THE UNIVERSITY OF ILLINOIS LIBRARY From the collection of Julius Doerner, Chicago Purchased, 1918. <21 5 . ©53 ~r < r- 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 fact * of anatomy, physiology, and organic chemistry, it can hardly be expected that its literature will be otherwise than crude and incoherent. Of the many valuable works 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or remotely connected with Hydropathy, as well as an extensive range of private correspondence, and written but unpublished experience in domestic practice. The great number of topics embraced in the scope of the work, 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. Eor 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 , 185*, 703327 ANALYSIS OF THE CONTENTS. INTRODUCTION. History of Medicine. — The Earliest Ancient Physicians— The Early Grecian Physi- cians— The Dogmatic and the Empirical Physicians — Medical Philosophers — Hippo- crates — The first Irregular Physician — The Alexandrian School — The Regulars banished from Rome — The first Heroic Practitioner — The Pneumatics and Eclectics — The first Pharmacopoeia — Galen — The Arabian School — The Monks and Alchemists — The Chem- ical Physicians — The Prince of Empirics — The Regular and Irregular Controversy — The Anatomical Physicians — Revival of the Hippocratean Doctrine — The Fermenta- tionists — The Mathematical Physicians — The Vitalists — The Solidists — The Metaphys- ical Physicians — Boerhaave — Haller — The Semi-animists — Cullen — The Brunonian System — Medicine at the end of the Eighteenth Century — Medicine in the United States 9-36 History of Bathing. — Ancient Bathing — Bathing in the Middle Ages — Bathing Habits of different Nations — Medicated Baths — Medical Testimony in favor of the Remedial Use of Water 36-52 PART I.— ANATOMY. Chapter I. Of the Bones : Osteology. — S tructure ot Bone — Development — Stages of Ossification — The Skeleton — Vertebral Column — Bones of the Head — Sutures of the Skull — Orbits of the Eye — The Teeth — Bones of the Chest — The Thorax — Upper Ex- tremities— Pelvis — Lower Extremities — Sesamoid Bones 53-78 Chapter II. Of the Ligaments : Syndesmology. — V ertebral Joints — Neck-joint— Lower-jaw — Costo- vertebral — Costo-sternal — Sternal — Vertebro-pelvie — Pelvis — Sacro- coccygean — Pubic — Sterno- clavicular — Shoulder — Elbow — Wrist — Carpal — Carpo-me tacarpal — Metacarpo-phalangeal — Phalangeal — Hip — Knee — Ankle — Tarsal — Tarso-me. tatarsal — Metatarso-phalangeal — Toe 78-92 Chapter III. Of the Muscles: Myology. — S tructure — Development — Cranial Group — Orbital, Ocular — Nasal — Superior Labal — Inferior Labal — Maxillary — Auricular — Superficial of the Neck, Laryngeal — Linguinal — Pharyngeal — Palatal — Prevertebral — Of the Back — Of the Thorax — Of the Abdomen — Of the Trunk — Perineal — Upper Ex- tremity — Lower Extremity * 92-126 Chapter IV. Of the Fasciae : Afoneurology. — Cellulo-fibrous Fascia — Aponeurotic Fascia — Temporal — Cervical — Thoracic — Abdominal — Inguinal Hernia — Iliac Fascia — Pelvic — Perineal — Upper Extremity — Lower Extremity — Femoral Hernia 127-131 Chapt "r V. Of the Arteries : Angeiology. — Structure— Distribution — Intercom- munition — Systemic Arteries — Aorta — Innominata — Carotids — Temporal — Maxillary — Subclavian — Circle of Willis — Thyroid Axis — Internal Mammary — Axillary — Brach- ial — Radial — Ulnar — Thoracic Aorta — Abdominal Aorta — Gastric — Hepatic — Splenic- Mesenteric — Spermatic — Iliacs — Femoral — Popliteal — Tibials — Plantar — Pulmona- ry 131-148 Chapter VI. Of the Veins : Angeiology. — Structure — Of the Head — Diploe — Brain — Sinuses — Of the Neck — Upper Extremities — Axillary, Subclavian, Lower Extremi- ties — Popliteal — Femoral— Of the Trunk — Vena3 Cava? — Portal System — Vena Porta? — Pulmonary 148-155 Chapter VII. Of the Lymphatics : Angeiology. — Absorbent System — Valves — Lymphatic Glands — Lacteals — Thoracic Duct 148-161 Chapter VIII. Of the Nerves : Neurology. — Structure — Ganglions and Nervous Centers — Nerve-cells — Nerve-granules — Brain — Cerebrum — Cerebellum — Medulla Ob- longata- -Spinal Cord — Cranial Nerves— -Spinal Nerves — Organic Nerves — Ganglionic System 161-188 CONTENTS Chapter IX. Organs of the External Senses.— CYgan of Smell — Organ of Sight- Organ of Hearing — Organ of Taste — Organ of Touch 189-203 Chapter X. Of the Viscera : Splanchnology. — Heart — Larynx — Trachea — 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 204-234 PART II.— PHYSIOLOGY Chapter I. Of the Tissues.- -General Characters of the Tissues— Development o? Cells— Areolar Tissue— 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.. 235-25C 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 250-257 Chapter III. Of Voice and Speech. — Voice — Speech — Vowels — Consonants — Diph. thongs — Triphthongs — Tones — Pitch — Volume — Compass — Musical Notes — Ventrilc quisin 257-2GL Riapter IV. Of the Individual Functions. — Digestion — Circulation — Respiration — Absorption — Nutrition — Secretion — Excreti ^ — Calorification — Endosmose and Ex- osmose 260-287 Chapter V. Of Temperaments. — Nervous — Sanguine — Bilious — Lymphatic . 287-290 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. — V ital Property of Air — Quantity Respired — Purity of Air — Change of Air — Position and Habits affecting Respiration — Catching Cold — Purifying the Air- Sleeping Rooms — Stoves and Fireplaces — Lamps — Candles — Gas-burners — Public Con- veyances 295-304 Chapter II. Of Light. — R elation to Organization — Physiological Influences — Thera- peutic Considerations — Sanatory Inferences 304-307 Chapter III. Of Drink. — N ature’s Beverage — Is Man a Drinking Animal? — Quantity — Temperature — Artificial Drinks — Natural Waters — Purification — Adulterations 307-320 Chapter IV. Of Food. — C hemical Elements — Proximate Elements — Aliments, or Foods Proper — Animal Food — Vegetable Food — Condiments 320-363 Chapter V. Of Temperature. — V icissitudes of Weather — Generation of Animal Heat — Capacity to Endure External Heat — Artificial Heat — Healthfulness of Climate — Com- mon Colds — Mean Temperatures *. 363-367 Chapter VI. Of Exercise. — N ecessity for Exercise — Physiology of Exercise — Varie- ties — Exercises of Children — Times for Exercising 367-370 Chapter VII. Of Sleep.— D efinition — Phenomena — Natural Term of Sleep — After Meals — Position during Sleep — Beds and Bedding 370-374 Chapter VIII. Of Clothing. — P hysiological Natui'e of Clothing — Materials — Color — Particular Garments — Bed and Body Linen — General Rules 374-377 Chapter IX. Of Bathing. — R easons for Bathing — Methods — Time and Temperature of Baths — Precautions 377-378 Chapter X. Of the Excretions. — R elation to Nutrition — Involuntary Evacuations — Voluntary Evacuations 379-380 Chapter XL Of the Passions. — M ental Hygiene — Passions as Affecting Health- Healthful Exercise — Relation to Longevity — Relation to the Secretions — Physiological Law of the Passions 381-383 Chapter XII Of Longevity.— N atural Duration of Life — Examples of Longevity — Natural Death — Advantages of Longevity — Special Means — Occupations as Affecting Longevity 383-39S PART IV— DIETETICS. Chapter 1. Dietetic Character of Man.— Bible Evidence — Anatomical Evidence- Physiological Evidence — Medical Evidence — Chemical Evidence — Experimental Evi- dence 397-41T CONTENTS. ▼i Chapter II. Hydropathic Cookery. — Practical Considerations — Preparations of Ani mal Food — Preparations of Vegetable Food — Breads — Seeds — Mushes- -Gruels and Soups — Puddings — Pastry — Cakes — Roots — Green Vegetables - Fruits — Nuts — Condi- ments 417-441 Chapter III. Dietaries. — General Rules for Invalids — Therapeutic Divisions of Diet — Diet for Public Institutions 441-460 PART V. — THEORY AND PRACTICE. hapter I. Philosophy of Water-Cure. — Relations of Water to the Healthy Organ ism — Modus Operandi — Water and Drug-treatment Contrasted — Rationale of Drug-med- ication 3-22 Chapter II. Water-Cure Processes. — Wet-sheet Packing — Half-pack — Douche- Rubbing Wet-sheet — Hip, or Sitz-bath — Half-bath — Plunge — Foot-bath — Head-bath — Shower — Cataract-bath — Dry Pack, or Sweating-bath — Vapor-bath — Wave-bath — River bath — Rain-bath — Fountain, or Spra^y-bath — Portable Shower-bath — Atfusion — Tow*' 1 ., or Sponge-bath — Wet-dress Bath — Warm and Hot Baths — Swimming-bath — Eye and Ear Baths — Nasal-bath — Oral, or Mouth-bath — Arm-bath — Hand-bath — Finger-bath — . Leg-bath — Drop-bath — Air-bath — Fomentations — Bandages — Chest-wrapper — Abdom- inal-wrapper — Friction — Temperature of Baths — Duration of Baths — General Rules for Hydropathic Bathing — Water-drinking — Lavements and Injections 22-59 Chapter III. Crises. — Docrine of Crisis — Forms of Crisis — Management of Crises— Rationale of Crisis 59-67 Chapter IVi Of the Pulse. — Nature of the Pulse — Varieties of Pulse — Indications of the Pulse 67-71 PART VI.— PATHOLOGY AND THERAPEUTICS. Chapter I. Of Fevers. — C lassification of Fevers — General Characters — Causes — The- ory — Type — Rationale — Crisis — Duration — General Treatment — Ephemeral — Inflam- matory — Yellow — Nervous — Putrid — Ship — Spotted — Camp — Jail — Hospital — Marsh — Typhoid — Remittent — Intermittent — Symptomatic — Small-pox — Chicken-pox — Cow. pox — Measles — Scarlatina — Erysipelas — Miliary — Plague 72-107 Chapter II. Visceral Inflammations — T heory of Inflammation — Rationale — Varie- ties — Terminations — General Treatment — Phrenitis — Quinsy — Laryngitis — Croup- Mumps — Pneumonia, or Pleurisy — Carditis — Hepatitis — Splenitis — Gastritis — Enteritis — Peritonitis — Hysteritis — Orchitis 108-122 Chapter III. Arthritis. — P odagra, or Gout — Rheumatism — Lumbago — Sciatica 122-128 Chapter IV. Indigestion. — D yspepsia — Liver Complaint — Misdentition — Colic — Chol- era — Diarrhea — Intestinal Concretions — Worms — Hemorrhoids, or Piles 128-150 Chapter V. Fluxes. — C atarrh — Influenza — Dysentery 151-153 Chapter VI. Cachexies. — Consumption — Marasmus — Atrophy — Anheemia — Tabes — Elephantiasis — Epistaxis — Heemoptysis — Hsematemesis — Hasmaturia — Scurvy — Pleth- ora — Scrofula — Cancer — Melanosis — Catacausis 154-180 Chapter VII. Diseases of the Eye. — O phthalmia — Nebul© — Ulcers — Pterygium- Staphyloma — Closed Pupil — Cataract — Amaurosis — Strabismus — Psorophthalmia— Trichiasis — Entropium — Ectropium — Hordeolum — Excrescences — Ptosis — Fistula Lachrymalis — Asthenopia — Hemeralopia — Nyctalopia — Myopia — Presbyopia — Ecchy- mosis — Extraneous Substances — Burst Eye 180-187 Chapter VIII. Diseases of the Ear. — O titis — Otorrhoea — Deafness— Otalgia — For- eign Bodies and Insects 137-195 Chapter IX. Erythematous Inflammations. — (Edematous — Erysipelatous — Gan- grenous — Anatomical — Chilblain — Fret — Nettle-rash — Aptha, or Thrush — Pemphigus — Yaws 195-203 Chapter X. Spasmodic Diseases. — C onvulsions — Epilepsy — Hysterics — Tremor — Delirium Tremens — Shaking Palsy — St. Vitus’ Dance — Raphania — Barbiers — Cough- Dyspnoea — Asthma — Laryngismus — Incubus — Bronchitis — Sternalgia — Pleuralgia — Hiccough — Sneezing — Palpitation — Nictitation — Subsultus — Stretching — Hydrophobia — Acrotismus — Tetanus — Locked-jaw — Cramp — Muscular Distortion of the Spine — Muscular Stifl-joint — Wry Neck 204-239 Chapter XI. Diseases of General Torpitude. — A sphyxia — Ecstasy — Catalepsy — Lethargy — Apoplexy — Palsy 239-248 Chapter XII. Visceral Turgescenci. — H epatic — Splenic— Pancreatic — Mesenteric — Intestinal — Omental — Complicated 248-252 CONTENTS. rii Chapter XIII. Dropsical Diseases. — A nasarca -CEdema — Hydrocephalus — Spina* bitida — Hydrothorax — Ascites — Hydrops Ovarii — Hydrops Tubalis — Hydrops Uteri — Hydrocele — Emphysema — Puerperal Tumid Leg — Tropical Tumid Leg 252-261 Chapter XIV. Diseases of Mis-ossification. — R ickets — Cretinism — Mollities Ossium — Fragilitas Ossium — Osthexy — Exostosis 262-264 Chapter XV. Diseases of Sensation. — H eadache — Neuralgia — Sleeplessness — Rest- lessness — Antipathy — Vertigo — Syncope — Morbid Sight — Morbid Hearing — Morbid Smell — Morbid Taste — Morbid Touch 264-272 Chapter X v L Mental Diseases.- Insanity — Melancholy — Madness — Fury — Despond- ency — Hallucination — Sentimentalism — Hypochondriacism — Revery — Absent-minded- ness — Men tal Abstraction — Brown-study — Somnambulism — Sleep-talking — F atuity — Irrationality — Imbecility 273-280 Chapter XVII. Diseases of the Vocal Avenues.— C atarrh — Ozsena — Polypus- - snoring — Wheezing — Speechlessness — Dissonant Voice — Stammering — Misenuncia- tion 280-284 Chapter XVIII. Diseases of the Sexual Function. — M ismenstruation — Amenor- rhoea — Dysmenorrhoea — Chlorosis — Leucorrlicea — Spermorrhoea — Venereal Diseases — Satyriasis — Nymphomania — Displacements 285-296 Chapter XIX. Diseases of the Urinary Organs. — S uppression of Urn.'' — Isehuris — Strangury — Diabetis — Eneuresis — Urinary Diarrhea — Vicarious Urination — Gravel— fotone 296-300 Chapter XX. Diseases of the Skin. — R oseola — Gum Rash — Lichenous Rash — Pru- risrinous Rash — Millet Rash — Water-blebs — Herpes — lthypia — Eczema — Veal Skin — - Mole — Freckles — Sunburn — Orange Skin — Piebald Skin — Albino Skin — Cyanosis — Lou- siness — Insect Bites — Worms — Dandruff — Leprosy — Psoriasis — Icthyiasis — Impetigo — Porrigo — Ecthyma — Scabies, or Itch — Morbid Sweat — Morbid Hair 301-311 Chapter XXI. Poisons. — A cids — Alkalies — Neutral Salts — Mercurial — Arsenical — An- timonial — Lead — Copper — 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- fects 311-324 PART VII.— SURGERY. Chapter I. Surgical Appliances. — Instruments — Compress — Ligature — Sponge — Adhesive Plaster — Tents and Pledgets — Dry-cupping — Bandages — Splints — Caustics — Torsion — The Tourniquet — Congelation — Fomentations — Emetics — Anaesthesia — Hte- mastasis — Transfusion 325-331 Chapter II. Wounds. — Distinctions — General Consequences — Treatment 332-334 Chapter III. Injuries. — Concussion — Compression — Bruises — Strains — Burns and Scalds — Particular Wounds and Injuries 334-339 Chapter IV. Tumors. — W helk — Sycosis — Warts — Corns — Bunion — Onyxis — Gangli- ons — Ranula — Epulis — Broncliocele — Whitlow — Schirrus and Cancer — Fungus Haema- todes — Bone cancer — Carbuncle — Lupus — Aneurism — Varix — White Swelling — Hy- drops Articuli — Varicocele — Haematocele — Sareocele — Hernia Humoralis — Cystic Sarcoma — Polypi — Enlarged Prostate Gland 340-357 Chapter V. Ulcers. — F urunculus — Parulis — Fever Sores — Caries and Necrosis — Fis- tula in Ano — Fistula in Perineo — Strictures and Fissures — Salivary Fistula — Fistulas Lachrymalis 356-364 Chapter VI. Abscesses. — E mpyema — Maxillary Abscess — Mammary Abscess — Onyx — Lumbar, or Psoas Abscess — Hip-disease — Prostatic Abscess 365-368 Chapter VII. Hernia, or Ruptures. — Varieties of Hernia — Technology — Path- ological Distinctions — Special Causes — Diagnosis — General Treatment — Radical Cure 369-377 Chapter VIII. Deformities. — H are-lip — Tied-tongue — Enlarged Tonsils and Uvula — Squinting — Superfluous Fingers and Toes — Web Fingers — Wry Nock — Spina Bifida — Spinal Curvatures — Mercurialized Tongue — Pseudarthrosis — Club-foot — Contracted Sinews 377-384 Chapter IX. Dislocations. — T echnology — Dislocation of the Jaw — Clavicle — Shoul- der — Elbow — Wrist — Carpal and Metacarpal — Fingers — Hip — Knee — Ankle — Foot — Toes „ 385-407 Chapter X. Fractures. — T echnology — Fractures of the Cranium — Nose — Lower-jaw — Scapula — Clavicle — Sternum — Ribs — Spine — Pelvis — Humerus — Elbow — Fore-aym— Wrist— Hand — Fingers — Thigh — Patella — Leg — \nkle — Foot 407-423 CONTENTS Chapter XI. Particular Operations. — Trephining — Paracentesis Capitis — Paracel* tesis Oculi— Fistula Lachrymalis — Entropium and Ectropium — Anchyloblepharon and Symblepharon — Ptosis and Lagophthalmos — Blepharidoplastice and Khinorrhape — Khinoplastice — Schlesekotomy — Keratoplastice — Otoplastice — Chelio and Genio-plas- tice — Couching — Extraction, Absorption, or Solution — Teeth-drawing — Pumping the Stomach — Catheterism — Inoculation— CEsophagotomy — Choking — Laryngtomy — Tra- cheotomy — Paracentesis Abdominis — Paracentesis Vesicse — Imperforate Anus — Imper- forate Urethra — Lithontripsy and Lithotomy — Amputation — Ligating and Compressing Arteries - 423-437 PART VIII.— MIDWIFERY. Chapter I. History of Midwifery. — Ancient Midwifery — Modern Midwifeiy — Fe male Authors and Practitioners — Man-midwifery — Who should be Midwives?-. 439-443 Chapter II. Reproduction. — Theories of Reproduction — Transmission of Organiza- tion — The Marriageable Age — Physiological Law of Marriage 443-447 Chapter III. Physiology of the F(etus. — Foetal Development — Foetal Circulation — The Thymus Gland — The Placenta — The Umbilical Cord— The Liquor Amnii. 447-452 Chapter IV. Obstetrical Anatomy. — Bones of the Pelvis — Cavity of the Pelvis — Diameters of the Pelvis — Deformities of the Pelvis 452-456 Chapter V. Pregnancy. — Signs of Pregnancy — Duration of Pregnancy — Extra-uter ine Pregnancy — Superfoetation — Pathology of the Foetus — Hygienic Management dur- ing Pregnancy — Accidents of Pregnancy 455-460 Chapter VI. Parturition. — Rationale of Labor — The Pains of Childbirth — Medicating Labor Pains — Natural Labor — Diagnosis of Presentations — Stages of Labor — Position during Labor — Management during Labor — The After-birth — After-management — • Convalescence of Lying-in Women — Accidents during the Lying-in Period... 46L-475 Chapter VII. Infant Nursing. — Dress of Infants — Bathing — Food — Drink — Sleep- Exercise — Excretions — Teething — Drugging — Infantile Diseases 475-482 Chapter VIII. Complicated Labors. — Tedious, or Protracted Labors — Preternatural Presentations — Operations in Midwifery — Face Presentations — Breech Presentations — Foot and Knee Presentations — Presentations of the Superior Extremities — Compound Presentations — Plural Births — Monsters — Prolapsed Coro — Retained Placenta — Hem- orrhage — Convulsions — Puerperal Mania— Lacerations 483-49*1 Sffkndiz. — T heory of Conception - 493-494 HYDROPATHIC ENCYCLOPEDIA, INTRODUCTION. Before Lie prevailing medical practice can be revolutionized, 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 community will demand reasons the most profound and e^ idences 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 surrounding nature, have been, in my judgment, al- ready sufficiently demonstrated to satisfy the intellectual mind of the former class, and their application to the preservation of health and cure of disease amply demonstrated by actual experiment for the ex- ercise of the faith of the latter class. All that seems necessary now, in order to achieve that great reform in human society, which shaH 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 shaH 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 aU ages *>f the world, will prove that the Water-Cure, though in its infancy as a system of the healing art, has had, in aH its essentia particulars, the sanction of the most Earned men of all professions in 10 INTRODUCTION. all ages. These topics, therefore, present themselves as forming a pertinent introduction to this work. Many of the histo^ or »l data relative to these subjects are collected from Bostock’s Histoiy of Medicine, and Bell’s work on Baths and the Water Regimen. In the application and generalization of these data, and in relation to the principles to which they refer, I have, however, differed often and widely from these authors fi-JSTOKY OF MEDICINE. Writers generally agree that medicine first became a profession among the Egyptians. Its origin, however, is involved in fabulous and impenetrable obscurity. In Egypt 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 appears 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 are 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 understanding the laws of both. Nay, I would have the same person exercise the function of priest, doctor, iawyer, and schoolmaster ; and that individual who can present to hia fellow- creatures the most harmonious whole of a human being — who can best teach in theory, and most faithfully exemplify in practice, the law’s of being in his moral, physiological, legal, and social relations, should belong to the learned profession and be a leader among men. The Earliest Ancient Physicians. — The Egyptian priests prac- ticed the healing art by means of magical incantations, which, of course, produced their good or bad impressions through the medium of the imagination, the efficacy 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 arts, while the actual learning they possessed was carefully concealed m a mystical technicality. Among the early Jews the priests, who were the physicians also, treated the leprosy and other diseases with various ceremonies to affect the imagination, at the same time enforc- ing judicious regulations to avoid the sources of contagion, and promote personal cleanliness ^he Early Greci an Physicians,— In Greece the genius of Hip* HISTORY OF MEDICINE. 11 pocrates first caused medicine to be regarded as a science, though Chiron, who lived about 1300 b.c., is accredited for having introduced the healing art to his countrymen. iEsculapius, 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 tlieir medical skill, though, as they were employed piincipally as surgeons in the Greek armies, their medication was doubtless mostly confined to crude yet simple methods of dressing wounds and recent injuries, which were exceedingly common in that warlike age. The descendants of iEsculapius, called Asclepiadae, 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 were, no doubt, the real cura- tive agencies. We 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 all employed externally. The Dogmatic and the Empirical Physicians. — For several centuries succeeding the age of iEsculapius and his sons, we have no records that medicine made the least progress. Numerous temples were erected in honor of iEsculapius, who 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 .he temples into schools of medicine. But then there w T ere men of superior sagacity and inordinate selfishness, who desired to turn the common knowledge to individual advantage. The temples of Oos and Guidos became rival establishments. One assumed to be philosophical, by uniting reason with experience, while the other professed to be governed solely by facts and observations. Thus arose two medical sects — tne Dogmatists and the Empirics, who long divided the medical world, and whose influence is not yet extinct, for we find at mis day many physicians wdio follow wherever theory leads, regardless of facts nr consequences : and another set of practitioners who are merely 12 INTRODUCTION. loutine imitators, without a particle of pretension to any rational system. Medical Philosophers. — Pythagoras, in the sixth century before Christ, was the pioneer of a class of scholars of general information and philosophical mind, who gave much attention to the investigation of the structures, functions, and diseases of the human body. He established a school at Crotona, to which students resorted from most parts of Greece and Italy. More than twenty years of his life were spent in Egypt, Chaldea, and Eastern Asia, and he prosecuted the study of comparative anatomy by 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. Among the most illustrious of his followers were Democritus and Hera- clitus, the former being regarded as the first person who attempted the dissection of a human subject. Acron is mentioned by Pliny as among the first who undertook to apply philosophical reasoning to medicine. Herodicus is considered the inventor of gymnastic exercises, which the Greeks regarded as an important branch of the healing art. Hippocrates. — 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 up among the Asclepiadse, 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 doctrines are extensively rec- ognized. His practice has been called a rational empiricism ; in other words, a careful observation of facts, and a reasoning process based upon their consequences. 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 leading physiological proposition was, the existence of a general presiding principle of vitality for the whole bod}^, 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 some of the ablest living physiologists. His doctrine that the fluids were the primary seat of disease was never disputed, save by some small factions of medical men, until about the commencement of the e'gbteentli century* and even now it has at least as many advocates a? HISTORY OF MEDICINE. 18 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 dry, 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 efficiency of our arms,” in killing pain and patients, being then unknown. Purgatives, sudorifiqs, diuretics, and injections were his principal internal remedies, 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 great principle which directed 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 seldom 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 that this 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 wliat object he ought more particularly to direct his attention.” It must be admitted that the bleedings, active purgatives, the sweat- ings ano diuretics of the Hippocratean practice were inert comrared 2 14 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 iEsculapians, though much more powerful doctors, are much less successful ones. The First “Irregular” Physician. — Subsequent to the age of Hippocrates, medicine remained stationary for several centuries. His sons, Thessalus and Draco, his son-in-law Poly bus, Diodes of Carystus, and Praxagoras of Cos, are the only names distinguished among his immediate successors One of their contemporaries was a Dr. Clirysip- pus, who opposed bleeding and the employment of active purgatives ; he was, however, regarded as a sort of “irregular,” who did not pay due deference to the authority of great names. Plato and Aristotle, like most of the ancient Greek philosophers were conversant with the medical doctrines of their day, though not practicing physicians. The latter published the first works on anatomy and physiology, and ail his writings, though full of refined vagaries, held a strong influence over the public mind for many f»enturies after his death. The Alexandrian School. — The Ptolemies founded a medicai school at Alexandria about 300 b.c. The most famous of its professors were Erasistratus and Herophilus, who dissected bodies of criminals obtained of government. Erasistratus, having been a pupil of Chrysip- pus, adopted his opinions against bleeding and violent remedies, profess- ing to trust nature more and art less. Herophilus paid particular attention to the action of the heart, and was 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 druggists, and surgeons, became distinct vocations ; and not long after this event the great schism occurred which divided medical men into two sects, the Dogmatists and Empirics, already mentioned. All the medical men of the day, and for several succeed mg ages, were attached to one or the other of these rival parties. The Regulars Banished from Rome. — After the decline of Grecian literature, medicine, as a distinct pursuit, made no progress 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 prcr- Cossnor . The superstitions and 'eremonies of the Greeks were trans* HISTORY OF MEDICINE 15 oorted to Roma, 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 Epicurus, went to Rome as a teacher of rhetoric. Being unsuccessful, he turned his attention to medicine, by which he acquired great 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, tie 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, astringents 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 great 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 metasy nocrisis, 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 or fabricator for no other purpose than to get gold and fame, was generally adopted by subsequent medical writers, and is 'k»w the nrii?:ipal ccruer-stone of orthodox medical 16 I N T it 0 D U C T ION. practice Until the advent of Thessalus, the physicians were content to study the indications of nature, aid and assist her efforts, and remove obstacles in her way. Since his time faith in the integrity 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 destructive agents to ravage within the domain of vitality, heedless of, or faithless to, the great truth that nature, and nature alone, is the true physician. Soranus and C. Aurelianus are the next Roman physicians of celeb- rity. They were strict Methodics, and their writings did much to dvance the particular notions which they had imbibed ; their remedial measures were, however, very mild, and hence generally successful. But it is worthy of especial remark, as evidence of the powerful influ- ence of a preconceived theory 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 promptness. Its success was no argument in its favor so long as it wanted power ! Abstinence, the bath, frictions, and external ap- plications were their leading remedial measures. Topical bleeding was also employed, though general blood-letting was rarely resorted to ; narcotics and oleaginous applications were frequently used, and great attention paid to pure air ; sometimes a moist ah* was enjoined. The Pneumatics and Eclectics. — During the first two centuries of the Christian era the Methodic sect prevailed, yet the peculiar speculations of different individuals were gradually introduced, causing at length the formation of several subdivisions, or new sects, of medical practitioners, the most prominent of which were the Pneumatics and the Eclectics, or Episynthetics. Pneumatology and eclecticism are not therefore quite as modern notions as many have supposed. The Pneumatics evidently had a glimpse of the true idea of vitality, yet were incapable of expressing it rationally. They taught that the human body was composed of solids, fluids, and spirits. Their ideas of the spiritual agency in the production and cure of disease were strikingly analogous to the modern doctrine of the nervous influence. The most eminent writer of this sect was Areta3us. His practice was more active and less expectant than that of the Methodics. The most celebrated of the Eclectics was Archigenes, of Appamea, who practiced at Rome in the time of Trajan. His writings are ex- tremely obscure and chimerical, yet he acquired great popularity and influence ; perhaps he is as much indebted to the unintelligible chara* *er of his works as to any other circumstance for his fama. HISTORY C F MEDICINE. IT Celsus is the first native Roman physician of whom we have any account. Tie wrote several books on medicine, which show that sur gory and pharmacy had made considerable progress. It is difficult to class him with either of the sects of his day ; in practice he pursued mainly the method of the Asclepiades. His origin, or the age in which tie lived, are not precisely known, though it is conjectured that he lived in the reigns of Augustus and Tiberius. Tiie First Piiarmacofaths or earth baths have been employed in Germany, France, Italy, ana 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 made 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 c i oees, have been among the acknowledged outward 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 wrapped 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 all 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, pennyroyal, 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 carrots, hard soap, basswood roots £axsoed, Indian meal, bread and milk, yolk of eggs, scraped u INTRODUCTION. potatoes, with a great variety of barks, roots, and herbs have in thou- sands of instances filled the spectator with amazement by producing effects very like those of a common rag dipped in common water. Sulphur fumigations were among the ancient baths ; and several modern authors have written learned treatises on their employment 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 sulphur fumigating treatment in this disease. It may excite the risibles of those who have seen the itch effectually cured by a single soap-suds bath, to be told that among the many sat- isfactory conclusions to which the jury of investigation arrived was the fact that, “on an average, thirteen fumigations and a period of seven days were sufficient to cure the disease.” Vinegar fumigations have been employed since the days of Hippo- 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 allopathic materia medica. The articles in most common use are the mercurials — calo mel, corrosive sublimate, and cinnibar — the protoxide of zinc, and deut- oxide of arsenic. Sulphuretted 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 , called 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- stances, so as to fill the room and the patient’s lungs with their fumes, as turpentine, tar, gum, resin, styrax, vinegar, sugar, old leather, old rags, etc. 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 fresh 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 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 waters, have had the sanction of the medical profession be employed for medicinal purposes. The catalogue is worth record- ing, if for no other purpose, to aid some future virtuoso in making up a museum of obsolete medical curiosities: 1. Dry air; 2. Dry and hot air; 3. Dry and cold air; 4. .Rapid and hot air; 5. Rapid and cold air; 6. Moist air; 7. Moist and warm; 8. Moist and cold; 9. Rapid, moist, and warm; 10. Rapid, moist, and .old; 11. Steamed air; 12. Highly oxygenated, by an admixture of oxygen; 13. Less oxygenating, by diluting air with nitrogen ; 14. Deoxidating, by adding agents to abstract a part of the oxygen; 15. Nitrous oxide — intoxicating gas; 16. Nitrous 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-sulplmte of ammonia. Iodine has lately found a place in medical books as a fumigator, or atrimatric agent. Iodine with alcohol was introduced by Sir Charles Scudamore, who also employed the tinctures of opium, conium , ipecac, deadly nightshade , digitalis, Prussic acid, and chlorine. The hydriodale of potassa, which is so frequently the efficiently evil agent in the sarsaparillas of the shops and the newspapers, is consider- ably employed atrimatrically. 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 faculty. The smoke of tobacco cigars and camphor cigarettes has been recently recom- mended for affections of the throat, chest, and lungs, by the professors of our New York medical schools. Peruvian hark, oak hark, myrrh, preparations of iron, subnitrate of bismuth, hepar sulphuris , white 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 boen 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 are 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 waters of our fashionabe adui 46 INTRODUCTION. terated springs, are employed more or less, and many imitations of them are manufactured at home. They are merely water impregnated with various mineral, earthy, alkaline, and saline ingredients. Any person, by throwing a handful of dirt, a shovelful of coal or wood ashes, a spoonful 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 anaesthetic agents, ether and chloroform, which are properly atrima tries, are now well known, and, except for surgical purposes, are destined to have a short-lived popularity. Finally, we have the grease bath . This is the very latest external application which has emanated from the allopathic school. It consists in rubbing the whole surface of the body frequently with various inguents, 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 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 Testimony in 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 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. j 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 the pain in the side, chest, and back, con- cocts the sputa, promotes expectoration, improves the respiration, and allays lassitude. He advised pouring cold water on inflamed and swelled joints, in gout and rheumatism, and in spasms, luxations, and fractures. 