents through the same cavity without admixture. 2. That the inferior cava opens almost directly into the left auricle. 3. That by the aid of the Eustachian valve, the cur- rent in the inferior cava will be almost entirely excluded from the right ventricle. "3dly. That the blood which circulates through the arch of the aorta comes directly from the placenta; and, although mixed w^ith the im- pure blood of the inferior cava, yet is propelled in so great abund- ance to the head and upper extremities, as to provide for the increased nutrition of those important parts, and prepare them, by their greater size and development, for the functions which they are required to per- form at the instant of birth. " 4thly. That the blood circulating in the descending aorta is veiy impure, being obtained principally from the returning current in the superior cava, a small quantity only being derived from the left ventri- c\c et it is from this impure blood that the nutrition of the lower eX^ , jties is provided. Hence we are not surprised at their insig- nificant development at birth; w^hile we adm.ire the providence of na ture that directs the nuti-ient current, in abundance, to the organs of sense, prehension, and deglutition: organs so necessary, even at the instant of birth, to the safety and welfare of the creature." ThQ foramen ovale becomes gradually closed by a membranous layer which separates the two auricles. As soon as the lungs are inflated by inspiration, the blood of the pulmonary artery rushes through its right and left branches ioto the lungs, to be retui'ned by the pulmonary veins to the left auricle. PHYSIOLOGY OF THE FCETUS. 451 The Thymus Gland. — This structure is situated on each side of the trachea in the neck, resting against the pericardium, and extend- ing from the fourth rib upward to the thyroid gland. It becomes per- ceptible between the second and third months of embryotic existence, and continues to increase in size until the seventh month ; during the ninth month it suddenly enlarges again, weighing then nearly an ounce. After birth it enlarges during the first year, and then gradually dimin- ishes, almost disappearing at puberty. It is composed of numerous lo- bules, containing secretory cells, and its office appears to be to prepare nutrient material until the digestive function is fully developed. The Placenta. — This is a spongy, vascular mass, found at the surface of the chorion, and ad- Fig. 297. herent to the uterus, which ex- ists in some form in all mam- malia. It possesses little or no sensibility, hence it has little or no nervous structure. It is to the foetus what the lungs are to the adult, serving for the aera- tion of the blood of the former until respiration brings the blood in contact with atmospheric air in the lungs. Fig. 297 repre- sents the placenta with the um- bilical cord attached. The di- ameter of the placenta is usually about six inches, and its thick- ness an inch and a half. placenta and cord. Physiologists do not agree whether the vessels of the placenta term- inate in or communicate w^ith those on the uterus ; or whether, in its utei«ne portions, there are intermediate cells in which the arteries terniiijate, and from which the veins commence. Nor do they agree whether any portion of the blood of the foetus actually circu- lates through the heart, lungs, etc., of the mother. From all the in- vestigations which have been made, my own conclusion is, that the placenta serves, in part, to purify the blood ; and that the blood of both mother and fostus mingles, to some extent, in the placenta, in conse- quence of the placental vessels extending into the uterine sinuses ; and that, further, while the blood of mother and foetus act and react upon each other in the substance of the placenta, in a manner analagous to tbe action between water and blocd, in the bronchial vessels of aquati« 452 MIDWIFERY. animals, some portion of the blood of the foetus does actually go ih^ round of the mother's circulation. The Umbilical Cord. — The funis, cord, or navel-string forms the connection between the }3lacenta and child. It is composed of two ar- teries and a vein, and, like the placeuta, is insensible. The arteries •;vind spirally around the vein from right to left, forming in their course .1 number of loops or knots. The length of the cord varies gi-eatly ; its average is eighteen or twenty inches. The pulsation of the cord, which is usually strong and distinct, ceases in ten. fifteen, or twenty minutes after birth, and the portion attached to the child shrinks and falls off in five or six days. The Liquor Am.mi. — This terra is applied to the fluid which col- lects in the cavity of the amnion ; it is secreted by the internal surface of this membrane, and its quantity varies from a pint to several quarts ; the average is fi'om one to two pounds. It serves as nutriment to rlie fcEtus : to allow it free motion ; to diminish the force of blows, shocks, and sudden movements, and also assists in dilating the os uteri during labor. CHAPTER IV. OBSTETRICAL ANATOMY Bones of the Pelvis. — The 055a innominata form the pelvis lat- erally and in front, each of which is divided into the ischiuin, or sit- ting-bone ; ilium, or hip or haunch-bone ; and 2^uhis, or share-bone, Ji3 heretofore explained : and the sacrum and coccyx behind. The brim of the pelvis is defined by the ilio-pectineal line. Ail below this Ime is called the true or lower pelvis ; while the false or upper pelvis, which is really the lower part of the abdcminal cavity, is immediately above. The brim of the pelvis is of an oval form, except where it is broken by the projecting part, or promontory, of the sacrum posteriorly. Cavity of the Pelvis.— This is bounded by the sacrum behind, the ischium laterally, and the pubis in front. It is of unequal depth, measuring five to six inches jjosteriorly, three inches and three fourths fi'oiu the brin: to the tuber ischii. and from tu ■ inches to two and a OBSTETRICAL ANATOMY. 453 ralf anteriorly at the symphisis pubis. The bones of the peh'ic cavity •xre smooth on their inner surface, and present a series of inclined «lanes, tending at first downward and slightly backward, then down- ward and forward. The brim or upper margin of the cavity, which is *ts narrowest part, is called the sujierior strait ; and the lower or outlet, *-he inferior strait. This outlet is of an oval shape, but irregular; its ^teral boundaries are immovable, but its antero-posterior diameter can 16 extended on account of the mobility of the coccyx. Diameters of the Pelvis. — The three principal diameters are Fig. 298. •^ :^ DIAMETERS OF THE PELVIS. represented by the lines in fig. 298. They are the antero-postenor (1), from the prominence of the sacrum to the inner and upper edge of the symphisis pubis ; the transverse (2), across the widest part of the brim, at right angles to tha antero-posterior ; and the oblique (3), from the sacro-iliac junction of one side to the opposite side of the brim, just above the acetabulum. The average admeasurements of these diameters are : antero-posterior, four inches ; transverse, five inches ; and oblique, four ar?^ three fourths. Half an inch either v/ay may be allowed for variations. The circumference varies from thir- teen to fifteen inches. The only practical importance of these admeasurements is in cases of deformities, disease, or raal-presentations. In ordinary cases nature will accomplish her woric just as well without our knowledge of ob- stetrical anatomy as with it. Deformities of the Pelvif. — The bones of the pelvis may be 464 MIDWIFERY c'istorted in a variety of ways, and to an extent which renders labor tedious and protracted, or entirely impossible. These cases, however, are exti-eraely rare, and it not unfrequently happens that the aggregate Fig. 299. OBLIQUE DISTORTION of the diameters is not materially affected. Fig. 299 is a representa- tion of one of the most common deformities. The usual causes are rickets in infancy, and violliiies ossium, or softening of the bony stiTic- ture, in adults. The brim of the pelvis, or superior strait, is most frequently affected by deformities, so that if the child's head can enter the cavity, the delivery will almost always be accomplished naturally, although the labor may be greatly prolonged. The extreme distortion in the antero-posterior diameter of the brim Fig. 300. AUTERO-POSTERIOR DISTORTIOIf. PEEGNANCY. 455 of the pelvis, is seen in fig. 300. This is one of the conditions wlVich render natural labor impossible, although slight deformities in this re- spect are usually overcome by the natural efforts. CHAPTER V. PREGNANCY. Signs of Pregnancy. — The cessation of menstruation at the usual period of its occurrence is among the first indications, though not in itself conclusive of pregnancy. Most women experience some degree of nausea, and sometimes vomiting on rising, called morning sickness ; this usually begins in the fifth or sixth week, and continues to the end of the third month. Salivation sometimes, though not often, attends. The breasts manifest an uneasy sensation of fullness about two months after conception ; throbbing and tingling pains succeed, and they soon increase in size and firmness, become knotty, and the areola around the nipples darkens ; these are the most unequivocal of all the signs of pregnancy. The enlargement of the abdomen is gradual fi'om tlie first, although in some cases it becomes a little flatter for a month or two. Quickening occurs usually during the fourth month, after which the motions of the fcetus are decisive. Duration of Pregnancy. — The natural duration of pregnancy has usually been reckoned at nine calendar or ten lunar months, or two hundred and eighty days. A majority, probably, are born in the for- tieth week ; nearly as many in either the thirty-ninth or forty-first ; many births take place in the thirty- eighth, foity-second, and forty third weeks ; and they are not very unfrequent in the thirty-seventh, forty-fourth, and forty-fifth weeks. The ordinary period seems there- fore to range from two hundred and fifty-two to three hundred and sixteen days. The commencement of pregnancy is generally dated two weeks subsequent to the last appearance of menstruation ; yet this calculation is liable to an error of between two and three weeks. Extra-Uterine Pregnancy. — In some extraordinary instances, the precise causes of which we can never understand, the ovum is impregnated, and remains in the ovary, fallopian tube, or the inter- ^456 MIBWIFERY space in the avails of the uterus. In all these cases the general signs of pregnancy are more or less apparent, wliile the enlargement of the abdomen is confined to one side, and develops very much like an ordi- nary tumor, with a^sense of weight, uneasiness, heat, and pain. Sooner or later the "vst which incloses the fittal mass ruptures, the child dies, and the surrounding parts either accommodate themselves to their pe- culiar circumstances as well as may be, and allow the organic remains to occupy th« part for an indefinite period, or make an effort to remote the foetus by the formation of an abscess opening externally, or a fistu- lous communication to the vagina or rectum, through which the osseous parts of the mass are discharged. The practitioner must here restrict his or her duty to keeping the patient quiet, attending to the general health, especially keeping the stomach and bowels easy, and sootliing all local inflammation, always recollecting that nature best accomplishes what she undertakes in her own way. SuPERFCETATioN. — The occuiTence of a second conception before the termination of the first, has been regarded as impossible by many Authors ; y?t there are some well-authenticated cases on record. Sometimes both fcetuses are fully developed, and the second born sev- eral months after the first : in other cases, one foetus is expelled in a half-formed or blighted condition. Practically we are to regard the latter variety as a case of abortion. PathglooY of the Fcetus. — Nearly ail the maladies to which the child is subiect may aftcct the foetus: and when we consider how un- healthfully the majority' of females live while in the pregnant state, and how readilv rhe organic instincts, true to the all-pervading law of self- preservation, throw the morbid conditions of the mother upon the new being within, it seems almost wonderful that so great a majority can live until tiic time for being born arrives. But the foetus does often die in the uterus, and it is sometimes important to ascertain the fact. The signs are : a cessation of its motions; flaccidity or falling in of the abdomen ; recession of the umbilicus ; a sensation of coldness, and of a dense weight in the abdomen ; the breasts suddenly becoming flac- cid ; to which may be added a loose feeling of the uterine tumor, fail- ing health, sunken countenance, dark areola round the eyes, foetid breath, frequent chills, etc. Here, as usual, we are to '* trust to na- ture." At an uncertain time the uterus will expel its contents, and the treatment required is the same, in all essential paiticulars, as for or- dinary aboitious. P R £ G N A :\ C Y 467 Hygienic Management during Prkgnancy. — Those females who would escape the usual and dangerous maladies which frequently accompany pregnancy, and avoid in a great degree the ordinary pains of childbirth; and, above all, those who would be mothers of hcaWiy children — healthy in body and mind, in constitution and in disposition — must observe attentively and obey inviolably a few simple hygienic pre- cepts. 1. All high-seasoned, high-salted, and complicated dishes must be abstained from. The whole course of diet must be plain and sim- ple, and coarse enough to keep the bowels always free. Animal food, if used, should not be taken more than once a day. 2. All drugs must be eschewed, especially every thing of the narcotic kind, as opium and its preparations, which have a direct tendency to stupefj' and enfeeble tlie future being. 3. Some form of bath must be taken daily; a towel wa^a will answer, and it need not be very cold ; about 70" will do very well ; and if the patient is very sensitive or feeble, it may be taken in a warm room. Pregnant women usually hear cold water remarkably well. 4. The hip-bath should be frequently employed, especially near the period of delivery. For a month or two preceding the expected time it should be employed daily ; this may not be so cold as to be par- ticularly disagi-eeable ; 65° to 70° in temperature, and five to ten min- utes in time, is a good general rule. 5. The patient must keep on her feet a good part of the time during the whole term. She may walk frequently in the open air, or do house-work, or exercise in any easy manner in the erect attitude. Nothing is more likely to induce a wrong position of the child in the womb, or a painful, lingering labor, than pressing and cramping the abdomen by sedentary habits. Females who are compelled to work with the needle, or sitting at a work-table, should be particularly careful at all times to maintain an upright pos- ture. Adhesions of the afterbirth, flooding, tumors, and inflammations of the parts are frequently owing to the compression produced by a misposition of the body. 6. Excessive labor and violent exertions, also strong mental passions, or depressing emotions, are to be avoided as far as possible. Accidents of Pregnancy. — Medical books give us a formidable catalogue of " diseases of pregnancy ;" but 1 think the j)hrase is another of those misnomers which are so plentiful in the books, and so well cal- culated to mislead. Diseases during pregnancy are common enough; but so for from being naturally r/that condition, they are merely the evidences of the unnatural habits or circumstances of the individual. The familiar fact that those diseases which rapidly exhaust the vitality of the body, as consurai>tion, are suspended during pregnancy, to re- 11—39 M I D W I F E R Y. 458 appear with all their formidable and fatal array rf symptoms soon after the completion of the rei^roductive function, sufficiently attests the prin- ciple that nature is true to her own purposes, and ihat all diseases dur- ing pregnancy are entirely fortuitous. Abortion, which is the expulsion of the foetus before the sixth month, and premature labor, its expulsion between the sixth month and matu- rity, are the most painful disorders or accidents attending pregnancy. The danger is usually in proportion to the hemorrhage. The common causes ai-e general or local debility — " inward weakness" — violent men- tal perturbation, and bodily shocks or injuries. Leucorrhoea is the cause of the greatest number of miscarriages. Excessive sexual in- dulgence is also a frequent cause. The symptoms of miscarriage are, an unusual sense of languor, un- easiness, and weariness, with aching or pain in the back, followed after a few hours or days by a slight discharge of mucus or blood from the vagina, and bearing-down pains ; these are at first felt in the back, ex- tending around the loins to the abdomen, and down the thighs, recur- ring at regular intervals, and increasing in strength and frequency ; in most cases the pain is as great as in labors at the full term. In some cases the ovum is expelled with but little pain, and sometimes the fuetus is expelled and the membranous shell of the ovum retained for many days, and perhaps finally passed off in a dissolved state with the lochia. Hemorrhage seldom continues after the expulsion of all parts of the ovum, but until then it is to be apprehended. As a general rule, the flooding is less the nearer gestation approaches maturity. Our first treatment should be preventive ; but if the case has pro- gressed too far, the flooding requires our principal attention. Allopath ic authors deal largely in opium, ergot, sugar of lead, and the forcible extraction of the ovum with instruments, and even bleeding from the arm. These drugs and destructives are never necessary, but always in- jurious ; in fact, they often injure the constitution much worse than the abortion does. The patient should recline in an easy, leoumbent posture, the wet bandage be applied around the abdomen, and changed several times a day, and two or three vaginal injections of cold water employed daily. When the flooding is excessive, and in cases of internal hemorrhage, denoted by headache, gi-eat lassitude, shiverings, frequent and feeble pulse, and the patient becoming pale, exhausted, and faint, with a dark shade under the eyes, the tav.ipion miiy be employed with advant- age, or a silk handkerchief, wet in the coldest water, or inclosing a cylindrical piece of ice or snow, may be introduced into the vagina as far as convenient ; it may remain for six ar eight hours, and then be ia- PREGNANCr.' 459 troduced again if necessary. Enemata of the coldest water are also valuable auxiliaries in severe cases. lu all cases it is important to have the room well ventilated, and the patient placed on a cool and rather hard bed or mattrass. The inexperienced attendant should not be unduly alarmed at the faintaess which takes place after severe or protracted flooding, for it generally happens that this condition favors the formation of a clot or coagulum, which obstructs the bleeding ves- sels and effectually arrests the hemoirhage. It is not uncommon for patients to remain an hour or two in a state o^ dcliquium animi. Morning sickness, when very troublesome, is best alleviated by a light, dry evening and morning meal, as Graham crackers, toasted bread, etc. Toothache may be relie.'ed by eating very sparingly for a day or two, and careful attention to the bowels. Cramps, for which the old-school practice ia, bleeding and laudamim, may be quieted by rubbing the lower limbs with a cold wet cloth, fol- lowed by dry friction. Constipation is more apt to occur in tlie early than the later months of pregnancy. It requires coarser food and water-injections. Piles, which have previously affected the patient, are liable to reap- pear or become aggravated. Frequent sitz-baths should be employed, with a small, cold injection immediately before each stool. Pruritus, or itching of the genital organs, may be relieved in the same way ; if excessive, warm water is more soothing than cold. Heartburn, sick headache, sleeplessness, nud salivation, are among the unpleasant incidents that are occasionally presented. They are to be treated in the same way as morning sickness. Frequent sips of cold water are very soothing in most of t'hese cases ; and when the sick headache is attended with prolonged nausea and retching, warm water should be drank freely until the stomach feels easy, or vomiting occurs. Cravings or longings for improper food should not be gratified. There is vastly more danger of " marking the child," by improper in- dulgences on the part of the mother, than by proper self-denial. If the mother takes proper care of her general health, and kee))s all un- healthy articles out of her stomach, the trouble from this source will bo of little consequence. Pains in the breasts are sometimes severe. They may always and safely be relieved by cold wet cloths, covered with dry ; exce{)t when of a spasmodic or neuralgic character, in which case warm fomentations are appropriate. Excessive vomiting sometimes occurs, and may be so severe as to en 460 xM I D W I F E R r danger abortion. Fasting, and cold water-drinking, are the special remedies. Pain in the side — usually the right — often occurs after the middle period of pregnancy ; it is rarely severe, but generally constant. Bleed- ing, leeching, cup{)ing, and blistering have been perseveringly pre- scribed for it by '• old-school" doctors, but without the slightest benefit in the great majorit}' of cases. The w^et bandage and hip-bath are the better remedies. Difficulty of breathing frequently affects the patient more or less to- ward the completion of the term; in some cases it is attended with se- vere cough. Indolence or over-exertion are alike to be regarded in the treatment. Great fatigue of body or mind Should be avoided. Lifting heavy articles, running up stairs, walking too fast, are among the ex- cesses against which the patient should be cautioned. When hemorrhage occurs, it is to be regarded as a premonition of abortion, and treated accordingl3% Diarrhea is among the unusual occurrences. The ti-eatraent is, hip- baths, the abdominal bandage, cold injections, and a strict dietary. Difficult urination sometimes proves veiy annoying. AVhen it amounts to actual retention, the catheter may have to be employed; this, however, is extremely seldom. Cold hip-baths and bandages are usually sufficient. Foot-baths are also useful ; and in severe cases the warm hip-bath, immediately followed by the cold, will often relieve. Varicose veins^ with a swelling and knotty appearance of the lower extremities, sometimes result from the obstructed circulation occasioned by the pressure of the uterine tumor on the adjacent blood-vessels. Attention to the general health, and a judicious regulation of the amount of exercise — neither too much nor too little — are all the therapeutic in- dications in this case. Hysteria is named among the "diseases of pregnancy" by authors. I have never known it to occur in females whose hygienic habits were reasonably correct ; and the affection is probably always attributable to noveJ reading, exciting company or parties, stimulating drinks, irritating food, cathartic and opiate medicines, etc. The treatment is wholly negative — an avoidance of these causes. Convulsions are less frequent occurrences than hysterical parox- jsms, but are produced by the same general causes, and can be pre- vented or cured by their avoidance or removal. PARTURITION. 461 CHAPTER VI. PARTURITION. Rationale of Labor. — Many ingenious, if not profound specula- tions, have been written by medical philosophers, to explain wliy the foetus and its appendages are expelled from the womb at about the end often lunar months, or two hundred and eighty days. As well might they have expended their learning in endeavoring to divine why man arrives at a given stature, and then ceases to grow ; or Nvhy the earth performs its circuit around the sun in three hundi-ed and sixty-five days, instead of a longer or shorter period. We are sufficiently wise for "our being's end and aim," if we know the fact that il is so. But the physiology of parturition, which it behooves us to understand, is easily explained. As the ripened fruit drops from its parent stem, so the foetus, when sufficiently developed for independent existence, is separated from its parental connection. A slight discharge of mucus, often more or less tinged with blood, called labor-shoiu, and which serves to lubricate and prepare the parts for the requisite distention, is the first decisive indi- cation of approaching labor. Wandering pains about the back, around the abdomen, and down the tliighs, gradually becoming fixed and reg- ular, with intervals of perfect ease, denote the preparation going on in the uterine region. Each labor ^^pahi" is produced by a distinct, pe- riodical contraction of the longitudinal and circular fibres of the uterus, which diminish its diameter and dilate its mouth. These contractions, and consequent pains, are renevred at certain intervals until the dilata- tion is sufficient to permit the passage of the child without injur}' to the soft parts. The pain experienced by the patient bears no very near relation to the force of the conti'action of the uterus, but is rather measured by the healthful condition or morbid sensibility of the parts. Those who live healthfully, suffer but little ; while nany of opposite habits, endure the most excruciating agonies. In the early stage of labor, the pains are called cutting or grinding ; they are of an acute and stinging character, and are occasioned by the stretching of the fibres of the os uteri. In the second stage, the con- traction of the uterus is aided by the contraction of the abdominal mus- cles- -somo writers say the volunta'y effovti of the patient; but this 462 M U W I F E R Y. action takes place whether the patient wills it or not — when the pa- tient is obliged to co-operate with the expulsive eftbrt, by holding her breath, and then the pains are called /orcfng, or hearing-down. The forcing or expulsive pains gradually increase in severity, but the pa- tient usually bears them better as the labor approaches its termination. Says Dr. Churchill {System of Midwifery): "The amount of suffer- ing depends a good dpal upon the temperament of the patient, and ui)oii the habits of life among savages it appears slight, but it is ex- cessive in civilized life." There is an important lesson implied in the above quotation. Happy will it be for those mothers who can appre- ciate and apply it. The remarkable peculiarities of labor pains are, their periodicity; the intervals of perfect ease, during wliich the patient is often inclined to sleep; each uterine contraction gradually increasing to its maximum of force, and then suddenly subsiding the intervals of rest diminish- ing, and the length of the pain increasing as the labor advances. The membranes are sometimes ruptured, and the water of the amnion dis- charged at the commencement, and sometimes not till very near the conclusion of labor ; and not unfrequently the water escapes on the first occurrence of the premonitory pains. Sometimes the membrane does not ru})ture at all, and the child is expelled entirely inclosed — ia common parlance, " born with a vail." The Pains of Childbirth. — An erroneous interpretation of Scrip- ture has caused the opinion to prevail extensively in the civilized world, that great suffering is the ordained law of woman in childbirth ; and this error has had a paralyzing effect on the popular mind, and caused the sufferers to submit reverently to their fate, instead of seeking the true light of physiology on the subject. If Eve was sentenced to bring forth in sorrow, it was because of her personal transgression. Show me a woman on earth who agonizes through the period of part- urition, and I will prove her to have transgressed the laws of health ia her own person ; and conversely, find me a inother who lives physio- V)gically, and I will show you one with whom the act jf childbirth has leither agony nor terror. The philosophy of this mutter is admirably expressed in a httle work (The Curse Removed), by Dr. T. L. Nichols: "The women of nature have no such word as ' confinement' — a word so apjn-opriate in civiliza- tion. The great truth to be learned by every body is, that gestation and parturition are natural processes. It is as natural for a woman to bring forth children, as for a shnil) to produce flowers and fruit; and her organs are as naturally adapted for the purpose. In a state of PARTURITION. 4G3 health no natural process is painful. Pain is, in all cases, the sign of d.sease. It has no other use or signification. With a sore throat, it is painful to swallow; with a diseased stomach, digestion is painful; so is childbirth painful to a diseased nervous system, but never to an entirely healthy one. "It is not credible that any natural function should be attended with pain in a healthy state of the system. All nature protests against the idea — all experience is opposed to it. Causes and effects are too well adapted to each other — ends and means too admirably fitted. This world is the work of infinite power and benevolence ; all the human system is the masterpiece of all this fair creation. It is not to be sup- posed that the most imjjortant of all the functions of the most perfect of created beings, of whom we have any knowledge, should be sub- ject to inevitable pain and peril in its performance. Such a belief is an insult to Providence. When God looked upon His creation, and pronounced it good, He could not have overlooked the most important function of His last and most perfect work ; and there can be no question that in the original creation of woman, she was fitted to obey the command, 'Increase and multiply, and re[)lenish the earth,' with- out peril or pain. The very idea of the curse inflicted upon her car- ries with it the belief, that she was originally created perfect in this particular. " What, then, has made the change ? Why is woman subjected to all her pains, sufferings, outrages, and perils, in the pei-formance of the great function of her life? It is because the forbidden fruit of ener- vating luxuries and excesses is continually eaten. And just in propor- tion as woman transgresses the laws of nature, which are the real and unquestionable commands of God, just so far are they subject to the curse. " Man has it in his power to incur all direct curses by transgression, or to avoid all curses and invoke all blessings by obedience to the divine law. Industry makes of the barren earth another Eden. Temper- ance and cleanliness give health, and health brings happiness in all the duties of life. So it is with woman. Indolence, self-indulgence, vo- luptuousness, and all the sins against the laws which God has written in the structure of ouir bodies, bring with them the curse of deranged nervous systems, broken health, irregulirity of function, disease, pain, and premature death. Every woman is an Eve, and forbidden fruits are all around her. If she listen to the voice of the beguiling serpent, hers is the wo. But, on the other hand, fnith in God, obedience to His laws, and living in harmony with His works, assure to woman health and safety, and joy, in ifulfilUng alj her destiny. I'hese ar» 404 MIDWIFERY. truths i)regnant \>irh meaning, and incontrovertible us the principles of nature." 3Irs. Pendleton remarl^ (Parent's Guide): "It is a well-establish- ed tact, that women are to be found in almost every country who suf- fer no pain in childbirth. N'»w, as a natural law never admits of an exception, this exemption fron pain could not occur in any individual, unle:-s it were fairly within the capabilities of the race." Mrs. Gove — now Mrs. Dr. JNicliolj — testifies (Lectures to Ladies). "I know many mothers who, wnth their husbands, have adopted the ' Graham System,' or, in other words, those correct habits recom- mended in these lectures (that is, attention to diet, exercise, and bath- ing freely and constantly with pure, cold water), and those mothers have abridged their sutlerings it parturition from forty hours to om hour, nrn\ have escaped altogether iht ^«»athly sickness of the three fir^t months of gestation." George Combe observes (Constitution, of Man) : "The sufferings of women in childbed have been cited as evidence that the Creator has not intended the human being, under any circumstances, to exe- cute all its functions free from pain. But, besides the obvious answe^v that the objection applies onlj^ to one sex, and is therefore not to be too readily presumed to have its origin in nature, there is good reason to deny the assertion, and to ascribe the sufferings in question to de- partures from the natum! law^s. in either the structure or the habits of the individuals who experience it." The late Dr. Andrew Combe wrote : "If women in childbed could be convinced, from previous knowledge, that, as a general rule, the danger attending that state is proportioned to the previous sound or unsound condition of the system, and to its good or bad management at the time, and is not the mere effect of chance, they would be much more anxious to find out, and successful in observing, the laws of health, both for their o^vn sakes and for the sake of the future in tant, than they now are, while ignorar.t of the influence of their own conduct." Dr. Eberle's opinion {Theory and Practice) is to the same effect* "The pregnant female, who observes a suitable regimen, will, ceeteris paribus, always enjoy more tranquillity both of mind and body, and in- cur much less risk of injury to herself and child than s])e who, givinfia free rein to her appetite, indulges to excess, or in the use of improper articles of food." Dr. Dewees, Professor of Obstetrics in the Medical School of Penn- sylvania, has argue i [Tresis ok Oullhirth) that " Pain is a morlid PARTURITION. 