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: 44 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 drinks are good in continued and ardent fevers. They discharge ths 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 warm water-drinking, with fehe transition bathing — hot followed by tepid or cold. Celsus , in treating affections of the head, directs a warm sweating bath, followed by the tepid and cold bath, with an additional quantity of cold water to the head. He recommends water in fullness of the Btomach, headache, weak vision, deafness, 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 filso advises cold immersion in skin diseases and in hy- drophobia. Asclepiades, 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-treatment in a manner sim- ilar to that of Galen. JKtius 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. Hoffman 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 it3 use answers to all indications , both of preservation and cure.” Boerhaave has written : No remedy can more effectually secure health and prevent disease than pure water. Haller , as a testimonial of its value, drank nothing but 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 INTRODUCTION. Baynard supposed good water to possess healing and balsamic prop- erties. He was a strong advocate for bathing as a remedy. Gregory regarded water as a tonic to the digestive organs. The celebrated Cheyne exclaimed : Without all peradventure, watef was the primitive original beverage, and is the only simple fluid fitted for diluting, moistening, and cooling. Macquart in an especial manner recommended men of science and letters to make water their favorite 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. Sir John Ross , Miller, and other Northern navigators, have testified that exclusive water-drinkers endure the rigors and withstand the dis eases of the frigid zone better than any other persons. Dr. Jackson , and Mr. Marshall , of the British army, and Drs. Mosely, and James Johnson, of London, assure us that the dangers of living in tropical climates are the least for the pure water-drinkers, and that these are far less liable to the diseases of acclimation. Haly Abbas, and Mesues , Arabian writers, prescribed bathing in most diseases, and their directions for conducting the processes were generally singularly judicious. Alsaharavius, Arabian, recommends bathing to moisten the body, open the pores, dispel flatulence, remove repletion, procure sleep, re- lieve pain, fluxes of the bowels, and lassitude, restore lean bodies to plumpness, soften contracted limbs, etc. Lanzani, Italian, commended large doses of cold water internally as the best remedy for fever, and wrote two elaborate books to explain the grounds of his practice. Fra Bernardo , Sicilian, acquired, in the early part of the last cen- tury, the title of “ cold-water doctor,” and won a high reputation for curing affections of the chest, palpitations, convulsions, obstinate dyspep- sia, diarrhea, dropsy, hemorrhages, gout, and rheumatism, by water- treatment. He used iced- water freely internally, and applied ice to hot and inflamed parts. All food was withheld during the first four days — a point in practice which our beef-tea, mutton-broth, and chick en-soup slopping and stuffing doctors would do well, for their patients to imitate. Cirillo, Neapolitan, in 1729, treated a malignant fever, which prevailed at Naples, with what he called “the watery diet.” He administered a pint or two of water, cooled by snow, every two hours for several days, permitting no kind of aliment whatever. When free perspira- HISTORY OF BATHING. 49 tion took place the drink was omitted, and very light food allowed. Ho directed co-id applications of snow to painful and inflamed parts, but did not prescribe general bathing. Rovida, of Arragon, is said to have practiced the water- treatment extensively on the plan of Cirillo and Fra Bernardo. Samoilowitz , Russian in 1771, experienced signal success in treating the plague at Moscow, by means of cold acidulated drinks, and fric- tions to the whole body, with pounded ice. Rev. John Hancock , an English clergyman, 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 , C.M. , English, wrote a book about a century ago, which is full of testimonials to the curative powers of water in nearly all the prevalent diseases of the day. Its title was, “ The Curiosities of Com- mon Water,” and a large 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, Kcill , 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. Pomme, French, at a later period, wrote in favor of cold water- drinking and warm bathing for various remedial and hygienic 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, employed cold water and ice successfully in stran - 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 glassful being administered every ten or fifteen min ute«5. I — 5 60 INTRODUCTION, Those celebrated medical philosophers and physicians, Harvey Louret , Cocchi , Sanctorius , Marziano , and Barth ez , advocated and practiced cold applications to gouty swellings, and inflammations. Ambrose Pare declared that the true vulnerary, or dressing for wounds, was water alone. Michael Angelo Blondi , Italian, wrote an essay, in 1542, on water as a remedy for gun-shot wounds. Gabriel Fallopius , of Venice, Felix Palatius , of Trebia, and Joi> hart, Martel, and Lamorier, of France, strongly 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 surgec? U vance ever produced v 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, phlegmons, erysipelas, and gangrene. Macartney , of Dublin, advises the free and methodical employment of water-dressings in wounds With him irrigation was a favorite mode of application. Lancassani , in 1753, Caldani , in 1767, Leanter , in 1780, and Percy in 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 treatment of fevers by cold affusions in 1787. For several years he treated scarlet and typhus fevers, small-pox, and other diseases, principally by bathing, and with a success universally admitted to have been far greater than that of the ordinary drug- treatment. His work on the subject was pcMished in 1797. Dr. Robert Jackson , 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 treating fevers by cold affusions for nearly twenty years. Giannini , of Milan, strongly recommends cold immersion in typhus and petechial fevers. Dr. Thaer , 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, sa as to drench both the body linen and bedding. HISTORY OF B ilHIKG. 51 Dr. Forbes , present editor of the ablest medical journal of Europe, and one of the physicians to her Majesty Queen Victoria, confessei that in a large proportion of the cases of gout and rheumatism tho Water-Cure seems to be extremely efficacious. He says further: “In that very large class of cases of complex disease, usually known under the name of chronic dyspepsia, in which other modes [Why wait to try “ other modes ?”] of treatment have failed, or been only partially successful, the practice of Priessnitz is well 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. John Bell, author of the ablest historical work 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 all 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 hydro pathists, the question naturally arises, Why is it, if regular physicians, in al' ages, and of all countries, have found water-treatment so superior in the great mass of human maladies, that the medical faculty of the present day, as a body, employ it so little, in fact alm ost wholly neglect it, nay, bitterly and vehemently oppose it? This is indeed a strange problem, but it can be solved. The minds — professional minds — of medical men cf this day are as mystified and twistified, as superstitious and fantastical, as irrational 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, lie may know all the facts of all the sciences in exist- ence, yet if he does not recognize the principles to which those facts 62 INTRODUCTION. relate, his writing and liis talking may be unintelligible jargon, and hia practice a promiscuous medley of truth 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 airy, 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 ; nature 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 powerful remedies. Their patients die ; nature gets the blame, and the doctor is excused, for surely no one could have done more! The rock on which the water-treatment has ever been wrecked 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 little medicine of some sort. It may be very little, infinitesimal, the thirtieth dilution, or a ten-millionth part of a drop of the tincture of a shadow, or the weakest decoction of catnip or canary seed ; still it must be something tmnatural, 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 gradually 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 deper.'b on seeping it clear of all ‘‘entangling alliances,” and on that alone. FART I ANATOMY. Diifijsiti )ji. — 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 ether. All organized bodies are either animal or vegetable Comparative anatomy teaches the structures of animals. Human anat omy contemplates a knowledge of the’ structures of all the organs and parts of the human body, and their relations to each other. Those structures 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, and 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 scrum. Bile, sweat, urine, etc., are excretions. Organic Elements. — Reduced to their ultimate constituents by chemical 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 phosphoroub, sulphur, silicon, chlorine, iodine, bromine, fluo- rine, potassium, sodium, calcium , magnesium, iron, manganese, and aluminum. To this list some late chemists have added arsenic and copper; and even lead and gold have quite recently been found in organized bodies, and hav 3 quite absurdly been put down as con- stituents. Some of these elements, however, are only occasionally found in the numan body, particularly arsenic, opner, lead, and gold ; hence a more 54 ANATOMY. rational inference is, that they are accidental ingredients, instead of ele- mentary constituents. When it is considered how extensively metallic substances and min- eral preparations are employed as medicines, and how generally metallic vessels, liable to oxidation, are. used in cooking, to say nothing of the casual admixtures of drugs kept about dwellings, for various domestic purposes, wi f h the articles of food and drink, it need not be surprising that chemists should now and then detect ingredients in the solids and fluids of the numan body which have no natural 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, fibrin, and gelatin, which form the basis of the nervous, 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 gastric glands , globulin , in the blood corpuscles; spermatin, in the semen; keratin , in the hair and skin ; hematin, 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 ; cholesterin ; oleate , mangarate, and stearate of soda ; chloride of sodium ; sulphate , lactate , and phosphate of soda ; phosphate of lime. I can see no reason why a hundred or a thousand others may not be ieveloped by similar experiments, which certainly tend much more to „he complication of scientific words and phrases than to the demon- stration of true science. Tissues. — E ach 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 charac- teristics in all parts of the body. Every portion of the animal organism is formed of nucleated ceils, 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 properties, will be treated of in tho physiological pail of this work. OSTEOLOGY. 65 CHAPTER I. 100.00 Structure of Bone. — T he bony structure 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 are irregular in form and size, and give off numerous branch- ing tubes, which, by communi- cating with each other in various directions, constitute a very del- icate network. RELATION OF BONES TO BULK. OF THE BONES— OSTEOLOGY. The osseous structure constitutes the framework of the body. It gives form, firmness, and individuality to the physiological character and affords surfaces and points hold the bones in position, and the attachment of muscles which move them. The proportion of the bony structure. to the gene- ral bulk may be seen at a glance in Fig. 1. The proximate constituents of bone are — >r the connection of ligaments which Fig. 1. Cartilage . . (parts) 32.17 Blood-vessels . . . . 1.13 Phosphate of lime . .51.04 Caibonate of lime . . 11.30 Fluate of lime .... 2.00 Phosphate of magnesia . 1.16 Soda, chloride of sodium 1.20 66 ANATOMY. A microscopic view .>f the minute structure of bone is shown in Fig. 2. 1. One of the Haversian canals, surrounded by concentric lamell®. 2. The same, with the cells and tu- buli. 3. Area of one of the canals. 4 4. Direction of the medullary, or central canal. The upper part oi the cut represents several long cor- puscles, or cells, with their tubuli , the lower part exhibits the outlines of several other canals. Investing Membrane. — All the bones are invested with a dense fibrous mem- brane, 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 termed perichondrium. The internal cavities of long bones, and the canals and cells of oth- ers, are lined by a membrane called medullary, and filled with an oily substance, called medulla , or marrow. Development of Bone. — The osseous, like all organized struc- tures, is found to exist primordially in a state of extremely minute vesicles, or cells. Each cell is composed of a thin membrane, enclosing a fluid matter, in which is a small, denser mass, constituting the nucleus around which the cell itself was originally developed. Within each nucleus may usually be found one or more smaller granules, or cells, called nucleolus, or nucleoli. And whether there are within these nucleoli yet smaller vesicles, and. within them more minute nucleoli still, and so on, must be left to imagination. The human mind must grasp infinity before it can comprehend the primal atom, or starting- point, of vital organization. Stages of Ossification. — The first recognizable change of ordinary resides toward bony structure is an assemblage of minute cells, of a gelatinous or jelly-like consistence. In the piocess of growth these cells are separated by intercellular substance , which is transparent and fluid at first, but gradually becomes condensed and opake. Then the cartilaginous stage of ossification exists. In the cartilaginous substance Fig. 2. OSTEOLOGY. 67 rascular canals are formed by a union of ceils in rows, 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 punctum ossijicationis. As the earthy particles are deposited around the central point, the surrounding cartilaginous cells become elongated, and within each cell two or three nucleoli are developed. Each of these second- ary cells soon attains the size of the parent cell, the membrane of which disappears, and the newly-formed cells are separated by freshly effused intercellular substance. Still progressing, each newly-formed cell produces four, five, or six young cells, which destroy 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, which form in clusters of from thirty to fifty. The clusters are oval in figure, and are disposed longitudinally to the axis of the bone, while the cells them- selves are arranged 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 areolcs and Herva&ian canals are formed by the conjunction of the cells. A highly magnifying power shows the 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 — osiicula auditbs ... 6 Face 14 Teeth 32 Back — verteh ral column . . 24 Ribs — twelve pairs .... 24 Tongue — os liyoides ... 1 Upper extremities —arm, wrist, and fingers 6‘i Breast — sternum 1 Pelvis — hip, sacrum, and coc- cyx 4 Lower extremities — leg, in- step, and toes 60 Sesamoid — knee pan, and bones in tendons . .... 8 246 ANATOMY. Anatomists distinguish three kinds of bones : the long, flat , and irregular The long appertain to tha limbs, the arms, legs, fin- gers, and toes ; the flat enclose cavities, as the brain and pelvis; the ir- regular are mostly found about the base of tke skull, face, trunk, wrist, and instep. VERTEBRAL COLUMN. The bones of the back, constituting the vertebral column, are divided into thirty-three pieces in the young person, but in ad- vanced life the nkie lower pieces unite into two. Each piece is called a vertebra. The whole are divided into true and false . The true are the twen- ty-four upper ones, ana 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 five 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 animals. Each vertebra, except the upper cervical, which has no body, con- sists of a body , by which it is articulated with the adjoining vertebrae ; two laminae , or plates, which arch backward and enclose the passage for t) e spinal cord; a spinous process , which projects backward for OSSEOUS SYSTEM. OSTEOLOGY. 6 $ Fig. 4. the attachment of muscles ; two transverse processes pi ejecting laterally from each side of the laminae for the attachment of muscles ; and four articular pro- cesses, which project upward and downward froir. the laminae, for articulation with adjoining vertebrae 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 vertebrae. 5. Cervical region and its corresponding curve. 6. Dorsal region and its corre- sponding curve. 7. Lumbar region and its corresponding curve. 8. Sacrum. The distinctive parts of a vertebra are seen in Fig. 5. 1. The body, concave in the centre, and rising into a 1 sharp ridge on each side. ' 2 2. The lamina. 3. The part 2 called pedicle, rendered con- cave by the superior inter- vertebral notch. 4. Spinous 4 process, its extremity bifur- cated. 5. Transverse pro- cess. 6, Vertebral foramen. 7. Superior articular pro- cess. 8. Inferior articular process. Fig. 5, A CERVICAL VERTEBRA. fERTEBRAL COLUMN, The first cervical vertebra supports the head, 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- 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, G3 though it were turning 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 :le, to which the strong ligament of the neck lige.n^mtum nuchce , is attached. 60 AN A'l 0M Y. The dorsal vertebrae are marked on each side by articulating sur- faces, facets , for receiving the head of the ribs. In size the dorsal are midway between the cervical and lumbar. The lumbar vertebrce are the largest ; their bodies are thicker before than behind; their spinal cavity is large and oval, and their spinous processes are thick and broad. The sacrum is of a triangular figure, concave in front and convex posteriorly. It is marked by four transverse ridges, which indicate the consolidation of five separate pieces. The coccyx, which terminates the vertebral column below, is com- posed of four small pieces, which gradually unite in one ; and this one becomes consolidated to the sacrum soon after the middle period of life. T he 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, narrower in the middle of the dorsal, and again broad in the lumbar region. The spinous processes are hori- zontal in the cervical, gradually becoming oblique in the upper part of the dorsal, 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 very small. The intervertebral foramina are openings formed by the juxtaposition of the vertebral notches ; they are smallest in the cervical region, gradually 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. Pliey are divided into those of the cranium , and those of the face. The cranial, like all fiat 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 : BONES OF THE SKULL. Occipital, Two parietal, Cranial Bones, Frontal, Two tempora Sphenoid, Ethmoid. OSTEOLOGrl 61 Facial Bones. Tavo nasal, Two palate, Two superior maxillary, 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. Sphe * jid. 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 bone forms the base and back part of the cranium. Itr 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 bump of parentiveness. About an inch below this projection is the foramen magnum , 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 the 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 process, on which rests the medulla oblongata. The Parietal bones are quadrilateral in form, situated at the side and vertex of the skull, and connected with each other by a straight suture, called sagittal . On the externa surface of each bone is an arched G 62 ANATOMY. line, called the tempoi il ridge. The internal surface is marked by numerous furrows, which lodge the ramifications of the middle me- ningeal artery, and by digital fossa, corresponding 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, ami below this is a depression, called the temporal fossa. The sharp, prominent arches, which 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 nasal bones, and a projection, called the nasal spine. The internal surface is divided by a grooved ridge ; in the groove the longitudinal sinus is lodged, and to the edges of the ridge the falx cerebri is attached. On the orbital portions are fossa corresponding to the convolutions of the anterior lobes of the cerebrum. The Temporal 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 part of each bone, and the thin, translucent part of the temple. A long, arched process pro- jects from its external surface, called the zygoma. Its internal sur face is irregularly depressed by the convolutions of the cerebrum. The mastoid portion forms the back part of the bone. Beginners in phrenological science, on feeling behind the ears, have often mistaken its projection for an enormous u combativeness.” It is thick, rough, and pierced 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 organ of hearing. In front of it is the meatus auditorius externus, or external ear passage. The petrous portion is extremely hard and dense. In shape it is a three-sided pyramid. Near the middle of its posterior surface is the entrance of the meatus auditorius interims, about one third of an inch in depth. At the bottom of ihe 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 wall 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 an! irregular, and assists to form the OSTEOLOGY 68 under surface of the base of the skull. To a smooth fossa, cabed glenoid , the condyle of the lower jaw is articulated. At the inner angle of this fossa is the foramen of the Eustachian tube. The Sphenoid hone 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 extended It is divided into a centra] portion, or body ; 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 ; spinous processes , ex- tending backward from the base of the greater wings ; and pterygoid processes , extending downward from the greater wings. On the su- perior surface of its body are seen the optic foramina , which transmit the optic nerve and ophthalmic arteries. The posterior surface is flat, rough, and articulated with the basilar process of the occipital bone. The lesser wings form the posterior parts of the roof of the orbits, and are traversed 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 process is articulated with the squamous portion of the temporal bone ; its internal border is grooved for the reception of the Eustachian tube. The pterygoid processes form the lateral boundaries of the posterior 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 two lateral masses . From the upper part of the septum a strong 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 cribriform 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 turbinated bone is a thin, curled plate of the internal surface, constkuting 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 turbinated bone. ' The Nasal bones are small, quadrangular pieces, forming the bridge and base of the nose They are convex superiorly, and slightly coa- ANATOMY*. cave on their under surface, which is grooved for the nasal branch of the ophthalmic nerve. The Superior Maxillary bones 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 processes, for containing the upper teeth. The posterior surface forms part of the zygomatic fossa, over which 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 antrum, which is an irregular 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 lachrymal and inferior turbinated bones, constituting the nasal duct. The margin of the nasal process is marked by a small tubercle, which serves to guide the knife of the surgeon in operating for fistula lachrymalis. The palate process projects horizontally inward — its upper surface forming the floor of the nares, and its under surface a part of the roof of the mouth. Each Lachrymal bone is a thin, oval 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 fossfe and nasal duct. The Malar bones are the quadrangular pieces which form the prominences of the cheeks. The external surface of each has many small openings for the passage of filaments of nerves and minute arte- ries. A process, called frontal, ascends to articulate with the external angular process of the frontal 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 process. The Palate bones are situated at the back part of the nares, aid 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, irregularly curved bones, projecting inward toward the septum narium, or partition of the nose. Each one is attached to the maxillary bone in front, and the palate bone behind. The Vomer is a thin quadrilateral piece, forming the back and lowei part of the septum of the nose OSTEOLOGY. 65 The Inf trio'; Me ciliary bone , or ing the under low of teeth. Its distinctive parts are shown in tig. 7. 1. The body. 2. The ramus. 3, The fymphisis, or point of union. 4 Fossa tor the depressing muscle of the lower jaw. 5. Mental foramen. 6. External oblique ridge. 7. Groove for the facial artery. 8. The angle. 9. Extremity of the milo-liyoidean ridge. 10. Coronoid process. 11. ITie condyles, which 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. 1. The canine tooth, b. The two bicuspids, m. The three molars. SUTURES OF THE SKULL. The bones of the skull are connected with each other by sutures ysutura , a seam), of which anatomists distinguish several varieties ; the most important are serrated , saw-teeth-like ; squamous , or scaly ; har- 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 parietal bones. The lambdoidal diverges at an acute angle from the posterior extremity 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. Regions. — The skull is divisible into four regions — superior, lateral, inferior, and anterior; or, vertex, side, base, and front. The superior region is bounded by the frontal eminences in front, temporal ridges and parietal eminences on each side, and by the upper curved line and pro- tuberance of the occipital behind. The ,ateral is subdivided into te?u- j)oral , mastoid , and zygomatic portions. The inferior region is sub- divided into a cerebral , or internal, and a basilar , or external, surface. The cerebral surface is again subdivided into anterior , middle, and j posterioi fossa . The face constitutes tha anterior region . A> ATOMY. Fig. 8. Fig. 8 exhibits several peculiarities of structure not described in the text. *. The 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 spheno-maxillary. 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. Mental foramen. 13. Ramus of the lower jaw. 14. Parietal bone. 15. Coronal suture. 16. Temporal bene. 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. 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 caacum. 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 occipital bones. The uneven ridge between 13 and 14 is called dorsum ephippii, and the prominent angles of the ridge constitute the posterior clinoid processes. 15. Foramen rotundum. 16. Foramen ovale. 17. Foramen spinosum ; a small opening between 17 and 12 is called hiatus Fallopii. 18. Posterior fossa of ths 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. ORBITS OF THE EYE. These are hollow cones for the lodgment of the eyeballs, with their OSTEOLOGY. 67 muscles, vessels, arid nerves, and the lachrymal glands. The superior boundary is formed by the 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 ala, or wing of the sphenoid. Communicating with the orbit are nine openings for the transmission of arteries, veins, and nerves. The Nasal Fossce are irregular cavities in the middle of the face, bounded above by the nasal bones, ethmoid and sphenoid ; below by the palate processes of the palate and superior maxillary bones ; outwardly by the superior maxillary, 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 three irregular 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 those of childhood, called deciduous , or milk teeth. The sec- ond are permanent. The teeth of childhood are twenty: eight in- cisor, or cutting, four ||| canine, and eight mo- lars, or grinding teeth. Fig. 10. — a. Central in- eisor. b. Lateral incisor. c. Canine, d. First molar. «. Second molar. Fig. 10. TEMPORARY TEETH. The permanent teeth are thirty-two, sixteen in each jaw. The eigki central 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 grinding. Each lateral half of each jaw, reckoning from the centre, contains two incisors, one canine, two bicuspids, and three molars, 68 ANATOMY. In Fig. 11, a is the central incisor, b. Latera. incisor, c. Cuspid, or canine, d. Firs! 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 tementum. The enamel covers the exposed surface of the crown, an^ Fig. 12. INFANT TEETH, AND RUDIMENTS OF THE PERMANENT OSTEOLOGY the cementum forms a thin coating over the root of the tooth. Its structure 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 an I other drugs. In Fig. 12 are seen the number, arrangement, and nervous connec- tion 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 ninth the two lateral incisors ; in the twelfth the first molares ; 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 G£ years. Two middle incisors, 7th year. Two lateral incisors, 8tli year. First bicuspids, 9th year. Second bicuspids, 10th year. Canine, 11th to 12th year. Second molares, 12th to 13th year. Last molares, 18th 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 tongue bone, called os hyoides , 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 antcro- superior side of the body. 2. Greater 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 o 7 d age. os HYOIDES. Fig. 13. BONES OF THE C±i«T. The sternum, or breast bone, in front, and the twelve pairs of rib&r on the sides, constitute the thorax . The Sternum is situated in the central 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 forward. Its 70 ANATOMY. apper end is called manzbriun , to each side of wiich the clavicle ia attached. The middle portion is called the body , and the inferior ex- tremity terminates in the xiphoid , or ensiform cartilage . 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 ox each rib. The Ribs. — The first or upper seven pairs are called sternal , or true ribs, because they are articulated with the sternum. The five lower pairs 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 breadth 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 vertebra] end. Each rib is curved to correspond with the arch of the thorax, and twisted 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. Behind this angle is the rough elevation called the tubercle . The vertebral end of the rib is expanded into a head for articulation with two contiguous vertebrae. The two lower false ribs are much shorter than the others, and are called floating ribs. The sternal ends of the ribs are cartilaginous, thus contributing mainly to the elasticity of the thorax ; in old age these costal cartilages are more or less ossified. The first seven cartilages articulate with the sternum ; 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, eleventh, and twelfth, which are only articulated with a single verte >ra each Fig. 14. THE THORAX. OSTEOLOGY. 7i BONES OF THE UPPER EXTREMITIES. Each upper extremity comprises the clavicle, or collar bone ; the scapula, or shoulder blade ; the humerus, 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. TLs 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 f. The Scapula, or shoulder blade, is a flat, triangular 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 border 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, which is artic- ulated with the scapula, neck, and greater and lesser tuberosity. The lower extremity is divided into two articular surfaces, the external of which a rounded prominence, called emincntia capitata , which articu- lates with tho 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. 0. 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 trochlea, y 13. External condyle. 14. Intenal jondyle. 15, 16. Condyloid Tidges. 17. Fossa for receiving thrj coronoid process of the uinau HUMERUS 12 A N AT OMY, Fig. 16. The Ulna and Radius are the bones of the fore-arm. The ulna is a long bone, slender in the middle, and larger a*- its upper than ita lower extremity. The upper end forms principally the articulation of the elbow; the lower end is excluded from the wrist joint by an inter- vening cartilage. On its upper extremity is a large semilunar con- cavity, called the greater sigmoid notch , for articulation with the humerus ; and on its outer side is a smaller sigmoid notch , which articulates with the head of the radius. On the posterior side of the greater notch is the olecranon process . The lower extremity terminates in a small rounded head, from one side of which projects a pro- cess, called styloid ; on the opposite side of the head is a smooth surface for articulation with the side of the radius. The Radius is the rotatory bone of the fore-arm. Its upper end is small, and its lower large, forming almost the whole of the wrist joint. Its upper ex- tremity presents a rounded head, the side of which articulates with the ulna. The lower end is broad and triangular, having two articular surfaces — one at the side, for the head of the ulna, and the other at its extremity, for connecting with the scaphoid and semilunar bones of the wrist. Fig. 16 exhibits the ulna and radius in front. 1. Shaft of the ulna. 2. Greater sigmoid notch. 3. Lesser sigmoid notch. 4. Olecranon process. 5. Coronoid process. 6. Nutritive foramen. 7. Sharp ridges to which the interosseous membrane is attached. 8. Capitulum ulnae. 9. Styloid process. 10. Shaft of the radius. *1. Its head. 12. Its neck. 13. Its tuberosity. 14. The oblique ULNA AND RADIUS. line. 15. Lower extremity. 16. Its styloid process. The anterior surface of the iddius is somewhat concave superiorly, where the long flexor muscle of the finger is lodged, and flat below where it supports the pronator quadratus muscle. The nutritive fora- men is seen near the upper third of this surface, directed upward. The posterior surface is round above, where it supports the short supinator muscle, and marked by several shallow, oblique grooves be- low, where the extensor muscles of the thumb are attached. Most of the tendons of the extensor muscles of the fingers arise from grooves and ridges around the projecting point of its lower extremity, which point is called its styloid process , BONES OF THE WRIST. These are eight in number, arranged hi two rows, which constitute the car- pus. The first row, counting from the side of the radius, comprises the sca- phoid, semilunar , cuneiform , and pisi- form ; the second row, the trapezium, irapezoid.es, magnum , and unciform. Their shape and position are seen in Fig. 17, which represents the outside of the right hand. L Lower end of the radius. 2. Lower end of the ulna. 3. Inter articular cartil ages, attached to the styloid process of the ulna, and to the margin of the articular surface of the radius. S. The scaphoid. L. Semilunar. C. Cuneiform. P. Pi- siform. T. Trapezium. T. Trapezoides. M. Os magnum. U. Unciform. Fig. 17 THE CARPUS. BONES OF THE HAND. These are divisible into the meta- carpus and phalanges. The metacarpus is composed of the five long bones be- tween the fingers and wist; that per- taining to the thumb is one third shorter than the others. The phalanges are the finger bones ; they are fourteen in number, three belonging to each finger, and two to the thumb. Fig. 18 shows the aspect of the hand anteriorly. 1. The scaphoid bone. 2. Semilunar. 3. Cunei- form. 4. Pisiform. 5. Trapezium. 6. A groove in the trapezium, which lodges the tendon of the fiexor carpi radialis. 7. Trapezoides. 8. Os magnum. 9. Unciform. 10, 10. The five meta- t'A/pal bones. 11, 11. First row of phalanges. 12, 12. Second row. 13, 13. Third row. 14. First phalanx of the thumb. 15. Second do. Fig. 18 . METACARPUS AND PHALANGES BONES OF THE PELVIS. The pelvis is composed of the two ossa innominata, which form its sides and front, and the sacrum and coccyx behind. Anatomists divide 1—7 ANATOMY. *4 it into a true and false pelvis. The true is the portion beneath a line, called linea ilio pectinea , which forms the margin, or brim, of its proper cavity ; the false pelvis is the part above, and is in reality the fewer part of the abdominal cavity. perior spinous process of the ilium — left side. 8. Anterior inferior spinous process. 