465 symptom, the consequence of arfciftcial modes of life and treatment, and can be avoided by appropriate habits and treatment." In corroboration of this ah'eady conclusive weight of authority, I can add, that I have known females in the city of New York adopt a i-e- forra system of living — a plain, simple, vegetable diet, with a daily cold bath, and go through the period of gestation without losing an hour from sickness, the ordeal of parturition with no assistant or attendant in the room save the husband, take the entire chiirge of the child from the moment of its birth — assisted, of course, by its other parent — and " recover" without experiencing a single symptom of any one of the numerous diseases so common to the lying-in period. This shows that nature can be returned to, as well as departed from, even among civ- ilized people. I am aware that the easier labors of the less civilized portions of the human family are accounted for by some on the supposition that the children have smaller heads. There is something in this circum- stance, no doubt ; but if the mother lives properly, and the foetus is healthfully nourished, the osseous structure will be so elastic and pli- able that the size of the hea ^..though larger among the educated class- es, will constitute no serious obstacle to easy delivery. Among the improper habits which are the sources of the pains and perils of childbirth, improper food, unquestionabJy, ranks foremost. The immediate causes of the pains are a rigidity and inflexibility of the soft structures on the part of the mother, and advanced ossification of the bones of the cranium on the part of the child. Acting upon this theo- ry, Mr. Ramsbotham, of London, instituted an experiment, which was published in 1841 {Essay on Human Parturition), for the purpose of securing safe and easy delivery. The experiment succeeded perfect- ly ; and, although I do not explain the result as others have, the facts are just as interesting. Mr. Ramsbotham restricted the patient prin- cipally to vegetables and fruits ; farinaceous articles, as wheat, barley, beans, peas, rice, and especially fine wheaten flour, being but sparingly employed on account of the phosphates of lime and magnesia they con- tain. Mr. R.'s idea was, by withholding some portion of the natural bony constitutents, to de-ossify the systems of both mother and child to some extent — to produce an absolute abnormal state — trusting to a more farinaceous diet, after parturition, to supply tlie requisite ele- ments of bone. The same experiment has been repeated in this coun- try in several cases, and always successfully. Now I think the whole explanation is furnished by the prmciple of a more plain, and simple, and less concentrated diet. Such a dietary will alwavs keop the system open and unobstructed, and the excre- 466 MIDWIFEllY. tions free, so that the superfluous particles of earthy matter, if any ex- ist in the farinaceous articles, will be readilj' washed away. The real objection to urge against farinaceous food is, that being highly nutri- tious, most persons, without a large admixture of fruits and vegetables, are very apt to eat too much. I agree entirely with Mr. R., that the diet is far the most impoi-tant of any one of the hygienic considerations affecting the security or happiness of the pregnant female, or the health of her offspring. Medicating Labor Pains. — The fashion of giving ergot and other "forcing medicines" to expedite delivery, has prevailed to an alarming extent; happily, however, it is now on the decline- But the auEES- thetic agents, ether and chloroform, are threatening to have "a run'* among ever-changing medical fashions. Among the advantages alleged by Dr. Stearns, who first introduced the employment of ergot in 1807, was "saving to the accoucher a considerable portion of time." Per- haps an hour or two of a doctor's time is more precious than the health of the infant — and perhaps not. "The pains induced by it," says Dr. iS'tearns, "are peculiarhj farcin g^ Again says the doctor, "since I have adopted the use of this article, I have seldom found a case that de- tained me more than three hours!'' Dr. Beck tells us the profession is divided on the question, "Whether the use of ergot has an injurious influence on the child — some maintaining that its common use is the principal cause of the increasing number of still-born children." Now it is perfectly clear, that if it forces the uterus to rapid and extraordi- nary "forcing" contractions, it must to precisely that extent expose the mother to tearing and laceration of the soft parts, and endanger an in- jurious and fotal compression of the child's head in the passage ; and further than this, if the child s not soon born after its administration, the narcotic properties of the drug — which are known to be potent — may narcotize or destroy the child through the medium of the circula- tion. The only plausible argument which has ever been advanced for its use is, that the strong uterine contraction which it induces, will tend to the prevention of hemorrhage. But when it is considered that there is no danger of hemorrhage under ordinary circumstances, and that, in those extraordinary cases in Avhich it does occur, we have a surer re- source in simple cold water, the argument appears almost foolish. As long ago as 1812 it was noticed by many physicians, and recoi led in the New England Journal of Medicine and Surgery, " that in a large proportion of cases where ergot was employed, the children did not re- spire for an unusual length of time afl m- birth, and in several cases they Were irrecoverablv dead." "Since hen." savs Dr. Beck, "a larg« PARTURITION. W, amount of testimony has been furnished, confirmatory of the truth of this suggestion." Still more pointed and direct evidence is found in the following statistics, collected'by Dr. Beck. Dr. Ward, of New Jer- sey, who used the article extensively, came to the conclusion, that unless the child was expelled in forty minutes after its effect was ap- parent, it would be born dead. Dr. Hosack gave it in three cases, and the result was three still-born children. The late Dv. William Moore, "a veteran practitioner of obstetrics in this city," testified, " It appears to be injurious to the child at all times, for in every case in which I have seen it exhibited, the child was still-born." Dr. Chatard, of Bal- timore, gave it in thirty-seven cases, and fourteen oi them were still- births. Dr. Holcombe, of New Jersey, Dr. Davies, of London, Mr. T. Chavasse, of Birmingham, Mr. Paterson, of Abei-deen — all expe- rienced obsteti'icians, coincide with the previous authors. Dr. Per- kins, of this city, testifies : " I have reasons satisfactory to my own mind for believing, that it has frequently destroyed foetuses, and pro- duced sterility in mothers." Dr. Beatty, of Dublin, states that he has known infants which have been narcotized by ergot before birth, to have been affected with con- vulsions afterward, terminating in idiotcy ! This is but a small part of the evidence extant, but T trust it is suffi- cient for a proper understanding of the subject. Nor is the employment of chloroform, ether, or any other unnatural agent free from danger. These agents will, it is true, mitigate the suffering from labor pains to a much greater extent than they dimin- ish the contractile power of the uterus. But already the attention of practitioners has been called to the injuriously narcotic effect of these articles on the child. And even in cases where it has not stupefied the child, it has produced a narcotic shock upon its nervous system which proved a lasting and incurable injury. If mothers will take proper care of themselves, there will be rarely occasion for such treatment ; and if doctors would teach them this lesson, and so avoid the necessity of using those agents, they would confer on suffering humanity a much greater boon than in assuaging pains which might have been avoided. Natural Labor. — All labors are usually called natural in which the child is so disposed within the uterus or pelvis that the h'v'Sa can be ac- complished by the efforts of nature ; in contradistinction to unnatural and complicated labors, which require maaual or instrumental assist- ance. In the most common, and perhaps the only truly natural labor, the head presents at the superior strait, with the occiput in front or to- ward the symphisis pubis, and the Aice turned toward the sacruno. 468 MIDWIFERY. The reversed presentation — the face forward — is mrely attended with any other difficulty tiian a more tedious delivery. Foot presentations aJmost ahvays terminate naturally, and the same is true of breech pre- sentations. Diagnosis of Prkse.xt^iions. — The distinctive signs b\' which dif- erent parts of the body can be recognized at once, ought to be familiar not only to all mid wives, but to all females who are liable to be called upon to assist in emergencies. The head may be readily known by its hardness and by the sutures and fontanelies ; the breech, by its soft- ness, the anus, os coccygis, the scrotum or vulva, and the cleft between the buttocks; the knee, by its rounded form, and by the condyles of the femur ; the foot, by its long narrow form, its being at right angles with the leg, the narrow heel, and near!}- equal length of the toes : the elbow, by the olecranon process, which renders the joint much sharper than the knee ; and the hand, by its shortness, the unequal length of the fingers, and the divarication of the thumb. Stages of Labor. — The first stage is usually reckoned that period in which the first obstacle to delivery is overcome, which consists in the dilation of the cervix uteri. In most cases, a pouch of the mem- branes, filled with liquor amnii, called '-the bag of the waters." la pressed forward of the child's head, and serves as an equable wedge to effect the dilation in the easiest possible manner ; but when the wa- ters have been prematurely discharged, the child's head acts as a wedge, in which case there is considerable more suffering. In the second stage the second obstacle, which is the brim of the pelvis, is overcome ; the head of the child is compressed, and, as it were, mold- ed into a shape exactly adapted to the passage. When the due posi- tion of the head is attained, it advances with every pain, and recedes somcAvhat during their intervals until it arrives at the lower outlet. The obstacles here are the ligaments, muscles, cellular tissue, and perine- um, which gradually yield Jis the head is repeatedly pressed against them, until the dilatation is sufficient to i>ermit the head to pass, con- stituting the third stage, and completi^ig the birth. The duration of natural labor varies from a few hours to several days. The average lime is abou;: twelve hours. In the fourth and last stage, the placenta is detached and ex[)e1!ed. It may occur in a few minutes after the delivery of the child, or not till a lapse of several hours. Its expulsion 'b attended by comparatively slight l;ih-v pains. Position during Labor. — Sinco )nan-midwifery has been i trade. PARTURITION. j*19 an immense amount of ridiculous parade and scientific barbarity has be- come fashionable on parturient occasions. It is quite customary to fix and fasten the patient in some awkward position for hours together, surrounded by some half a dozen female helpers, each one having some particular pushing, pulling, holding, or lifting duty to perform in the premises, while the doctor is fantastically and frightfully dressed, as if about to perform some terrible surgical operation. It is not strange that mothers, with a first child, are so often tormented or alarmed into dis- eases and accidents. In the cities, labor-chairs are common; but m the country the patient is commonly perched up on four chairs, tied together and covered by bedding, with four attendants supporting the four extremities — the husband bracing behind — the doctor conveniently disposed, and one or two extra attendants making themselves " gen- erally useful" in preparing medicinal slops for tiie woman in travail, and tea for the partj^ as soon as the travail can be urged to a conclu- fiion. All this is wrong. The patient should walk, sit, or stand until she feels inclined, by the severity of the pains, or the local disturbance, to rest. She shoulu then recline o-n a hard bed or mattrass. She may assume any position that she finds most comfortable. She may have the head high or low ; lay on the right or left side, or back ; or, for a change, rest on the knees, sup- porting the breast with pillows; or she may change from any one of these positions to either of the others as often as she pleases, and even get up and walk, if the labor is protracted, whenever she feels able and inclined to. There is no necessity for her being confined to a fixed po- sition, and constantly attended upon, by the man or woman-midwife. Nay, such constant attention is invariably injurious. Management during Labor. — So many erroneous notions are aoroad on this subject, that I can scarcely write a paragraph without crossing some professional error or non-professional whim. Ii] a nat- ural labor there is almost nothing to be done, and the principal duty of the physician is to keep the attendants from meddling. After an ex- amination, to ascertain if the presentation is favorable or otherwise, the duty of the midwife and attendants is resolved into keoi)ing the patient in a comfortable position on the bed, supporting her during the pain by making firm pressure with the hand upon the lower part of the back, whenever she desires it — assisting her to change position, and giving her a swallow of water occasionally, which should be the only food, drink, or medicine allowed. Many abominable customs of "hastening the delivery," have had their day ; and many doctors have acquired great celebrity for " deliv- 40 470 MIDWIFERY. ering womeu" quickly ; but iil. people ought to be taught that all these thini^s pertain either to rash measures or false pretences. It is a cunnnon, and, I believe, universal dogma among professional men- midwives, that the perineum must be supported by pressing against it externally, while the child's head presses against it internally. I know of no standard author who does not recommend this practice. Pro - feasor White, of Buffalo, not long since testified in a court of justice, that the principal use of the physician was to support the perineum during the passage of the child's head. Now, in opposition to all this high authority, I protest against this practice as not merely useless, but actually injurious. And against the science urged in favor of the prac- tice, and the affidavit of Dr. White, I oppose the common sense, that the distended part is more likely to be injured or ruptured when pressed between two resisting bodies than w4ien only pressed on one side. The practice I am controverting can only be predicated on the notion that nature has not constructed the parts on correct principles, or has not provided the necessary means to accomplish her o\vn pur- poses. Some authors recommend the nurse to press upon the uterus ex- ternally as the child is being born, with a view of loosening the after- birth. This, too, had better be let alone. The umbilical cord is some- times coiled around the child's neck; and, although it can be easily slipped off, it seldom does any harm. When the head is very strongly pressed in the cavity of the pelvis, the integument of the scalp often forms a i-ather firm, circumscribed swelling ; and probably no occurrence so trifling has ever occasioned 80 manj' serious alarms and accidents. It has been mistaken for an ab- normal tumor, and cut open ; and, for a presentation of some other portion of the body. No one, not even the most inexperienced, need make any mistake here if he or she will only employ the thinking facul- ties, for the hair of the scalp will in all cases