9. The acetabulum, a . The notch of the acetabulum, b. Body of the ischium, c. Its tuberosity, d. The spine of the ischium seen through the obturator foramen, e. Os pubis. /. Symphisis pubis. Arch of the pubes, h. Angle of the os pubis, i. Spine of the pubes ; the prominent ridge between h and i is the crest of the pubes, k , k. Pecti neal line of the pubes. Z, Z. The ilio-pectineal line ; m , m , its prolongation to the promontory of the sacrum. The brim of the true pelvis is represented by the line h } i, k k, 1 1, m m, n. The ilio-pectineal eminence, o. The smooth surface which supports the femoral ves eels, p, p. The great sacro ischiatic notch. The pelvis is situated obliquely in relation to the trunk of the body, the inner surface of the ossa pubis being directed upward to support the superincumbent viscera of the abdomen. Its cavity measures in depth four inches and a half posteriorly, three and a half in the mid die, and one and a half at the symphisis pubis. Its inlet has three diameters, antero-posterior, transverse, and oblique . Its outlet has two the antero-posterior and transverse . Each os innominatum is divided into three portions, which, in the young subject, constitute separate bones; they are called os ilium, oa ischium, and os pubis. The ilium is the upper expanded portion form- ing the prominence of the hip, and articulating with the sacrum. The PEI.VIS. Fig. 19. Fig. 19 ia a front view of a female pel- vis, which is broader its cavity more shal- low, and the bones lighter than in the male. 1. The last lumbar vertebra. 2, 2. The intervertebral substance connecting the last lumbar ver- tebra with the fourth and sacrum. 3. Pro- montory of the sa- crum. 4. Anterior surface of the sa- crum, on which the transverse lines and foramina are seen. 5. Lower point or tip of the coccyx. 6, 6. The iliac fossae, form- ing the lateral bound- aries of the false pel- vis. 7. Anterior su- OSTSOLOG Y. 75 ischium is the inferior strong part of it on which the body rests in sitting. The pubis forms the front of the pelvis, and supports the ex- ternal genital organs. The acetabulum is a deep cavity at the junction of the three portions of the innominatum, for receiving the head of the femur, or thigh bone. Between the ischium and pubis is a large oval opening, called obturator foramen ; it is covered by a ligamentous membrane ; a groove in it* upper part lodges the obturator vessels and nerves. BONES OF THE LOWER EXTREMITIES. These are the femur, patella, tibia and fibula, tarsus, metatarsus. And phalanges. The Femur , or thigh bone, is the longest in the body ; it stands liquely between the hip and knee, this obliquity being greatest in the female, on account of the greater breadth of the pelvis. Its upper extremity is divided into a rounded head, a neck, a large pro- cess, called trochanter major, situated on the outside, and a smaller projection on the inside, called tro- chanter minor . The lower extremity is broad, and divided into two condyles , which articulate with the tibia and fibula. Fig. 20 is the right femur, seen anteriorly. 1. The shaft. 2. Head. 3. Neck. 4. Great trochanter. 5. Anterior intertro* clianteric line. 6. Lesser trochanter. 7. External condyle. 8. Internal condyle. 9. The tuberosity to which the external lateral ligament is attached. 10. The fossa for the tendon of the origin of the popliteal muscle. 11. The tuberosity lbr the inter- nal lateral ligament. The Patella, or knee-pan, is one of the sesamoid bones ; it is developed in the tendon of the muscle called quadriceps extensor; its figure is heart- shaped, and it is articulated with the condyles of the femur. The Tibia and Fibula are the bones of the leg. The Tibia is the inner and largest. Its upper end is expanded into two tuberosities, the upper surfaces of which are smooth, for articulation with the femur. On the outer side of the external tuberosity is an articular surface which receives the head of the fibula. A spinous process rises between the artic- Fig. 20. OS FEMORJS f6 ANATOMY. ular surfaces, on each side of which are depressions for the attachment of the crucial ligament . The lower extremity is nearly quadrilateral in shape, and prolonged on its inner side into a process, called internal malleolus . On its outer side is an articular surface, which unites it with the fibula. Below is a smooth triangular surface, which articulates with the astragalus. A front view of the tibia and fibula, as articulated with each other, is seen in. Fig. 21. 1. The shaft of the tibia. 2. Inner tuberosity. 3. Outer tuberosity. 4. Spinous process. 5. The tubercle. 6. Internal or subcutaneous surface of the shaft. 7 . Lower extremity of tibia. 8. Internal malleolus. 9. Shaft of the fibula. 10. Its upper extremity. 11. Its lower extremity, called external malleolus. The sharp border between 1 and 6 is called the crest of the tibia. The Fibula is the outer and smaller bone. Its upper end, or head , is large and thick, having a con- cave surface, which articulates with the external tuberosity of the tibia. The lower end is prolonged beyond the articular surface of the tibia, thus forming the external malleolus, the internal surface of which is articulated with the astragalus. The Tarsus. — The tarsal bones are seven in number : astragalus, calcaneus, scaphoid, internal, middle, and external cuneiform, and cuboid. The Astragalus has a convex surface above for articulating with the tibia and fibula, and a concave surface oelow, which articulates with the calcaneus and scaphoid. The Calcaneus , or heel bone, is of an oblong figure, articulated with the astragalus and cuboid Into its bones of the leg. i ower p ar t the tendo AckilUs , or strong jord of the heel, is inserted, which is sometimes ruptured in dancing, jumping, and other violent exercises. The Scaphoid is boat-shaped, convex before, where it articulates with the three cuneiform bones, and concave behind, to articulate with the rounded head of the astragalus. The Cuneiform bones are wedge-shaped, whence their name. The internal is the largest, and its convex internal surface assists in forming the inner border of the foot. It articulates with the scaphoid, middle cuneiform, and the first two metatarsal bones. The middle cuneiform 'S the smallest; it is connected with the scaphoid, internal and external cuneiform, and second metatarsal. The external cuneiform is orticu OSTEOLOGY. 73 lated with the scaphoid, middle cuneiform, cu- Fig. 22. boid and second, third, and fourth metatarsal. The Cuboid is irregularly cuboid in figure, articulating with the calcaneus, external cunei- form, and fourth and fifth metatarsal. The dorsal surface of the left foot is shown in Fig. 22. 1. The astragalus ; its superior quadrilateral articular surface. 2. The anterior extremity of the astragalus, which articulates with the scaphoid. 3. Os calcis. 4. Scaphoid. 5. Internal cuneiform. 6. Middle cuneiform. 7. External cuneiform. 8. Cuboid. 9. Metatarsal bones of first and second toes. 10. First phalanx of the great toe. 11. Second do. 12. First phalanx of second toe. 13. Second do. 14. Thiid do. The Metatarsus. — The metatarsal bones are five in number, situated between the toes and the tarsus. The first , pertaining to the great toe, is the thickest and shortest; the second is the largest ; the third is smaller ; the fourth still smaller ; and the fifth has a large tuberosity on its outer side, in place of an articular surface. They are articulated with the tarsal bones pos- teriorly, and the first row of phalanges anteriorly, bones of the foot. The Phalanges. — The phalanges of the toes correspond with those of the fingers, there being two for the great toe, and three for each oi the other toes. The first row is convex above, concave beneath, and compressed on the sides. The second is short, yet rather broader than the first. The bones of the third are called unequal phalanges, and, including the second phalanx of the great toe, are flattened and spread laterally at the extremities, to articulate with the second row and support the toe nails. SESAMOID bONES. These are small osseous masses, formed in tendons, which exert a degree of force upon the surface over which they glide. They serve to protect neighboring parts from injurious pressure and friction, by furnishing a sort of pulley for the tendons to play upon. The patella is a sesamoid bone. Besides this, there are four pairs found in differ- ent parts of the skeleton, as pr perly belonging to it — two upon the metacarpo-phalangeal articulation of each thumb, and two upon the corresponding joint of the great toe. Sesamoid bones are frequently found upon the corresponding joints of the little finger and little toe. f8 ANA JO MY. also in the tendon of the peroneus longus muscle, where it passes through the groove in the cuboid bone. Sometimes they are found in the tendons around the malleolar processes ; in the psoas and iliacus muscles, where they pass over the body of the os pubis, and in the external head of the gastrocnemius. The bones of the tympanum , be onging to the auditory apparatus, are sesamoid. CHAPTER II. OF TIIE LIGAMENTS — SYNDESMOLOGF. The connection between any two bones constitutes a joint, or articu- lation. In movable joints the opposing surfaces are coated by an elastic substance, called cartilage ; this is lubricated by a fluid, called synovia , secreted by an enclosing membrane, called synovial ; while the bones are firmly held together by bands of glistening fibres, called ligaments , The forms of articulation are divided into three classes. 1 . Synar- throsis, or fixed joint, as in the skull, upper jaw, vomer, and teeth. 2. Diarthrosis , or movable, the shoulder, hip, elbow, wrist, knee, ankle, carpus, and tarsus. 3. Amphi-arthrosus, or intermediate, as in the bodies of the vertebrae. The motions of joints are of four kinds. 1 . Gliding , the sliding motion of one articular surface upon another. It exists to some extent in all joints, and is the only motion in the carpus and tarsus. 2. Angu lar , which may be forward, called flexion ; backward, called extension ; inward, called adduction ; or outward, called abduction. Flexion and extension are illustrated in the knee and elbow, and, more or less, in most other joints ; adduction and abduction are seen complete in the shoulder, hip, and thumb. 3. Circumduction , which consists in a slight motion of the head of a bone, while the extremity is made to desaribe a large circle, as in the hip and shoulder. 4. Rotation , the movement of a bone on its own axis, as with the radius, the atlas upon the axis, and in the hip and shoulder. The structures in the formation of a joint, in addition to the bone, are cartilage, fibrous tissue, adipose tissue, and synovial membrane. The cartilage of joints serves not only to connect different bones, but also as a separating medium. It forms a thin coating to the articu- lar surface, and has been classed into true, reticular, and fibrous. Fibrins tissue about the joints exists in the form of ligament, some- S YNDESMOLCGY. 79 times constituting bands of various breadth and thickness, and some- times layers, which extend around the joints ; these are called capsular ligaments . Adipose tissue is found in greater or less quantities about joints, where it serves to fill up vacant spaces, and probably increase their elasticity. Synovial membrane is the smooth, polished lining of a joint which secretes the synovia, and enables opposing surfaces to move upon each cf\cr with the most perfect ease and freedom. Fig. 23. in Fig. 23 is seen a portion of fibrous cartilage, largely magnified. Its development »ias already been described ; the different kinds of cartilaginous structure are owing t« subsequent changes in the cells and intercellular substance. PARTICULAR ARTICULATIONS. The connecting media of joints are generally named from some prominent circumstance in relation to form, position, points of connec- tion, etc., as capsular , surrounding ; transverse, running across ; occi- pilo-axoid , attached to and holding together the occipital and axis bones ; lateral, connecting the sides of articulating bones, etc. ; hence, except with the most important ligaments, the name will be a sufficient description The Vertebral Joints. — The vertebrae are held together by the following ligaments : 1 . Intervertebral substance, a disc of fibrous car- tilage interposed between the bodies of all the vertebrae. This varies in thickness in different parts of the column, which circumstance con- tributes much to the formation of the vertebral curves. 2. Anterior common ligament, a broad, thin band of fibres attached to the bodies of the vertebrae in front, and extending along the whole column from the ■aeck to the sa<^r m 3. Posterior common ligament, attached to thft BO ANATOMY bodies behind in a similar manner. 4. Ligamenta subflava, two thtrt plates of yellow fibrous tissue, situated between the arches. 5. Cap- sular ligaments , loose synovial membranes surrounding the articular processes. 6 . Inter-spinous ligaments , thin membranous bands ex- tended between the spinous processes in the dorsal and lumbar regions. 7. Supra-spinous ligament , a strong, inelastic fibrous cord, extending from the apex of the spinous process of the last cervical vertebra to the sacrum, being attached in its course to each spinous process. 8. biter-transverse ligaments , connecting only the transveiso processes of the lower dorsal vertebrae. The connection of the anterior liga- ments and those of the ribs is seen in Fig. 24. 1. Anterior common ligament. 2. Anterior costo-vertebral ligament. 3. Anterior costo-transverse ligament. 4. Interarticular ligament connecting the head of the rib to the intervertebral sub- stance, and separating the two synovial membranes of this articulation. The Neck Joint. — There are seven ligaments connecting the atlas with the os occipitis : Two anterior ligaments , one of which is a rounded cord, attached above to the base of the occipital, and below to the anterior tubercle of the atlas ; the other is a broad membranous layer, lying deeper, attached to the margin of the occipital foramen above, and to the whole length of the anterior arch of the atlas below ; a posterior ligament, thin and membranous, attached above to the mar- gin of the occipital foramen, and below to the posterior arch of the atlas ; two lateral ligaments, strong fascicula of fibres, attached below to the base of the transverse process of the atlas, at each side and above to the transverse process of the occipital bone ; two capsular ligaments, thin ligamentous capsules surrounding the synovial mem- branes of the articulation, between the condyles of the occipital bone and the superior articular processes of the atlas. The motions between the cranium and atlas are flexion and extension. The axis is articulated with the occipital bone by three ligaments — the occipito-axoid, a broad band covering the odontoid process and its ligaments, and two odontoid, short, thick fibrous fasciculi, which pass outward from the apex of the odontoid process to the sides of the occipital foramen and condyles. These ligaments are called check liga- ments, because they limit the rotatory movements of the head. Fig. 24. VERTEBRAL LIGAMENTS. S YNDESMOLOG Y. 81 The atlas is articulated with the axis by five ligaments. The ante- rior consists of ligamentous fibres, passing from the anterior tubercle and arch of the atlas to the base of the odontoid process and body of the axis. The posterior is a thin membranous layer, which passes be- tween the posterior arch of the atlas and the laminae of the axis. The two capsular loosely surround the articular processes of the atlas and axis, and permit great freedom of movement. The transverse is a strong band, arching across the area of the ring of the atlas, from one articular process to the other. It retains the odontoid process of the axis in connection with the anterior arch of the atlas. "Where it crosses the odontoid process, some fibres pass downward to be attached to the body of the axis, and others are sent upward to the basilar pro- cess of the occipital bone. This disposition enables the atlas, and with it the whole head, to rotate upon the axis, its extent of rotation being limited by the odontoid ligaments. Fig. 25 is a posterior view of the ligaments connecting the atlas, axis, and occipital bone. The back part of the occipitis and the arches of the atlas and axis have been removed. 1. The superior part of the occipito-axoid ligament, which has been cut away to show the ligaments beneath. 2. Transverse -ligament of the atlas. 3, 4. Ascending and descending slips of the transverse ligament, which have given to it the title of cruciform. 5. One of the odon- toid ligaments ; the other is seen on the opposite side. 6. One of the occipito-atloid capsular ligaments. 7. One of the atlo- axoid capsular ligaments. Joints of the Lower Jaw. — These are formed by the external lateral ligaments , short, thick bands of fibres extending obliquely back- ward from the zygomas to the external surface of the necks of the lower jaw ; the capsular ligament , consisting of a few irregular fibres passing from the edges of the glenoid cavities to the necks ; the inter- articular fibrous cartilages , thin, oval plates, thicker at the edges than in the centre, placed horizontally between the heads of the condyles and the glenoid cavities, thus dividing each joint into an upper and a lower cavity ; and the synovial membranes , one situated above and one below the cartilages. The movements of the lower jaw are depression and elevation , by which the mouth i* opened and shut ; also a forward , backward , and lateral movement from si3e to side, constituting the grinding motion. Fig. 25. NECK JOINT POSTERIORLY 62 ANATOMY. Fig, 26. Fig. 27. JOINTS OF THE LOWER JAW. Fig. 26 is an external view of this articulation. 1. The zygomatic arch. 2 Tubercle of the zygoma. 3. Ramus of the lower jaw. 4. Mastoid portion of the temporal bone. 5. External lateral ligament. 6. Stylo-maxillary ligament. Fig. 27 is an internal view. 1. A section through the petrous portion of the temporal bone, and spinous process of the sphenoid. 2. An internal view of the ramus and part of the body of the lower jaw. 3. Internal portion of the capsular ligament. 4. Internal lateral ligament. 5. A small opening at its insertion, where the milo-hyoidean nerve passes. 6. Stylo-maxillary ligament. The Costo-Vertebral Joints. — The ribs have a double articular connection with the vertebra. 1. By ligaments connecting the head of the rib with the bodies of the vertebra . 2. Those connecting the neck and tubercle' of the rib with the transverse processes of the vertebrae. This arrangement renders dislocation impossible, as the neck of the rib would break before dislocation could occur. In addition, most of these costo-vertebral articulations have a capsular , inter articular, and three transverse ligaments , named, from their positions, anterior , middle, and posterior costo-transverse ligaments. Fig. 28 is a posterior view of a part of the tho- racic portion of the vertebral column, showing the ligaments connecting the vertebrae with each other, and the ribs with the vertebrae. 1, 1. The supra spinous ligament. 2, 2. Ligamenta subflava, connecting the laminae. 3. Anterior costo-trans- verse ligament. 4. Posterior costo-transverse lig aments. The movements of these articulations are upward and downward, and slightly backward and forward, all the move- ments increasing from the head to the anterior extremity of the rib. Fig. 28. S Y ND ESMOLOGY. 88 Costo-Sternal Join vs. — In front the ribs are articulated with the Sternum, and some of them with each other. The ligamentous con- nections are the anterior , posterior , superior, and inferior costo-sternal , and the synovial memb'anes. The sixth, seventh, eighth, and some- times the fifth and ninth costal cartilages have a perfect synovial mem* Drane, and articulate with each other. The motions of these articulations are limited to a slight sliding movement. Joints of the Sternum. — -The pieces of this bone are connected >y a thin plate of interosseous ligament, and anterior and posterior sternal ligaments, which contribute very much to its strength, and to the elasticity of the front of the chest. Vertebro-Pelvic Joint. — The last lumbar vertebra and the sa- crum are connected by the same general ligaments as are the vertebrae with each other ; in addition to which there are two proper ligaments, called lumbo-sacral and lumbo-iliac . Joints of the Pelvis. — There are four articulations of the pelvic bones. 1. Sacro-iliac, the connection of which is formed by an ante- rior and posterior sacro-iliac ligament. The latter is also called inter- osseous ; it is composed of strong fibres passing horizontally between the rough surfaces of the sacro-iliac articulations. 2. Sacro-ischiatic, the union of the sacrum and ischium, formed by the anterior and. poste- 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 is a soft fibrous cartilage. The bones are held together also by the ante- rior and posterior sacro-coccygean ligaments. This articulation admit! 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 slighl separation of the bcnes. 84 ANATOMY. The numerous vacuities in the walls of the pelvis, and their closure by ligamentous structures, diminish materially the pressure on the soft parts during the passage of the head of the foetus. Note. — The obturator ligament or membrane is a tendo-fibrous ex^ pansion stretched across the obturator foramen. It is not concerned in articulation, but gives attachment to the obturator muscles, and leave a space in the upper part of the foramen for the passage of the obturato Vessels and nerves. Sterno-Clavicular Joint. — The breast and collar bones are con nected by the anterior , posterior, sterno-clavicular, inter -clavicular, and costo-clavicular ligaments, an interarticular cartilage , and two synovial membranes. The motions of this articulation are gliding and circum- duction. This joint is the centre 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- formity. Fig. 29. Fig. 29 shows the ligaments of th* sterno-clavicular and costo-sternal articu- lations. 1. Anterior sterno-clavicular liga- ment. 2. Inter-clavicular ligament. 3. Costo-clavicular. 4. Interarticular carti- lage. 5. Anterior costo-sternal ligaments of the first and second ribs. Soapulo- Clavicular Joint —The shoulder blade and breast bone are connected by two sy- novial membranes, an interarticu lar cartilage, a superior acromio- clavicular, an inferior acromio- clavicular, and a cor aco- clavicular ligament. This articulation admits of a gliding and rotatory move- ment. Note. — The shoulder blade has two ligaments, cor aco- acromial and transverse, which are proper to itself. The first is a thick triangulai band, forming a protecting arch over the shoulder joint. The second crosses the notch in its upper border, thus converting it into a foramen. The Shoulder Joint. — The scapula and humerus form a ball-and- socket articulation ; its ligaments are the capsular , coraco-humeral , and glenoid SYNDESMOLOGY. U 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. Capsular. 6. Co- /aco-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 greater 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. The Elbow Joint. — At this articu- SHOULDER JOINT. lation the humerus, ulna, and radius are connected by four ligaments in addition to its synovial membrane . 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 greater 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 condyle of the humerus, which conceals the posterior ligament. Fig. 31. 2 ELBOW JOINT I1V< TERN ALLY 8 ANATOMY. H Fig. 32. ELBOW JOINT EX- TERNALLY. 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-Ulnar Joint. — The radius ana uma are held together by an inter articular cartilage, the lower surface of which enters into the articulation of the wrist; the orbicular ligament , which sur rounds the head of the radius, and is attached at each end to the extremities of the lesser sigmoid cavity ; the oblique ligament, a narrow slip between 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 necessarily 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 are chiefly concerned in limiting the movements of the radius, and hence, in great muscular efforts are 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 wrist 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 space. SYNDESMOLOGY. 8? Thn ligaments of the wrist and hand are seen an- teriorly in Fig. 33. 1. Interosseous membrane. 2. Anterior inferior radio-ulnar ligament. 3. Anterior ligament 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 carpo-metacarpal articulation of the thumb. 10. Anterior ligament of the metacarpo phalangeal ar- ticulation of the thumb. 11. One of the lateral liga- ments 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 articu- lations. 14. Transverse ligament connecting the h?ads of the metacarpal bones of the index and middle fin- gers ; the same 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 are connected by ligamentous bands, which pass transversely and longitudinally from bone to bone on the back, called 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 membranes enter into the carpal articulations. Between the bones of each range there is a slight movement of flexion and extension . 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 metacarpal 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 are limited to a slight degree of sliding motion, except in the case of the metacarpa. bone of the thumb with the trapezium, which has flexiyn, extension t adduction, abduction , and circumduction. Fig. 33. ANATOMY m Metacarpo-Phalangeal Joints. — The metacarpal and finger nones are united by anterior fibro-cartilaginous ligaments, strong, nar- row lateral ligaments, and strong ligamentous bands, called transverse 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 office of a posterior ligament, as with the preceding articulations. The movements are flexion and extension . 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 capsular, which embraces the acetabulum superiorly, and the neck of the femur inferiorly ; the ilio-femoral , an accessory Attachment to the anterior portion of the capsular; the ligamentum teres, which holds the centre of the head of the femur 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 acetabulum ; and the synovial membrane , which invests the hea< of the femur, and spreads around the ligamentum 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- ament of the vertebrae, extending down- ward over the front of the sacrum. &. Lumbo sacral. 3. Lumboiliac. 4. Ante- rior sacro-iliac. 5. Obturator membrane. 6. Poupart’s ligament. 7. Gimbernat's. 8. Capsular. 9. Ilio-femoral, or acces- sory. The fossa at the bottom of the acetabulum is filled by an adipose mass, covered by synovial membrane, which serves as an elastic cushion to the head of the bone during its movements. Fig. 34. PELVIS AND HIP ANTERIORLY SYNDESMOLOGY. 89 A side view of the ligaments Fig. 35 , of the pelvis and hip joint is Been in Fig. 35. 1. Oblique sa- cro-iliac. 2. Posterior saero-is- chiatic. 3. Anterior saero-ischi* itic. 4. Great sacro-ischiatic for- amen. 5. Lesser sacro-ischiatic foramen. 6 . Cotyloid ligament of the acetabulum. 7. Ligamen- tum teres. 8 . Edge of the cap- sular. 9. Obturator membrane partly exhibited. The Knee Joint.— The femur, tibia and fibu- la, and the patella, are con- nected at the knee joint by 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 pelvis and hip laterally. membrane. The anterior, or ligamcntum jpatellce, is a prolongation of the tendon of the extensor muscles of the thigh downward to the tubercle of the tibia, enclosing the patella ; the interior is a broad expansion covering the whole back part of the joint ; the internal lateral is a broad layei extending between the internal condyle of the femur and the innei 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 patel ae is a mass of fatty substance 9 0 ANATOMY. Fig. 36. tvhich presses the membrane toward the interior of the joint, and occu- pies the fossae 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 are two fringed folds of synovial membrane, ex- tending from 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. 1. The ten- don of the quadriceps extensor muscle of the leg. 2. Patella. 3. Anterior ligament. 4, 4. Synovial membrane. 5. Internal SNl E JOINT ANTE- lateral ligament. 6. The long division of the external lateral RIORLY. 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,-^The 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 external lateral. 7. Its short division. 8. Tendon of the popliteus cut short. 9. Posterior superior tibio-fibular ligament. The movements of this joint are flexion 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 membrane. The movements between these bones is a very slight degree of y ield- ing or sliding motion. KNEE JOINT POSTE- RIORLY. The Ankle Joint. — This is formed by the tibia and fibula with their malleolar processes above, and the astragalus below, connected by three ligaments : the anterior , a thin membranous layer ; the in- ternal lateral , or dd toid , a triangular layei 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- 33 '.eolus. the anterior of which is attached to the astragalus, 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 ligament con- necting the tibia and fibula. 3. Transverse ligament. 4. Internal lateral. 5. Posterior fasciculus of the internal lateral. G. 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 flexion and extension take place. Fig. 39. 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-Piialangeal 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. 52 ANATOMY. Fig. 40. SOLE OF THE FOOT. The Toe Joints. — The phalanges of the toes have the same ligamentous connection as those of the fingers, and the same variety and extent of motion. The ligaments of the sole of the foot are seen in Fig. 40. 1. Os calcis. 2. Astragalus. 3. Tuberosity of the scaphoid. 4 . Long calcaneo-cuboid 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 ol 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 liga- ments of the phalanges of the great toe ; the same ligaments are seen upon the other toes. Note. — In amputations at the tarso-metatarsai joint, it must be understood that the metatarsa bone of the second toe is strongly wedged between the internal and external cuneiform bones, being the most firmly articulated of all the metatarsa* bones. CHAPTER III. OF THE MUSCLES— MYOLOGY A he muscies 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 attached 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 some of the joints. In the trunk 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- MYOLOGY. 93 The names of muscles are generally de- F1 &- 41 * rived from some prominent character in shape, structure, or use, or points of attach- ment. The more fixed or central point of attachment is called the origin of a muscle, and its movable extremity its insertion. Some muscles, however, pull equally at both ex- tremities. Structure of Muscle. — Muscular tis- sue is composed of bundles of fibres, of variable size, called fasciculi, enclosed in a cellular sheath. Each fasciculus is composed of smaller bundles, and each bundle of single fibres. These ultimate fibres, by microscopic examination, appear to be composed of still smaller fasciculi, called ultimate fibrils, en- closed in a delicate sheath, called myolemma . Anatomists distinguish two kinds of ultimate muscular fibre : that of voluntary, or animal life, and that of involuntary, or organic life. The ultimate fibre of animal life is distin- guished by uniformity of calibre, by its longi- \udinul stria?, and by transverse markings, which occur at short regular distances. The ultimate fibrils are regarded as beaded filaments, consisting of a regular succession of segments and constrictions. An ultimate fibre is composed of a bundle of these fibrils, so disposed that all the segments and all the constrictions correspond, in this manner giving rise to alternate light and dark lines of the transverse striae. MUSCULAR SYSTEM. Fig. 42 represents an ultimate fibre of animal life, in which the transverse splitting into discs, in the direction of the constrictions of the ultimate fibrils, is seen. The ultimate fibre of organic life is a simple homogeneous filament, flat, without transverse markings, and much smaller than that of animal life. The fibres are collected into fasciculi of various sizes, and held together by dark nuclear fibres* Gen- Fig. 42. ULTIMATE FIBRE. u ANATC MY. erally a dark line, or several dark points, may be seen in the interior of the organic fibres ; and sometimes the fibre is enlarged at irregular distances ; these appearances are owing to the presence of unobliter- ated nuclei of the cells from which the fibre was originally developed. Fig. 43. i 2 In Fig. 43, 1 exhibits a muscular fibre of organic life from the bladder, magnified 600 times. Four of the nuclei are seen. 2 rep- resents a fibre of organic life from the stomach, equally magnified. Development of Muscular Fibre. — This is effected by the formation of nucleated cells out of an original blastema, or fluid substance capable of becom- ing organized, ana the conversion of the cells into the tubuli of ultimate fibres, by the process already de- scribed in relation to the development of bone, while their contents are transformed into ultimate fibrils ; in this way the cell membranes constitute the myolem- ma, and their contents a blastema, out of which new FIBRES. cells are formed. In Fig. 44, 1 is a muscular fibre of animal life, enclosed in its myolemma. The transverse and longitudinal striae are seen. 2, 2. Muscular fibres of animal life, more highly mag nified than the former. The myolemma is so thin and trans- parent that the ultimate fibrils can be seen through it. They show the nature of the longitudinal striae, as well as the formation of the transverse striae. The voluntary system, or that of animal life , is developed from the external or serous layer of the germinal membrane, and comprehends all of the muscles of the limbs and trunk. The involuntary , or organic system , is formed from the internal or mucous layer, and constitutes the thin muscular struc- ture of the alimentary canal, bladder, and internal organs of genera- tion. At the commencement and termination of the alimentary canal, both classes of fibres are blended in the formation of the muscular coat, The heart is developed from the middle or vascular layer of germinal membrane, and is composed of ultimate fibres having the transverse striae of the muscles of animal life, although its action is involuntary. Fig. 44 . 1 2 DEVELOPMENT OF MUSCLE. MUSCLES OF THE HEAD AND FACE. These have been divided into eight groups — cranial, orbital, ocular, nasal, superior labal, inferior labal, maxillary, and auricular. Cranial Group. — This has but cne muscle, the occipito - frontali * MYOLOGY. $5 It is a broad expansion, covering the whole side of the vertex of the Bkull from the occiput to the eyebrow. It arises by tendinous fibres from the outer two thirds of the upper curved line of the occipital, and from the mastoid process of the temporal bone. It is inserted above the orbit by means of a blending of its fibres with those of the orbicularis palpebrarum, corrugator supercilii, levator labii superioris alaeque nasi, and pyramidalis nasi* Its use is to raise the eyebrows, in doing which the integuments of the forehead are wrinkled. In some persons the whole scalp moves by the contraction of this muscle. Fig. 45 shows the muscles of the head and face. 1. Frontal portion of the occipito-fron- talis. 2. Its occipital portion. 3. Its aponeu- rosis, or expansion. 4. Orbicularis palpebra- rum, which conceals the corrugator supercilii and tensor tarsi. 5. Pyramidalis nasi. 6. Compressor nasi. 7. Orbicularis oris. 8. Levator labii superioris alaeque nasi. 9. Le- vator labii superioris proprius ; the lower part of the levator anguli oris is seen between 10 and 11. 10. Zygomaticus minor. 11. Zygo- maticus major. 12. Depressor labii inferioris. 13. Depressor anguli oris. 14. Levator labii inferioris. 15. Superficial portion of the mus- eeter. 16. Its deep portion. 17. Attrahens aurem. 18. The buccinator. 19. Attollens aurem. 20. Temporal fascia covering in the temporal muscle. 21. Itetrahens aurem. 22. Anterior belly of the digastricus ; its tendon is seen passing through its aponeurotic pul- ley. 23. Stylo-hyoid, pierced by the posterior belly of the digastricus. 