determine its character; and all the treatment it requires is to be left to itself. As soon as the child is born it will cry lustily, if healthy and vigor- ous, soon after which the umbilical cord may be tied and cut ; but if the child does not ciy, or appears apoplectic or feeble, the cord should not be cut until the pulsation in it ceases. Some authors have recommended pla|)ping the child on the back to excite circulation and respiration ; but a more merciful and more efficacious practice is to dash a little cold water on its chest, abdomen, and spine. The cord maj be tied about two inches from the navel, and again an inch farther oflT, and then cut through near the first hgature with a pair of scissors. Dr. Burke {Acccurhers Vade-mecum) tells us with b»- P A r. T U E I T 1 N i: 1 coming gravity, that " a piece of narrow, flat tape makes the best liga- ture ;" but I cannot conceive any reason for selecting one kind of a string in preference to another ; and, in fact, if the cord is not severed too soon, there is no rea\ necessity for a ligature at all, as we may learn from the examples of the animals around us. The Aftkr-Birth. — The contractions of the uterus, which expel the child, also detach the placenta; and in most cases it lies loose in the vagina after delivery of the child. Sometimes, however, it is not en- tirely detached, or is still attached to some portions of the uterus by morbid adhesions. If no expulsive efforts are made in an hour or two —^evinced by a recuiTence of bearing-down pains — the cord may be gently pulled upon — never forcibly ; and if the after-birth Joes not read- ily follow, gentle pressure may be made on the lower part of the abdo- men with the hand : or the abdomen manipulated from above down- ward. Should the placenta be retained several hours without expul- sive pains, the hand may be dipped in cold water and applied as above, to excite uterine contraction. The sudden application of a cold wet cloth to the abdomen is often effectual. After the removal of the pla- centa, a free vaginal injection of cold water is always harmless, and generally remarkably soothiP-g and strengtlieoiDg. After-Management. — Professors of midwifery instruct theh- pu- pils to conclude their duties in this matter by placing a bandage around the abdomen of the mother to prevent a "pendulous belly ;" and anoth- er around the child to secure it against being " pot-bellied." All wrong again. They do not prevent such results. The most unshapely abdo- mens I have ever known occurred after severe bandaging. To the infant such an application is particularly cruel and barbarous. Its ten- der, flexible muscles cannot have too much freedom ; and those men- midwife philosophers who imagine one portion of the body wants re- forming by artificial supports, while all the rest is pretty well put to- gether by Dame Nature, must have a veiy mean opinion of her handi- work, as well as an exalted estimation of their own superior skill and taste. The wet and soiled clothing should be removed from the bed as Boon as convenient, and the patient supplied Avith clean linen ; after which she should be allowed to rest as long as she feels so inclined. A tepid sitz-bath or ablution may be advantageously taken after resting awhile. It is a great mistake that lying-in women should keep their rooms or beds any prescribed length of time. But, on the other hand, there is nothing gained in being too heroic. I have known females i»» 472 MIDWIFERY. this citv take the entire charge of their infouts from the moment of oirtli, and li^nve their rooms comfortably on the vlay after delivery ; but if all sliould attempt to do so some of them would most certainly have the experiment to regret. Whenever the patient feels faint or ex- hausted, she should be allowed the most perfect repose, until her sen- sations indicate exertion. If she has been subject to prolapsus, or se- vere leucorrhoea, she should be guarded against exerting herself too soon. The rule for her to be governed by is, to sit and walk as soon or as much as she can without inducing pain, distress, lameness, or bear- ing-down sensations — but not to transcend those limits — with no regard whatever to time. Convalescence of Lying in Women. — There is no place where more mischievous meddling with the harmonious operations of nature is found than in the chamber of the hing-in woman ; nor is any place more abounding in mal-practice on the part of the physician ; nor more infested with the conceits, whims, miseducation, prejudices, and su- perstitions of nurses. When the usual stimulating and slopping of the mother, and the stuffing and dosing of the child is taken into the ac- count, we have no occasion to wonder that so many mothers have a '• bad getting up," nor that so many children decline and die. The mother is gorged with catnip teas, panada, wine-whey, soups, broths, and medicated slops innumerable to promote the lochia] discharge, or increase the secretion of milk ; and the child is made to swallow cas- tor-oil, sweetened urine, and other nauseous and disgusting trash, to " clear out the meconium," and afterwai'd fed on magnesia, prepared chalk, and dosed with aromatic seeds and pungent essences to "keep out the wind," and paregoric or laudanum, or opiate cordials, to quiet the pain and irritation which the doctoring has produced. These doings, which are almost universal in civilized society, indicate a stupid ignor- ance or gross perversion of the simple and efficient operations of na- ture, destroy thousands uj)on thousands of infants in their cradles, and lay the foundation for debility, imperfect development, and '-nnumera- ble diseases in those who are so fortunate or unfortunate as to survive them. The food of the mother should be essentially of the same nature as usual, having reference, of course, to the state of the sj'stem, amount of exercise, etc. The mother does indeed, to some extent, "eat for two," but the appetite will always demand food enough; and it may be satisfied short of overloading or oppressing the stomach. Bread and milk, or gruel with toasted bread, cracked wheat, boiled rice, etc., with a moderate supply of ordinary fruits and vegetables, are suffi* PARTURITION. 47i L-iently watery for all needful purposes if the milk be deficient, while dry toast, crackers, good bread, potatoes, etc., are amply corrective whe-d the breasts are overburdened with this secretion. Accidents during the Lying-in Period. — The majority of acci- dents and diseases which follow ordinary labors, are artificially jjro- duced, the result of meddlesome doctoring or bad nursing. The r.ia- joriiy of medical wi'iters on midwifery give directions for mannging the pcitient, which, if strictly followed, could hardly fiil to induce ac- tual diseases. It is a common practice to stimulate with wine or bran- dy, or camplior and carbonate of ammonia, if the patient seems ex- hausted and chilly after parturition ; give opium if she is restless, and bleed or leech if she is feverish, aiid take blood even if she is cold and shivering, if the practitioner susjyccls the siiivering to be the cold stage of an approaching puerperal fever. Thus is the whole organism thrown into confusion and disorder, and called upon to waste its pros- trated energies in resisting the effects of poisons at the precise mo- ment when it needs the most profound and undisturbed repose, both as regards external disturbances and internal irritations. A single ex- tract from a standard text-book will show that I neither misrepresent nor exaggerate in this matter. Dr. Huston, as quoted by Dr. Condie, in Churchill's Midv/ifery, says : '' I have seen more than one instance in which there v/as reason to believe the life of the patient was sacrificed from ignorance of the true character of tlie condition here referred to [nervous shock or exhaustion after delivery]. If the attention of the practitioner be at the time particularly directed to puerperal fever, he is liable to con- found the exhaustion in which he finds the patient with the early stages of that disease. The cold extremities constitute the chill, while the haggard countenance, hurried respiration, and frequent pulse are regarded as conclusive evidence of a rapid peritonitis. Bleeding iVom the arm or by leeches, is the instant resort, und a few short hours con- firm the worst anticipations, by the fatal lei .nination, a result which the efforts of the attendant have but too successfully aided in pro- ducing." Who can fail to see the "lesson of wisdom" taught b}' tl ese fata' mistakes ? Lancets and leeches have no business in the lying-in cham- ber ; and if they were always wliere they should be no woman would be kiUed by them; the doctor might err in opinion without causing the di'iith of his patient. And here I may pertinently state a rule of uni- versal application, which doctors, midwives, and nurses might often revert to advantageously ' Whenever there is serious doubt us to 1" I M I D W I F E R Y. \v!i;it uuglii to be done fur the patient — du nolhing — ten cbnnces to o:ie lliiit while the doubts ai'e being solved, nature will solve the dif- (iculty. Floo-^ing sometiraes, though rarely, occurs several hours afier de- livery. It is to be treated precisely as when occuiTing at any other time. The lochiai discharge, or jioivins, sometimes ceases suddenly, or is suppressed by tiiking cold, Dr by inflammatory excitement, followed bj di^tress or swelling in the abdomen, or pain in the head, sense of numb- ness, coldness, etc. The warm hip-bath or hot fomentations are to be occasionally employed untL the action is re-established. Puerperul fever, or periionilis, is one of the most frequent and fatal diseases under old school practice ; but I have never known nor ireard of it among several hundreds of cases treated hydropathically. In fact, I consider this frightful form of fever an impossibility under judi- cious water-treatment. Medical authors distinguish several varieties or forms of this disease, as acute puerperal peritonitis, adynamic or malignant puerperal fever, puerperal intestinal irritation, false periton- itis, etc. ; but they are all merel}' accidental modifications or difierent degrees of severity of the same disease, which consists essentially in an infiammation of the peritoneal membrane, sometimes, however, com- plicated with infiammation of the bowels or uterus, and attended al- ways with a violent but low prostrating fever of the typhoid tj'pe. Among the more prominent symptoms are swelled, hard, and painful abdomen, and obstinately constipated bowels. There is no disease the pathology of which physicians confess them- selves more ignorant of; and certainly there is none which has been more unfortunately treated by the medical faculty, the deaths averag- ing about one in three cases. The treatment is the same as for ordinary inflammation of the bow- els : cold wet cloths to the abdomen, the pack or general ablution, warm foot-baths, cold applications to the head, and tepid injections. There is no danger whatever in appl3'ing cold wet cloths to the abdo- men in these cases: the danger is in withholding them. I have known too many to sink rapidly under the hot mustard plaster and tur|)etit!ne ti-eatment, not to speak advisedly on this point. IiijUnnrnation of the breast, resulting in abscess or "broken breast," is iiniuiig the frequent results of the system of living and doctoring we oi>pose, and among the things unknown in hj'dropathic practice. Cold wet cloths, well covered with dry ones, and very often renewed, con- stitute the local treatment. When the breast has a surplus quantity of milk it may lie d^awn off with the breast-pump, or b}' that ever- INFANT NURSING. 475 convenient suction-pump, the human mouth. When the nipple is malformed or deficient, the breast-pump will often succeed in drav/ing it out. It is no uncommon circumstance for a young mother, especially with her first child, to suffer horribly for three or six months, or even a year, with this loathsome complaint ; and yet it cfin never occur if the system is kept free from obstruction by proper diet atjd bathing, and is not drugged. Sore nipples require nothing more th;in a little cream, olive oil, or simple cerate, with the occasional application of cold wet cloths when they are hot or painful, and occasional fomentations when they are cracked and sore. Milk fever, which is owing to an overheated or unventilated apart- ment, oi- to heating food, drinks, or medicines, usually appears about the third day after delivery. It is attended with the ordinary symp- toms of general fever, great pain and throbbing in the head, and, un- less speedily relieved, a suppression of the secretion of milk. If the patient is not very weak or exhausted, the wet-sheet pack should bo promptly resorted to, and repeated as often as the general heat de- mands ; otherwise, tepid ablutions are to be very frequently employed. Puerperal swelled leg — phlegmasia clolens — is yet another frequent occurrence in ordinary practice, but unknown in the Water-Cure sys- tem. This malady has already been considered in the chapter on Dropsical Diseases ; and I need only add in this place, that the man- agement is the same as for local inflammations generally: cold wet cloths, according to the local heat, and cold or tepid sponging or wash- ing of the whole body, according to the degree of general heat. CHAPTER VII. INFANT NURSING. Dress of IxFANih. — The first provision to make for the new-born infant is suitable clothing. All the usual bandaging and swathing is to be rejected, with every other article of apparel that in the least con- strains its motions. After a washing in tepid water, a soft rag should be tied around the remnant of the cord, and the child dressed with the diaper, a loose shirt, a soft flannel petticoat, and an easy frock. Od up 476 MIDWIFERY. account should any thing be pinned or tied around the abdomen, of any part of the body, like a belt or bandage, unless for some surgical purpose. J Bathing Infants. — Every child should be washed over the whole surface daily; always, too, immediately after waking from sleep, and never soon after eating. The water should be of a mild temperature at first — 85° to SO^ — and gradually reduced to 70° or 65°. Food of Infants. — Greater errors are committed in this depart- ment of infantile nursing than in any other, unless it be in that of drugging. Indeed, I know of no subject in relation to which our American women are so ignorant, or, rather, so full of errors as this. The women of England are far more intelligent in the method of rearing children healthfully ; and the animadversions of some of them upon the foolish habits which prevail in this country, of stuffing and gorging young children on complicated dishes, sweet cakes, candies, and the like, though very severe, are perfectly just. No American mother could be induced to feed her child in the way children are generally fed in this country, if she knew the consequences. Not long since a gentleman and his wife, from a neighboring state, were under treatment at one of my establishments. A child happened to be present which liad been thus far reared hydropathically, and was a perfect picture of health and happiness. During a conversation about this child, she went to her trunk, and then exhibited the da- guerreotypes of three beautiful children she had lost. They were all fine, healthy children, and grew hopefully ; but alas ! at two, three, and four years of age they suddenly died of convulsions ! After in- quiring into her habits of feeding them, I could only wonder how they lived so long. Poor, childless mother ! she still weeps for the lost ones ; but I fear if others are born unto her, they will be lost in the same way, so difficult is it to teach a mother that her artificial appetite is no guide to the natural diet of a child. The mother's milk, it is known, is the appropriate food during the first few months ; but in cases where the breast does not yield a sup- pi}^ at first, a little sweetened milk and water is the best substitute. It must be remembered that, in the great majority of cases, the breast will yield the food as soon as there is any real necessity for it on the part of the child. Nurses generally commence giving solid food too soon — as early as the third or fourth month. The first appea-ance of the teeth, about the seventh month, seems to indicate that as the nat- ural period for commencing the employment of solid food. It b a NFANT N I'll SIN a. great mistake to suppose that all the food taken into the ten-^er and delicate stomach of the infont shoula be fine, concentrated, divested of all innutritions matter, and very nutritious. It is, on the