24. Mylo-hyoideus. 25. Upper part of the sterno-mastoid. 26. Upper part ol the trapezius. The splenius is muscles of the HEAD AND FACE seen between 25 and 26. The Orbital Group. Three muscles: 1 . Orbicularis palpebrarum, a sphincter or closing muscle, which surounds the orbit and eyelids 2. Corrugator supercilii , a narrow, pointed muscle, arising from the inner extremity of the superciliary ridge ; inserted into the orbicularis palpebrarum. 3. Tensor tarsi , a very small muscle, arising from the orbital surface of the xachrymal bone ; inserted by two slips into the lachrymal canals. The use of this group is to close the lids, draw the eyebrows downward and inward, and extend the lachrymal canals. The Ocular Group. — This group consists of seven: 1 . Levator palpebrce, long thin, and triangular, situated in the upper part of the orbit ; arises from the upper margin of the optic foramen and sheath Fig. 45. 06 ANATOMY. ®f the optic nerve ; inserted into the upper border of the upper tarsal cartilage. 2. Rectus superior, arising with the preceding; inserted into the globe of the eye about three lines from the margin of the cornea. 3. Rectus inferior ; arises from the inferior margin of the optic foramen and sheath of the optic nerve ; inserted into the inferior surface of the globe near the margin of the cornea. 4. Rectus inter nus, a short, thick muscle ; arises from the common tendon and the sheath of the optic nerve; inserted into the inner surface of the globe neat* the margin of the cornea. 5. Rectus externus ; arises from the common tendon, and from the margin of the optic foramen ; inserted into the outer surface of the globe near the cornea. 6. Obliquus superioi , arises from the margin of the optic foramen and sheath of the optic nerve ; inserted into the sclerotic coat near the entrance of the optic nerve. 7 . Obliquus inferior ; arises from the inner margin of the superior maxillary bone ; inserted into the outer and posterior part of the eyeball near the entrance of the optic nerve. Uses. — The levator raises the upper eyelids ; the four recti, when acting singly, pull the eyeball upward, downward, inward, and out- ward ; the superior oblique rolls the globe inward and forward ; the inferior oblique rolls the globe outward and backward. Fig. 46 is a view of the ocular group, taken from the outer side of the right orbit. 1. A small fragment of the sphenoid bone around the en- trance of the optic nerve into orbit. 2. Optic nerve. 3. Globe o. the eye. 4. Levator palpebr© mus- cle. 5. Superior oblique. 6. Its cartilaginous pulley. 7. Its reflected tendon. 8. Inferior oblique. 9. Su- perior rectus. 10. Internal rectus, almost concealed by the optic nerve. 11. Parts of the external rectus, bmo wing its two heads of origin. 12. Extremity of the external rectus at its insertion. 13. Inferior rectus. 14. The tunica albuginea, which is formed by the expansion of the ten- dons of the four recti muscles. The Nasal Group. — Three muscles : 1. Pyramidalis nasi, a slip of fibres extending from the occipito-frontalis downward upon the bridge of the nose ; inserted into the tendinous expansion of .he com- pressores nasi. 2. Compressor nasi, a thin triangular muscle ; arises from the canine fossa of the superior maxillary bone, and, spreading out on the side of the nose into a tendinous expansion, is continuous across its ridge with its fellow of the opposite side. 3. Uilitator naris, a thin muscular slip expanded upon the ala of the nostril. Fig. 46 MUSCLES OF THE EYEBALL. MYOLOGY. 97 Uses, — The first draws down the inner ang.e of the eyebrow, and assists the occipito-frontalis ; the second expands rather than com • presses the nostril; the last dilates the cavity of the nostril. The Superior Labial Group. — Seven muscles constitute this group : 1 . Orbicularis oris , a sphincter completely surrounding the mouth, the use of which is to close the lips. 2. Levator labii superioris alceque nasi ; thin, triangular, arising from the nasal process ; inserted , by two distinct portions, into the ala of the nose and upper lip ; its use is to raise the upper lip, and expand the opening of the nose. 3. Leva- tor labii superioris proprius ; thin, quadrilateral, arising from the lower border of the orbit ; inserted into the integument of the upper lip ; its use is to elevate the upper lip. 4. Levator anguli oris , arising from the canine fossa of the upper jaw, and, passing outwardly, is inserted into the angle of the mouth, which it draws inward and upward. 5. Zygomaticus major , and zygomaticus minor ; two slender fasciculi of fibres, arising from the malar bone ; inserted into the angle of the mouth ; they pull the angle upward and outward, as in laughing. 7 . Depressor labii superioris absque nasi , an oval slip arising from the incisive fossa ; inserted into the upper lip, and into the ala and columna •)f the nose ; it lifts the upper lip, with the ala of the nose, and expands the opening of the nares. The Inferior Labial Group. — Comprising three muscles : J. Depressor labii inferioris ; arises from the side of the symphisis of the lower jaw; inserted into the orbicularis muscle and integuments of the lower lip ; it draws the under lip directly downward and a little outward. 2. Depressor anguli oris , a triangular plane, arising from the external oblique side of the lower jaw ; inserted into the angle of the mouth ; it pulls the angle of the mouth either downward and in- ward, or downward and outward, by the radiation of its fibres, as in the expression of grief. 3. Levator labii inferioris , a conical slip, arising from the incisive fossa of the lower jaw; inserted into the integuments of the chin, which it raises .and protrudes. The Maxillary Group. — Five muscles: 1. Masseter , short and thick, composed of two planes of fibres, superficial and deep ; the superficial arises from the tuberosity of the upper jaw, the lower edge of the malar bone and zygoma, and is inserted into the ramus and angle of the lower jaw; the deep layer arises from the back part of the zygoma, and is inserted into the upper half of the ramus. 2. Tempo - alls, a broad radiating muscle, occupying a considerable extent of the 1—9 98 ANATC MY. side of the head, and fitting the temporal fossa ; arises from the tem- poral ridge, temporal fascia, and temporal fossa, and converging into a strong, narrow tendon, is inserted into the coronoid process. 3. Bucci- nator ; arises from the alveolar processes of the upper jaw, and from the external oblique line of the lower jaw ; inserted into the angle of the mouth, where its converging fibres cross each other. 4. External pterygoid, a short, thick muscle, arising two-headed from the sphenoid bone ; inserted into the neck of the lower jaw. 5. Internal pterygoid . thick, quadrangular, arising from the pterygoid fossa ; inserted into the ramus and angle of the lower jaw. Uses. — This group comprises the active agents in mastication. The ouccinator circumscribes the cavity of the mouth, and shortens the cavity of the pharynx in deglutition The masseter, temporal, and internal pterygoid close the jaws, and perform the bruising motions. The two last mentioned, with the external pterygoid, carry the lower jaw forward upon the upper, thus producing the grinding motion. Ah of these muscles, acting successively, produce a lateral and rotatory move- ment of the lower jaw. The two pterygoid muscles are seen in Fig. 47. The zygomatic arch and most of the ramus have beon removed to bring them into view. 1. The sphenoid origin of the external ptery- goid. 2. Its pterygoid origin. 3. Internal pte- rygoid muscles. The Auricular Group. — Three muscles: 1. Attollens aurem ; 2. Attrahens aurem ; 3. Retrahens aurem . These small muscles of the ear possess ordinarily but little contractility ; they raise, extend, and re- tract the ear in the lower animals. MUSCLES OF THE NECK. The muscles of the neck are divided into eight groups, viz. : The Superficial Group — Two muscles : 1. Platysma myoides , arises from the integument over the pectoralis major and deltoid mus- cles ; inserted into the side of the chin, oblique line of the lower jaw, angle of the mouth, and cellular tissue of the face. It draws the angle of the mouth, depresses the lower jaw, also produces traction on the integuments of the neck. 2. Sterno-cleido-mastoid is the large oblique muscle of the neck ; arises from the sternum and clavicle ; inserted Fig. 47. MYOLOGY. 9© 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 group is subdivided into depressors and elevators of the os hyoides 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 extremity 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 from the oblique line of the thyroid cartilage ; inserted into the lower part of the body and great cornua of the hyoid bone. 4. Omo-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 larynx. 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-hyoideus , a slender muscle, arising from the middle of the styloid process ; in- serted into the central part of the body of the os hyoides. 3. Mylo- hyoideus , 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-liyoideus , 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 dosed, 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-glossns ; this 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 from the great cornua and body of the os hyoides; inserted into the side of LOO ANirOMT. the tongue. 3. Lingualis , consisting of a small bundle, running from the base to the apex of the tongue. 4. Stylo- glossies, arising from the styloid process and stylo -maxillary ligament; inserted into the sub- stance and side of the tongue. 5. Potato- 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 directions 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 thyroid carti- lages ; inserted into the middle of the pharynx. 2. Constrictor medius , arises from the great cornu of the os hyoid es and stylo-hyoidean liga- ment, and its fibres, radiating from the origin, are inserted into the pharynx and basilar process of the cccipitis. 3. Constrictor superior, arises from the molar ridge of the lower jaw, the internal pterygoid 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 mucous membrane of the pharynx, and are inserted into the posterior border of the thyroid cartilage. 5. Palato-plmryngeus, arises from the soft palate ; inserted into the inner surface of the pharynx and posterior border of the thy- roid cartilage. Uses. — The constrictors contract upon the food as soon as it passes into the pharynx, and convey it downward to the (esophagus. Tiro stylo-pharyngei draw the pharynx 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 three ; 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 uvula. Pracvertebral Group. — Five muscles: 1. Pectus anticus major arises from the anterior tubercles of the transverse processes 3f the third, fourth, fifth, and sixth cervical vertebrae ; inserted into the basilar process of the occipitis. 2. Pectus anticus minor, arises from the side of the atlas ; inserted with the preceding. 3. Scalenus anticus , a tri* MYOLOGY. 101 angular muscle, arising with the rectus anticus major; inserted into the inner border of the first ril . 4. Scalenus posticus ; arises from the posterior tubercles of all the cenical 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 ante*w tubercle of the atlas, and inserted into the transverse processes of the third, fourth, and fifth cervi- cal vertebrae ; and the lower 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 coll?, 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 larynx. In Fig. 48 the mo prominent muscles of the head and neck re seen. A. Occipito- frontalis. B. Attollem aurem. C. The coa- cha. D. Orbicularis palpebrarum. E. Com- pressor naris. F. Zygomaticus major. G. Levator labii superioris alaeque nasi. IL Zygomaticus minor. I. Levator anguli oris. K. Masseter. L. Depressor anguli oris. M. Sterno-cleido mastoideus. O. Depressor la- bii inferioris. P. Orbicularis oris. Q. Tem- poralis. R. Splenius. S. Trapezius. T. SterLo-hyoideus. a. Helix, b. Anti-helix, c. Concha. Fig. 48. MUSCLES OF THE BACK. The muscles of the back are divided into six layers. First Layep — IV d muscles: 1. Trapezius ; arises from the upper 102 ANATOMY. r/urved line of the occipitis, ligament of the neck, and spines of the dorsal vertebrae ; inserted into the spine and acromion of the scapula, and scapular third of the clavicle. 2. Latissimus dor si , covering the Fig 49. 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. Infraspinatus, teres minor, and teres major, all muscles of the dorsum of the scapula. 7. External oblique. 8. Gluteus medius. 9. Glutei maximi. 10. Levator anguli scapulae. 11. Rhomboideus minor. 12. Rhor'boideus major. 13. Splenius capi- tis ; the comvplexus is immediately above, and overlaid by it. 14. Splenius colli ; partially seen 15. Vertebral aponeurosis. 16. Serratuy posticus inferior. 17. Supra-spinatus. 18. Infra-spinatus. 19. Teres minor. 20. Teres major. 21. Long head of the triceps, passing between tne teres minor and major to the upper arm. 22. Serratus magnus, proceeding 'orward from its origin at the base of the scapu-h 23. Internal oblique. MYOLOfrl. m 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 are inserted into the bicipital groove of the, humerus. Uses. — The upper fibres of the trapezius draw the shoulder upward jnd 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 spine 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. F'ote. — T he ligamentum nucha is a thin cellulo-fibrous layer between the jccipital bone and spine of the seventh cervical vertebrae. Second Layer. — Three muscles: 1. Levator anguli scapula ; 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. Rhomboideus 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 upward and backward. Third Layer. — These muscles all arise from the spines of the ver- tebral column, and pass outwardly. There are three of them : 1. Serratus posticus superior; arises from the spines of the lower cervical and upper dorsal vertebrae ; inserted into the upper borders of the upper ribs. 2. Serratus posticus 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. The splenius muscle, arising from the lower part of the ligamentum nuchae, and spines of the four iower cervical and six upper dorsal vertebrae ; inserted by two divisions, the first, called splenius 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 the chest, thus rendering the first an inspiratory, and the seoond an 104 ANATOMY. expiratory muscle. The splenii of one side draw the vertebral col* umn backward and to one side, and rotate the head toward the cor- responding shoulder. The splenii of both sides acting together draw the head forward ; they antagonize the sterno-mastoid muscles. Fourth Layer. — Seven muscles: 1, Scrro-lum,balisf arises from the back part of the crest of the ilium, posterior surface of the sacrum and lumbar vertebrae ; inserted by separate tendons into the angles of the six lower ribs. 2. Longissbnus dor si ; arises 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 three lower dorsal vertebrae ; inserted into the spines of all the upper dorsal verte- brae. 4. Cervicalis ascendens ; arises from the angles of the four upper ribs ; inserted into the transverse processes of the four lower cervical vertebrae. 5. Transversalis colli ; arises from the transverse processes of the four upper dorsal vertebrae ; inserted into the like processes of the five middle cervical. 6. Trachleo-mastoid ; arises from the trans- verse processes of the four upper dorsal and five lower cervical verte- bra} ; inserted into the mastoid process. 7. Complexus , a large muscle, forming, with the splenius, the great bulk of the back of the neck ; arises from the transverse processes of the four upper dorsal, and transverse and articular processes of the five lower cervical vertebrae ; inserted into the occipital 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- rior side of the neck ; when the muscles of one side act alone, they produce a rotation of the head. Fifth Layer. — Seven muscles : 1. Semi- spinalis dorsi; arises-iroxn the transverse processes of the six lower dorsal, and is inserted into the spines of the four upper dorsal vertebras. 2. Semi-spinalis colli ; arises from the transverse processes of the four upper dorsal, and is inserted into the spines of the five upper cervical vertebras. 3. Rectus ])oslicus major ; arises from the spines of the axis; inserted into the lower curved line of the occipitis. 4. Rectus posticus minor; arises from the spinous 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. 6. Obtiquus inferior: arises from the spine of the axis ; inserted into the extremity of the transverse process of the atlas. 7. Obliquus superior ; arises where the preceding is inserted ; inserted in^o the occipitis, between th« curved lines. MYOLOGY. m Uses . — The semi-spinale? contribute to the support of the back in the erect position; the recti produce the antero-posterior, and the obliqui the rotatory movement of the atlas on the axis. Sixth Layer. — Five muscles: 1 . Multijidus spincz, 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 vertebrae above their origin. 2. Levatores costarum , con- sisting of twelve distinct fasciculi on each side, which arise from the trans- verse processes of the dorsal vertebrae, and are inserted into the ribs below, between the tubercles and angles. 3. S upr a- spinalis, composed of fasciculi arising from the lower cervical and upper dorsal vertebrae ; inserted into the spine of the axis. 4. Intcrspinalcs , small slips arranged in pairs, situated between the spines of all the vertebrae. 5. Inter- transversalcs , small quadrilateral slips between the transverse processes of all the vertebrae. Uses. — The levators raise the poste- rior parts of the ribs in inspiration ; the others are auxiliaries to the larger mus- cles in supporting the body, and holding the bones in position. 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-lumbalis. 3. Longissimus dorsi. 4. Spinalis dorsi. 5. Cervi- calis ascendens. 6. Trans versalis colli. 7. Trachleo-inastoideus. 8. Complexus. 9. Trans- versals colli. 10. Semi-spinalis dorsi. 11. Semi- spinalis colli. 12. Rectus posticus minor. 13. Rectus posticus major. 14. Obliquus superior. 15. Obliquus inferior. 1G. Multifidus spin®. 17. Levatores eostarum. 18. Intertransversales. 19. Fig. 50. Ciuadratus lumborum. INNER MUSCLES OF THE BACK MUSCLES OF THE THORAX. The principal muscles of the thorax belong uls • to the upper ex tremity. Those proper to the thorax are three » 106 ANATOMY. 1. External inter costals 2. Internal interccstals. 3 THangularis sterni . The intercostals are eleven internal and eleven extei nal planes of muscular and tendinous fibres, situated obliquely between the adjacent ribs, and filling the intercostal spaces. The fibres of the external are directed obliquely downward and inward, and those of the internal ob- liquely downward a id backward, so that they cross each other. The triangularis sterni is situated within the chest, connecting the side of the sternum and sternal extremities of the costal cartilages with the cartilages of the second, 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 from above or below, being thus both inspiratory and expiratory. The tri- angularis is a muscle of expiration, by drawing down the costal carti- lages. MUSCLES OF THE ABDOMEN. The muscles of 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 thread out to a broad aponeurosis, which is inserted into the outer part of trie 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 PouparVs ligament. GimbernaVs ligament is that part of the aponeu- rosis inserted into the pectineal line. 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, are two curved lines, extending from the sides of the chest to the pubis, called the linea semilunar es ; 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 triangular opening, formed by the separation of the fibres of the aponeurosis, called the external abdominal ring. Through this ring passes the spermatic cord in the male, and the round ligament of the uterus in the female ; both are invested in their passage l y a thin fascia derived from the edges of the ring, called inter columnar, or spermati: fascia. In ingui- nal hernia the pouch, in projecting through this opening., receives aa additional covering from this spermatic fascia. MY0L3GY. im Fig. 51. MUSCLES OF THE TRUNK. In Fig. 51 are seen the muscles of the trunk anteriorly. The superficial layer Is seen on the left side, and the deeper on the right. 1. Pectoralis major. 2. Deltoid. 3. Ante- rior border of the latissimus dorsi. 4. Serrations of the serratus magnus. 5. Subclaviuf 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. Jts 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 line® transverste. 14. Poupart’s ligament. 15. External abdominal ring; the margin above is called the superior or internal pillar ; the margin below the inferior or external pillar; the curved intercolumnar fibres are seen proceeding upward from Poupart’s ligament to strengthen the ring. The numbers 14 and 15 are situated upon the fascia lata of the thig*' : 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 *ine. 20. The arch formed between the lower curved border of the internal oblique and Poupart’s lift* tnent. beneath which the spermatic cord passes, and hernia occurs. 108 ANATOMY. 2. Internal oblique ; called the middle ascending flat muscle. It arises from the outer half of Poupart’s ligament, from the middle two thirds of the crest of the ilium, and from the spines of the lumbar ver- tebrae ; and is inserted into the pectineal line, crest of the pubis, line a alba, and five lower ribs. 3. Cremaster ; arises from the middle of Poupart’s ligament ; it forma a series of loops upon the spermatic cord, and some of its fibres ar© 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 third of Poupart’s ligament, internal lip of the crest of the ilium, spines and transverse processes of the lumbar vertebrae, and from 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 from the crest of the pubis ; in- serted into the cartilages of the fifth, sixth, and seventh ribs. 6. Pyramidalis ; arises from the crest of the pubis in front of the rectus ; inserted into the linea alba midway between the umbilicus and pubis. 7. Quadratus lumborum ; arises from the last rib and transverse processes of the four upper lumbar vertebrae ; inserted into the crest of the ilium and iiio-lumbar ligament. 8. Psoas parvus ; arises from the tendinous arches and intervertebral substance of the last dorsal and first lumbar vertebras ; inserted by an expanded tendon into the ilio-pectineal line and eminence. 9. Diaphragm ; this forms a muscular partition between the cavities of the chest and abdomen. In shape it is somewhat conical, and is composed of two portions, called greater and lesser muscles. The greater muscle arises from the ensiform cartilage, inner surfaces of the six inferior ribs, and ligamentum arcuatum externum and internum ; from these points its fibres converge to the central tendon, into which they are inserted . The lesser muscle arises by two tendons from the bodies of the lumbar vertebrae ; these tendons form two large fleshy Dellies, called crura , which 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 transversalis. The liga- mentum arcuatum. \ internum, or proprium, 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 sides of the ensiform cartilage and the cartilages of the adjoining ribs is a triangular space where the muscular fibres of the diaphragm are M Y 0 L 0 G Y. 109 wanting ; this space is closed by the peritoneum on the abdominal side, and the pleura on the side of the 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 diaphragm : 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 (esophagus and pneumogastric 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 great 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 constrict its general cavity. The recti and pyramidaiis together pull the thorax forward ; 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 column 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 magnus. 3. Upper part of external oblique. 4. Two external inter- costals. 5. Two internal intercostal^. 6. Transversalis. 7. Its posterior aponeurosis. 8. Its anterior. 9. Lower part of the left i ictus. 10. Right rectus. 11. The arched opening where the spermatic cord passes and hernia takes place. 12. The gluteus maxi- mus, and medius, and tensor vagin as femoris muscles invested by fascia lata. All the abdominal muscles 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 loins and back, «md to some extent by the upper muscles of the trunk 10 Fig 52 MUSCLES OF THE TRUNK LATERALLY. no ANATOMY They compress the cavity of the abdomen in all directions, thus aiding the expulsion of the contents of the stomach, bowels, gall-ducts, blad- der, and uterus, and also mucous and irritating substances from the bronchia, windpipe, and nose. MUSCLES OF THE PERINEUM. These muscles pertain to the urethra, the outlet of the bowels, an h£ organs of generation. There are eight of them. In the male are: l. Accelerator urinve ; 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 ramu3 and tuberosity of the ischium, and, curv- ing around the root of the penis, is inserts i into the upper surface of its corpus cavernosum. 3 . Compressor uret,\rce; 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 tho urethra, from the apex of the prostate gland to which they are attached, to its bulbous portion. 4 . Transversus perinei ; arises from the tuberosity of the ischium ; inserted into the tendinous centre of the perineum. 5. Sphincter ani , a thin band surrounding 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 triangular layer arising from the spine of the ischium; inserted into the side of the coccyx and lower part 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- ference in organization. The muscle corresponding with the accelerator urinai in the male, is called constrictor vagince ; and the analogue of the erector penis, is called erector clitoridis. MUSCLES OF THE UPPER EXTREMITY. These may be conveniently grouped according to different regions $f the limb. Thoracic Region. — This region comprises three anterior and one nteral muscle : 1. Fectoralis major ; arises from the sternal two thirds of the clavicle, the whole length of the sternum, the cartilages of all the true ribs except the first and last, and from the aponeurosis of the ex- ternal oblique musclo ; inse) 4 ed by a broad tendon into the anterior bicipital ridge cf the humerus. 2. P ector alls minor ; arises by three M Y 0 L 0 G Y 111 dictations from the third, fourth, 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. Uses. — The pectoralis major draws 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 tb^'e muscles are cfdled into action in forced respiration, but cannot act unless the shoulders are fixed. The serratus 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. Subscapularis; arises from nearly the whole of the under surface of the scapula ; inserted by a broad, thick tendon into the lesser tuberosity of the humerus. 2. Supra - 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 minor ; arises from the middle third of the lower border of the scapula; inserted into the lower depression on the greater tuberosity of the humerus. 5. Teres major ; arises from the lowei third of the inferior border of the 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 tlie outer side of the humerus, where they are inserted into a rough elevation. Uses. — The 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 the arm feebly from the side ; the infra-spinatus and teres minor rotate the head of the humerus 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-spinattu, infra-spinatus, and teres minor is to protect the joint against displacement, for which purpose their 112 ANATOMY. Fi S S 3 - 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 dorsalis scapula} vessels pass. 6. Coraco-brachialis. 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 tendon of the biceps. 10. Internal head of the biceps. Humeral Region. — Four muscles: first three are anterior, the last posterior. Coraco - brachialis ; tho 1 arises from the cor- acoid process ; in- serted into a rough line on the inner side of the middle muscles OF THE upper of the humerus. 2. ARM. , Biceps ; arises 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 part 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 the lower part of the humerus ; arises from fleshy serrations on both sides of the insertion of the deltoid, the anterior surface 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 short head. 4. Olecranon process of the ulna 5. Radius. 6. Capsu- lar ligament Fig. 54. TRICEPS MUSCLE MYOLOGY. 113 nerted into the coronoid ptucess 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 ihe septum and the humerus, below the insertion of the teres major ; the middle , or scapular heady 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. 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 other 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 fascia. 4. Flexor sublimis digitorum ; arises from the inner condyle, internal lateral ligament, coronoid process of the ulna, and oblique ridge of the radius, and divides into lour 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 ulnaris ; arises i y two heads, one from 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 brachialis anticus. 3. Part 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 ulnaris. 9. Palmar fascia. 10. Palmaris brevis. 11. Abductor pollicis. 12. One portion of the flexor brevis pollicis. 13. Supinator longus. 14. Extensor ossis metacarpi, and extensor primi in ternodii (SUPERFICIAL ANTEI 101 pollicis, curving around the lewer border of tb j fore-arna. LAYER. Fig. 55. 114 A N A T O M Y the inner condyle, the other from the olecranon and upper two thirds of the inner border of the ulna; its tendon is inserted into the pisiform bone, and base of the metacarpal bone of the little finger. 6. Flexor 'profundus digitorum ; 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 longus pollicis ; arses from the upper two thirds of the radius and part ex 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, into the lower part of the oblique line on the outer side of the radius. Fig. 56. In Fig. 56 is seen the deep layer of muscles of the fore-arm. 1. Internal lateral ligament of the elbow joint. 2. Anterior ligament. 3. Orbicular ligament of the head of the radius. 4. Flexor profundus digitorum. 5. Flexor longus pollicis. 6. 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, is 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 metacarpal 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 fingers. 13. Extensor minimi digiti , is an offset from the extensor communis; inserted into the last two phalanges. 14. Extensor carpi ulnaris ; orrises 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 triangular muscle, arising from the outer con- dyle ; inserted in the olecranon and upper end of the ulna. MYOLOG Y. 116 In Fig. 57 is seen the superficial layer of the muscles c f 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 longus. 5. Extensor carpi radialis longior. 6. Extensor carpi radialis brevior. 7. Tendons of insertion of these muscles. 8. Extensor digitorum communis. 9. Extensor minimi digiti. 10. Extensor carpi ulnaris. 11. Anconeus. 12. Part of the flexor carpi ulnaris. 13. Extensoi ossis metacarpi 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 ®nd brevior. 15. 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 metacarpi pollicis ; 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 primi 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 pollicis ; 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- Fig. 57. SUPERFICIAL LAYER POSTERIORLY ed by the common extensor tendon of the index finger. Note. The tendons of the flexor and extensor muscles of the fore arm are provided with synovial bursae, as they pass beneath the annular ligament ; those of the back of the wrist have distinct sheaths formed by the posterior annular ligament. These bursae are small membnm 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 great 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. 116 ANATOMY p. gg Fig. 58 exhibits the deep layer of muscles on the poa ®’ terior aspect of the fore-arm. 1. Lower part of the hu- merus. 2. Olecranon. 3. Ulna. ■*. Anconeus. 5. Su pinator brevis. 6. Extensor ossis metacarpi pollicis. 7. Extensor primi internodii pollicis. 8. Extensor se. cundi internodii pollicis. 9. Extensor indieis. 10. First dorsal interosseous ligament. The other three dorsal interossii are seen between the metacarpal bones of their respective fingers. Uses. — The pronator radii teres and pro- nator quadratus rotate the radius upon the ulna, producing pronation of the hand. The flexor carpi radialis and ulnaris bend the wrist ; the flexor sublimis and profundus bend the second and last joints of the fingers; the flexor longus pollicis bends the last joint of the thumb. The palmaris longus draws the palmar fascia tense, and assists in the flexion of the wrist and fore-arm. The an- coneus assists the triceps in extending the fore-arm upon the arm ; the supinatus longus and brevis produce supination of the fore- arm, and antagonize the pronators ; the ex- tensor carpi radialis longior and brevior, and ulnaris, extend the wrist, antagonizing the two flexors of the carpus. The extensor communis digitorum extends the fingers, an- tagonizing the flexors, sublimis, and profun- dus. The extensor ossi metacarpi, primi internodii, 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 longus pollicis. The extensor indieis 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 . Abductor pollicis ; arises from the scaphoid and annular ligament; inserted into the base of the first phalanx of the thumb. 2. Flexor ossis metacarpi ; arises from the trapezium and annular ligament ; inserted into the whole length of the metacarpal bone. Flexor brevis pollicis: its external portion arises M Y 0 L 0 G Y. 117 with the preceding; its internal from the trapezoides 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 the joint. 4. Ad- ductor 'pollicis ; 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 phalanx. Uses. — These muscles, as their names import, produce in the tliumk the movements of abduction, adduction, and flexion. Fig. 59. The 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 pollicis. 5. Its deep portion. 6. Adductor pollicis. 7, 7. Lum- bricales, arising from the deep flexor ten- dons, on which the numbers are placed, the tendons of the flexor sublimis having been removed from the palm. 8. One of the tendons of tho deep flexor, passing between the two terminal slips of the tendon of the flexor sublimis, to reach the last phalanx. 9. Tendon of the flexor longus pollicis, passing between the two portions of the flexor brevis to the las^ phalanx. 10. Abductor minimi digiti. 1 1. 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. Ulnar Region. — Four muscles: 1. Palmaris brevis; a thin plane arising from the annular ligament and palmar fascia, and passing trans- versely inward, is inserted into the integuments on the inner border of the hand. 2. Abductor minimi digiti ; a small tapering 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, aris- ing from the unciform bone and annular ligament inserted into the base of the first 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 : ) . Lumbricales ; four 118 ANATOMY. in number, arising 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 from the base of the metacarpal bone of one finger, and are inserted into the base of the first phalanx and aponeurotic expansion of the ex- tensor tendon of the same finger, the middle one being excepted. 3. Dorsal interossei ; these are situated in the four spaces between the metacarpal bones ; they arise by two heads from the adjoining sides of the base of the metacarpal bones ; inserted into the base of the first phalanges, and aponeurosis of the extensor tendons. Uses . — The lumbricales are auxiliary to the deep flexors ; the palmar interossei are adductors, and the dorsal interossei abductors ; 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 metacarpal bone ; and the little finger a metacarpal flexor. MUSCLES OF THE LOWER EXTREMITY. These have usually been arranged into groups corresponding with the regions of the hip, thigh, leg, and foot. Muscles of the Hip. — There are nine muscles of the hip, which together constitute the Gluteal Region : 1 . Gluteus maximus , this is the thick quadrangular mass of flesh forming the convexity of the nates, or buttocks. It arises from the back part of the crest of the ilium, the posterior surface of the sacrum and coccyx, and the great sacro-ischiatic ligament ; passing obliquely outward and downward, it is inserted into the rough line between the trochanter 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 medius ; 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 trochanter 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. Pyriformis ; a pear-shaped muscle, arising from the anterior surface of the sacrum and ilium ad- joining; it passes out of the pelvis through the great sacro-ischiatic foramen ; inserted , by a rounded tendon, into the trochanteric fossa of the femur. 5. Gemellus superior ; a small slip arising from the spine of the ischium, and inserted into the tendon of the obturator internus, sind into the trochanteric fossa. 6. Obturator internus ; arises from MYOLOGY 119 the inner surface of the anterior wall of the pelvis ; passes out of the pelvis through the lesser sacro- ischiatic foramen, and is inserted into the trochanteric fossa. Tig. 60 shows the deep muscles of the gluteal region. 1. External surface of the ilium. 2. Posterior surface of the sacrum 3. Posterior sacro iliac ligaments. 4. Tuber osity of the ischium. 5. Great or posterioi aero-ischiatic ligament. 6. Anterior or less- er sacro-ischiatic ligament. 7. Trochanter major. 8. Gluteus minimus. 9. Pyriformis. 10. Gemellus superior. 11. Obturator inter- ims, passing out of the lesser sacro-ischiatic oramen. 12. Gemellus inferior. 13. Quad- ratus femoris. 14. Adductor magnus, its upper part. 15. Vastus externus. 16. Biceps. 17. Gracilis. 18. Semitendinosus. 7. Gemellus inferior ; arises from the anterior point of the tuberosity of the ischium ; inserted into the trochanteric fossa and tendon of the obturator internus. 8. Obturator externus ; arises from the obturator membrane and surrounding 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 into a rough line, called tinea quadratic on the posterior border of the trochanter major. Uses. — The glutei 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 rotates the limb slightly in- ward : the medius and maximus rotate it outward. The other muscles of this group are called external rotators, their office being to rotate the limb outwardly, everting the knee and foot. MUSCLES OF THE THIGH. These are divided into tl ree regions — anterior, internal, and posterior . Anterior Femoral Region. — Six muscles: 1 . Tensor vaginre femoris, a short flat 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. Sartorim Fig. 60. DEEP GLUTEAL MUSCLES 120 ANATOMY. (tailor’s muscle) ; a long ribbon-like muscle, arising from the anterior superior spinous process of the ilium, and the notch below, and cross- ing the upper part of the thigh obliquely, descends behind the inner condyle of the femur, and is inserted into the inner tuberosity of the tibia by an aponeurotic expansion. 3. Rectus ; a straight muscle, arising by two tendons, one from the anterior inferior spinous process 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 externus ; 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 of the patella; inserted into the femur and inner side of the linea aspera as high up as the anterior intertrochanteric line. 6. Crureus ; Fig. 6j. arises from the upper border of the patella; inserted into the front aspect of the femur, as 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 vaginas femoris ; its insertion into the fascia lata is seen interiorly. 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 vaginae 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 — the tailor’s sitting position : when fixed below it assists the extensors of the leg in supporting the trunk. The four remaining muscles extend the leg upon the thigh. By their attachment to the patella, which acts as a fulcrum, they are advan- tageously disposed for great power When their fixed point is from the tibia they steady the thigh upon the leg ; and the rectus, by its attachment to the pelvis, serves to balance the trunk upon the lower eternity. fc/TTERIOR FEMORAL MUSCLES. MYOLOGY. 121 Internal Femoral Region. — Seven musties: 1. Iliacus inltrnus; a flat; 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 vertebrae, 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 Pou part’s ligament, its tendon, united with that of the iliacus interims, is inserted into the posterior part of the trochanter minor, a bursa being interposed. 3. Pectineus ; a fiat quadrangular muscle, 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 linea aspera. 4. Adductor longus ; arises by a round tendon from the front surface of the pubis below the angle ; inserted into the middle third of the linea aspera. 5. Adductor brevis ; arises from the body and ramus of the pubis ; inserted into the upper third of the linea aspera. 6. Adductor magnus ; a broad triangular muscle ; arises from the ramus of the pubes and ischium, and tuber ischii, and, radiating outward, is inserted into the whole length of the linea 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 gracilis assists in adduction, and contributes also to the flexion of the leg. Posterior Femoral Reg'^n — Three muscles ; 1. Biceps femoris; double-headed, one head arising 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 fascia 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 from the tuberosity of the ischium in front of the preceding ; inserted into the back part of the inner tuberosity of the tibia. Note. — The biceps forms the outer hamstring ; the tendons of the semi-tendinosus, semi-membranosus, gracilis, and sartorius form the inner hamstring. I— 11 122 ANATOMY. Uses. — These muscles are the direct 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 exhibits the muscles of the posterior femoral and gluteal region. 1. Gluteus medius. 2. Gluteus maxinus. 3. Vastus externus covered in by fascia 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 the adductor magnus. 10. Edge of the sartorius. 11. The popli- teal space. 12. Gastrocnemius ; its two heads. MUSCLES 01 YITE 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 through 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 ] ower fourth of the tibia ; inserted into the base of MUSCLE. the metatarsal bone of the little toe. 4. Extensor proprius pollicis ; arises from the lower two thirds of the fibula and interosseous membrane ; 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 progression. 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. Whe» acting from below they increase the firmness of the ankle joint. MYOLOGY. 123 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 tli-e 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 from the head and upper third of the &hula, 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 Flg> 63 - powerfully on the os calcis, lift the heel, and contin- uing their 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 Dehind 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 muscles are inserted into the base of the last phalanx of the four lesser toes, perforating the tendons of the flexor brevis digitorum. 7. Tibiaiu 124 VN A V01Z Y. posticus ; arises by two heads from the adjacent sides of the tibia and fibula their whole length, and from the interosseous membrane ; its tendon runs into the sheath with the flexor longus digitorum, passes through its proper sheath over the deltoid ligament, and is inserted 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 inward, 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. Fibular Region. — Two muscles: 1 . Peroneus longus; arises from the head and upper third of the outer side of the fibula, and terminates in a long tendon which passes behind the external malleolus, and obliquely across the sole of the foot; inserted into the base of the metatarsal 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 bone of the little toe. Uses. — The peronei are extensors of the foot, conjointly with the 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. MUSCLES OF THE FOOT. Those may be arranged, according to their situation above or below, into those of the dorsal and those of the plantar regions. 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 phalanx of the great toe, and the others into the sides of the long ex- tensor tendons of the second, third, and fourth toes. 2. Dorsal inter ossei ; these are placed between the metatarsal bones. Plantar Region. — The muscles of this region are subdivided into four layers. First Layer. — Three muscles : 1 . Abductor pollicis , lies along the 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 ; inserted into the first phalanx of the great toe, and internal sesa* myology. 126 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 brevis digitorum , situated between the two preceding; arises from the under surface of the os calcis, from the plantar fascia ana intermuscular septa ; inserted , by four tendons, into the base of the second phalanx of the fom* lesser toes. The first layer of muscles in the sole of the foot is shown in Fig. G4. 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 longus pollicis. 7, 7. Lumbricales. Second Layer. — Two muscles: 1 . Musculus accessorius ; arises by two slips from either side of the under surface 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 longus 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 lcngus pol- licis. 5. Flexor brevis pollicis. 6. Adductor pollicis. 7. Flexor brei is minimi 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 pollicis ; arises from the 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 great toe. 3. Flexor .revis minimi digiti; wises from the base Fig. 64. FIRST LAYER PLANTAR MUSCLES. Fig. 65. PLANTAR MUSCLES m ANATOMY. Fig. 66. Deep plantar muscles. Fig. 67. of the metacarpal bone of the little toe, and sheath of the peroneal tendon ; inserted into the base of the first phalanx 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 great 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 longus pollicis. 2. Tendon of the flexor communis digitorum pedis. 3. Flexor accessorius 4 , 4. Lumbricales. 5. Flexor brevis digitorum. 6. Flexoi brevis pollicis pedis. 7. Flexor brevis minimi digiti 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 great toe, like the thumb, is provided with special muscles for inde- pendent action. The lumbricales are assistants to the long flexor ; and the transversus pedis is placed across the foot for the purpose of drawing the toes together. The firm articulations of all the metacarpal bones, and the great strength and number of tfa$ ligaments and tendons of the leg, feet, and toes, are admirably adapted for combining power of en- durance with facility of motion ; the toes generally have four flexors, two extensors, four adductors, and four abductors ; while the great toe, in addi- tion, has two distinct flexors, two extensors, one adductor, and one abductor. TLANTAU INTERC S3R. . APONEUROLOGY. 12T CHAPTER IV. OF THE FASCIiE— APONEUROLOGY. The soft structures and delicate organs of the body are every where invested with protecting coats, or bandages, called fasciae. They are composed of laminae of various thickness, and are divided into cellulo- fibrous and aponeurotic. The cellulo-fibrous 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 two layers, between which the subcutaneous vessels and nerves are 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. Fig. 68 is a transverse section of the neck, showing the deep cervical fascia and its nu- merous prolongations, forming sheaths for the different muscles. 1. Platysma myoides. >2. Trapezius. 3. Ligamentum nuchae, 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). 6. 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. Lateral lobe of the thyroid gland. 12. Trachea. 13. .Eso- 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. Multifidus spinae. 28. A cervical vertebra ; the transverse processes are seen to be traversed by the vertebral artery and vein; The aponeurotic fascia is strong and inelastic, composed of parallel jendiitf'us fibres, connected by others passing in different directions. 128 ANATOMY. In the limbs it forms distinct sheaths, inclosing all the muscles and ten dons, constituting the deep fascia. It is firmly connected to the bones* and to the prominent points of the clavicle, scapula, elbow, wrist, 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 structures. PRL UPAL FAS cm. Temporal Fascia. — The fascia of the temple is a strong aponeuroti membrane covering the temporal muscle on each side of the head. Cervical Fascia. — The fasciae of the neck are divided into the superficial , which is a part of the common superficial fascia of the entire body, and the deep, a strong 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 membrane 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 esophagus, which pass through it. Abdominal Fascia.— The lower 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 different situations its parts are called fascia transversalis , iliac, and pelvic fascia. The transverse and iliac fasciae meet at the crest of the ilium and Pou part’s ligament; the pelvic is confined to the cavity of the true pelvis. These fasciae are important in their relations to INGUINAL HERNIA. There are two kinds of inguinal hernia, oblique and direct. In the oblique , the intestine escapes from the abdominal cavity into the sperm- atic canal, through the internal abdominal ring ; this ring is situated in the fascia transversalis, about midway between the spine of the pubis and superior antertor 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 transverse fascia. After emerging from the internal 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 the cremaster muscle as an additional investment, and upon protruding from the external ring, still another from the intercolumnar fascia APO NEUROLOGY 120 Hence the coverings of an inguinal hernia from the surface to the Dowel are : 1. The integument 2. Superficial fascia. 3. Inter- columnar fascia. 4. The cremaster muscle. 5. Transversalis fascia, (i. Peritoneal sac. The spermatic 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 the 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 transversalis 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 . Common oblique ; already described. 2. Congenital ; this has no proper sac, but is con- tained within 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 externally 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 hernia 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 as great bulk as the oblique form ; all these varieties may descend into the cavity of the scrotum, and are 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 pelvic cavity, where it divides into two layers, the pelvic and obturator. The pelvic layer is reflected inward from near the symphisis pubis to tiie neck of the bladder, forming the anterior vesical ligaments ; an 130 ANATOMY. ascending inflected portion encloses the sides of the bladder and vesical plexus ot veins, and forms the lateral 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 obturator internus mustje, and encloses the internal pudic vessels and nerves. Perineal Fascia . — The superficial 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 Camper's , and triangulai ligament , is stretched across the pelvis, so as to constitute a defence to its outlet. In the side view of the viscera of the pelvis, Fig. 69, is shown the distribution of the perineal and pelvic fasciae. 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 ring of elastic tissue encircling the prostatic portion of the urethra at its commence- ment. 9. Prostatic urethra. PELVIC FASCIA. 10. Membranous portion. 11. The commencement of the cor- pus spongiosum penis, the bulb. 12. Anterior ligaments of the bladder. 13. Edge of the pelvic fascia reflected upon the rectum. 14. Location of a plexus of veins, between the pelvic and deep perineal fascia. 15. l'he deep perineal fascia; its two layers. 16 Cowper’s gland of the right side. J 7 . Superficial perineal fascia, ascending in front of the 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 given off from the posterior layer of the deep 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 upon the dorsum of the scapula, but thin in the axillary space In the fore-arm it is very strong at the elbow and wrist joints, uniting with the ligamentous structures. In the latter joint it forms the pos- terior annular ligament. The palmar fascia occupies the middle and side of the hand, its central portion spreads over the heads of the meta- carpal bones v where t divides into slips which are attached to th§ phalanges. Fig 69. ANGEIOLOGY. 181 Fascia of the Lower Extremity . — As in the upper extremity, the tuperficial fascia of the lower contains between its layers the superficial vessels and nerves. At the groin these layers are separated by the lymphatic glands. The deep fascia of the thigh is called, from its great extent, fascia lata. It is strongly connected with the prominent points of bone around the hip, knee, and 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 boun ied in front by Poupart’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 abdominal viscera, a portion of intestine may be foreed through the femoral ring into the interval or space in the sheath of the femoral vessels, consti- tuting femoral hernia. The protruding 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 iribriform fascia ; next curving upward over Poupart’s ligament, the hernia becomes fixed beneath the superficial fascia and skin. Its direc- tion being therefore downward, 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 narrow 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 part of the circulating system wine** carries the blood from the heart to all parts of the body. They are dense, cylindrical tubes, which form they retain when emptied of 132 ANATOMY. blood, and even after death, from which circumstance the ancients regarded them as air-vessels.* Yhe aorta , which proceeds from the left ventricle of the heart, and branches, contain the pure or arterial blood, and, with the veins which return this blood again to the heart, constitute the greater or sys- temic circulation . The pul- monary artery, which conveys the venous or impure blood to the lungs, with its correspond- ing veins, is called the lesser or pulmonary circulation. Structure of Arteries. -—Arteries are composed of three coats : the external is cellular, or areolo-fibrous ; the middle is muscular, or, rather, a mixed tissue of elastic and contractile fibres ; and the in- ternal is nervous, or a serous membrane, throughout 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 capillary 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, which favors the most rapid circulation. When an artery divides, the area of its branches is always greater than that of the sin- * The terra angeiology has been applied to the vascular system; it includes the blood vessels, arteries, and veins, and the lymphatics. ANGEIOLOGY. I8d gle trunk ; and the combined area of the ultimate 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. Intercommunication of Arteries. — In all parts of the body the arterial tubes communicate with each other by branches passing be- tween, called inosculations , or anastomoses . These connections in- crease in frequency as the vessels diminish in size, so that their finaJ 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 abdominal . At its commencement there are three dilata- tions, called its sinus , corresponding with the three semilunar valves . The coronary arteries are the only branches given off by the ascend- ing aorta ; they arise just behind the semilunar valves, pass through the grooves between 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 tne right side in front of the trachea ; 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 bifurcation 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 arch *f the aorta, ascends the neck, and divides like the right.. 184 AN J 10 MY. Fig. 71 shows the relations of the 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 pulmonary. 15. Right pulmonary. 16. Trachea. 17. Right bronchus. 18. Left bronchus. 19, 19. Pul- monary veins. 20. Bronchial ar- teries. 21. Intercostal. External Carotids. — Each external 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 three posteriorly. 1. Superior thyroid; curves downward to the thyroid gland, where it is distributed. It sends a hy- oid branch to the muscles 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 serpentine direction to its tip, where it is called the ranine artery ; it gives off the hyoid, dorsalis lingua, and sublingual branches. A branch of this latter branch is often divided in cutting the frsenum iinguse in tongue-tied children. 3. Facial ; this arises above the os hyoides, and descends obliquely to the submaxillary 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 Fig. 71. A N G E I 0 ^ 3 G Y. 185 muscle and lymphatic glands of the neck. 5. Occipital passes back- ward a little below the facial, forms a loop with the liypo-glossal nerve, and is distributed 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 between 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 brandies of the carotid and subclavian, after the ligature of the common carotid. 6 . Posterior auricular ; arises above the level of the digastric and stylo-hyoid muscles, and ascends below 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, und Eustachian tube. 8. Parotideans ; four or five branches distributed to the parotid gland and adjacent integuments. 9. Transver- salis facei ; arises from the trunk 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 infra-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 portion of the tempora. bone. 5. Superior thyroid. 6 Fig. 72. Lingual. 7. Facial. 8. Mastoid 9. Occipital. 10. Posterior aurio- ular. II. Transverse facial. 12. Internal maxillary. 13. Temporal M. Ascending pharyngeal CAROTIDS AND BRANCH** m 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 witii its fellow, the frontal and supra-orbital. 2. Posterior temporal ; curves upward and back- ward, inosculating with its fellow, the occipital and posterior auricular It sends off three branches — the orbitar to the palpebral arteries, the middle temporal to the temporal muscle, and the anterior auricular to the ear. The Internal Maxillary Artery. — The other terminal branch of the external carotid passes inward behind the neck of the lower jaw to tiie deep structures of the face. Its branches are : 1. Tympanitic , distributed 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 ; distributed to the muscles 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, antrum, 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. Spiheno - 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 palatine ; descends along the posterior palatine canal, and is distributed to the palate. A branch called Vidian passes backward to the sheath of the Vidian nerve and Eustachian tube Internal Carotid Arteries. — From the bifurcation of the com. /non carotid, each internal carotid curves slightly outward l, then ascends nearly perpendicularly through the maxillo-pharyngeal space, to the carotid foramen in the os petrosum. It next passes inward along the carotid canal, forward by the sella turcica, and then upward, piercing ANGEIOLOGY. 137 the dura mater, 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 retinae. 2. Tympanitic ; this enters the tym- panum through a small foramen in the carotid canal. 3. Anterior me- ningeal ; distributed to the dura mater and Gasserian 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- sum, and inner surface of the hemispheres. The two anterior cere- bral arteries are connected soon after their origin; the anastomosing trunk is called the anterior communicating artery. 4. Middle 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 striatum. 5. Posterior communicating ; passes backward, and inosculates with the posterior cerebral. 6. Choroid ean ; 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 the chest by passing over the first rib between the anterior and middle scaleni 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 vertebra?, 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 fossa?, 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 orain ; superior cerebellar, to the upper sur- face of the cerebellum; and posterior cerebral, to the posterior lobes ‘88 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 communicate called the circle of Willis. 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. Interior ce- rebellar. 6. Basilir, giving off 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 trunk, dividing soon after its origin into four branches : Inferior thyroid , distributed to the thyroid gland, and send- ing twigs to the trachea, larynx, and oesophagus ; suprascapular , distributed to the muscles on the upper surface of the shoulder blade, sending a twig to the trapezius ; posterior scapular , passing across the neck, supplying the muscles behind the scapula, and giving branches to those of the neck ; with the branches of the exter- nal carotid, subclavian, and axillary, it establishes an important anasto- motie communication ; superficial cervical , distributed to the deep muscles and glands of the neck, and sending twigs through the inter- vertebral foramina to the spinal cord and membranes. 3. Profunda 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 is then divided into branches to supply the integument of the side of the head and back part of the pinna, sending off several facial 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 connect with the sympathetic, pneumogastric, and hj^po- glossal ; muscular, distributed to the trapezius, levator anguli, scapulas, 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 tc the ligamenturm nuchse, integument of the bnck part of the neck, and posterior region of the scalo ; and the occipitalis major, which is dis- tribute''! to the muscles of the neck and integument of the scalp. i/8 ANATOMY The brachial plexus is broad in the neck, narrowing as it descends into the axilla, enlarging 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 rhomboidei muscles, short thoracic to the two pectora and deltoid muscles, long thoracic (external respiratory of Bell) to the serratus magnus muscle, suprascapular to the supra-spinatis and infra- spinatis muscles, subscapular to the subscapularis muscle, and inferior muscular to the latissimus dorsi and teres major. The terminal branches 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 dividing into two branches ; the anterior descends along the palmarus longus to the wrist, 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 artery, crosses the brachial artery 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- arm, wrist, and fingers : the ulnar, which arises with the internal head of the median, runs down the inside of the arm to the groove between the internal condyle and olecranon, where it is superficial and easily 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 distributed to the structures of the arm, fore-arm, wrist, and hand, and communicates With the other surrounding branches of nerves; the tnusculo-spira. NEUROLOGY. 179 verve, the largest branch of the brachial plexus, 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 posterior 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 are distributed to the joint; and the circumflex nerve , which arises with toe 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. The Dorsal Nerves. — There are twelve pairs of dorsal nerves. 3ach nerve, as it emerges from the intervertebral foramen, divides into iorsal 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 sympathetic, 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- ply 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- pathetic, and pass obliquely outward behind the psoas magnus muscle, where they intercommunicate and anastomose to form the lumbar plexus. 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, aro distributed to the integument of the gluteal region. The lumbar plexus gives off the following branches: 1, Musculo-cutaneous \ which 180 ANATOMY. divides into a superior branch, and this, after winding around the crest of the ilium, divides into abdominal and scrotal branches, the former of which is distributed 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 branch, 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- tributed 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 largest 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 knee ; b. muscular , round, large twigs, distributed 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 femoral 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 artery into several 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 saphenous , 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 distributed to the integument on the inner side of the foot. In its course it receives a communicating branch from the obturator, near the division oj* the femoral artery, and another at the internal condyle, and gives off a femoral cutaneous branch, a tibial cutaneous branch, 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 enter aspect of the leg, and the ankle joint. 5. Obturator ; formed NEUROLOGY. 18] by a branch from the third and another from the fourth lumbai nerve, passe3 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 off 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 off, 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 hist 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. I- 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 oeMs ; an obturator branch to the obturatus interims, a coccygeal branch, and a hcemorrhoidal nerve, which descends to the rectum, supplying the spincter and integument. 3. External muscular ; sev- eral branches, distributed to the capsule of the hip joint and surround- ing muscles. 4 . Gluteal ; passes out of the pelvis with the gluteal artery, and divides into a superior branch, which goes to the gluteus iredius and minimus, and an inferior, which is distributed w/th tli$» 16 182 ANATOMY. above, and also to the tensor vaginae femoris. 5. Internal pudic , passes out of the pelvis with the former, 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, tran«ve.'sus perinei, and accelerator tirinag, and terminates by ramifying in the corpus spongiosum. In the female the internal pudic is distributed to the parts analogous to those of the male ; the superior branch supplies the clitoris, and the inferior the vulva and parts in the perineum. 6 . Lesser ischiatic ; passes out of the pelvis through the great ischiatic foramen, and divides into mus- cular branches (inferior gluteal), which are distributed to the gluteus maximus ; and cutaneous, which send ascending filaments to the gluteal integument; th v pterineal 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 ischiatic ; this is the largest nervous cord in the whole body. It is a prolongation of the sacral plexus, and measures, at its exit from the great sacro- ischiatic foramen, three fourths of an inch in breadth. It descends be- tween the trochanter major and tuberosity of the ischium, and along the back part of the thigh to its lower third, where it divides into ter- minal branches, called popliteal and peroneal . Previous to its division it sends off 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 largo Tierve descending between the heads of the gastrocnemius, and forming telow the knee, with a connecting branch from the peroneal nerve, the external saphenous nerve, it becomes the •posterior tibial. The external saphenous penetrates 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 distributed to the outer side of the foot and little toe, sending sumerous filaments to the integument of the heel and sole of the foot. The posterior tibial nerve continues along the back of the leg from tne lower border of the popliteus muscle to the back of the inner ankle* where it divides into bis interna anc external plantar nerve ; in its NEUROLOGY. 183 course it sends muscular 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 the heel. The internal plantar nerve crosses the posterior tibial vessels, to ?nter the sole of the foot, and is distributed to the toes, integument, md tarsal and metatarsal articulations. The external plantar nerve is smaller than the former, and is dis- r ibuted to the outer side of the foot, the little toe, and outer side of the second. The peroneal nerve passes down by the tendon of the biceps, crosses the head of the gastrocnemius 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, distributing, in its course, filaments to the muscles and articulations of the tarsus and metatarsus. The musculo-cutaneous nerve passes downward 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 brandies, 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 distribute 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 ihe different organs, and form communications around them called plexuses, which are named after the arteries, as mesenteric, hepatic, splenic, 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 rouble ; its branches of distribution supply the coats of the eye. 184 ANA TOMY. Fig. 93. Fig. 93 in a rep re sentation of eraaial ganglia of the organ* ic system. 1. Gan- glion of Kibes. 2. A filament by which it communicates with the carotid plexus (3). 4. Ciliary or lenticular ganglion, giving off ciliary branches to the globe of the eye. 5. Part of the inferior division of the third nerve, receiving a short, thick branch (the short root) from the ganglion. 6. Part of the nasal nerve, receiving a longer branch (the long root) from the gan- CRANIAL GANGLIA. 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 ganglion (spheno-palatine). Id. Its ascending branches, communi- cating with the superior maxillary nerve. 11. Its descending, or palatine branches. 12. Its internal branches, spheno-palatine, or nasal. 13. The naso palatine branch, one of the nasal branches. 14. Posterior branch of the ganglion, the Vidian nerve. 15. Its carotid branch communicating with the carotid plexus, lo. Its petrosal branch, joining the intumescentia gangliformis of the facial nerve. 17. Facial nerve. 18. Chorda tympani, 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 largest of the cranial ganglia, situated in the spheno-maxillary fossa. Its branches of distri- bution are : nasal , or spheno-palatine, four or five in number, which enter the nasal fossa through the spheno-palatine foramen, and supply the mucous membrane and spongy bones of the nose, and the upper part of the pharynx and the Eustachian tube ; the naso-palatine to the septum of the nose and palate; the anterior palatine to the hard palate, bones of the nose, and the antrum ; 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 ganglion. The posterior branch is the Vidian or pterygoid nerve, which passes to the foramen laeerum, and divides into carotid and petrosal branches to the carotid plexus and the gangliform enlargement of the facial nerve. NEUROLOGY. 186 it also sends a filament to the otic ganglion. 4. Otic ganglion (Arnold’s) is a 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 tym- pani, and branches of communication to the auricular, chorda tympani, jaervi molles, facial, and Vidian nerves, and the facial and Cassenan gai glions. 5. Submaxillary ganglion , a small, triangular ganglion upon the subma dllary gland; it sends branches of distribution to the gland jnd 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 centre of communication between all the cranial ganglia, and being derived from the superior cervical ganglion, between the cranial ganglia and those of the trunk, it also communicates with most of the cerebral nerves, and distributes filaments with each of the branches of the internal caro- tid, which 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 occasionally 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 nor branches to the inferior cervical ganglion ; external branches to the third, fourth, and fifth cervical nerves ; and internal branches to the inferior thyroid plexus and artery, and middle cardiac nerve. 186 ANATOMY. Fig. 94.. GANGLIONIC SYSTEM. In Fig. 94 is present e4 a view of the organic or sympathetic system. 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 branches. G. Right coronary plex- us. II. 