contrary, even more important for children thau for adults, that the food should be unconcentrated and unobstructing, as well as simple and uncompli- cated. Farina, corn starch, fine flour, and refined sugar, are the fash- ionable materials for the infant dietary ; but a worse selection could hardly be made. Graham flour, mush, cracked wheat, coarse Indian meal, hominy, boiled j-ice, brown bread soaked in milk, boiled potatoes, stewed squash or pumpkin, roasted, baked, stewed, or boiled apples, etc., are the proper solid food for infants from the first moment that tliey are able to take any kind. This plan of dieting will secure the ciiiid against dysentery, cholera infant nrm, colics, gripes, spasms, con- vulsions, scrofulous swellings, skin diseases, painful teething, etc., etc., which annually sweep oft' so many thousands to their graves. Improper diet has a vast deal to do with making children cross, fi-et- ful, and ugly-tempered, as well as dull, sickly, and stupid. The most healthy children may be stuffed so outrageously as to suffer continu- ally from cramps, colics, and all sorts of aches and pains ; and so feeling bad, will act bad, in spite of good counsel, parental authorit}^ the nurse's lullaby, or the barbarian's rod. The practice of learning or forcing children to swallow flesh-meat, before they can properly masticate it, is deserving the severest repre- hension. Scarcely any thing, in my humble judgment, has a more injurious efl'ect upon its body or mind than this miserably foolish f>»°h- ion. Two or three years is early enough, and several years later is si ill better, for any child to first taste of flesh. But many mothers, perhaps the majority, stuft' fet, grease, and flesh into their mouths be- fore they are even weaned. Such children are always full of foul humors, or liable to severe inflammatory or febrile diseases every time they take a little cold ; all of which may be avoided by feeding the child on such plain, simple, vegetable food as it always relishes, and will always be satisfied with, until its parents or nurses, in their deep, dark, and pitiable ignorance, pervert and deprave its natural appetite. After being weaned, the usual time of which is at the end of nine or ten months, the child should be trained to regularity in the habit of eating; never allowed to eat between meals, nor after going to bed at night, until the next morning's breakfast-time. The practice of feeding children simply to amuse them or keep them quiet, is also deserving severe reprobation; yet it is one of the fashions of these days. Those who travel much on our raili-oads or steamboats will, it they are of observing habits, notice that a large 478 MIDWIFERY. proportion of all the children aboard, from one year old upward, have their hands full of candies, sweet cakes, or some other eatable ; and if their observing habits are close, they will also notice that those same children are crying, kicking, and yelling with teethache, headache, stomachache, and bellyache, a good portion of the time. If the moth- ers of those children understood the connection between these causes and effects, they certainly never would be the instruments of inflicting so much misery on their little ones. Drink of Infants. — Few words are required here. Those chil- dren who are fed properly know very little of thirst, unless it is de- rived from the bad dietetic habits of the mother. Still, if thirst exists water should be allowed ad libitum ; but the greatest care should be taken to provide perfectly pure and soft water. Children are more injuriously affected than adults by impure or hard water. Salted or greasy food provokes excessive thirst in young children. Common bakers' bread induces gi-eat thirst in all children who are principally fed upon it — a conclusive evidence that it is not fit for them. Warm drinks, with which some nurses are so fond of slopping children, after provoking unnatural thirst by unnatural food or seasonings, tend to pro- duce diseases and debility of the kidneys and urinary organs. It is an excellent practice to give the child a tea-spoonful of cold water two or three times a day, independent of its desire to drink. It soothes the irritability of the gums, and lessens the inflammation and tenderness during dentition. Sleep of Infants. — Young infants are naturally disposed to sleep a large proportion of the time — an instinct which may be indulged to its full extent. It is essential, however, to the health and perfect develop- ment of the young child that it does not sleep with a sickly or aged person ; and it is preferable to have it sleep in a crib or trundle-bed by itself, in all cases after weaning. The thorough ventilation of a child's sleeping apartment is even more important than that of the adult. Children do not often take cold from excess of air while asleep, but very frequently in consequence of sleeping in a hot or close room. Exercise of Children. — Young children, if healthy, are always in motion, except when asleep ; and those mothers do them wTong who try to keep them still and out of mischief. The true philosophy of hahyism is to keep mischief out of their way, and then let them run. They must exercise in play constantly, or be sick. A lazy or a quiet child i^ a sick one. INFANT NURSING. 473 ExcRETiojNS OF Lnf^ats. — Notlifiig caii exceed the absurdity of the common practice of dosing a young child, on every occasion of a little irregularity of the stomach and bowels. In most instances those disturbances are salutary efforts of nature to get rid of surplus, crude, or irritatmg matters. The conical shape of the infant's stomach ena- bles it to vomit with great facility ; and in most cases the vomiting is the result of overfeeding, or offending material. « In either case it will take care of itself if left to itself, and nothing put into it but proper food and drink in proper quantities. The bowels are necessarily subject to some degi'ee of irregularity. For a few days after birth the discharge-s will be dark and watery, consisting of the fa3cal matters, or meconium, which accumulate in the bowels during the latter part of the foetal life, mixed with the ordinary fcecal excrement and secretion ; gradually they become more yellow and of firmer consistence. When the teeth are pressing through the gums, the bowels are always naturally prone to laxness ; and if the irritation from teething is considerable, the looseness will amount to diarrhea. Here again, if w^e are not too blind, we may see the benef- icent provision of nature to remedy what seems to us to be abnormi ties. If the child is properly fed, no trouble need be apprehended from this source — the bowels will take care of themselves. In ex- treme cases of irregularity, either of diarrhea or constipatim'i, no other medication is necessary than cool injections, with the wet abdominal bandage in the former case, and tepid injections, and perliaps a greater proportion of fruit, in the latter ditlficulty. The ideas of curing diar- rhea in young persons by astringent medicines and constipating food, and constipation by purgatives, are both exceedingly mischievous in practice. Both complaints arise from irritation or debility, and health- ful action is the proximate ren.edy for both. Teething. — The lax state of the bowels lessens, to a considerable extent, the inflammatory state of the gums during the protrusion of the teeth. The irritation can be further allayed by occasionally put- ting a tea-spoonful of cold water into the mouth. When the teeth are about coming through, rubbing the swelled gum with the finger is ex- tremely soothing; when there is great heat and tenderness, a piece of ice inclosed in a rag and rubbed on the gums will alleviate the pain. Children often manifest, for a few hours, a high constitutional fever, the result of the local irritation. Beware of meddling with this fever in the way of drug-medicines, as an inflammation of the bowels may be the consequence. I protest also against the common practice of cutting or lancing the gums ci children. Serious evils oftfc:i result 480 MIDWIFERY'. from it, and all the good it promises can be assured by the otht^r riieaus I have mentioned. Drugging Im'ANTS. — From a little book {Essays on Infant Thera- peutics), by the late John B. Beck, M.D., Professor of Materia Med- ;ca and Medical Jurisprudence in the College of Phj-sicians and Sur- j^eons of the University of the State of New York ; Corresponding Member of the Royal Academy of Medicine of Paris: Corresponding Member of the Medical Society of liondon; one of the Vice-presi- tents of the Academy of Medicine of New York, etc. — these titles f-how that this book is one of autlu/rity — I copy the following state- ments : '^ With regard to the effects of opium on young subjects, there are •"WO facts which seem to be well established. Th.^ first is, that it acts with much greater energy on the infant than it does on the adult ; the fiecond is, that it is more uncertain in its action on the infant than the «idult. It is in consequence of these peculiarities attending its opera- tion on the infant, that even the smallest quantities have not unfre- quently produced the most unexpected and even fatal results." Of this, almost every physician must have seen some melancholy examples. Dr. John Clarke states that half a drachm of sirup of white poppies, and also a few drops of Dalby's carminative, have proved fatal in a few hours. Mr. Marley knew a case in which half a small tea-spoonful of sirup of poppies proved nearly fatal, and one case in which thirty-five drops of Dalby's carminative proved quickly fatal to a young child. Dr. Bard knew an infant of several months old killed by ten drops of laud- anum, and another nearly killed by less than two diops. Dr. Christi- Bon states that three drops of laudanum in a chalk mixture for diar- rhea, killed a stout child, fourteen mouths old, in six hours. Dr. Ry- an has known one drop of the "sedative liquor of opium" narcotize an infant. Pereira has seen a powerful effect produced on an in- fant by one drop of laudanum. The London Medical Gazette states that two drops of laudanum, and in one case one drop, resulted in the death of the infant. In the Southern Medical and Surgical Journal for July, 1849, the following case was reported by Di N. V. Woolen, Loundesboro', Alabama: "A fine, healthy female child, in the fifth day of its age, suf- fered from ' griping,' as its mother supposed, for which she adminis- tered to it one drop of laudanum. Thirty minutes afterward its breath- ing became slow and stertorous, and other symptoms of narcosis came on. Notwithstanding every eflfort made, the child died in eleven hours after." INFANT NU USING. 431 If so nmuy children die from the e fleets of buch small doses, how ruinous must be its common administration by ihe hands of nnrsos on any occasion when the child is uneasy, or refuses to keep as still as suits their comfort and convenience. It is an ingredient in most of our medicated candies and lozenges^ cough-drops, sootlfmg sirups, cordials, carminatives, nervines, etc. Dr. Beck says; "The effect is to stunt the growth of the child; it is emaciated and puny; the skin is flabb}'- and shriveled ; the lips are bloated, and the countenance sallow and wrinkled. There is an absence of all intelligence, and the whole ai)pear- ance is haggard and aged, presenting a sort of' miniature of old age.'" Now, as antimonial preparations are among the medicines which are freely given to children, and which enter into a great variety of fever, cough, emetic, and cathartic mixtures, and are even one of the med- icating ingredients of candies, lozenges, and sirups, it behooves the peo- ple to know something about them. In the work above quoted. Dr. Beck tells us that he has known one thirtieth of a grain of tartar emet- ic endanger the life of a child one year old; and in another case a child was killed by small doses of the article. Dr. Clarke, of London, states that a quarter of a grain of tartrate of antimony in solution has pro- duced the death of a young child. Dr. Hamilton testifies that alarm- ing convulsions have followed its use. Mr. Noble, of Manchester, En- gland, and Mr. Wilton, surgeon to the Gloucester Infirmar}^ re})ort sevei'al cases of children of one to four years of age, dying from taking the common antimonial wme for ordinary cojigh and cold. Dr. Arm- strong has many times seen delirium produced in young children by very small doses of antimonial preparations. Professor Schjepf Merei, of the Children's Hospital in Pesth, Germany, certifies that he has known several ch:l(h-en vomited and purged to death by very small doses of tartar emetic. Dr. M'Cready, of this city, reports a death from the article administered in tJie form of Coxe's hive sirup. Dr. Beck says: "The vomiting induced by the preparations of anti- mony ought to be resorted to with great caution in very young chil- dren, and should never be used except in those cases where a sedative effect is required, and can be borne with safety." The rule stands self-stultified, for the frequent deaths resulting from its use in the hands of the experienced physician, show that no medical man on earth can ever know that it can be " borne with safety." Mercurial medicines, in a variety of disguised forms, are more fre- quently taken into infants' stomachs than most people are aware of. Dr. Beck tells us that their action is more energetic in the infant than the adult, and that when salivation takes place its effects are most dis- aslTous. "Sloughing of the gums and cheek," says Dr. Beck "gen- ii— 41 i82 M 1 1> •'»' 11" 2 R r. era) prostratioa and death, are by no maans unconimou occurrences." Dr. West [Diseases of Infancy and Childhood) has known fatal g ^V 1 ^ 1^ 1'^ '^■ o( midwifery wliicli are considered as regalar, are turning, the induc- tion of premature labor, the lever, the forceps, craniotomj, and hy- sterotomy. Turning, or version, consists, whatever may be the part presenting, in bringing forward the feet, this converting the case into a footling. The stati:^tics of English, French, and German practice together show that the operation has been performed once in about 120 cases. In English jiractice alone it was performed but once in over 250 cases. It is sometimes resorted to in cases of convulsions, flooding, prolapsed cord, etc., in order to terminate the labor sooner. It is generally proper and often indispensable in presentations of the superior extremities or trunk, and in presentations of the placenta, which are attended with alaruiing flooding. In performing this operation, the hand is inti'oduced very gradu- ally during the intervals of the pains, the Angers being kept in a con- ical form, following the curve of the pelvic passage, until the fingers and hand are gently insinuated through the os uteri, and through the membranes, if they have not been ruptured. If the shoulder ])reseut, it can then be pushed upward, and the head brought down to the oblique diameter of the brim of the peivis, and the labor thus left to the eiForts of nature. If the case is an arm presenfcition, the hand is to be passed along the arm until it reaches the body, then passed over the front of the chest and abdomen to the feet. After one or both lower extremities are reached, the feet are to be brought, with a gen- tle, Waving motion, to the pelvis, during the intervals of the pains, which accomplishes the turning; after which the labor is finished as an orig- inal footling presentation. The feet, in turning, are to be brought over ihe front of tlie child, and as the feet are drawm down, the misplaced hand or arm will ascend. The labor will then be concluded without further assistance in most cases; but if the patient be in a state of ex- treme exhaustion, it is proper to exert a moderate extracting force upon the feet during the jmins. The proper time for commencing the process is as soon after a suf- ficient dilatation of the os uteri as possible. As preparatory measures, the bladder and rectum should ahvays be emptied. Madame Bouvin performed this operation 218 times, with a loss of 48 children. Premature labor may be justifiably induced in such known deformi- ties of the pelvis as will not admit of the delivery of the child at the full period. The operation has been very rarely underfciken by regu- lar physicians in any country; and the results, as ffir as statistics have been gatliered, show that about half the children survive, while the mortality of the mothers is about one death in ten cases. No less • COMPLICATED LAB OKS. 4fej Oian six different methods of exciting prematurely tke uterine co!i- tnictions have been advocated, the most effective of which are punc- turing the membranes, or niechanica! dilatation of the os uteri. Uter- ine action usually cc nes on in one, two, tln-ee, or four days, and the patient requires the same management as in ordinary labors. The lever, or vecLis, is not frequently employed in midwifery, yet, more frequently than it should be. Its first introduction into practice was "ha'led as a discovery calculated to confer immense benefit upon the human race ;" but, like many other pretentious afi\iirs, its reputa- tion soon began to wane. Its use is said to be, " to correct malposi- tions, or aid the natural motions of the head at the brim or in the cavity of the pelvis." My own opinion of the insti'ument is, tliat it ought to be. excluded from midwifery practice altogether. The forceps is employed rather frequently, and has been in use about two centuries. It is undoubtedly a valuable contrivance for cer- tain morbid conditions and abnormities. Its object is to grasp and coju- press the head of the child, and it can be then used as a lever or ex- tractor. Authors specify a great variety of conditions and circumstances to which they are applicable; but in my judgment their proper em- ployment is Umited to cases in which uterine contractions fail from ab- solute exhaustion of the patient; in cases of convulsions, hemorrhage, or rupture of the uterus, demanding an immediate conclusion of the .abor, in order to save the life of the patient; and in cases of breech presentation, when the head is retained a long time from incompressi- biiity of the base of the skull. In Dublin, Dr. Clarke used the forceps once in 728 labors ; in Paris, Madame Lachapeile once in 293 labors ; in Berlin, Dr. Kluge once in 16 labors ; and Dr. Siebold, of Berlin, used them once in 7 labors. These figures show that they are em- ployed more according to the fancy of the practitioners, than from the real necessities of the cases. Craniotomy, which consists in opening the head of the child, and evacuating the contents of the cranium, is employed when there is too great disproportion between the size of the foetal head and the pelvis to permit the passage of the former, as in the case of deformed pelvis or dropsy of the head; also, when the child has been dead for some time without the labor progressing; also, when, from disease or accident, the head has been separated from the body ; and, finally, when the passage is obstructed by immovable tumors. There is another complication which requires this operation as tho only chance for the mother; and although I do not find a similar case mentioned in any of the books, an instance occurred a few years ago in my own practice. T' was a case of twins, one of which was a foot, 48C MlDWIFEllY and tlio other a head presenration. The difficulty consisted in the lieads, both of which were small, being locked in .he pelvic cavity; the head of the footling remaining fastened hack ofxhe head of the other I ilid not see the patient until the lalx^r was too far advanced to remedy the malpositions, and hence was obliged to eviscerate both heads belore cither could advance. From the statistics of over three hundred tnousand cases, it appears that this operation has been resorted to once in about eight hundred la- bors. Of course, in those cases where the child is not dead, the opera- tion contemplates a sacritice of its life to save that of the mother ; as, othenvise, both would inevitably perish A great variety of instruments have been invented for this operation ^\\& perfurator is commonly employed to open the cranium, and then the crotchety or cranial hook, to extract the foetus. A pair of long-point- ed scissors, or a scalpel with the edge wound to very near the point, will answer. The principal point of skill consists in keeping the point of the instrument exactly in position during the operation, and avoiding injury to the surrounding parts. When the os uteri is well dilated, the fingers may be employed as tractors more advantageously than any other instrument. Embryotomy is a modification of craniotom}' ; it consists in dissecting the trunk and limbs, and bringing the foetus away in fragments, in those cases of cross presentations of the trunk or superioi- extremities in which the body is immovably fixed in the cavity of the pelvis, and in cases of deformities or monstrosities of the foetus. Hysterotomy, or the Ccesu- sa7i section — as it is called after Claudius Ca3sar, who lias the rej)utation of being the first who came into the world in this way — consists in making an incision through the abdom- inal walls and the utei'us, renjoving the foetus and placenta, and then dressing the external wound by sutures and adhesive plaster. It is the dernier resort, and only justifiable \vhen distortion or obstructions ren- der all other methods unavailable. In British and American practice nither more than ha.f ■:he mothers operated upon have been lost. Symphyseotomy, or a division of the bones at the symphisis pubis, was proposed as a substitute for the Caesarean operation by Sigault, who evperimented in this way at Paris in 1777; and notwithstanding lie was voted a medal and a pension, the operation soon fell into disre- pute, for the very good reason assigned by Dr. Hull, •' every operation had its victim." I am not aware that any among the living authors justify the operation under any circumstances. Face Puesentatios —The face may present in either of two po« COMPLIC ATED LABORS. 48; Bitrons, as the forehead is toward the riglit or loft acetabulum. Tim presenting part is known by the general inequalities of the surfoce, or by the recognition of distinctive parts, as the eyes, nose, mouth, or chin. After the labor is somewhat advanced, a swelling of the face may make it liable to oe mistaken for a breech presentation. The bridge of the nose is here the best guide, presenting, as it does, a firm, sharp promi- nence unlike any other part. These cases do not necessarily require assistance. The labor is more prolonged and tedious, and the child's head is often considerably bruised and tumefied, but seldom dangeroush' so. Patience is here the best doctor. The tables collected in the books show that this form of presentation occurs once in two or three hundred cases. Breech Presentations. — In all these cases, as the child enters the cavity of the pelvis, its back is turned either anterioi-ly or posteriorly toward the symphisis pubis or sacrum. They occur, on an average, as appears from the statistical data, once in fifty or sixty cases. They may be distinguished from shoulder presentations by the movable coc- cyx. The labor is not as tedious as in the preceding presentation, and IS rarely dangerous to the mother, although it is hazardous to the child, more than one fourth of those born in this way having been lost. The duty of the midwife or attendant in these cases is well stated by Dr. Churchill: "As to the actual management, the less interference the better for the patient." Dr. Collins, another experienced practitioner, remarks to the sanie effect: "The most common and djingerous error committed by the medical attendant arises from ofificious and injudi cious attempts to hasten or assist during the early stages of labor, thar. which we could not well adopt a more hazardous course." Foot and Knee Presentations. — Experience shows that the in- ferior extremities present but once in about a hundred cases. The mortality among children has been somewhat greater than in bi-eech presentations, akliough the danger to the mother is no more. When the feet present, the toes may point forward or backward, and one or both feet may be advanced. In knee presentations, this i)Hi-t is lial)lc to be mistaken for the elbow; it may be distinguished by ifs two promi- nences, with a depression between them. In these cases, according to the admissions of the most experienced writers, it is even more important that the labor be let alone or left to Uselt than in either of the preceding varieties of malposition. Presentation oi the Suferiok Extremities.— In near'y -ili 'jf 488 MIDWIFE K Y. these cases the shoulder is the part primarily presenting, but afterward the arm prolapses ; the back of the child may be turned toward the ab- domen or spine of the uiother. the former being the most common oc- currence. In some of the instances of this presentation the kbor lias been accomplished without assistance, but in others this is impractica- ble. Its frequency has been one Ciise in two or three hundred. Irs danger may be judged of by the facts that, of the cases recorded, i-ather more than one half of the children were lojt. and one in nine of the mothers. The diagnosis is difficult or impossible iu the early stiges. When the bag of the membranes proti'udes in a conical or elongated form without inclosing the head, a suspicion may be justly entertained ; and after the labor has progiessed somewhat the axilla may be found, which, with the round prorainence of the shoulder, will convert the suspicion into certainty. Turning is the proper resort in all these cases, and the best time to commence tiie operation is, as soon as the os uteri is as fully dilated us possible. There is no danger in waiting so long as the liquor amnii has not escaped ; nor is there much difficulty in turning in this case ; but the difficulty is greatly increased afterward by the firm and more constant contractions of the uterus. If the conti-actioiis aie intense, turning will be impossible, and the attempt tlien would endanger the rupture of the uterus. In this case the whole abdomen should be Ib- meuted with warm wet clothes to relax the muscular system and lessen the contractions; and the patient should drink warm water to the extent of nausea to aid iu suspending the pains, after which the operation may be undertaken. Should all these measures fail, an*.^ turning prove impracticable, the only remedy is evisceration of the thorax. CoMPOU-ND Presentations. — In some rare cases, the liand or arm presents with the head, rendering the labor more difficult, rut not necessarily dangerous. If discovered early, the arm may be leplaced above the head ; but great care must be taken not to draw down the arm, as this procedure would convert the case into an arm j^resenta- tion. If the replacement is notpracticnble it must be treated as an or- dinary labor. The feet and hands may present together, or one of each, attended usually with prohijisus of the cord. As the labor progresses, one or the other extremity will descend, converting it into a footling or an arm presentation. Bj dniwing down the feet, the most favorable position b secured: and this, if done gently and skillfully, can always be done safely ; the attendant should bo especially careful not to mistake a hand COMPLICATED LABORS 48t for a foot, nor in any way maneuver so as to fiivor the descent of the hand or arm. Plural Births. — The signs which denote twin pregnancy are ex- tremely dubious. Each child has a separate placenta, and its special envelopes, and both are almost always .'smaller than usual. The labor may be in all respects natural in relation to both, or preternatural: or one may present a natural and the other an abnormal labor. Hence all the directions mentioned for single labors are applicable to twins. triplets, etc. As many as five children have been born at one time, and four have been born alive. Statistics make the proportion of twins lis rather above one in a hundred; and of triplets, one case in five or six thousand. After the birth of the tirst child there is an interval of rest, vai-yiug from a few minutes to sevenil hours ; in some instances, several weeks have intervened between the birth of the first and second child. In the majority of cases, however, the expulsive efforts of the uterus are resumed in less than half an hour. If the placenta of the first child is not easily removable, it should be lett until after tlie delivery of the second one : and the same rule applies to triplet and quadruplet cases. MoxsTERS. — In all of these cases there is excessive or defective de- velopment of some part or parts of the foetus, or two foetuses are con- joined. The only practical point relates to the obstacle which their bulk furnishes to the accomplishment of the labor; and here, when the deformity or monstrosity is too great to allow its passage, embryotomy is the necessary and only resort. In some cases of double monsters, as the Siamese twins, both have been born alive. The principal dis- eases which produce such morbid enlargements as to render the child disjjroportionate to the natural passages are, dropsy of the belly, and dropsy of the head — ascites and hj/drocejyhalus. In the former cases, after the expulsion of the head, it will readily bo discovered that the distention of the abdomen prevents the delivery of the body: and in the latter case the head is presented at the brim of the pelvis of unusual size and nearly incompressible ; and, notwithstanding strong uterine contractions, or "good pains," the head does not descend into the pel- vic cavity. In either case the child is either dead or in a dying condi- tion ; there need be no hesitancy in eviscerating or puncturing the ab- domen or the head. In footling cases of hydrocephalus, the head is to be perforated behind the ears. Prolapsed Corp. — The umb'^-'^al cord may protrude alone, or with 490 MIDWIFERY. the presenring part, either at the commeucement or during the course of labor. This accident has no influence on the labor, but endangers the child, by obstructing the circulation of the cord. Statistics indicate its occurrence once in about two hundred and fifty cases, with the loss of about half the children. A gi-eat variety of plans have been suggest- ed, and many of them tried to remedy this difficulty ; but some of them are hazardous to both inother and child, and all uncertain ; my own opimon is decidedly in favor of the let-alone practice in preference to any thing yet proposed. In this way the mother's life will never be endangered, whily the chances for the child are scarcely lessened. Retained Placenta. — Obstetricians differ as to the time a re- rained placenta should be left to the efforts of nature before proceeding to exti-act it by force. Some are for waiting onl}' an hour; others several hours ; and others still oppose its forcible extraction at any time except when hemorrhage attends. It is certain that it will slough off and be expelled sooner or later, but practitioners have generally ap- prehended dangerous inflammation. Under the ordinary practice, there is very great danger in this respect ; but with a more rational philosophy, and more efficient appliances to keep down inflammation, the hydropath can justly exercise greater hope in his own resources, as well as greater faith in nature. The irregular contraction, or "hour-glass contraction" of the uterus, by which the placenta is retained, has been noticed frequently to follow the use of ergot, and sometimes the employment of instruments. Hemorrhage. — Flooding, accompanying labor abortion, has already been considered. During the last month of gestation, at the com- mencement of labor, two forms of hemorrhage are liable to occur ; one is called accidental because it arises from an accidental and partial sep aration of the placenta while occupying its usual situation; tlie other it termed unavoidable^ because the placenta is placed over the os uteri and unavoidably separated as the dilatation progresses. Hemorrhage from these sources, according to the statistics, occurs once in about one hundred and fifty cases. In the first variety, the discharge occurs only between the pains ; whereas, in the second variety, it is increased durin44 Fage Butternut, vol. i 441 Cabbage, i 362, 439 Cachexies, ii 1 54 Cadaverous food, i 346 Caesarian section, ii 486 Caglivaii paste, i 3.54 (;airo, baths in, i 40 Cakes, i 354, 436 Cakium, in food, i 324 Calculus, intestinal, ii. .. 145 Calculus, urinary, ii. . . . 299 Calf's foot jelly, i 334 Calf 's head jelly, i. 335 Callipee, i 347 Caloiufication, i 281 Camel, diet of, i 407 Camp fever, ii 89 Cancer, ii 175, 346 Caudle smoke, i 303 Canine madness, ii 225 Capillary system, i 266 Carbon, heating, i 285 Carbuncle, ii. . ., 348 Carditis, ii 117 Caries, ii 358 Carolina potato, i. . . 361, 438 Carpal dislocations, ii... 396 Carpenter, on food, i 404 Carpus, i 73 Carrigeen, i 329 Carrots, i 362, 437 Casein, i 333 Cashew-nut, i 350 Cassava bread, i 327 Catacausis, ii 179 Catalepsy, ii 243 Cataract, ii 35, 183 Cataract-bath, ii 35 Catarrh, acute, ii 151 Catarrh, chronic, ii 280 Catarrhal fever, ii 107 Catheterism, ii 429 Caucasi;m race, i 290 Cauliflower, i 350 Caustics, ii 328 Caviare, i 349 Cayenne, i 363 Celery, i 350, 439 Cellars, unhealthful, i... 305 Cells, development, i. . . 