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. It. Superior branches. S. Inferior branch. T. Ex- ternal branches. U. Submaxillary gland. V. Vidian nerve. W. Na- so-palatine branch. N. 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, and hence called “ ver- tebral ganglion It sends superior branches to the middle cervical ganglion ; inferior NEUROLOGY. 187 io the first 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 from the lower part of the superior cervical ganglion, and, descending the neck, passes behind the arteria innominata, and joins the cardiac ganglion below the arch of the aorta, receiving in its course branches from the pneumo- 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 great 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 off numerous branches to the cardiac plexuses. The great cardiac plexus is situated upon the bifurcation of the trachea, above the right pulmonary artery, and behind arch of the aorta; the anterior cardiac plexus is situated in front of the ascending aorta, near its origin ; the 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 from the posterior cardiac constitute the posterior coronary plexus ; and the an- terior and posterior pulmonary plexuses are formed in part by branches from the great cardiac plexus. Thorach Qanglia. — There are twelve thoracic or dorsal ganglia on each sidt -esting 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, tc communicate 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 splanchnic nerve. The great splanchnic nerve arises from the sixtli dorsal ganglion, and, receiving branches from the seventh, eighth, ninth, and tenth, de- scends in front of the vertebral column, within the posterior mediasti* 188 ANATOMY. num, pierces the diaphragm, and terminates in the semilunar ganglion. The lesser splanchnic (renal) is formed by filaments from the thre6 lower dorsal ganglia, pierces the diaphragm, and descends to join the renal plexus. The semilunar ganglion is a large, irregular body, pierced by numer- ous openings, and appearing like an aggregation of smaller ganglia with intervening 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 gangliform circle, from which branches pass off radiatingly in all 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 referred to the heart have, no doubt, their source in this ganglion. The solar plexus receives the great splanchnic and part of the lesser splanchnic nerves, the termination of the right pneumogastric, 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 mesenteric , spermatic, and inferior mesenteric plexuses, all derived from the solar plexus. Lumbar Ganglia. — There are four lumbar 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 their internal branches interlace around the abdominal aorta, constituting the lumbar aortic plexus, and again over the promon- tory 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 nerves ; and the internal are distributed to the pelvic viscera, sending branches to the hypogastric plexus. The lower sacral ganglia give off branches which join the azygos ganglion on the coccyx, which connects the ganglionic system infercorly, as the ganglion of Ribes does superiorly. ORGANS OF THE EXTERNAL SENSES. 189 CHAPTER IX. ORGANS OF THE EXTERNAL SENSES. The organs of sense, which bring the animal machine into relation with external objects, are 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 distributed 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 fossae. The Nose. — The anatomical parts of the nose are: The nostrils, which overhang the mouth, and are so constructed 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 nostrils ; the vibrissae, stiff hairs which project across the openings, and guard their entrance ; the fibro-cartilaginous integument, which forms the tip, called lobulus, and wings, called aloe; the muscles , already described; the bones — nasal and nasal processes of the superior maxillary ; the mucous membrane , lining its interior; the arteries, from the facial 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. 95. the nasal bones. 2. Fihro-cartilage of the septum. 3. Lateral fibro-cartilage. 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 F oss^;. — The nasal fossae are two ir- regular sompressed cavities extending backward from the nose to the pharynx. They are bounded above by the lateral cartilage of the nose, and the nasal, sphenoid, and ethmoid bones ; below by the hard palate. On the outer wall 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- nasal cartilages. tween the upper and middle, the middle and lower, and lower and floor of the nostrils, are the superior, middle, an! inferior meatuses. 190 ANATOMY. In the superior meatus are several openings into the nasal fossae of the sphenoidal and posterior ethmoidal cells ; in the middle the anterioi 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 Schneiderian ; it is continuous with the lining membrane of the gastro- pulmonary cavities, and extends into the sphenoidal and ethmoidal cells, frontal sinus, and antrum, 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 mouth, thence through the lungs k &d alimentary canal. Its surface 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, the 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 THE ;rgan 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 formed 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 tuniia a.iuginea is covered by a mucous membrane ORGANS DF TIIE EXTERNAL SENSES. 191 railed the conjunctiva , which constitutes the “white of the eye.” The sclerotic forms a thin, sieve-like plate, called lamina cribrosa, at the entrance of the optic nerve ; this lamina is full of openings for the pas- sage of nervous filaments. The largest of these openings in the centre is called the porus opticus , through which the arteria centralis retinue — central artery of the retina — enters the eyeball. The cornea con- 6/tutes the anterior fifth of the globe. It is circular, transparent, and resembles a watch-glass. It is received into the grooved edge of the sc erotic in the manner that a watch-glass is received into its case. It composed of four layers, the external being the white membrane, or conjunctiva, before mentioned. 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. 3. The choroid, connected anteriorly with (4) the cil- iary ligament, and (5) the ciliary processes. 6. The iris. 7. The pupil. 8. The third layer of the eye, the retina, terminating ante- riorly by an abrupt border at the commencement of the ciliary processes. 9. The canal of Petit, which encircles the lens (12) ; the thin lajea in front of this canal is the zonula ciliaris, a prolongation of the vascular layer of thb- retina to the lens. 10. The anterior chamber of the eye, containing the aqueous hum :r, 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 vitreous humor enclosed in the hyaloid membrane, and in cells 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 centralis 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, ciliary processes, and with the junction of the sclerotic and cornea, by a dense white structure, called the ciliary ligament, which surrounds the circum- ference of the iris, liVe a ring. The choroid membrane is compost d Fig. 97. m ANATOMY. of three layers, the externa, being principally an arrangement of veins called vents vorticose. 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 surface. Fig. 98. 3 Fig. 98 is a dissection of the eye- ball, showing its second tunic, and the mode of the distribution of the vense 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 iris 6 6. The venae vorticosae. 7 7. The trunks of the venae vorticosa) at the point where they have pierced the sclerotica. 8 8. The posterior ciliary veins, which enter the eye- ball in company with the posterior ciliary arteries, by piercing the sclerotic at 9. 10. One of the long ciliary nerves, accompanied by a long ciliary vein. dissection OF THE eyeball The ciliary ligament forms a circle round the iris, connecting the cornea and sclerotic at their junction with 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 chambers of the eye, and has a circular opening near its centre, called the pupil of the eye. The iris is composed of two layers ; the anterior Fig 99 is muscular, consisting of both cir- cular fibres which surround the pu- pil, and radiating fibres from the centre to the circumference ; the combined contraction 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 tne three tunics ; sclerotic, choroid (the dark lay er), and retina. 2. The pupil. 3. The iris, the surface presented to view in this section being the uvea. 4. The ciliary processes. 5. The scalloped anterior border of the retina. The ciliary processes consist of ANTERIOR SEGMENT ORGANS OF THE EXTERNAL SENSES. 193 triargular folds of the middle and internal layers of the choroid. Their circumference connects with the ciliary ligament; they are covered with a thick black pigment. Tig. 100 is the posterior segment of a transverse section of the globe of the eye, teen from within. L. The divided edge of live three tunics. The membrane covering the whole internal surface is the retina. 2. The entrance of the optic nerve with the arteria centralis retinae 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 is the retina . It is formed of three Fig. 100. layers. The external is a mere posterior segment. 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 surface 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 limbus luteus. Humors of the Ete. — The aqueous humor occupies the two chambers of the eye. The anterior chamber is the space bounded by the cornea in front, and the iris 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 ciliary processes, crystalline lens, and zonula ciliaris behind. Both chambers are lined by a thin membrane, which secretes the fluid of the 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 memDrane, called the hyaloid. The inner surface of the hyaloid is disposed in thin lamellae or plates reflected inward, forming different apartments or cells, like the transverse section of an orange, for holding the vitreous humor. The crystalline humor , or lens is situated behind the pupil, sur- 1—17 194 ANATOMY rounded by the ciliary processes, and embedded in the front part of 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 layers, the external being soft, the middle firmer, and the interior still firmer. The canal cj Petit is a small triangular channel around the circumference of the lens. Uses of the Structures. — The ot alar group of muscles has ah ready been described. The firm sclerotic coat gives shape and form to the eye, and protects its complicated and delicate tissues. The transparent cornea furnishes a medium for the transmission of the rays of light. The choroid sup- ports the nutritive vessels, and by the black pigment of its 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 contracting when the rays are too strong, 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 eyebrows , eyelids , eyelashes , conjunctiva , caruncula Lachrymalis , and the lachrymal apparatus . The eyebrows , called super cilia, are projecting arches of integument covered with short thick hairs, forming the upper boundary of the orbit of the eye. The eyelids , called palpebrce, tire valvular layers in front of the eye. The elliptical space between is divided into the outer and inner canthus . The inner canthus is prolonged into a triangular space toward the nose, which is called the lacus lachrymalis . The lachrymal papilla is a small angular projection at the commencement of the lacus lachrymalis on each side, each of which papilla has a small orifice at its apex, called punx-urn lachrymale , and constituting the commencement of the lach- rymal canal. The thin, firm, fibro-cartilaginous bands supporting the edges of the eyelids are called tbe tarsal cartilages ; in their internal surface are embedded a number of secreting tubes or follicles, called the Meibomian glands. The eyelashes , called cilia, are triple rows of long thick hairs, curl ing upward from the upper lid, and downward from the lower ; an ar- rangement which prevents their interlacing each other. The conjunctiva covers the anterior surface }f the eye, and is so reflected on the lids as to form their inner layer. The duplicates ORGANS C E THE EXTERNAL SENSES. 195 formed between the globe and lids of the eye are called the superior and inferior palpebral 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 plica semilunaris ; this is the mem • brana nictitans in birds, and the rudiment of the third lid in animals. Fig. 101 is a representation of the appendages of the eye. 1. The superior tarsal cartilage. 2. The lower border of the cartilage, on which are seen the openings of the Meioomian 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. The lachrymal apparatus consists of the lachrymal gland with its excretory duct , the puncta lachrymalia , fhe 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 lachrymal canals commence at the puncta lachrymalia and run inward to the lachrymal sac. The superior duct first ascends, then turning suddenly inward, forms an abrupt angle; the inferior duct, by descending, and then turning abruptly 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 canrd, three fourths of an inch long, running downward, back- ward, and outward to the inferior meatus of the nose, terminating there in an enlarged orifice. Fig. 101. OF THE ORGAN OF HEARING. The auditory apparatus is divided anatomically into the exte nat eai tympanum, or middle ear, and labyrinth, 3r internal ear. ANATOMY. m Fig. 102. Aim nv^ Vi STRUCTURE OF THE EAR. Fig. 102 is a representation of all parts of the ear. 1. Meatus auditorius extern us. 2 Drum of the ear, or tympanum. 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 lannel-shaped cartilaginous plate, which collects the vibrations of air, and the meatus , the tube which conveys them to the tympanum. The pinna presents several folds and hollows upon its surface ; a prominent rim, called helix, a curved ridge 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 antitragus ; the dependent portion of the pinna is the lobulus; a space between the helix and antihelix is called fossa innominaia; and the large central space to which all the channels converge is the concha , which opens into the meatus . The muscles of the pinna are the major helicis, minor helicis , tragicus, antitragicus , and transversus auricula; they are merely rudimentary in the human ear, but in many animals are large and active. The meatus auditorius is about an inch in length, extending inward and a little forward from the concha to the tympanum, and narrower in the middle than at either extremity. In the substance of its lining membrane are ceruminous glands, which secrete the ear-wax. Short ORGANS OF THE EXTERNAL SENSES. 1 W gtifif hairs stretch across its interior, to prevent the ingress of insects and dust. The pinna derives a plentiful supply of arteries from the anterior auricular branch of the temporal, and the posterior auricular from the carotid. Its nerves are branches derived from the anterior auricular of the fifth, the posterior auricular of the facial, and the auricularis magnus o* the cervical plexus. Tympanum. — The middle ear is an irregular bony cavity within the petrous portion of the temporal bone. It is bounded externally by the membrana tympani, and filled with air, which enters by the Eustachian tube. Fig. 103 is a diagram exhibiting the principal divisions and parts of the ear. p. Pinna, t. Tympanum. Z. Labyrinth. I. Upper part of the helix. 2. Antihelix. 3. Tragus. 4. Antitragus. 5. Lobulua. 6. 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 fo. t 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. Eustachian 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 ampulla upon the perpendicular and horizontal ca-* nals. 17. Cochlea. 18. A depression between the convexities of the two tubuli which communicate with the tympanum and vestibule; one is the scala tympani, terminating at 12; the other the •cala vestibuli. The membrana tympani is a thin, semi transparent membrane, placed obliquely across the meatus, concave externally and convex toward the tympanum, and composed of an external epidermal , a mid- dle muscular , and an internal mucous coat. The proper bones of the ear ( ossicula auditus), viz., malleus , incurs* and stapes, are contained in the tympanum. Tho malleus (hammer- bke consists of a head, neck, and handle called menubmum , which m Fig. 103. m ANATOMY. connected with tl e membrana tympani by its whole length. The incu* has an imagined 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 orbiculare. These bones are conn<^ ted together and held in their places by various ligaments, and moveu upon themselves by four mus- cles, called tensa tympani, laxator tympani, laxator tympani minor, and stapedius. There are ten foramina, or openings, in the tympanum, five large and five small. The large openings are, meatus auditorius , already described; fenestra ovalis, communicating between the tympanum and vestibule ; fenestra rotunda, communicating between the vestibale 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 tympani ; 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 aquceductus Fallopii. Beneath the fenestra ovalis is the promontory 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 from the internal maxil- lary, internal carotid, and posterior auricular. Its nerves are branches from the facial, the chorda tympani, the tympanic branches of Jacob- son’s, and a filament from the otic gang’ion. The Internal Ear. — The term labyrinth 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 labyrinth 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 interims. It is divided into vestibule, semicircular canals, and cochlea. The vestibule is a small, three-cornered cavity 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 ri fzont. T::e fenestre :valis is on its outer wall, and ORGANS OF THE EXTERNAL SENSES. m 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 vcstibuli is the termination of the vestibular canal of the cochlea. The aqu&ductus vcstibuli 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- tremity being expanded like a flask, and called ampulla . The cochlea (snail-shell) forms the anterior part of the labyrinth. 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, which is a porous mass of bone perforated by numerous filaments of the cochlear nerve. The canal of the cochlea is partially divided into two passages (scalve) 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 cupola . The two scalae com- municate over the hamulus by an opening called helicotrema . Near the termination of the scala tympani is the small opening of the cochlear aequeduct. The internal surface of the osseous labyrinth is lined by a flbro-serous membrane, which exteriorly serves as a periosteum, and internally as a serous membrane, secreting a limpid fluid called aqua labqrinthu Fig. 104 shows the cochlea divided paral- % lei with its axis through the centre of the modiolus. 1. Modiolus. 2. The infundibu- lum. 3, 3. Cochlear nerve. 4, 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. S. 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. Helicotrema; a bristle is passed through it, in front of which is the hamulus. Fig. 154 The membranous labyrinth is in form a perfect counterpart of the vestibule and semicircular canals, but smaller in size. In structure 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 consists £00 ANATOMY. of a small sac, sacculus communis, of three semicircular membranous canals, and a small round sac, sacculus proprius . Fig. 1(15 is the labyrinth of the left ear, 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 canal, with its contained membranous canal. 5. Ampulla of the inferior canal. 6. Ter- mination of the membranous canal of the hori zontal semicircular canal in the sacculus com- munis. Ampulla of the middle semicircular canal, fe The same canal with its membranous canal, t Common canal. 10. Membranous common sanal. 11. Otoconite of the sacculus communis. 12. Sacculus proprins ; its otoconite is seen through its membranous parieties. 13. First turn of the o 'chlea. 14. 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 helicotrema. 20. The infundibulum. The auditory nerve divides, in the meatus auditorius internus, into a vestibular and a cochlear branch. The vestibular nerve divides into three branches, which are distributed to the various parts ; in the sub- stance of the sacculi and ampullae* the nervous filaments radiate in all directions, anastomosing with 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 bas^ of the 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 artery. THE ORGAN OF TASTE. The tongue is composed of longitudinal , transverse, oblique, and vertical muscular fibres, between which is a quantity of adipose sub- stance ; it is connected posteriorly with the os hyoid es by a muscular attachment; and to the epiglottis by mucous membrane, which forms the three folds called frcena epiglottidis ; and on each side with the lower jaw by the same membrane, which forms a fold in Iront beneath its under surface, called freenum lingvte. The surface of the tongue is covered by a dense layer, which sup THE LABYRINTH. ORGANS OF THE EXTERNAL SENSES. 201 ports its papilla, of which there are four kinds. 1 . Papillce circum* vallatce, 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 the letter A. At their point of meet- ing is a deep mucous follicle, called foramen cozcum. 2 and 3. Papilla conicce and papillce filif or mes, conical and filiform in shape, cover the sur- face of the tongue in front of the circumvallatae ; their extremities are pierced by a minute aperture, hence they may be regarded as follicles rather than sentient points, the true sentien 4 - organs being extremely minute papillae occupying their surface as well as that of the other papillae. 4. PapiUce fungiformes, or capitatce, are larger than the for- mer, have rounded heads, and are irregularly dispersed over the dorsum of the tongue ; a number of these are seen at the tip. Behind the papillae, at the root of the tongue, are a number of mu- cous glands . The tongue and its papillae are seen in Fig. 106. 1. The raphe, which sometimes bifurcates in the dorsum, as in the figure. 2, 2. Lobe3 of the tongue ; the rounded emi- nences on this part of the organ and near its tip are the fungiform papillae ; the smaller papillae, among which the former are dispersed, are the conical and filiform papillae. 3. Tip of the tongue. 4, 4. Its sides, on which the papil- lae are arranged in fringed and lamellated forms. 5, 5. The A-shaped row of papillae circumvallatae. 6. Foramen coecum. 7. Mucous glands at the root of the tongue. 8. Epiglottis. 9, 9. Fraena epiglottidis. 10, 10. Greater cor* nua of the hyoid bone. The tongue is abundantly supplied with blood by the lingual arteries . Its nerves are of large size, and three in number. The nerve of common sensation and taste is the gustatory branch of the fifth pair, which is distributed to the papillae ; the gloss o-pharyn- geal supplies the mucous membrane, follicles, and glands, and i3 a nerve of sensation and motion ; the hypo-glossal is the principal motor nerve, distributed to the muscles. The chorda tympani, sent from the facial nerve to the lingualis muscle, must be added to the motor influence. THE ORGAN OF TOUCH. The skin, which is continuous with the mucc&s membrane of the hrternal cavities, is composed of two layers — denv ~2 and epidcrviQL, Fig. 106. 3 THE TONGUE. 202 ANATOMY. The derma , or cutis (true skin), is chiefly composed of elastic ce! lulo-fibrous tissue, abundantly supplied with blood-vessels, lymphatics and nerves. It is divided into a deep stratum, called corium , the struc- ture of which is dense, white, and coarse, forming a network of chan- nels, by which the branches of vessels and nerves pass to the super ficial'Jayer; and a superficial stratum, called ‘papillary, which is raised in the form of papillae, or conical prominences each being composed of a convoluted capillary vesse 1 and a convoluted nervous loop. Fig. 107 Fig. 107 shows the anatomy of a portion of the skin taken from the palm of the hand. 1. Papillary layer, marked by longitudinal furrows (2), which arrange the papillee into ridges. 3. Transverse furrows, which divide the ridges into small quadrangular clumps. 4. The rets mucosum raisec from the papillary layer and turned back. 5, 5. Perspiratory ducts drawn out straight by the separation of the rete mucosum from the papillary layer. The epiderma , or cuticle (scarf-skin), en- velops and protects the derma, of which it is a product. Its external surface is hard and horny, its internal soft and cellular ; this sur- face or layer is called the rete mucosum. The 1 MTEGUMENT OF THE HAND. ^ whole epidermal structure is laminated, the plates or scales increasing in density from the inner to the outer surface. The pores of the epiderma are the openings of the perspiratory ducts, hair follicles, and sebiparous glands. The arteries of the derma divide into innumerable intermediate vessels, forming a capillary plexus in the superficial strata and papillary layer. No lymphatics have been discovered in the papillae, but they are supposed to be interwoven with the capillary and mucous plexuses in the superficial strata of the derma. Appendages of the Skin. — These are the nails, hair, sebiparous glands, and perspiratory glands and ducts. The nails are a part of the epiderma, and identical in structure ; they are implanted in a fold of the derma, called matrix , which acts the part of a follicle ; at the bottom of the groove of the follicle are a number of filiform papillae, which produce the margin of the root, and, by the successive formation of new cells, push the nail onward in its growth. The concave surface of the nail is in contact with the derma, and the latter is covered by papillae, which detain the nail in place, and increase i& thickness by the addition of newly-formed cells on its under surface ORGANS OF tHE EXTERNAL SENSES. 203 In Fig. 103 aro seen — 1. The epiderma. 1. Its deep layer, the rete mueosum. 3. Two of the quadrangular papillary clumps composed of minute conical papilla?, such as are seen in the palm of the hand or sole of the foot. 4. Deep layer of the derma, the corium. 5. Adipose cells. 6. A su- doriparous gland with its spiral duct, as are seen in the palm of the hand and sole of the foot. 7. Another sudoriparous gland with a straighter duct, such as is seen in the sealp. 8. Two hairs from the esalp, enclosed in their follicles ; their relative depth in the skin is preserved. 9. A pair of sebiparous glands, opening by short ducts into the follicle of the hair. The hairs are horny append- ages, produced by the involution of the epiderma, constituting the follicle , and subsequent evolution of the same structure, constitu- ting the shaft of the hair. Hairs are variable in length and thick- ness in different parts of the body. Their free extremity is generally pointed, and sometimes split into filaments ; the central extremity, called the bulb, is implanted deeply in the integument, extending through the epiderma into the cellular tissue, where it is surrounded by adipose cells. The hair is formed from its follicle by a process identical with the formation of the epiderma by the papillary layer of the derma. The color of the hair, and also of the epiderma, is owing to the adoration of the primitive granules, of which the cells are composed. The sebiparous glands , which are embedded in the derma, are sac- culated glandular bodies, of a complex variety of structure, from a pouch-like follicle to a lobulated gland. In some situations their ex- cretory ducts open on the surface of the epiderma, and in others they terminate in the follicles of the hairs. In the meatus auditorius the sebiparous glands, called ceruminous , are large, and in the eyelids are the largest in the body, and are there called Meibomian . The sudoriparous glands are deeply situated in the corium and sub- cutaneous tissue, and surrounded by areolar tissue. They are small oblong bodies, composed of convoluted tubuli, or a congeries of globu- lar sacs, opening in a common efferent duct, which ascends through the derma and epiderma, and terminates on the surface by an obliquo funnel-shaped aperture or pore Fig. ioa 204 ANATOMY. CHAPTER X. OP THE VISCERA— SPLANCHNOLOGY. Fig. 109. VITAL SYSTEM Those organs of tlia body called viscera, occupy three great internal cavi ties, the cranio-spinal, thorax, and abdomen. TI 10 first is occupied by the brain and spinal marrow already described ; the thoracic cavity, or chest, contains the heart, lungs, and thymus gland ; the abdominal cavity prop er contains the stomach and intestines, liver, pan- creas, spleen, kidneys, and supra-renal capsules ; and its lower portion, call- ed the pelvis, contains the bladder and internal organs of generation. The relative situation of the principal viscera may be seen in Fig. 109. A. Heart. B, B. Lungs. C Liver. D. Stomach. E. Spleen. to, to. Kidneys, g. Bladder, d is the diaphragm which forms the partition between the thorax and abdomen. Under the latter is the cardiac orifice of the stomach, and at the right ex- tremity, or pit of the stomach is the pyloric orifice. THORACIC VISCERA. The Heart.- -The heart, which is the central organ of circulation. SP LANCHNOLOi Y. 205 is a strong, muscular ofgan, enclosed in a proper membrane, called pericardium, and situated between two layers of pleura, which consti- tute the mediastinum. The pericardimn (heart-case) consists of an external fibrous and an internal serous layer. The heart is placard oblique between the lungs, with its apex pointing to the space between the fifth and sixth ribs, two or three inches from the sternum on the left side. It consists of two auricles, right and left, and two ventricles, also right and left. The right is the venous, and the left the arterial side of the heart. The right auricle is larger than the left ; its interior, called sinus , presents five openings and two valves. The openings are : the superior cava , which pours the venous blood from the upper part of the body into its upper part ; the inferior cava , which returns the blood of the lower half of the body into its lower part ; the coronary vein, which returns the blood from the substance of the heart; the foramina Thebeseii, small pore-like openings through which the venous blood oozes from the muscular structure into the auricles ; and auriculo-ventricular , the communication between the auricle and ventricle. The valves are : the Eustachian, which belongs to the foetal circula- tion, and serves to direct the placental blood from the inferior cava through the foramen ovale into the left auricle ; and the coronary, a semilunar fold across the mouth of the coronary vein. There are two relicts of the foetal structure , the annulus ovalis , situ ated on the partition ( septum arcularium) between the two auricles, occupying the place of the foramen ovale of the foetus ; and the fossa ovalis , an oval depression corresponding with the foetal foramen ovale, and closed at birth by a thin valvular layer. The proper structure of the auricle is divided into an intervening portion between the openings of the cavas, called tuber culum Loweri , and numerous small parallel columns of muscular fibres situated in the appendix auricula. The rigid ventricle receives the venous blood from the right auricle and transmits it to the lungs. Its anterior side is convex the greatei proportion of the front of the heart ; its posterior and lower side is flat, resting upon the diaphragm. It contains two openings, two sets of valves, and a muscular and tendinous structure. The openings are, the auricular ventricular , the communication be- tween the right auricle and ventricle ; and the opening of the pulmo- nary artery, which is situated close to the septum between the ventricles. The valw are, the tricuspid , three triangular folds of the lining 18 ANATOMY. nembrane, strengthened by a layer of fibrous tissue, connected by heir base around the auriculo- ventricular opening, and prevent the regurgitation of blood into tb Q auricle during the contraction of the ventricle; and the semilunar, three in number, situated around the commencement of the pulmonary artery. The muscular and tendinous apparatus belongs to the tricuspid valves. It consists of thick muscular columns ( columns carnece), and their ten- dons ( chorda tendmece), which stand iut from the walls of the ventri des, and serve as muscles to the valves. The left auricle receives the arterial blood from the lungs ; it is smaller and thicker than the right. It has four openings for the pul- monary veins , two from the right and two from the left lung ; and an auriculo-ventricular opening, which communicates between it and the left ventricle. Its musculi pectinati are fewer in number than in the right auricle, and are situated only in the appendix auriculae. 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 -ventricular commu- nication to prevent the retrograde passage of the blood, and, like the tricuspid, are furnished with a muscular apparatus ; and the semilunar placed around the commencement of the aorta. Fig. 110. Fig. 110 is a general view of the inter- nal structure of the heart. 1. Right auricle. 2. Entrance of the superioi cava. 3. Entrance of the inferior cava. 4. Opening of the coronary vein, hall closed by the valve. 5. Eustachian valve. 6. Fossa ovalis, surrounded by the annulus ovalis. 7. Tuberculum Loweri. 8. Musculi pectinati in the appendix auriculae. 9. Auriculo-vei, tricular opening. 10. Cavity of right ventricle. 11. Tricuspid valve, attached by the chordae tendinae to the carnero columnaB (12). 13. The pulmonary ar- tery, guarded at its commencement by three semilunar valves. 14. Right pul- monary artery, passing beneath the arch and behind the ascending aorta. 15. Left pulmonary artery, crossing in front of the descending aorta. * Re* AN ATOMY OF THE HEART. mains of the ductus anteriosus, acting as a ligament between the pulmonary artery and arch of the aorta. The arrows mark the course of the venous blood through the right side of the heart. 16. Left auricle. 17. Openings of the fourth pulmonary SPLANCHNOLOGY 207 reins. 18. Auriculc-ventricular opening. 19. Left ventricle. 20. Mitral valve, attached by its chordw ten din a} to two large column* carnc®, which project from the walls oi 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 the greatest possible amount of strength for its bulk. Its arteries are the anterior and posterior coronary ; its reins empty into the right auricle bj the common coronary ; its lymphatics terminate in the glands about its root ; and its nerves are derived from the cardiac plexus- Fig> 111# 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. g. Arteria inno- minata. h. Left subcla vian artery, i. Left ca- rotid. k. Pulmonary ar- tery. 1 , l. Its right and left branches. m, m. Veins of the lungs, n. Right auricle. o. As- cending cava. q. De- scending cava. r. Left auricle, s. Left coronary artery. P. Portal veins, which return the blood from the liver and bow- els. THE HEART. ORGANS OF VOICE AND RESPIRATION. The cartilaginous and muscular structure at the upper part of the windpipe, called the larynx, constitutes the apparatus of voice ; the kings and trachea are the organs of respiration. OF THE LARYNX. larynx is a short tube, of an hour-glass form, situated at the 208 ANATOMY. apper and front part of the neck, composed of cartilages, ligaments, muscles , vessels , nerves, and mucous membrane . 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 pomum Adami (Adam’s apple). Each ala forms a rounded border posteriorly, which terminates above in a superior cornu, and below in an inferior cornu . 2. Cricoid (like a ring), a circular ring, narrow in front and broad behind, where it has two rounded surfaces, which articulate with the arytenoid cartilages. The oesophagus is attached to a vertica: ridge on its posterior surface. 3. Two arytenoid (pitcher-like) ; triangular in form, and broad and thick below, where they articulate with the upper border of the cricoid ; above they are pointed and prolonged by two small pyriform cartilages, ^alled 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 situated 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 os 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 membrane, 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 arytenoid ; 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- arytenoid, thin bands between the receding angle of the thyroid and the anterior inner border of each arytenoid ; the lower border constituting the upper boundary of the ventricle of the larynx. 6. Two inferior thyro- arytenoid, the chordce vocales, which are thicker than the superior, and, like theny composed of elastic tissue. Each ligament, or vocal chord, is attached 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 bb continuous with the lateral expansion of the crico-thyroid ligament SPLANCHNOLOGY. 209 The superior border forms the lower boundary of the ventricle of the larynx. The space between the two chordae vocales is the glottis , or rim a glottidis. 7. Three glcsso-epi glottic , folds of mucous membrane connecting the anterior surface of the epiglottis with the root of the tongue. 8. The hyo-epi glottic, an elastic band connecting the anterior aspect of the epiglottis with the hyoid bone. 9. The thyro-epiglottic, a slender elastic slip embracing the apex of the epiglottis, and inserted into the thyroid above the chordae vocales. Fig. 112 is a vertical section of the larynx, showing its ligaments. 1. Body of the cs hyoides. 2. Its great cornu. 3. Its lesser cornu. 4. The ala of the thyroid. o. Its superior cornu. 6. Its inferior cornu. 7. Pomum Adami. 8, 8 Thyro-hyoidean membrane ; the opening Rear the posterior numeral transmits the superior | laryngeal nerve and artery. 9. Thyro-hyoidean liga- ment. a. Elpiglottis. b. Hypo-epiglottic ligament, c. Thyro-epiglottic. d. Arytenoid cartilage, e. Outer angle of its base. /. Corniculum laryngis. g. Cuneiform cartilage, h. Superior thyro arytenoid ligament, i. Chorda vocalis, or inferior thyro arytenoid ; the ellipti- cal space between the two thyro-arytenoid is the laryn- geal ventricle, k. Cricoid cartilage. 1. Lateral portion of the crico-thyroidean membrane, m. Its central por- tion. n. Upper ring of the trachea, which is received within the ring of the cricoid cartilage, o. Section of the isthmus of the thyroid gland, p, p. The levator of the glandulae thyroideae The muscles are eight in number : five larger ones of the chordae vocales and glottis, and three smaller of the epiglottis. The origin, insertion, and use of each is expressed ligaments of the larynx. by its name. They are the crico-thyroid , posterior Fig. 113. and lateral crico- arytenoid, thyro-arytenoid, aryte- noid, thyro-epiglottic, and superior and inferior ary - teno- epiglottic. The posterior crico-arytenoid opens the glottis; the arytenoid approximates the aryte- noid cartilages posteriorly, and the crico-arytenoi- deus lateralis and thyro-arytenoidei anteriorly ; the Fig. 113 is a side view of the larynx, one ala of the thyroid cartilage being removed. 1. Remaining ala. 2. One of the arytenoid cartilages. 3. One of the cornicula laryngis. 4. Cri- coid cartilage. 5. Posterior crico arytenoid muscle. 6. Crico- arytenoideus lateralis. 7. Thyro-arytenoic sus. 8. Cricc-thy- roidenn membrane. 9. One half of the ep glottis. 10. Uppei THE LARYNX IiAT* part of the trachea. E RALLY. ANATOMY. , -0 eatter also close the glottis mesially. The crico-lhyroidei are tensors of the vocal chords, an<. with the thyro-arytenoidei, regulate their posi- tion and vibrating length. The remaining muscles assist in regulating the tension of the vocal chords by varying the position of then cartilages. The aperture of the iai ynx is a triangular opening, broad in front and narrow behind; bounded in front by the epiglottis, behind by the arytenoid muscle, and on the sides by folds of mucous membrane. The cavity is divided into two parts by an oblong constriction produced by the prominence of the vocal chords ; the part above the constriction is broad above and narrow below, and the part beneath is narrow above and broad below; while the space included by the constriction is a narrow, triangular fissure, the glottis , bounded on the sides by the chorda; vocales and inner surface of the arytenoid cartilages, and behind by the arytenoid muscle ; it is nearly an inch in length, somewhat longer in the male than female. Immediately above the prominence caused by the chorda vocalis, and extending nearly its length on each side of the cavity of the larynx is the ventricle of the larynx , an ellipti- cal fossa which serves to isolate the chord. The mucous membrane lines the entire cavity of the larynx, its prominences and depressions, and is continuous with that of the mouth and pharynx, which is prolonged through the trachea and bronchial tubes into the lungs. In the ventricles of the larynx the membrane forms a csecal pouch, called sacculus laryngis, on the surface of which are the openings of numerous follicular glands, whose secretion lubri- cates the vocal chords. The arteries of the larynx are derived from the superior and inferior thyroid; the nerves are the superior laryngeal and recurrent laryngeal branches of the pneumogastric. . F THE TRACHEA. The trachea (windpipe) commences opposite the fifth cervical verte- ora, and extends to the third dorsal, where it divides into the right and left bronchi, the right bronchus passing off to the upper part of the right lung at nearly right angles, and the left , which is smaller, descend- ing obliquely beneath the arch of the aorta of the left lung. It is composed of fifteen to twenty cartilaginous rings , which form the anterior two thirds of its cylinder; fibrous membrane , which forms the posterior third of the tube ; mucous membrane , which lines it inter- nally; longitudinal elastic fibres, situated beneath the mucous mem- brane; and muscular fibres, which form a thin, transverse layer between the extrcmiti 3S of the cartilage s ; tl eir posterior surface is covered by SPLANCHNOLOGY. 211 cellular tissue, in which are lodged the tracheal glands, which secrete the lubricating mucus. THE THYROID GLAND. In structure this body is composed of a dense aggregation of minute independent membranous cavities, enclosed by a plexus of capillary vessels, and connected by cellular tissue The cavities are filled with cyto-blasts and cells. It is situated upon the trachea, above the sternum, being divided into two lobes, one of which is placed on each side ; the connection between the lobes is called the isthmus. This gland is larger in children and females than in adults and males. It is profusely supplied with blood by the superior and inferior thyroid arteries ; its nerves are derived from the superior laryngeal and sympathetic. The function of this organ is entirely unknown. Its enlargement constitutes the disease called goitre, or bronchocele. OF THE LUNGS. Fig. 114. Fig. 114 represents the anterior aspect of the anatomy of the heart and lungs. 1. Right ventri- ele; the vessels to the left of the number are the middle coronary artery and veins. 2. Left von- tricle. 3. Right auricle. 4. Left auricle. 5. Pul- monary artery. 6. Right pulmonary artery. 7. Left pulmonary artery. 8. Remains of the ductus arteriosus. 9. Aortic arch. 10. Superior cava. 11. Ar- teriainnominata ; in front of it is the right vena inno- minata. 12. Right subcla- vian vein ; behind it is its corresponding artery. 13. Right common carotid artery and vein. 14. Left vena innominata. 15. Left carotid artery and vein. 16. Left subclavian artery and vein. 17. Trachea. 18. Right bronchus. 19. Left bronchus. 20, 20. Pul- monary veins ; 18, 20, from the root of the light lung ; and 7, 19, 20, the root of the left, Uj^jer lobe of right lung. 22. Its middle lobe. 23. Its inferior lobe. 24. Superior lebe of left lung. 25. Its lower iDbe. HEART AND LUNGS The lungs are two conical organa occupying the cavity of the chedi 212 ANATOM Y. on each side of the heart, from which they are separated by a mem branous partition, the mediastinum. They are tapering above, where they extend beyond the level of the first rib, and broad and concave below, where they rest on the convex surface of the diaphragm. Their color is pinkish-grav, variously mottled and marked with black. Each lung is divided into two lobes by a long, deep fissure, and in the right lung the upper lobe is subdivided by a second fissure. The root of each lung, which retains it in position, comprises the pulmonary artery and veins, and bronchial tubes, with the bronchial vessels and pulmonary plexuses of nerves. The structure of the lungs is composed of ramifications of the bron- 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 structure of the bronchial tubes is changed from cartilaginous to membranous after they have arrived within one eighth of an inch of the surface of the lung, and diminished to a diameter between one thirtieth and one fiftieth of an inch. The pulmonary artery , which transmits the venous blood to the 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 pneumogastric, form anterior and posterior plexuses upon the front and back of the root of the lungs, from which branches follow the course of the bronchial tubes to supply the intercellular passages and air-cells. THE PLEURA. Each lung is invested and sustained by the pleura, 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 the lung is called pleura pulmonalis , and that in contact with the parieties of the chest, the pleura costalis ; the two reflected portions in the middle of the chest form a septum, called mediastinum, which divides* the thorax into two pulmonary cavities : } this portion is distinguishes SPLANCIINC LOGY. 213 nto anterior, postsrLir, and middle portions, the latter containing the heart and its pericardium, the ascending aorta, the superior vena ;ava, the bifurcation of the trachea, the pulmonary arteries and veins, vnd the phrenic nerves. TTIE ABDOMINAL VISCERA. The abdominal cavity is bounded above by the diaphragm, below 1} the pelvis, in front and laterally by the lower ribs and abdominal mus- cles, and behind by the vertebral column and abdominal muscles ; it contains the alimentary canal, liver, pancreas, spleen, and kidneys, with the supra-renal capsules. Abdominal Regions. — For convenience the abdominal cavity is divided into nine regions, by two transverse lines around the body, one parallel 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 umbilical , the two 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, mesentery, 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 diaphragm is lined by two layers, which, descending to the upper surface of the liver, form its coronary and lateral ligaments ; and, after surrounding the liver and meeting at its under surface, pass to the stomach, forming the lesser omentum . After surrounding the stomach they descend in front of the intestines, forming the great omentum ; they then surround the trans- verse colon, and pass backward to the spine, forming the meso-colon , where the layers separate. The posterior 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 meso-rectum , and a pouch called the recto-vesical fold, between the rectum and bladder 214 ANATOMY it then ascends upon the neck of the bladder, forming its false liga merits, and returns upon the front walls of the abdomen to the die phragm. Fig. 115. ABDOMINAL CAVITY Fig. 115 exhibits the abdominal cavity, with the intestines mostly remove!. U tJiVJH Vi rued up to show its under surface. G. Gall-bladder. P. Pancreas. K. jviducy*. 8 A. Descending aorta. Y V. Ascending vena cava. E. Pectum. B. L ladder. STLANCHNOLOGY. 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 through 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 appendices epploicce. The g astro-phrenic ligament is a du- plicature 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 structures, and an internal dense and smooth layer, deficient of vessels. In gen- eral character serous membranes resemble a shut sac, and secrete a fluid resembling the serum or watery part of tne blood. THE ALIMENTARY CANAL. The alimentary canal is a continuous tube from the mouth to the anus, musculo-membranous in structure, and distributed into various portions, called mouth, pharynx, 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 the surface of the jaws, and formed externally of common integument, internally of mucous membrane, with layers of muscles and numerous small glands between. The cheeks (buccae) form the sides of the face, and are constituted •imilarly to the lips ; their glands are called buccal. The hard palate is a dense structure of mucous membrane, fibrous tissue, glands, vessels, and nerves, firmly connected to the palate pio- cesses of the upper maxillary and palate bones. Its middle line is marked by an elevated raphe, on each side of which are transverse ridges and grooves. m ANATOMY. The gums are thick* dense folds of mucous membrane attached U the periosteum of the alveolar processes, and remarkable for their insensibility. The tongue has been already described. The soft p>alate (velum pendulum palati) is a fold of mucous mem- brane, with glands and muscles, at the back part of the mouth, con- tinuous above with the hard palate ; the uvula is a small rounded pro- cess hanging from the middle of its inferior border. The tonsils (amygdalae) are two glandular almond-shaped bodies on each side of the fauces, between folds of the mucous membrane of the soft palate, which are called the anterior and posterior 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 tho 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- tory ducts ; they are the parotid, submaxillary, and sublingual. The parotid , the largest, 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 -maxillary vein, and facial nerve. Its excretory duct opens on the internal surface of the cheek opposite the second molar tooth of the upper jaw. The submaxillary is situated in the posterior angle of the submaxillary tri- angle of the neck, and behind the lower jaw. Its excretory duct opens on the papillae under the tongue, by the side of the fraenum linguae. The sublingual is a flattened body beneath the mucous mem- brane of the floor of the mouth, on each side of the fraenum linguae. Its secretion is poured into the mouth by seven or eight small ducts, which open on each side of the fraenum linguae. In structure the salivary 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 caecal pouches, formed by the dilatation of the extreme ramifications of the ducts. The Pharynx. — The pharynx is a musculo-membranous sac be- tween the mouth and oesophagus. Its anterior part is incomplete, and has opening into it the two posterior nares, the two Eustachian tubes, mouth, larynx, and oesophagus. The CEsophagus. — The oesophagus is the continuation of the ali- mentary canal from the pharynx to the stomach. In its descending SPLANCHNOLOGY, 217 course 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 tne 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 extremity is a worm-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 . The rectum is the termination of the large intestine ; it descends in front of the sacrum, and near the extremity 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 faeces. (See fig 107 ) I — 19 218 ANATOMY. Structure of the Aijmentart Canal. — The pharynx hag 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 very closely resembles the cutaneous covering of the exterior; it is composed of three layers, an epithelium , a mucous proper , and a fibrous. The epithelium is the epiderma 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 gastric 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 fibrous layer (formerly called “ nervous coat") 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 rug roportion 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 system. This hypothesis is strengthened by its peeu- SPLANCHNOLOGY. 228 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 structure 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 trunk in its centre gives the capsule the appearance of a central cavity, col- lects the blood from the medullary 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 on the left. Their lymphatics are large and numerous, and terminate in lumbar glands. The nerves are derived from 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 (he left, from the position of the liver; the left is covered in front by the great 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, are 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 tc* poinS toward the circumference of the kidney. 224 ANATOMY. Fig. 117. Fig. 117 is a section of the kidney surmounted by the supra-renal capsule ; the swellings on the surface mark its original constitution in distinct lobes. 1. Supra renal capsule. 2. Vascular portion. 3, 3. Tubular portion, consisting of cones. 4, 4. Two of the papi'lae project- ing into their corresponding calices. 5, 5, 5 The three infundibula ; the middle 5 is situated in the mouth of a calyx. 6. Pelvis. 7. Ureter. In the cortical portion are contained a multitude of very small, led, globular bodies, called glomeruli , or corpora Malpighiana , each of which 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 section of the kidney, tubuli, and is reflected from their sides so as to form around each a cup-like pouch, or calyx . The caliees commu- nicate with a common cavity of large size at each extremity and in the middle, and three cavities, called the infundibula , unite and form a membranous sac, which occupies the hilus renalis, 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 two ureters to one kidney. Mr. Bowman, who has investigated the intimate structure of the Aidneys, thinks there are two distinct systems 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, like the bile in the liver, derived from venous blood. THE TELVIC VISCERA. The cavity of the pelvis is the lower portion of the abdominal cavity; it is included within the bonss of the pelvis, below the level of the linea-ilio-pectinea and the pre nontc ry of the sacrum. The male pet SPLANCHNOLOGY 225 ric viscera are the urinary bladder, prostate gland, vesicula seminales, ■nd 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 the fundus ; its broad surface resting on the rectum, the bzse ; and the nam w constricted portion against the prostate gland, 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 vesi- cate, the most sensitive portion of the bladder, and occasioning great suffering when pressed upon by calculi. At the entrance of the urethra there is a slight elevation of the mucous membrane, called uvula 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 from 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- tacliei l to the apex of the bladder, and thence ascending to the umbili- cus ; and four false ligaments, which 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 seminalis, 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 punc'uring the bladder. The prostate gland is situated in front of the neck of the bladder, and upon the rectum, through which it may be felt with the finger, surKmnding the commencement of the urethra for a little more than an inch of its extent, in size and form resembling a Spanish chestnut. It consists of two lateral lobes, an I a middle lobe or isthmus, and its ptructu s is composed of ramified lucts, terminating in lobules of fob m ANATOMY licular pouches. Its secretion is poured into the prostatic portion of the Fig. 118 is a side view of viscera of the male pelvis. 1. Divided surface of the os pubis 2. Divided surface of the sacrum. 3. Bo- dy of the bladder. 4. Its fundus ; the urachus is seen passing upward from the apex. 5* Its base. 6. Ureter 7. Neck of the blad- der. 8, 8. Pelvic fascia ; the fibres above 7 are given oflf from the pelvic fascia, and repre- sent the anterior ligaments of the bladder. 9. Pros- VISCERA OF THE PELVIS. tate gland. 10. Membranous por- tion of the urethra, between the two layers of the deep perineal fascia. 11. The deep perineal fascia, formed of two layers. 12. One of Cowper’s glands, between the layers and beneath the membranous portion of the urethra. 13. Bulb of the corpus spongi- osum. 14. Body of the corpus spongiosum. 15. Right crus penis. 16. Upper part of the first portion of the rectum. 17. Recto-vesical fold of peritoneum. 18. Second por- tion of the retium. 19. Right vesicula geminalis. 20. Vas deferens. 21. The rectum covered by the descending layer of the pelvic fascia, just as it is making its bend back- ward to consti ute the third portion. 22. Part of the levator ani muscle investing the lower part of tie rectum. 23. External sphincter ani. 24. Interval between the deep and superficial perineal fascia ; they are seen to be continuous beneath the number. The vesiculce seminales are lobulated bodies, about two inches in length, situated on the under surface of the base of the bladder, and separated from the rectum only by the recto- vesical fascia. Each vesicula is formed by convolutions of a single tube, which gives off several irregular caecal branches ; it is enclosed in a dense fibrous membrane, derived from the pelvic fascia, and is constricted beneath the isthmus of the prostate gland into a small excretory duct. The vas deferens of the testis, somewhat enlarged and convoluted, lies along the inner border of each vesicula, and is included in its fibrous invest- ment. It communicates with the duct of the vesicula, beneath the isthmus of the prostate, and forms the ejaculatory duct , which is about three fourths of an inch in length, and opens on v Jie mucous membrans of the urethra. SPLANCHNOLOGY. 227 The penis and testes , with their appendages, constitute the male organs of generation. The jpc/iis is divided into a head, the anterior extremity of which is the glans, a root which is strongly adherent to .0© pelvis, and an intervening body , consisting of two structures, called corpus cavernosum and corpus spongiosum . The integument of the penis is thin, and destitute of adipose matter. Surrounding the glans is a loose doubling, called the prepuce ; this is connected to the orifice of the urethra by a process called frcenum ; the edge around the base of the glans is called corona giandis ; the glands of Tyson are smaL papillary elevations around the base of the glans; their secretion is called smegma ; the fascia is situated beneath the skin, and is but a modification of the superficial abdominal fasc ; a ; a portion connecting the penis with the pubis is called ligamentum suspenscj'ium . The largest part of its body is formed by the corpus cavernosum , which in shape resembles a double cylinder ; these cylinders, separated and pointed at the root, are there called the crura , each crus being firmly attached to the ramus of the pubis and ischium . Externally this structure is covered by a thick fibro-elastic coat, and internally of erec- tile tissue. The partial separation of the two cylinders is called septum pcctiniforme. The corpus spongiosum is situated along the under surface and in the inferior groove of the corpus cavernosum. Its posterior ex- tremity is enlarged into the bulb , and its anterior is expanded into the glans . It is composed of erectile tissue, a peculiar cellulo-vascular structure entering largely into the composition of the organs of generation, and contains in its interior the spongy portion of the urethra. The urethra is the urinary canal from the bladder through the penis. Its structure is membranous, composed of mucous and elas- tic-fibrous coats. Its diameter varies in different parts of its course, which is somewhat curved. The first portion is called the prostatic urethra ; this is about an inch in length ; on its lower surface is a longitudinal fold of mucous membrane, called veru montanum , or caput gallinaginis ; on each side of this a depression called prostatic sinus , into which the prostatic ducts open ; at the anterior extremity of the veru montanum are the openings of the ejaculatory ducts. The next portion is membranous ; this is eight or ten lines in length, and very narrow, surrounded by loose tissue and a few muscular fibres. The rest is the spongy portion, six or seven inches in length ; it is narrowest in the body of the organ ; posteriorly it is dilated into the bulb, forming the bulbous urethra, and anteriorly in the glans it enlarges into the fossa navicularis. The external opening, meatus urinarus , is the most con- stricted portion of *he canal, so that a catheter which will ente* £28 ANATOMY that opening will pass freely through the whole extent of a health} urethra. Cowper's glands are two small tabulated bodies, about the size of peas, situated beneath the membranous portion ; their excretory ducts open into the bulbous portion. The whole internal surface of the spongy portion of the urethra is marked with lacunae , or openings of mucous glands situated in the submucous cellular tissue. These open- ings are directed forward, and sometimes obstruct the point of a small catheter in its passage to the bladder. The testes are glandular organs suspended from the abdomen by the spermatic cord, and enclosed in an integument called the scrotum. The scrotum is composed of a tegumentary layer , extremely thin, transparent, and corrugated, and beset with hairs having very prominent roots, and a proper cohering called dartos , a fibro- muscular tissue, which sends inward a nartition, septum scroti , which divides it into two cavities for the two testes. The spermatic cord , composed of arteries, veins, nerves, lymphatics, the excretory duct of the testicle, and investing tunics, is the medium of communication between the testes and interior of the abdomen. It commences at the internal abdominal ring, where the vessels composing it converge, and passes obliquely along the spermatic canal, escaping at the external abdominal ring, and descending through the scrotum to the posterior border of the testicle. The excretory duct of the testicle is called vas deferens ; its coats are thick and tough, and it may be dis- tinguished along the posterior border of the spermatic cord by the hard and cordy sensation it communicates to the fingers. Each testis is an oblong rounded gland suspended in the cavity of the scrotum by the spermatic cord ; its function is to secrete the sem- inal fluid. Encircling its posterior edges is a soft flattened body, called epididymis ; it is formed by the convolutions of the excretory seminal ducts; its upper extremity is called globus major, and the lower globus minor; tms extremity curves upward and becomes continuous with the vas deferens. The testis has three coverings, a serous coat called tunica vaginalis ; a thick, middle, fibrous membrane, called tunica albuginea , which surrounds the testis, and is reflected into its interior, forming the mediastinum testis , from which numerous fibrous cords, trabcculce septula , are given off ; and an internal nutrient membrane called tunica vasculosa, which, analogous to the disposition of the pia mater in the brain, sends processes inward between the lobules of the organ. The substance of the testis consists of numerous flattened lobules, with the-r bases toward the surface. Krause counted between four SPLANCHNOLOGY 229 nivl five hundred of them. Each lobule is invested in a distinct sheath, formed of two layers, one from the tunica vasculosa, and the other from the tunica albuginea, and composed of several minute tubuli, tubuli seminiferi , exceedingly convoluted, frequently anastomosing near their extremities, and terminating in loops or csecal ends of about ^ of an inch in diameter. The tubuli seminiferi are of a bright yellow color, become less convoluted in the apices of the lobules, and terminate by forming from twenty to thirty small straight ducts of about twice the diameter of the tubuli seminifera; these ducts are the vasa rectce. Fig. 1 19 represents the minute structure of the testis. 1, 1. Tunica albuginea. 2, 2. Mediastinum testis. 3, 3. The lobuli. 4,4. Vasa recta. 5. Re te testis. 6. Vasa efferentia ; six of them only are shown in the diagram. 7. Cervi vascu- losi, constituting the globus major of the epididymis. 8. Body of the epididymis. 9. Its globus minor. 10. Vas de- ferens. 11. Vasculum aberrans. The vasa recta enter the mediastinum, and terminate in from seven to thirteen smaller ducts, which pursue a waving course from below upward, through the fibrous tissue of the medi- astinum, and communicate freely with each other, constituting the rete testis. The ducts of the rete testis terminate at the upper extremity of the mediastinum in small ducts called vasa efferentia ; these vary in number from nine to thirty, and form, by their convolutions, numerous conical masses, the coni vasculosi ; from the bases of these cones larger-sized tubes proceed, whose complex convolutions form the body of the epididymis. anatomy of the testis. Fig. 119. THE FEMALE PELVIS. The viscera of the female pelvis are the bladder, vagina, uterus and its appendages, the rectum, and some portion of the small intestines, which occupy the upper part of the cavity. The bladder is situated behind the ossa pubis and in front of the uterus ; it is broader than in the male, corresponding with the broader pelvis. The urethra is about an inch and a half in length, and is lodged in the upper wall of the vagina, in its course downward and forward be- neath the arch of the os pubis, to the meatus urinarius. It is sur- rounded by a proper coat of elastic tissue, to which the muscles of the 20 m ANATOM Y. detrusor urinre are attached, and to which the remarkable dilatabibty of the female urethra is owing. gina, upon which the transverse rugas are apparent. 13. The thick wall of separation between the vagina and rectum. 15. The perineum. 16. Os uteri. 17. Its cervix. 18. Its fundus ; the cavitas uteri is seen along its centre. 19. Rectum, showing the disposi- tion of its mucous membrane. 20. Anus. 21. Upper part of the rectum, invested by the peritoneum. 23. Utero-vesical fold of peritoneum ; the recto-uterine fold is seen be- tween the rectum and the posterior wall of the vagina. 24. The reflexion of the peri- toneum, from the apex of the bladder upon the urachus to the internal surface of the abdominal parieties. 25. Last lumbar vertebra. 26. Sacrum. 27. Coccyx. The vagina is a membranous canal leading from the vulva to the uterus ; its structure is composed of mucous, erectile, and contractile fibrous tissues. The mucous membrane is marked by a number of transverse papillae, or rugte, and is covered by a thin cuticular epithe- lium, which is continued from the labia to the middle of the cervix uteri. The uterus is a flattened, pear-shaped organ, occupying the upper part of the pelvic cavity between the bladder and rectum. Its fundus and body are enclosed in s duplicature of peritoneum, which forms a transverse septum between the bladder and rectum, the folds of which, on either side of the uterus, are its broad ligaments . Its lower por fcion is the cervix; around the circumference the upper end of th* VISCERA OF THE FEMALE PELVIS. Fig. 120. Fig. 120 is a side view of the viscera of the female pelvis. 1. Sym- physis pubis, to the up- per part of which the tendon of the rectus muscle is attached. 2. Abdominal parieties. 3. Collection of fat, form- ing the prominence of the mons Veneris. 4. Bladder. 5. Entrant of the left ureter. Canal of the urethra, converted into a mere fissure by the contrac- tion of its walls. 7. Meatus urinarius. 8. Clitoris, with its praepu- tium, divided through the middle. 9. Left nympha. 10. Left la- bium majus. 11. Meat- us of the vagina, nar- rowed by the contrac- tion of its sphincter. 