236 Cellulw dropsy, ii 253 Cellular tissue, i 237 Celsus, i 17 Cephalaea, ii 265 Cephalagia, ii 265 Cereal grains, i 351 Cerebral epilepsy, li . . . 206 Cerebellum,! 167 Cerebrum,! 164 Cerumen, i 278 Chancres, ii 292 Change of air. i 300 Charlemagne, bath of, i. . 39 Cliatard, on labor pains,ii. 467 Cheese, i 333, 345 Cheilo-plastice, il 426 Chemistry of diet, i 413 Chemical physicians, i. . 20 Cherries, i 440 Chestnuts, i 431, 441 Page Chest- wrapper, vol. ii. . . 53 Chicken-pox, ii 99 C hickory, i 314 Chilblain, ii 198 Childbirth, ii 461 Childbirth, pains of, ii. . 462 Chill fever, ii 91 Chlorine, in food, i 324 Chloroform, in labor, ii. 467 Ciilorosis, ii 287 Chocolate, i 313 Choking, ii 431 Cholera, ii 139 Cholera infaiitum, ii. ... 140 Cholera morbus, ii 139 Cholera, seasons, i 412 Chord, in music, i 2.^5 Chorion, ii 447 Chorea, ii 212 Chrome, poisons of^ ii... 321 Chrysippus, i 14 Churchill, on pains, ii... 462 Chyle, i 264 Chyle-ducts, i 264 Chy lincation, i 264 Chylous diarrhea, ii. ... 144 Chyme, i 262 Chymification, i 262 Circulation, i 264 Cinnamon, i 363 Circocele, ii 353 Citric acid, i 329 Citrons, i 35C Clairvoyance,! 24rJ Clams, i 349 Clapp, ii t392 Clarke, Dr. Adam, i 340 Clavi, ii 343 Clavicle bandage, i! 386 Clavicle, fractured, ii. . . 410 Clavicle, luxated, !i 388 Climate, i 365 Closed pupil, ii 183 Clothing, i 374 Cloves, i 363 Club-foot, ii 382 Cochituate water, i 316 Cockles, i 349 Cocoa, i 314 Cocoa-nuts, i 350 Cod sounds, i 335 Cottee, i 312 Cold in the head, ii 281 Colds, common, i 365 Colic, ii 136 Collins, on parturition, ii. 487 Combe, Dr., on pains, ii. 464 Combe, G., on pains, ii.. 464 Common compress, i. .. 437 Common cress, i 351 Common diet, i 444 Common salt, i 336 Compress, surgical, ii... :^J6 Compressing arteries, ii. AJ7 Compression, ii 335 Conception, theory of, li. 493 Concords, in music, i . 255 Concretions, intestinal, ii. 145 Concussions, ii 334 Condiments,! ■*63,441 INDEX. 497 Congelation, vol. n 330 Congestive fever, ii 73 Consonants, i 258 Constipated colic, ii. ... 137 Constipation, ii 128, 459 Consumption, ii X54 Contracted sinews, ii. . . 284 Contractility, i 238 Convulsions, ii 204 Cookery, liydropatliic, i. 417 Cooper, on fractures, ii. 418 Copland, on bronchitis, ii. 149 Copper, poisons ot, ii. . . 21(5 Cords, vocal, i 259 Corn, i 43U Cornea, diseases of, ii... 182 Corns, ii 343 Corn starch, i 434 Corsets, i 297 Coryza, ii 280 C oughing, ii .''. 426 Cough, ii 215 Cows' heels jelly, i 335 Cow-pox, ii 98 Cowshps, i 350, 439 Coxalgia, ii 12G Coxarum morbus, ii 368 Crabs, i 349 Cracked wheat, i 431 Crackers, i 354 Cradle, i 369 Cramp, ii 231, 45C Cranberries, i, 43l« Cranium, i. 60 ; ii 408 Craniotomy, ii 485 Cravings,in pregnancy.ii. 459 Craziness, ii 273 Cream, i 345 Credulity, morbid, ii 279 Cretinism, ii 2G3 Crises, ii 59 Crotchet, the, ii 486 Croton water, i 316 Croup, ii 114 Crowing inspiration, ii.. 218 Crustacean food, i 349 Crusta lactea, ii 306 Cucumbers,! 350 Culien, i. 29 Curd, i 333, 3 io, 422 Currants, i 435, 440 Curvature, spinal, ii. ... 234 Custard, i 434, 436 Cutaneous rashes, ii. ... 301 Cutaneous vermin, ii, . . 308 Cuvier, on diet, i 403 Cyanosis, ii 309 Cynanche, ii 113 Cyrtosis, ii 263 Cystic sarcoma, ii 353 Cystitis, ii 121 Dall's, Mrs,, testimony, ii. 439 Dandelion tops, : 350 DandruU', ii 3U3 Darwin's Zoonoraia, i... 30 Davies, Dr., on ergot, ii. 46'' Daymare, ii 2l9 Deafness, ii 196 Death, apparent, ii 239 Deatii, natural, i 386 Decay of nature, vol. ii. 167 Decidua, ii 447 Decline, ii 167 Deformities, ii 377 Deglutition,! 261 Delirium tremens, ii. . . . 209 Democritus, i 12 Dentition, periods of, i.. 69 Derivative baths, ii 28 Despondency, ii 275 Devonshire colic, ii 136 Dewees, on pains, ii 464 Diabetis, ii 297 Diapliragm, i 270 Diarrhea, ii 139 Dicks )n, controverted, i. 404 Dietaries, i 441 Diet, divisions of, i 444 Dietetic rules, i 441 Dietetics, i 397 Dilhcult bi-eathiijg, ii. . . . 216 Digby, Kenelm, i 23 Digestion, i 261 Dioscorilles, i 17 Diplomas, first granted, i. 19 Diphthongs, i 258 Discords, in music, i.. .. 255 Disease, nature of, ii 4 i )islocations, ii 385 Displacements, ii 293 Dissoiiant speech, ii 284 Dissonant voice, ii 283 Dizziness, ii 269 Doane, on asphyxia, ii. . 243 Dogmatic physicians, i.. 11 Donne's experiment, i.. . 335 Dotage, ii 279 Douche-bath, ii 25 Dreams, i 371 Dress, female, i 298 Drink, i .307 Drinks, acidulous, i 314 Drinks, artificial, i 3 10 Drinks, intoxicating, i. . 314 Drinks, warm, i 312 Dripping-sheet, ii 27 Di'op-bath, ii 49 Drop serene, ii 183 Dropsical diseases, ii. . . 252 Drug fever, ii 73 Drug-treatment, ii 9, 15 Drunkard's delirium, ii. 209 Dry-cupping, ii 327 Dry pack-batli, ii 35 Dry scall, ii 304 Dumbness, ii 282 Dumplings, i , . . 355 Dung-baths, i 43 Dunglison, conti'o verted, i. 300, 331, 333, 336, 342, 358, 372, 404 Duodenitis, ii Y3Z Duration of life, i 383 Duration of pregnancy, i. 455 Dysmenorrhoaa, ii 286 Dysentery, ii 152 Dyspepsia, ii 129 Dyspeptic phthisis, ii. . . 158 Dyspnoea, ii 216 Dysuria, ii 297 Png« Earache, vol. ii i!j4 Ear, anatomy ol", i 195 Ear-bath, ii 47 Ear, diseases of, ii 187 Eai-, substances in, ii 194 Ear-wax, i 278 Earth-bath, i 43 Eberle, on pains, ii 464 Ecchymosis, ii 186, 338 Eclectic physicians, i . . 15 Ecstasy, ii 243 Ecthyma, ii 306 Ectropium, ii 184, 425 Eczema, ii 305 Efiervescing mixtures, i. 314 Eggs, i 347, 422 Egyptian baths, i 37, 40 Egyptian ophtiialana, ii. 184 Egyptian priests, i 10 Elasticity, i 2.17 Elbow, Iractured, ii 414 Elbov/, luxated, ii 393 Elbow-joint, i 85 Elderberries, i 350 Elements of food, i 325 Elements, organic, i. . . . 54 Elephantiasis, ii 168 Elephant leg, ii 260 Elephant skin, ii 168 l^^lUotson, on I'aL-y, ii. .. -^xi Embryotomy, ii 418 Emetics, surgical, ii. ... 3.i:j Emissions, nocturnal, ii. 291 Emollient herbs, i 44 Empirical physicians, i. 11 Emphysema, ii 259 Empyema, ii 3fi5 Encephalitis, ii 2i:J Endine, i 3.'il Endocarditis, ii il7 Endosmose, i. 286, 287 ; ii. 7 Enearesis, ii. 298 English bath.s, i 42 Enlargements, ii 248 Enteritis, ii 119 Entropium, ii 184, 4 J5 Ephemeral lever, ii b6 Epicures, i 341 Epilepsy, ii 2o6 Epithems, i 43 Epistaxis, ii 170 Episynthetics, i A Hi Epulis, ii 344 Erasistratus, i 14 Ergot, in labor, ii 466 El uptive fevers, ii 93 Eruptions, heat, ii 3u5 Eruptions, scaly, ii 303 Erysipelas, ii 103 Erysipelatous rasli, ii. . . 196 Erythemas, ii 195 Escpiimaux voracity, i. . ;J.")l Essenes, vegetarians, i . 414 Kthiopic race, i 291 EtioiatiMi vegetables, 1. . iJilj Eustachius, i 23 Evacuations, i . . 379 Exatnpli's ot iiingevity. 1. 384 Excitability, i 238 Excreliona, i 37S} 498 INDEX. rage Kxcreraentitious secre- tuins, vol. i 277 i:xcTctoiy organs, i 279 Kxcrfsc»;nee, genital, ii. . 294 Excrfeceiii gums, ii 135 i Kxt-nise, i 367 Kxtuliation, ii 358 Kxlinhition, i 277 i;xatmuhe, i. 286 ; ii. . . . 7 t.xperieiice in diet, i 411 Extaiiguiuity, ii lot) LxteriKil absorption, i... 271 Kxti'rual senses, i 189 ICye-batl'., ii 47 Eye, diseases of, ii 180 Eye, excrescences of, ii. 184 Eye, structure of, i 190 P3ye, substances in, ii 186 Fabriculi lever, ii 73 Factitious atmospheres, i. 45 Factitious gases, i 44 Faculties, i 245 Faeces, i 262 Fainting-fit, ii 27U Falling sickness, ii 206 Fallopian dropsy, ii 258 Fallopian tubes, i 231 Fanaticism, ii 276 Farina, i 354, 4.32 Fasciae, i 127 Fat, i 330 Fattening poultry, i 347 Fatty livers, i 347 Fatuity, ii 279 Feculent diarrhea, ii. ... 144 Feculoid, i 327 Felon, ii 345 Female authors, ii 440 Female dress, i 298 Ferment, i 426 Fermentationists. i 24 Fermented breads, i. 353, 425 Fi^rmentation, i 427 Ferxi-tree, i 350 Fever and ague, ii 90 Fever diet, i 444, 447 Fever sores, ii 357 Fevers, classified, ii 72 Fevers, ephemeral, ii. . . 86 Fevers, eruptive, ii 93 Fevers, inflammatory, ii. 87 Fevers, intermittent, ii.. 90 Fevers, remittent, ii. ... 90 Fevers, symptomatic, ii. 92 Fevers, typhoid, ii 72 Fevers, typhus, ii 88, 89 Fibrin, i 331 Fidgets, ii 268 Figs, i 440 Filberts, i 350 Finger-bath, ii 48 Fingers, dislocated, ii. . . 397 Fingers, fractured, ii 416 Fingers, superfluous, ii.. 379 Finlanders' baths, i 40 Fireplaces, i 3(J2 Fish aliment, i 348 Fishes, as food, i 339 348 Fishes, poisonous, ii. . . . 323 Fieh »kin, ii 304 Page Fissures, vol. ii 363 Fistula lachrymalis, ii. 185,364,424 Fistula in ano, ii 360 Fistula in perenio, ii. ... 362 Fistula, salivary, ii 364 Fixed oils, i 330 Flatulence, ii. 129 Flatulent cholera, ii 139 Flatulent colic, ii 137 Flesh-meat, i 339, 343 Flooding — Flowing, ii.. . 474 Fluor tifbus,, ii 239 Fluorine, in food, i 325 Fluxes, ii 151 Foetal anatomy, i 233 Foetal development, ii... 447 Foetal pathology, ii 456 Follicles, gastric, i 278 Fomentations, ii 50 Fomentations, medical, i. 43 Fomentations, surgic, ii. 330 Food, i 320 Food, animal, i 339 Food, vegetable, i 350 Foot-bath, ii 31 Foot, dislocated, ii 407 Foot, fractured, ii 423 Fore-arm, fractured, ii. . 415 Forceps, in labor, ii.. .. 48^) Forsyth, Dr., on diet, i.. 4G0 Fountain-bath, ii 40 Fowl, i 422 Fractures, ii 407 Fragillitas ossium, ii 26:3 Framb'jesia, ii 203 Freckles, ii 30d French baths, i 41 Kret, ii 198 Friction, ii 54 Fritters, i. 354 Frogs, as food, i 339 Fruit-cake, i 354 Fruits, i 439 Frying food, i 330 Full diet, i 444 Fumigations, i 44 Functions, divisions of, i. 235 Functions, individual, i.. 260 Fungus hematodes, ii... 347 Funis, ii 449 Furunculus, ii 357 Galen, i 17 Gall-bladder, i 221 Gall-stones, ii 133 Ganglia, i 183 Ganglion, ii 344 Ganglionic system, i. . . . 186 Gangrenous erythema, ii. U>6 Gaping, i 238 Garlics, i 3.50 Garments, i 376 Gas-burners, i 302 Gases, facti ious, i 44 Gastric fever, ii 107 Gastiic-juice, i 262 Gastric remitt. fever, ii. 166 Gastritis, ii 118 Gastroenteritis, ii 119 Ganla, bathing Labits» . 38. Gelatin, vol. i 334 Gelatin commission, i.. . 335 Genio plastice, ii 426 Genital displacements, ii. 293 Generation of heat, i 364 German baths, i 39 Ginger, i 363 Ginger beer, i 314 Ginger-bread, i 354, 437 Gin-liver, ii 249 Glandular secretions, i. . 278 Glandules, odoriferous, i. 279 Gleet, ii 292 Globus hystericus, ii 208 Glue, i 335 Gluten, i 333 Goitre, ii 345 Gold, poisons of, ii 318 Good, criticised, ii. 122, 156, 198, 213, 228, 270, 302 Gooseberries, i 435, 440 Gonorrhoea, ii 292 Gout, ii 122 Graham crackers, i 354 Graham flour, i 432 Graham, on diet, i 403 Grain, constituents of, i. 3.52 Grtmular eyelids, ii 182 Grapes, i 360, 439 Gravel, ii 299 Gravel doctors, ii 300 Gravies, i 430 Gray hair, ii 310 Greatrix, Valentine, i. . . 23 Grease, i 330 Grecian physicians, i. . . 10 Greek baths, i 38 Green corn, i 430 Green-sickness, ii 287 Green vegetables, i 439 Griddle-cakes, i 354, 437 Groats, i 355 Grog-roses, ii 342 Ground-nuts, i 437 Gruels, i 432 Gully, Dr., on crisis, ii. . 63 Gully, on dyspepsia, ii. . 129 Gum, i 326 Gum-rash, ii 302 Gums, i 216 Gums, excrescent, ii 135 Gutta rosea, ii 341 Guy, Dr., on hysteria, ii. 208 Ha^mastasis, ii 331 Hajmatamesis, ii 170 Ha^maturia, ii 170 Haemoptosis, ii 170 Hair, morbid, ii 310 Ilalf-bath, ii 29 Half pack-bath, ii 25 Haller, i 28 Hallucination, ii 27f Hand-bath, ii 48 Hand, fractured, ii 416 Happiness, i 245 Hare-lip, ii 377 Hartshorn, i 335 Harvey, i 23 Hash.i 430 Hazel-nuts.i 350 INDEX. 499 Headache, vol. ii 2(55 Head-biith, ii 32 Head, dropsy oi, ii 255 Hearing, morbid, ii 271 Hearing, organ of, i 195 Hearing, sense of, i 252 Heart, anatomy of, i. . . . 204 Heartburn, ii 129, 459 Heart, inflamed, ii 117 Hf^at, animal, i 2F1 Heat eruption, ii 305 Heated rooms, i 365 Hematocele, ii 353 Hem«ralupia, ii 185 IL^miplegia, ii 247 Hemorrhage, ii 169 Hemorrhage, in labor, ii. 490 Hemorrhoids, ii 148 Henner, on nodes, ii. . . . 355 Hepatitis, ii 118, 132 Hernia humoralis, ii. ... 353 Heruiifi, ii 369 Hernial anatomy, i.. 128, 131 Heroic physician, i 15 Herophilus, i 14 Herpes, ii 305 Hiccough — hiccup, ii. .. 236 Hill, Dr., on hernisB, ii.. 375 Hip-bath, ii 27 Hip-disease, ii .368 Hip, dislocated, ii 397 Hip joint, i 88 Hippocrates i 13 Hirse, i 359 History of bathing, i 36 History of medicine, i. . 10 History of midwifery, ii. 439 Hoe-cake, i 424 Hoiiman, i 26 Hog, diet of, i 407 Holcombe, on ergot, ii. . 469 Holy tire, ii 196 Home, on diet, i 403 Hominy, i 358, 432 Hooper, criticised, ii. 74, 118 Hooping-cough, ii 215 Hop-yeast, i 4295 Hygiene, mental, i 381 Hj yienic agencies, i 295 Hypochondi-iacism, i 276 Hysteria, ii 207 Hysterics, ii 207 Hystcritis, ii 121 Hysterotomy, ii 486 Iced-watcr, i 309 Iceland moss, i 351 Ichthyophagists, i 348 Icterus, ii 132 Icthj'iasis, ii 304 Idiotism, ii 279 Ignis sacer, ii. 196 IH%2 passion, ii 136 Illusion, mental, ii 276 lilutation-bath, i 43 Imbecility, ii 279 Imbibition, i 287 Immelodious voice, ii... 283 Imperforate anus, ii. ... 432 Imperforate urethra, ii.. 432 Impetigo, ii 30i) Imposthume, ii 3()5 Incantations, i 10 Incubus, ii 219 Incurvation, spinal, ii. . . 232 Indian baths, i 40 Indian corn, i 358 Indian meal, i 432, 437 Indian puddings, i 358 Indigestion, ii 128 Individual functions, i.. . 160 Infant-drugging, ii 480 Infantile diseases, ii 484 Infantile hectic fever, ii. 166 Infantile ophthalmia, ii. . 182 Infant nursing, ii 475 Infant teething, ii 479 Infection, sources of, i. . 299 Inilammation, ii 1U8 Inflammatory dropsy, ii. 260 Inflammatory fever, ii. . 87 Inflation, pulmonary, ii. 242 Influenza, ii 151 Inhalations, medicated, i. 45 Injections, ii 58 Injuries, ii 334 Innervation, i 260 Inordinate lust, ii 293 Inosculation, ii 4.30 Insalivation, i 261 Insanity, ii 273 Insects, as food, i 350 Insects, poisonous, ii 234 Insects, wounding, ii 198 Insolation-bath, i. 43 Insurttation, i 44 Intermittent fever, ii. . . 90 Internal absorption, i. . . 271 Intertrigo, ii i.':iti Intestinal concretions, ii. 145 Intestinal enlargem't, ii. 251 Intestines, i 217 Intoxicating beverages, i. 314 Invalids, rules for, i 44 1 Invermination, ii 145 Inversion, uterine, ii. 294, 492 Pag« Involuntary evacuations, vol. i 379 Iodine fumigation, i 45 Iodine, poisons ot, ii. . . . 320 1 1'ish moss, i 35 L Iritis, ii igi Iron, in food, i 324 Iron, poi^^ons of, ii 318 Irrationality, ii 279 Irritability, i 238 I.?churia, ii 297 Isinglass, i 3;j,5 Italian baths, i 39 Itch, bakers, etc., ii 304 Itch, common, ii 307 Jail fever, ii 89 Jams, i 329 Jarrold, on curvatures, ii. 235 Jaundice, ii 1.32 Jaw, dislocated, ii 387 Jaw, fractured, ii 408 Jelly, i 328 Jelly, animal, i 334 Jelly, preparations of, i. 33o Jewish pi-iests, i 10 Johnson, Dr. E., opposed, h 103, 105,211 Johnson, Dr. J., contro- verted, i 396 Johnny-cake, i 358 Joints, structu'v -A', i. . . 79 Juints, dropsy •.., ii 352 Keratoplastice, ii 425 Kernels, i 359 Kidneys, structure of, i. 223 Kidneys, function of, i. . 280 Kidneys, inflamed, ii IgO Killing animals, i 341 Kine-pox, ii 98 Kin-cough, ii 215 King's evil, ii 173 Knee, dislocated, ii 404 Knee-joint, i 189 Labium leporinum, ii. . . 377 Labor, ii 461 Labor, complicated, ii... 483 Labor, management of, ii. 469 Labor, natural, ii 467 Labor, pains of, ii 462 Labor, premature, ii 484 Labor, protracted, ii. ... 483 Labor, rationale of, ii. . . 461 Labor, stages of, ii 463 Lacerations, ii 491 Lachrymal fistula, ii. . . . 185 364, 424 Lacteal absorption, i 272 Lactic acid, i 329 Lactometer, i 344 Lagcphthalmus, ii 42.5 Lainbe, on diet, i. . . 403, 413 Lamps, i 302 Langhaus, criticised, ii.. 195 Lard, i 330 Laiyngismus stridulus, ii. 218 Laryngitis, ii H3 Laryngotomy, ii 431 Larynx, i 207 Larynx, inflamed, ii 113 Lavemeuts, ii, ^ i;co I5BEX. .as, 1 id, i .34^ I'fid i i; :)TiHmh, n. -jos, ii ni: fei^rs, a . pfiiflfmsaf^iL i/etaict. i_ — 3£- ]jin>f jTiirriiSBH, iL L' ■ i:-iEiil, i. — Lj 01.. -muoiieaf :. . . _^ ■ . r-fci, i r-iji-ijijji- i: _ . -- grjjeraQiS oi gm^, -.; ^Ji,ii -.. ^liw fl^ in. 4ai I JsioanE cygrBnd.: of n'a- 'v?3f' I f- '^' . . a^ 35i) €1 3K SIT 367 I^ 2rf5 2X 2S2 ■M5K, ij ±iurgi<:Hl, ii. . -ss, ii ifwioTiiii — lat,!. 'd .- -zed ii ■ 'Lj'ttSBra, - >., a L.: .- L gntmry. : L ■ iimi"] L Li. Li -as, ii. ... Li- L; "3 ii. ... Li LjHiE-m, i '-■mrriLi £ — 'iiy-mrii ,, i. .• fikis., iL n»tti;iLiUj arts i ^^"j;T"fimTr icf.ai4>x j^ i .lUJOf.. iiiictaeUi i 335 ULltnist,! . ■:f ioud,i JE diet, i. — ■•ace,i r. jjjciuU:. Kmosg, i. LTiaida cm diet, i i^rylist, i.-- ; .. cm ereca, 3L- Btaence a^i an fiftsh-RHThig, 1 L ii UF hltmfTTlt, 1. r.. a. • i 1 znyvsrxii^ i_ lar sense, au -- lar lisaaifi, i. ^ >oEi, i... -m's. ii US, a. .3S3, fjfiirefi. 1. --- 4 3G6 ^2 ^SS IS 433 4& 45S 4C7 31 341 :ai 45 ::{3i 3M nr: 1377 ,'58 3S1 135 4i3. 251 f^ 4:a ^1 :23 440 ?0 43 .«Q iSU S41 322 47 sro 3d€ 353 ■967 215 13 INDEX. 501 Page Neck-joint, vol. i 80 Necrosis, ii .'J58 Nectarines, i 350 Neijhritia, ii 120 Nerve-acbe, ii 266 Nf rve«, i 161 Nervous fever, ii 88 Nervous influtnce, i. ... 246 Nervous ay stems, i 240 Nervous temperament, i. 288 Nervous tissue, i 329 Nettle-rash, ii 201 Nrmralgia, ii 266 Neurology, i 161 Neutral salts, poisons, ii. 313 Nevvr York nuisances, i. . 299 N. York temperature, i. . 362 Nichols, Dr., on labor, ii. 4fi2 Nichols, Mrs., on labor, ii. 464 Nictitati'jn, ii 2.'i8 Nightmare, li 219 Nipples, deficient, ii 474 Nipples, sore, ii 475 Nitrogenized tood, i.. . . . 322 Nodes, ii 355 Noli-metangere, ii 349 N'jn-nitrogenized food, i. 3^2 Nose, i ■-... 189 Nose-bleeding, ii 170 N(jse, fracture of, ii 408 Nutmegs, i 363 Nutrition, i 274 Nutritive nerv's syst'm, i. 211 Nuts, i 359,441 Nyctalopia, ii 185 Nymphomania, ii 293 Oritmeal — oats, i 355, 432 Obesity, a disease, i 274 Obstetrical anatomy, ii.. 45 Occupation, i 393 Ocular specters, ii 271 Odoriferous glandules, i. 279 (Edema, ii 253 (Edematous erythema, ii 195 CEsophagotomy, ii 430 (Esophagus, i 217 Oil, as food, i 285 Oils, fixed, i 330 Oleaginous aliments, i. . 330 0:ive oil, 1 330, 437 Omelettes, i 4j2 Omentum, i. 2[5 Omentum, enlarged, ii. . 2-'J2 Onions, i 4;J9 Onychogryphosis, ii. ... 313 Oiiyx, ii 367 Oijyxis, ii. 343 Opacity of cornea, ii 182 Ophthalmia, ii 181 Oranges, i 3.30 Orange akin, ii 308 Oral-bath, ii 48 Orbits of the eye, i 66 Orang-outan-g, diet of, i. 411 Orchitis, ii 122 Order of development, 1 249 Order of the Bath, i. . . . 39 Organic elements, i... , 53 (Jiganic transmission, 444 Orient!).' baths, i 40 Page Origin of races, vol. i. . . 293 Orthopnoea, ii 216 Osmazome, i 344 Ossification, i 56 Osteology, i 55 Osteo-sarcoma, ii. 34ft Osthexy, ii 263 Otalgia, ii 194 Otitis, ii 187 Otoplastice, ii 426 Otorrhoea, ii 189 Ovaries, i 231 Ovary, dropsy of, ii 257 Oxalic acid, i 3-..9 Oysters, i 349 Ozajna, ii 281 I'acking-sheet, ii 22, 35 I'ain, nature of, i ' 11 Pains of labor, ii 462 Painter's colic, ii 136 Palate, i 215, 216 i'alpitation, ii 237 Palsy — paresis, ii 246 I'anary fermentation, i.. 427 i*ancake3, i 354 rancrea.% i 263 Pancreatic juice, i 263 Pandiculation, ii 2^)9 Panther, diet of, i 406 J'apuloua scall, ii 306 Paracelsus, i 21 Paracentesis, ii..424, 431, 432 i'araly.sis agitans, ii 215 Paraplegia, ii 247 Parched corn, i 431 Pari.-iian fashions, i 297 Parker, controverted, ii. 275 Parkinson, criticised, ii. 212 Pi.ronchia, ii 345 Pai-otid glands, i 216 Parotitis, ii 115 Paranep, i 362, 437, 438 Parturition, ii 461 Parulis, ii 3.57 Pa-isions, hygiene of, i. . 381 Passions, ungovemab., ii. 275 Pastry, i 434 Patella, fractured, ii. ... 420 Pathology, ii 72 Pathol of the foetus, ii. . 4.56 Peaches, i 435, 439 Peach-li;atuer, i 44u i'eanuts, i 4-il Pearl barley Pearl wheat, i 354 Pears, i ^559, 4;J5 Peas, i 359, 430, 432, 433 Pectin — pectid acid, i. . . 323 Pnctinaceous aliment, i.. 326 P(;lvis, cavity of, ii 4.52 Pelvis, fracture of, ii. ... 412 Pelvi.H, viscera (ji\ i 22i Pemphigus, ii 202 Pendleton, on paiiis, ii. . 46*1 Pepper, i 363 Pepsin, i ij62 Percussion, ii 161 Pereira controverted, i. 2!i3 285, 313. 314, 321, 324, 336 Perforator, obstetrical, ii. 486 Pericarditis, vol. ii U? Peripneumony, ii U8 Peritoneum, i 213 Peritonitis, ii 120, 474 Perkins, on ergot, ii 46 Pernicioua fever. iL . 73 Pernio, ii 198 Persian baths, i 40 Perspiration, i 278 Pertussis, ii 215 Peruvian hatha, i 41 Pessaries, ii 295 Petechial fever, ii fj.) Pettit-Loes' jelly, i 3;j5 Pharynx, i 21 6 Phenomena, mesmeric, i. 249 Phenomena of sleep, i. . 371 I'hilosophy of mind, i... 244 Philos. of water-/:ure, ii. 3 Phlebitis, ii 338 phlei)otomy, ii 3^38 Phle-gmasia dolcns, ii. 2(W, 475 I'iionographic reform, i. 259 Phosphorus, in food, i.. . 323 I'iiosphoru.'?, poisons, ii.. 320 i'hrensy — phrcnitis, ii... 112 Phthisis, pulmonalia, ii.. 152 Pliysiology, i 235 Phy.'iiology of diet, i. . . . 410 Piebald skin, ii 308 Pica, i 434 Piles, ii 148, 4.59 I'ine-apple, i 3.jO Placrnta, iu 451, 490 Plague — pestis, ii 107 Plantain, i 350 Platina, puiaona o^ ii. .. 321 Plato, i 14 l'l,;dgets, surgical, ii. ... 327 Plethora, ii 173 Pleura, i 212 Pleuralgia, ii 126, 2j4 lleurisy, ii 116 Pleurodyne, ii 126, 224 Plica polonica, ii 310 Pluin-cakCji •i54 Plum pudding, i 'iTA i'l-ums, i 440 i'lungf;-bath, ii 30 I'lural births, ii 489 Pneumatic physicians, L 16 I'lieumatology, i 16 Pneumonia, ii 116 Podagra, ii 122 Poisons, ii 31 1 I'olypua, ii 2al, :j.>l Pompholy.x, ii 3i)5 Population,! 21i4 Pork, i 3.!9 I'orrigo, ii 3ij6 Portabh; shower-bath, ii. 41 Portal, .M., criticised, ii.. 243 I'ortal systf-m, i 15-1 Positions aSeet'g brcata- ing. i 300 PiLiition,"*, bodily, i 301 Positions during sleep, i. 372 positions in labor, ii 468 Potassium, in fof>d, i. ... 325 Potatory i 361. 136, l:«7 602 INDEX. Paje Poiato-tops, vol. i 439 Potato-starch, i 361 ^ot-cln>ese, i 44:2 "^otherbs, i 362 ."'oultices, i 43 .^oultry, benighted, i 305 Poultrj', fattened, i 347 Pox, venereal, ii 292 Pravvna, i 349 Pregnancy, ii 455 Prejniancy, accidents, ii. 457 PregnHncy, diseases, ii. . 459 Preparing iood. i 421. 423 Presbyopja, ii 186 Presentations in labor, ii 468 Presentations, unnat., ii. 483 Prickly heat, ii 302 Prince of empirics, i. 21 Priests, a7Mient, i 10 Prolapsed cord, ii 4S9 Prolapsed uteius, ii 293 Propensities, i 245 Prostatic abscess, ii 368 Prostatic enlargement, ii. 355 Protein, i 331 Proteinaceous aliment, i. 331 Prout, controverted, i... 327 Proximate elements, i. . 54 Prunes, i. 440 Pruriginous rash, ii 302 Pruritis, ii 4.59 Pseudarthrosis, ii 382 Psoas abscess, ii 367 Psoriasis, ii 304 Psorophthalmia, ii 184 Pterygium, ii 183 Ptosis, ii 185, 425 Puddings, i 433 Puerperal convulsions, ii. 491 Puerperal fever, ii 474 Puerperal mania, ii 491 Puerperal swelled leg, ii. 260,475 Pu monary consump., ii. 1.52 Pulse, nature of, ii..* 67 Pulselessness, ii 229 Pumping the stomach, ii. 429 Pumpkins, i 361, 440 Pupil, closed, ii 183 Purificati ;n of air, i 302 Purification of vcater, i.. 319 Pythagoras, i 12, 414 Quadrupeds as food, i.. . 339 Quicksilver, poison of, ii. 313 Quicksilver quack, i. . . . 22 Quinces, i 350 Quinsy, ii 113 Rabies, ii 225 Races of men, i 290 Radishes, i 439 Rain-bath, ii 40 Rainbow-worm, ii 305 Rain water, i 316 Raised bread, i 428 Pcaisins, i 360 Ramolissement, ii 234 Ramsbotham on labor, ii. 465 Ranula, ii 344 Raphania, ii 213 Raspberries, i 440 Rationale of crisis, vol. ii. Rationale of drugs, Ii. . . Rationale ot fever, ii. . . . Rationale of iuflamma. ii. Rationale of parturi. ii. . Rationale of water-cu., ii. Rattling m I he throat, ii. Riiyer, criticised, ii Rau-se, Dr., on crisis, ii. Rear buildings, i Recrementitious secre- tions, i Reflex nervous system, i. Regulars banished, i. . . . Relapsing fever, ii Remittent fever, ii Reproduction, ii Reptiles as food, i Respiration, i Respiration, habits affect- ing, i Respiratory food, i Restlessness, ii Retinitis, ii Retroverted uterus, ii. . . Revery, ii Rhazes, i Rheumatism, ii Rhinoplastice, ii Rhinorrhape, ii Rhubarb plant, i Rhypia — rhupia, ii Ribs, fracture of, ii Rice, i 355, Rickets — rachitis, ii Ringworm, ii River-bath, ii River water, i. , Roasting flesh, i Roller, surgical, ii Roman baths, i Ronchus, ii Root-beer, i Roots, edible, i 361, liose-rash — roseola, ii.. Ross, Sir J., on rum, i. . Rubbing wet-sheet, ii. . . Kubeola, ii Rubula, ii Rum-blossoms, ii R:; nning scall, ii Ru|>tures, ii Rush on alcohol, i Rusks, i Russian vapor-bath, L . . Rye— rye meal, i 430, .Sacchar ne urine, ii Sago, i 327. Salads, i 362, Saline aliment, i Saliva, i Salivary fistila, ii Salivary gland.=, i Salt antiseptic, i Salt, common, i Samp, i Sand-bath, i Sanguine temp'ment, i. . Sarcocele, ii Satyrias's, ii Salvages, vol. i Sax, on organic laws, ii Scabies, common, ii Scabies, rough, ii Scalds, ii Scall, dry, ii Scalled head, ii Scall, humid, ii Scallops, i Scaly eruptions, ii Scapula, fractured, ii. . . Scarifying, ii Scarlet fever, ii Scarlatina, ii Schirrus, ii Schlesekotomy, ii Schuylkill water, i Sciatica, ii Sclerotitis, ii Scoresby, on alcohol, i.. Scorbutus, ii 61 15 77 108 461 4 262 305 63 305 277 ,242 14 73 90 443 339 267 .301 322 Scrofula, ii. 268 181 293 278 IS 126 425 425 436 305 411 430 262 305 39 316 345 328 38 2f2 314 437 301 284 261 99 203 342 306 369 284 354 30 432 297 434 439 335 261 364 216 338 336 358 13 288 3.53 tcurvy, 11 Scybalum, ii Sea-biscuit, i Seasonings, i 322, 362. Sea water, i Sebaceous glands, i Secretion, i Sedative baths, ii Seed?, cooked, i Semi-aiiimist physici. i.. Semolina, i Sensation, i Sensation, diseases of, ii. Senses, external, i...l89, Sensibility, i Sensitive hair, ii Sentient nerv's syst'm, i. Sentimen alism, ii Sequestrum, ;i Serous diarrhea, ii Serpents, bites of, ii. 197, Serpents, poisonous, ii. . Serum, i Sesamoid bones, i Sexual diseases, ii Shaddocks, i Shaking palsy, ii Shallots, i Shallow-bath, ii Shell fish as food, i Sheeps' trotters jelly, i. Shew, Dr., on crisis, ii.. Shingles, ii Ship-bread, i. Ship fever, ii Shrimps, i Shoulder-joint, i Shoulder, dislocated, ii. . Shower-bath, ii Sight, organ of, i Sight, morbid, ii Siiiht, s nse of, i Silliness, ii Silver, poisons of, ii Sinews, contracted, ii. . Singultus, ii Sinuses, i 1.50, 293 I Sitz-bath, ii. . 2d . 445 307 306 335 3;J4 3u6 306 349 303 410 338 lUO 100 .346 425 316 126 181 281 173 173 172 145 354 441 317 278 277 28 430 28 354 250 264 250 239 309 242 276 359 144 200 324 277 77 285 350 211 3.50 29 3:39 335 63 305 354 89 349 84 389 33 190 270 256 279 217 384 ■2'S 151 27 INDEX. 503 Page Skeleton, vol i 57 Skey, on dislocations, ii. 386 Skin, diseases of, ii 301 Skin, functions of, i 279 Skin, structure of.J.-e'^^^Ol Sleep, i ^,^^^^370 Sleep disturbanc^ii. - . Sleeplessness, ii .^ Sleeping apartig^(jMKD^>'-3' Sleep-walking, ii? 27S Small-beer, ^jpr. 314 Small-pox, ii 93 Smee, on hysterics, ii... 209 Smell, morbid, ii 272 Smell, organ of, i 189 Smell, sense of, i 2.'i3 Snail-food — snail-parks, i 349 Sneezing, i 253; iL 236 Snoring, ii 282 Soda water, i 314 Sodjum, in food, i 334 Solidist physicians, i 26 Somnambulism, ii 278 Sordid blain, ii 305 Sorrel, meadow, i 436 Sound, philosophy of, i. 254 Sounds, of the heart, i.. 265 Sounds, vowel, i 258 Spare diet, i 446 Spartan baths, i 37 Spasmodic diseases, ii. . . 204 Special senses, i 189, 250 Specks in the eye, ii 182 Speech, i 257 Speechlessness, ii 282 Spermatic cord, i 218 Spermatocele, ii 358 Spermorrhea, ii 291 Spina bifida, ii 255, 380 Spinach, i 362, 439 Spinal column, i 59 Spinal cord, i 169 Spinal curvatures, ii. 232, 380 Spinal dropsy, ii 255 Spinal irritation, ii 290 Spinal nei'^'^s, i. 176 Spine, fraclares of, ii... 412 Spitting of blood, ii I7i) Splanchnology, i 204 Spleen, enlarged, ii 250 Spleen, inflamed, ii 118 Spleen, mental, ii 276 Spleen, structure of, i... 222 Splints, surgical, ii 328 Sponge-bath, ii 41 Sponge, in surgory, ii... 326 Spontaneous combus , ii. 179 Spotted fever, ii 89 Spring water, i. 315 Spray-bath, ii 40 Squashes, i 36!, 440 Squinting, ii ,. .184, 379 Stahl,i 26 Stammering — stutter., ii. 284 St. Anthony's tire, ii 103 Staphyloma, ii 183 Starch, i 327 Stearns, on ergot, ii 466 Sternum, dislocated, ii. 338 Page Stemal^a, vol. ii 224 Sternuin, fractured, ii.. . 411 Stethescope, ii 161 Ste\ ens, controverted, ii. 243 tift'-joint, ii. 235 itch in the side, ii 224 omach i 217 Siomach, fever of, ii 166 stomach, inflamed, ii... 218 Stomach, pumping, ii. . . 429 Stone in the bladder, ii. 299 Stoves, i 302 Strabismus, ii 184, 379 Strains, ii 335 Strangury, ii 297 Strawberries, i 440 Stretching, ii 239 Strict diet, i 444 Strictures, ii 262 Struphulous, ii 302 Structural developm't, i. 249 Struma vulgaris, ii 173 Studium inane, ii 278 Stunning, ii 334 Stupidity, ii 279 Sturgeon, isinglass of, i. 335 St. Vitus's dance, ii 212 SubmersioQj, death by, ii. 241 Subsultus, 11 238 Succotash, i 431 Sudoriferous glands, i.. . 278 Suet, i 330 SuflbcatioD, ii 240 Sugar, i 336 Sulphur, in food, i 323 Sulphur, poisons of, ii. . 320 Summer rash, ii 302 Sunburn, ii 3('8 Superannuation, ii 279 SuperfcBtation, ii 456 Superstition in medici., i. 19 Suppers, late, i 312 Suppressed urine, ii 296 Supra-renal capsules, i. 223 Surfeit, ii 137 Surgery, ii 325 Surgcal appliances, ii.. . .325 Suspended animali(;n. ii. 239 Sutures, i. 65 ; li. 329 Swathmg children, i 376 Sweat, morbid, ii 309 Sweating-bath, ii 35 Sweating-cradle, ii 39 Sweet potatoes, i . . .361, 440 Sweet, on dislocations, ii. 386 Swimming-bath, ii 42 Swine, as food, i 339 Swine pox, ii 99 Swooning, ii 270 Sycosis, ii 342 Sydenham, i 24 Sylvius, i 21 Symblepharon, ii 425 Symptomatic fevers, ii.. 92 Syndesmology, i. 78 Syncope, ii 270 Synocus fever, ii 87 Synovitis, i 376; ii. 339 Syphilis ii 292 Tabes, i: 167 Pn:?« Table beer, vol. i 314 Talipes, ii 383 Tallow, i 330 Tamarinds, i. 350 Tapioca, i 327, 434 Tarsal joint, i 91 Tartaric acid, i 3-9 Tartarous teeth, ii 135 Taste, morbid, it 272 Taste, organ of i 200 Taste, sense oi', i 252 Ti'a — tea-drinking, i. 310, 312 I'ears, i 279 Teeth, i 67 Teeth-drawmg, ii 428 Teething, ii L'io 'l\ inperaments, i 287 Temperature, i 1363 Tenements, lighted, i. . . 306 Tents, surgical, ii 327 Testes, i 228 Testimony for bathing, i. 46 Tests of waters, i 318 Tetanus, ii 299 Tetter, ii - - 305 Thames, water of the, i. . 5i6 Theobroma cacao, i 313 Theory and practice, ii. . 3 Theorj' of conception, ii. 493 Theory of fever, ii 75 Theory of inflamm'n, ii. 108 Theory of population, i. 294 Tnerapeutics, ii 72 Thigh, fractured, ii 416 Thirst, i 264 Thoracic duct, i 158 Thoracic viscera, i 204 Throat, inflamed, ii 113 Thrush, ii 201 Thymus gland, ii 451 Thyroid gland, i 311 Til»ia, fracture of, ii 421 Tic Doloreaux, ii 26u Tiger, diet of, i 405 Tight dresses, i 297 Tinea capitis, ii 306 Tin, poisons of, ii 31 7 Tissues, i 54, 235 Tobacco inhalations, i.- - 45 Tobacco smoke, i 299 Todd, on rabies, ii 2~'7 Toe joints, i ■ • - 92 Toe-nail, incurvnted, ii.. 343 Ties, superfluous, ii. . . . 379 TfJinatoes, i 440 Tunes of voice, i 259 Tongue, i • - 200 Tongue, mercurializ'd, ii. 381 Tongue tied, ii 378 Tonic-baths, ii 28 Tonicity of muscle, i 238 Tonsillitis, ii H'^ Tonsils, i 216 Tonsils, enlarged, ii . . . . 378 Tonsils, excised, ii 378 Toothache, ii 138 Toothache in pregnan. ii. 459 Toothedge, ii 135 Toothlessness, ii j •'^5 Tooth raah, ii ^03 504 INDEX. Page Tope, bakers', vol. i 354 Torpitude, dieeaees of, ii. 2.39 Torsion, surgical, ii 329 Toucli, morbid, ii 272 Touch, orjrftn of, i 201 Touch, Bvuse of, i 252 Touriiiqunt, ii 32^) Towel-bath, ii 41 Trachea, structure of, i. 210 Trachea, inflamed, ii 114 Tracheitis, ii 114 Tracheotomy, ii 431 Trance, ii 243 Transfusion, ii 331 'Jransudation, i. 287 Tremor — trembling, ii. . . 209 Trepliining, ii 423 Trichiasis — trichosis, ii. 184, 310 Triphthongs, i 2.38 Trismus, ii 2.31 Tubular diarrhea, ii 144 Tumors, ii .340 Turnips, i 362, 4.37 Turgescence. visceral, ii. 248 Turkish baths, i 40 Turning in childbirth, ii. 484 Turn ot life, ii 287 Turtles, as food, i 347 Twitchell. Dr., case of, i. 413 Tjphoid iever, ii 73 Typhomania, ii 244 Typhus fever, ii 88, 89 Typhus syncopalis, ii... 89 Ulcerated sore throat, ii. 113 Ulcers, ii 35fi Ulna, fracture of, ii 415 Umbilical cord, ii. . .449, 452 Underground tenem'ts, i. 305 JJnfermented bread, i. . . 355 Ungovernable passion, ii. 275 United States, baths in, i, 42 UnU-avened bread, i. . . . 423 Urethra, i 2-.J9 Urethra, imperforate, ii. 43v! Urethra, stricture of, ii.. 3fi2 Urinary calculus, ii 2P9 Urinary diseases, ii 296 Urinary secretion, i 280 Urticaria, ii 201 Uterine hcmorrhasre, ii.. 170 Uterus, anatortiy of, i. . . 230 Uterus, displaced, ii 292 Uterus, dro|-sy of, ii. . . . 2.58 Uterus, inflamed, ii jo] Uterus, inverted ii..294, 492 UTiila, enlarged, ii 378 Vaccination, vol. ii. . .96, Vaccine disease — vacci- nia, ii Vagina, i Vapor-bath, ii Vapors, ii Varicella, ii Varicocele, ii Varicose aneurism, ii... Variola, Varix—varices—varicose veias, ii 351 Vaults, i 305 Veal skin, ii 308 Vectis, in parturition, ii. 485 V'egetable diet, i 444 Vegetable food, i.. . .350, 423 Vegetables, green, i 4.39 Vegetarian dietaries, i.. . 455 Vegetarian societies, i. 412, 414, 416 Veins, anatomy of, i 148 Venesection, ii 338 Venereal disease, ii 291 Venous absorption, i. . . 273 Ventriloquism, i 260 Venus de Medicis, i 299 Vermicelli, i....333, 354, 434 Version, obstetrical, ii.. 484 Vertebral column, i 58 Vertigo, ii 269 Verucca, ii 342 Vesiculae seminales, ii.. 266 Vesiciilar erythema, ii.. 196 Vesicular fever, ii 202 Vicarious menstruati., ii. 287 Vicarious uriitalion.ii.. . 298 Vicissitudes of weath. i. 36:3 Vinegar, i 329 Vipers, dried flesh of, i.. 25 Viscera, anatomy of, i. . . 204 Visceral inflamm'tion, ii. 108 Visceral turgescence, ii. 248 Vismedicat. naturplied to Health of Body and Power of Mind. By O. S. Fowler. Paper, 62 cents ; muslin, 67 cents. 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