12, 22. Canal of the va- sp:- a NC UNO logy. 231 ragina is attached ; its opening into the vagina is the os uteri . Its structure consists of an external serous coat, derived from the perito- neum, a middle muscular coat, and an internal coat of mucous mem- brane . The muscular coat gives it density and bulk, and in the unim- pregnated state is exceedingly firm in texture, appearing to be composed of whitish fibres, inextricably interlaced and mingled with blood-vessels. During pregnancy the fibres become large and distinct, and disposed in two layers. The superficial layer consists of vertical fibres, some of which are longitudinal and others oblique. The deep layer consists of two hollow cones of circular fibres, having their apex at the openings of the Fallopian tubes, and intermingling by their bases on the body of the organ. Around the cervix they assume a circular form, and inter- lace at right angles. Its arteries are the uterine from the internal iliac, and the spermatic from the aorta. Its veins are large, and in the unimpregnated state are called sinuses, being canals channeled through the substance of the organ, and lined by the mucous membrane. They terminate in the uterine plexuses on each side. The lymphatics terminate in the lum- bar glands. The nerves are derived from the hypogastric, spermatic, and sacral plexuses. Dr. Robert Lee, after making the nervous struc- ture of the uterus a subject of special investigation, concludes that “ The human uterus possesses a great system of nerves, which en- larges with the coats, blood-vessels, and absorbents, during pregnancy, and which returns after parturition to its original condition before con- ception takes place.” The appendages of the uterus are the Fallopian tubes and ovaries, enclosed by the lateral duplicatures of the peritoneum, which consti- tute the broad ligaments. The Fallopian tubes are the oviducts by which the impregnated ovum is conveyed to the uterus. Each tube is four or five inches in length; its canal is exceeding small; its opening into the uterus is called ostium uterinum, and that of its outer or free extremity, ostium abdominale ; this end has a fringed-like appendage, called fimbria^tu , and is connected with the ovary by a short ligamentous cord, by which it is conducted to the surface of the ovary during sexual excitement. The floats of the tubes are peritoneal , muscular , and mucous . The ovaries are oval, flattened, whitish bodies, situated in the poste- rior layer of peritoneum of the broad ligament, and connected to the upper angles of the uterus by a rounded cord, called the ovarian liga- ment. In structure each ovary is composed of cellulo-fibrous parenchy- ma or stroma, traversed by blood-vessels, and enclosed in a capsule consisting of vascular, fibrous, and serous layers In the cells of th* 232 ANATOMY. stroma the small vesicles or ovisacs of the future ova, the Graafian vesicles , are developed. Each ovary contains about fifteen fully formed vesicles, although innumerable microscopic ovisacs exist, in the paren- chyma. A yellow spot or cicatrix, called corpus luteum , is found in one or both ovaries after conception. A false corpus luteum is some- times met with in the ovaries of virgins ; it is of a similar appearance, out smaller in size and without a central cavity. The external organs ofi generation in the female are the mons V'eneris, labia majora, labia minora, and clitoris; the internal being the vagina, uterus, ovaries, and Fallopian tubes, which have been de- scribed. The mons Veneris is the prominent integument upon the front of the ossa pubis ; its cellular tissue is loaded with adipose substance, and the surface covered with hair. The labia majora are longitudinal folds of adipose cellular tissue and integument, which form the common urino- sexual opening, or vulva . The labia minora , or nymphce , are smaller folds, situated within the former. The clitoris is a small elongated body, situated in front of the ossa pubis, analogous to the corpus cav- ernosum of the penis, and, like it, arises by crura from the pelvis ; its extremity is called its glans. The entrance of the vagina is about an inch behind the clitoris ; it is closed in virgins by a partial membrane stretched across the opening; this is called the hymen; it is extremely variable in its form and appearance, and not unfrequently is entirely wanting. Sometimes it is imperforate, and occasionally it is so firm as to require a surgical trans-section. Frequently there is the appear- ance of a fringe of papillae, carunculae myrtiformes, around the opening of the vagina, which are the remains of a rudimentary or ruptured hymen. The meatus urinarius is situated behind the clitoris, and im- mediately in front of, and surrounded by, a tubercle at the upper angle of the vagina, and formed by the prominence of its upper wall. THE MAMMARY GLANDS. The mammae exist in a rudimentary state in the male, and form a part of the reproductive system of the female. They are situated in the pectoral region, and only separated from the pectoralis major mus- cle by a thin fascia. The base of each mamma is somewhat elliptical ; the anterior aspect is convex, having a central prominence of integu- ment, called the nipple •, surrounded by a colored areola. In structure it is a conglomerate glan i, consisting of lobes held together by firm cellular tissue ; the lobes are composed of lobules, and those of minute ©gecal vesicles, which are the ultimate termination of the excretory ducts. The excretory ducts tubuli lactiferi , are ten to fiftaeip ip number, commencing by small openings at the apex of the nipple, and passing inward parallel with each other to the central part of the organ, where they form dilatations, ainpullee, and give off numerous branches to ramify through the gland to their ultimate termination in the minute lobules. The ducts and ca3cal vesicles, in common with all others in the body, are lined by mucous membrane. GENERAL ANATOMY OF THE F(ETUSt The medium weight of a child of the full period is about seven pounds, and its length seventeen inches. The head is disproportionately T arge, and greatly lengthened from before backward, while the face is small. The chest is fully expanded, and the upper extremities well developed. The great size of the liver renders the upper part of the abdomen large and prominent; the lower part is small and conical, and the lower extremities very small comparatively. The osseous system is to a great extent soft and cartilaginous. The bones of the head are separated by spaces where the ossification has not yet taken place, allowing them to move upon and even overlap each other. The muscular system is well developed at birth, the muscles being generally large and fully formed. Their color is lighter, and their texture softer than in the adult. On the fibres of animal life the trans verse striae are not distinguishable until the sixth month of foetal life. The vascular system presents many peculiarities. The two auricles of the heart communicate by means of the foramen ovale . There is a communication between the pulmonary artery and descending aorta by means of a large trunk, the ductus arteriosus . The internal ilia: arteries are continued to the placenta, by which the foetal blood is re- turned to the placenta for revivification. There is also a communica- tion between the umbilical vein and the inferior vena cava, the ductus venosus. In the nervous syste?n the brain is very soft, almost pulpy, but the nerves are firm and well developed. The eye and car of the organs of sense are large and fully developed, while the internal structure of the nose is very imperfectly developed The lungs are dense and solid in structure until inflated by the act of inspiration. The lung is proportionately large, and early developed, at first appearing like a simple vessel, but gradually becoming more complicated until perfected at birth. The two auricles communicate with each other until the moment of birth. There is also a commu- nication between the pulmonary artery and aorta, called ductus arit- riosus. £34 AN ATOM! - in the foetal circulation the pure blood is brought from the placenta y the umbilical vein, which passes through the umbilicus and enters the liver, dividing these into numerous branches. Of the abdominal viscera, the liver is first formed ; the stomach and spleen are comparatively small, the pancreas large ; the large intestines are filled with a greenish viscous secretion, called meconium . Note. — The particular anatomy ant/ physiology of the foetus will be |iven in Part VIII PART II PHYSIOLOGY. Definitions. — Physiology is the doctrine of the functions, it ex * plains the actions and uses of the various organs and parts of the living body in its healthy or normal condition. Its abnormal or diseased states belong to the department of pathology. The functions have been divided into various classes, and each class admits of numerous subdivisions. The ancient physiologists divided them into vital, animal, and natural, corresponding to nutritive, mental, and excretory processes. Some modern authors have adopted Bichat’s arrangement into individ- ual and social, the former being subdivided into animal and organic . In general terms, innervation, circulation , and respiration are called vital functions ; while these with digestion, absorption, assimilation , secretion , and calorification , are regarded as nutritive functions; sensa- tion, voice, muscular motion, and mental manifestation constitute the ani- mal or relative functions ; and generation is the reproductive function. CHAPTER I. OF THE TISSUES. General Characters of the Tissues. — Though ,^:he bodily structures admit of many divisions, according to form, color, consistency, and arrangement, the phenomena of life may be more clearly pre- sented by considering them in the relations of primary and secondary The primary tissues are the cellular or areolar, muscular, and nervous. The vital property of the cellular substance is elasticity, of the muscu- lar contractility, and of the nervous sensibility. Distinguished chemi- cally, gelatin is the prevailing quality of the cellular tissue, fibrin of the musculai and albumen of the nervous. The cellular structure m PHYSIOLOGY. supplies the body with materials of form, the muscular furnishes the agents of action, and the nervous provides the instruments of feeling. The secondary tissues are membranes , ligaments , cartilages , and a portion of the bones, hair , and nails , being various forms of cellular or gelatinous substance in different degrees of density. The varied forms of all animal and even vegetable tissues are consti- tuted of aggregations of two kinds of cells, variously modified. The cells are called formative and secreting ; the only difference between them is, the former secretes a solid or semi-solid substance, which re- mains in the body with the debris of the cell for an appreciable time, and the latter secretes a fluid which escapes from the body with the remains of the cell which produced it. Each of these little cell-bodies has been compared to a laboratory, which receives from the surround- ing matter the elements which it requires, and combines them so as to accomplish a desired result. Development of Cells. — A cell originates in a mass of soft or liquid matter which is formed of a combination of elements capable of being fitted into an organized structure. The matter is called blastema. In this blastema a minute point arises, which gradually increases in size, while a transparent wall springs up from one side of the point or granule, and continues to swell until the granule is seen to exist in and adhere to one side of the cell wall. Thus is formed the cell wall, with its fluid contents, and the granule or nucleus which, in a further stage of development, exhibits in its interior several new granules or nucleoli. The development and mul- tiplication of cells are repre- sented in fig. 121. 1. Devel- opment of cell from the blas- tema. On the left is seen the corpuscle which becomes the nucleus ; on the right the complete nucleated cell. 2. Development of new cells within the parent cell. 3. Development of new cells from the outer wall of pre- existing cells. DEVELOPMENT OF CELLS. various transformations in the production of The cells undergo the different structures. They may lose their fluid contents, and their walls, by collapsing and adhering together, form simple, membranous, transparent disks. They also elongate, so as to form tubes or solid rods ; in the former case they adhere by their ends to neighboring cells, and their cavities THE TISSUES. 237 mutually open into each other, forming a vessel ; in the lattei case the contained fluid is lost, and a solid rod or fibre is the result. The cavi- ties of cells may be obliterated by solid deposits within them, as in the formation of cartilage. The Cellular Tissue. — The cellular or areolar tissue is the sim- plest form of animalized matter. It is flexible and adhesive, yet these properties seem to be included in the general term, elasticity. It per- vades and connects together every part of the system, and being com- posed of membranous layers irregularly joined, so as to form numerous interstices of various capacities, air introduced under the skin may dif- fuse itself all over the surface of the body, a circumstance often result- ing from wounds of the lungs. Fig. 122. The cellular tissue is not composed of a congeries of distinct, isolated cells, but of cavit'es and interstices freely communicating with each other ; hence the term areolar is generally applied to this structure by late authors. There are two kinds of this tissue, called reticular and adi- pose . The former is dispersed throughout the entire body, except the brain, the bones, and humors of the eye. It is scarcely perceptible in the tendons of muscles, but plenti- ful in their fleshy parts. The adipose portion is a connection of fibres run- ning in various directions so as to form cavities, which have been called cells ; into these cavities the fatty or oily matters are deposited. In some parts of the body it is merely a network of slender fibres, which give pliability and looseness. In other places it is more or less loaded with oil. The uses of the areolar structure are, to g ve form and symmetrical smoothness to the body by filling up the interstices, defend the various organs and parts against pressure, connect different parts so as to admit of some degree of sliding motion between them, and serve as a bed for more tender organs, as the eye. It also relieves the body, to some extent, of the immediate bad effects of excessive alimentation, by afford ing a reservoir for surplus animal fat. It is a common error to suppose AREOLAR TISSUE. 238 PHYSIOLOGY. that persons who increase in bulk after having attained maturity of growth, acquire more flesh . They are merely burdened with a useless load which should have been expelled as waste matter. The areolar structure is very readily regenerated when destroyed. The Muscular Tissue. — The muscular or fibrinous tissue is of a higher grade of organization. Physiologists ascribe to it the vital properties of contractility , irritability or excitability , and tonicity ; but to my mind, one term includes all the others. They are all merely expressions of the power of the muscular fibre to act, move, contract, upon the application of exciting causes. Muscles are said to be im- pressible to stimuli, and to contract when so impressed, by which mo- tion or action is produced. The term contractility seems to imply impressibility — the susceptibility to be acted on and the action itself. Irritability and excitability are but different names for this susceptibil- ity. Tonicity, by which physiologists mean the ability to maintain per- manently a certain degree of contractility, is certainly nothing but a greater or less degree of contractile energy. All the actions or motions of the various parts and organs are pro- duced by the contraction or shortening of these muscular fibres, of rather, their alternate contraction and expansion. Muscular contraction is accompanied with the production of souna and heat ; the sound is probably owing to the movement of the adja- cent fibres on each other, and the elevation of temperature is doubtless to be attributed to those chemical changes by which the disintegration and renewal of the tissue is effected. Fig. 123. In Fig. 123 are represented fragments of striped element* ary fibres, and showing a cleavage in opposite direc- tions. 1. Longitudinal cleav- age. 2, 3, 4. Transverse cleavage forming disks. 5. A detached disk, showing the primitive particles, called sarcous elements. 7, 8. Sep arated fibrillse, showing the beaded enlargements. An ordinary muscle consists of bundles of magnified fragments of muscular fibres. ... j fibres, arranged wuth great regularity in the direction of its action. Each individual fibre may be separated into fibrillse by the splitting of its contents in a longi THE TISSUES. 2S9 tudina direction ; these fibriJIse then present a banded appearance, caused by the arrangement of the contents of the tube. In structure muscular tissue is divided into striated (striped) and non-striated (unstriped) — the former being mainly appropriated to the voluntary functions, and the latter to the organic or involuntary. Func- tionally muscles are divided into voluntary and involuntary . The former contract in obedience to the will, and are the instruments by which the mind acts on external objects. Their fibres are arranged in parallel lines, and are connected together by areolar substance. Those of in- voluntary motion are more simple in their structure and arrangement than those under the influence of the will. Their fibres are disposed in layers, generally transverse or diagonal, with distinct parallel lines continually interlacing. In this way they form circular rings around the cavities of the circulating vessels, as the arteries, veins, absorbents, excretory ducts, and hollow viscera, as the stomach, bowels, uteruf, and bladder, constituting one of their coats or coverings, which, by contracting, diminishes the calibre or cavity in length and diameter; and thus their contents are moved forward or expelled. The muscular tissue is not reproduced when once destroyed, but the loss is supplied by areolar substance, which is wholly insensible. The Nervous Tissue. — The nervous is the highest order of organ- ized matter. Though sensibility, or feeling, is its only property we can call vital, its immediate relation to mind causes it to manifest varied and wonderful powers. The nervous substance is the medium through which all impressions are received from the external world, and througli which the mind conveys its mandates to the voluntary muscles. All motions, changes, or functional actions which are performed by the muscles, depend on the power, energy, or influence transmitted to the muscular tissue from the nerves. The nervous structure is composed cf a white or fibrous matter, which in the nervous trunks is tubular, with a secondary deposit within the cavity of the tube ; and a gray or vesicular substance found in the ganglions. Wherever these two kinds of nervous matter are united together they constitute a nervous centre . The ultimate nerve-fibre is tubular, consisting of an external thin and delicate membrane, which forms a sheath, and isolates the contain- ed matter in its whole course from its central to its peripheral extrem- ity. This has been called the tubular membrane , within which is con- tained a more opake substance, called the white substance of Schwann ; and within this white substance is a tjansparent material, called th* 240 PHYSIOLOGY pressions on the sensitive nerves are not propagated to the sensoriu»i from below, but are from above the injured point. The spinal cord is divided into two lateral halves, and each of these into an anterior, middle, and posterior column, corresponding 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 origin in the gray matter of the spinal cord. These fibres are supposed to form a distinct nervous circle, and they constitute the system to which those actions are due, called reflex. All spasmodic or convulsive movement® of the body are considered examples of extreme reflex action ; the producing causes of them may be seated in the spinal cord itself, then called centric irri- tation , or at a distance, the irritation of which is transmitted to tha 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 (he 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 centrifugal 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 gray matter in the centre of the 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 I, We 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 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 capucity, 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 limited. The object of these convolutions is to afford an extensive surface for the gray or vesicular matter which generates the nervous power, and a more free communication between the blood-vessels on one side, which supply the materials of nervous 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 th© mental organs are double, as are also the sentient and motor nerves, which convey impres- sions to and from them. All physiologists agree 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 thirty-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 are created with reference to the circumstances 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 where 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 nervous influence to the muscles of locomotion, seems to be established from experiments on animals. When the organ was removed, although sensibility in any part was never destroyed, 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, bo 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 pow \v of directing the mind \o particular sensorial impressions. Philosophy cf Mind. — The brain is the presiding centre of sensa 24S THE TISSUES. fion, voluntary motion, the intejectua 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 powers may be distinguished into facul- ties and propensities. The faculties together constitute the intellect. They are the pow- ers concerned in thought the formation 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 trace out their relations of cause and effect. The perceptive faculties are the func- tions of the observing organs ; the reflective 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 clairvoyance. When the faculties have discerned the object, or ascertained the manner of satisfying the impulse or propensity, the will determines its instru- 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 circle, 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 happiness >onsists in rifht feeling ; (hindng is but a means 246 PHYSIOLOGY. to it. The healthful exercise of all the mental powers is the perfect condition of right feeling ; and the normal play of all the bodily func- tions is indispensable to this healthful exercise of the mental powers. x t 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 nature of that power, principle, or influence, which endows the nervous tissue with its pecu- liar 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 instrument; but this doctrine was abandoned on discovering that the nerves, instead of being attached firmly at their extremities, are diffused into a soft, pulpy mass. The prevalent opinion now is, that the source of nervous power is some modification of electricity. The identity, however, of the nervous influence with electricity, galvanism, or magnetism, as manifested by any structure 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 currents remains. In the present state of physiological science, therefore, we can only say that the nervous influence, the sensibility of the nervous tissue, the contractility of the muscular, and the elasticity of the areolar, are each vital properties peculiar to, and developed in, the organization of the structures 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, etc. ; 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 influence 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 demonstrated 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 nervous 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 contraction and expansion of the muscular fibres — analogous to electrical attraction and repulsion in inorganic matter — not as de- pending on two principles of influence, or on one principle alternately bestowed and withdrawn, 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 their structure and arrangement are so different that its operation is more difficultly traced. Instead of running 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 Df the mental nervous system, known as dreams, somnambulism, second sight, mesmerism, clairvoyance, etc., deserve a passing notice The sum total of these pheuomeua has been called 248 PHYSI0L0G7. mesmerism, pathetism, electrical psychology, or electro -biology, etc, The fact that the mind can and does take cognizance of things — some- times real and sometimes imaginary — while in the state or condition termed mesmeric, which it cannot and does not in its ordinary state or condition, is unquestionak e. 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 are in the ordinary functional condition, the mind will have a larger field of perceptions, a greater capacity to form ideas, whether correctly or incorrectly. If the brain and nervous system maintain, by any unusual internal or external exciting cause, the normally active condition, while the external or special senses are 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 are under the abnormal influence which preternaturally augments their functions, while the external senses are not merely in a state of normal repose, but of profound and preternatural rest — abnormally insuscepti- ble — then the objects at a very great distance, or in a direction which could not be seen, felt, heard, 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 mesmerizee or clairvoyant is directed to places, objects, and persons at great distances, hundreds or thousands of miles, when 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 may render the cognizance of r II E 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 mam festation of the phenomena in question, and others are capable of ac quiring a great degree of mesmeric susceptibility, so much so as to pass into the clairvoyant 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 those effects on the nervous influence which have been made available as remedial pro- cesses in disease, may all be accounted for 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, jy 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 scarf-skin ; others are connected by an intermediate substance, as bone uid cartilage ; and others are united in rows, forming hollow tubes, capillary vessels, and the tubuli of nerves and muscles. The first distinct structure 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 controlling instruments over all the functions of nutrition and growth. 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 are numerously distributed throughout the body, according to the importance and complexity of the functions to which they specially 250 PHYSIOLOGY. appertain. They serve undoubtedly to collect, direct, rr odify, regulate, and adapt 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 enlarging 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 particular organs, to which they hold the same relation that the brain does to the voluntary muscles. The ganglia which form the subordinate centres 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 brains, 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 great centre 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 from one to the other, which form the solar plexus. To this general centre the numerous special centres are united by nervous cords and plexuses. Death takes place the functions of this system of nerves be suspended but for a moment. With the increasing formation of the ganglionic centre the alimentary organs are developed ; the stomach, intestines, pancreas, etc., followed by the excretory organs, the liver, kidneys, and skin. Lastly are de- veloped the lungs, spleen, brain, and spinal marrow, the membranes, bones, ligaments, and cartilages, terminating in the hair, nails, and epidermis, CHAPTER II. OF THE SPECIAL SENSES. Sensation is the recognition by the mind of an impression. That part of th3 brain, or rathe: quality, which perceives impressions is often THE SPECIAL SENSES. 251 calW 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 lave 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 are the posterior roots of the spinal nerves, and some fibres of the fifth and eighth pairs c cerebral nerves. They are distributed to the 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 papillae of the palm of the hand, the cuticle being removed. Fig. 126. CUTANEOUS PAPILiliJE. 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 attributed 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 weight are but degrees of extension and resistance, and temperature, whether its essential nature 252 P.'IYSIOL. GY. is caloric, light, or electricity, is but the perception of rays or particles coming in contact with the sensory surface, and expanding or contract- ing, that is to say, moving the contractile tissues so as to impress the nervous papillae. 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- tributed. The epidermis is also very thin in those parts, and the innumerable lines and furrows afford the papillae a greater degree of isolation. The development of the sense corresponds with the number and extent of these lines and furrows. The sense of touch, like all the special senses, may be educated to a surprising degree of acuteness and accuracy, as with the blind, who have been taught to read and even distinguish colors by it. Sense or 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, are supposed to be concerned in the common sensibility or feeling of the tongue, and the remainder are regarded 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, will 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 ©rally 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 direct us in the selection of alimentary substances, and assists us in judging of their adaptation to the wants of the nutritive apparatus. The ability to appreciate and enjoy the gustatory property of natural and healthful food is exactly proportioned to the integrity of the sense ; and those persons who cannot realize any agreeable savor in any article of nutriment until the papillae of the tongue are stung into action by salt, pepper, mustard, vinegar, or other pungents, know .but little of the bountiful and luxurious repast nature has pro- vided for her unsophisticated children, or of the real pleasures of eat- ing. Like the drunkard, who swallows the burning poison of alcohol THE SPECIAL SENSES. 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 mucous 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 olfactory region, to which the olfactory nerve is distributed. Sneezing, which is called a reflex action, is supposed 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 sense 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 strong 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 are 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 from all directions. The external meatus conveys them, strengthened by reflection from the walls of the canal, and modified by the resonance of the mass it encloses, to the membrana tympani. This membrane is not essential to sound, for its perforation or destruction 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 bones, moved by their muscles, conducts the vil. rations across the tympanum the internal ear . The tensor tympc.ni. i*» the 22 £54 PHYSIOLOGY. function of hearing, performs au office analogous to that of the iris in seeing. Its contractio n draws down the handle of the malleus, render- ing the membrana tympani tense. When very tense it cannot recipro- cate loiv sounds, and by very loud sounds it may be excited to reflection, in which state the membrane is too tense to reciprocate them. Its natural condition is rather lax, the state in which it can reciprocate the greatest variety of sounds. The tensor tympani muscle contracts more powerfully as the sound is louder, as the iris does upon the application of the stimulus o^ light. The tympanum isolates the chain of bones, and allows free motion to the membrane at each of its extremities, while its contained air rever- berates the sound, which is still further strengthened and modified by reflection from the neighboring walls, cells, spaces, and cavities, par ticularly by the reflection from the membrane of the fenestra ovalis and fenestra rotunda . The Eustachian tube serves principally to maintain an equilibrium between the external air and that enclosed in the tympanum, by which undue tension of the membrana tympani is prevented. The uses of the different parts of the labyrinth are not well under- stood. It is supposed that the semicircular canals regulate the per- ception of the direction of sounds, while the cochlea determines the pitch of the notes. The duid contained in the membranous portion of the labyrinth, and the e&r-stones, otoconites , which float in it, doubt- less increase the impression on the sentient nerves by being thrown into vibratory motions, while this part of the labyrinth itself affords a more extended surface for the expansion of the auditory nerve. Philosophy of Sound. — The whole complex structure of the au- ditory apparatus has reference to two principles : the propagation of sonorous vibrations, and their multiplication by resonance. In some of the lower animals the perception of sound takes place by means of a very simple contrivance, consisting essentially of a sac containing a fluid, and having a nerve spread out upon it ; the membrana tympani, ossicula, cochlea, and semicircular canals being absent. Sounds are said to be propagated by reciprocation, by resonance , and by conduction. An example of the first method is found in two strings of equal tension, placed side by side ; if the one be thrown into vibra- tion, the other will reciprocate by making corresponding vibrations. Resonance occurs when a sounding body is placed in connection with any other, of which one or more parts may be thrown into reciprocal vibrations, although the tone of the whole be different, or if the medium be incapable of producing any tone at all. Thus, if a tuning-fork, while vibrating, be placed in contact with a sounding-board the latter will di- THE SPECIAL SENSES. 255 ride itself, as it were, into a number of parts, each of which will recip- rocate the original sound so as greatly to increase its intensity. Sounds of conduction are propagated through all bodies, solids being better conductors than fluids, and fluids more conductive than gases. If the ear be placed at one extremity of a log or a long board, and the other end be struck, the sound will extend along or through the whole length of the material, and be perceived by the organ. A more definite idea of sound may be obtained from the familiar illustration of the common church bell. When the tongue, a, strikes the side at 5, it springs out to c, changing entirely the form of the bell, which is represented by the dotted line. When the bell springs back to its original form, its sides retract and expand in an opposite direction, as a vibrating string rebounds beyond its centre, or starting point ; and so alternately, making a succes- sion of sonorous waves of air, as a stone thrown into a pool causes circular rings to expand in all directions. When these movements of the air become sensible to the ear, we have the perception of sound. The primitive sounds of the musical scale are derived from the different forces or kinds of vibration. Thus, when a bell is struck, the first full, loud sound is the fundamental or key note. When the force of the blow is partially spent, there is a different degree of mo- tion, producing a different force of atmospheric vibration, and occasion- ing a modified perception of sound ; and when the vibrations have decreased still further in intensity, a third primitive sound is rec- ognized. A musical chord is the combined sound of several sounds produced simultaneously. When the effort is pleasant to the ear, these chords are called concords ; and when unpleasant, discords. The most pleas- ing concords are produced when the greatest number of vibrations in a given time occur together ; and the most disagreeable discords, when the fewest vibrations take place simultaneously. A good idea of concord may be gathered from the following illus- tration : On counting the waved lines, it will be found that every third vibration of the sound represented by the upper line, and every sec- ond vibration of the sound represented by the under line, come together, the conjunction being denoted by the dotted cross-lines According to the greater of Fig. 128. AvvjWwfv^A /jWVjWvy^ 250 PHYSIOLOGY. less frequency of these coincident vibrations, are the sounds concord- ant or discordant. The most agreeable concord is, of course, that where every vibration of one sound and every other vibration of an- other sound come together. The Sense of Sight. — Vision makes us acquainted with the exist- ence of light, by which medium the mind recognizes the form, size, color, position, etc., of bodies that transmit or reflect it. The roots of the optic nerves unite, before Entering the orbits, into intimate junctions, called chiasms from ihese chiasms they diverge and enter the orbit through the optic foiamina, part of the fibres of each passing to the opposite eye, a part being connecting or commisu- ral, and the remainder passing to the eye of the same side. This arrangement seems to associate the two eyes in a single act of vision, although most physiologists regard the single vision with two eyes as a result of the rays of light from a luminous object falling upon parts of the retinae accustomed to Fi S- 129 - act together. 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 two retinae, p. Pos- terior fibres, commisural between the thalami, or origin of the optic nerves, a! pJ Diagram of the OPTIC CHIASM. preceding. The essential parts 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 sup- port to the globe, and is opake, except in front, where it becoir s transparent for the admission of the rays of light, and is called corn? i The dark pigment called choroid , between the sclerotic and retina, ab- sorbs the rays of light after they have impressed the retina. The choroid becomes gradually lighter 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 central perforation is the pupil. The contrac- tion and relaxation of the circular fibres surrounding the orifice of the pupil, as the rays of light are stronger or weaker, regulate the impres- sion on the nervous expansion. When the iris becomes insensible or weakened, the pupil remains permanently dilated and vision dull, a» VOICE AND SPEECH. 25 * an affections of the optic nerve, compression of the brain, etc. The iris 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 re±.jurkably contracted ; and also during the stage of excitement, when the brain is jaboring under the influence of the stimulating narcotics, 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 af habit or education, while others suppose the perception of a distinct image, whether the object be far 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 from the opposite points of a luminous object cross one another by the successive refractions 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, l£ps, 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 capable of uttering words and sentences very distinctly. £58 PHYSIOLOGY A! the vowels are voice-sounds, being made without any change in the shape or position of the vocal organs during their continuance. Short vowel sounds are distinguished from those termed long , broad , 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 rudi mental sounds, or elements, sixteen of which are vowels and twenty- eight consonants. The vowel elements are : the long , short, broad, and grave sounds of a, as in ail, at, all, ah ; 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 ow, 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 ad ieu, which is pro- nounced as if written ad u. 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 came ; the name sound of z, as in suffice ; 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 germ ; the hard or guttural sound of g, as in gull ; the sound of g represented by zli, as in rouge ; the aspirate or name sound of h, as in hale ; the name sound of l , as in late ; the name sound of m , as in man ; the name sound of n, as in nun ; the sound of n represented by ng, as in link ; the name sound of p, as in page ; the smooth sound of r, as in far ; the trilled sound of r, as in rough , the name sound of w, as in wool ; the sound of x, represented by ks , as in flax; the sound of x, represented by gz, 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 suund of ch, as in church . In a strictly philosophically written language, each distinct element- ary sound should bo represented by a distinct character, making as many VOICE AND SPEECH 259 letters as there are vocal and articulate elements. But in the English language there are 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 instru- ments, in which 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 mto approaching parallelism with each other by the approximation of the points of the arytenoid oartilages ; in the intervals they are again separated, and the opening between them, rima glottidis , assumes the form of the letter V. Fig. 130 exhibits the vocal ligaments as seen superiorly. G, E, H. Thyroid cartilage. N, F. Arytenoid cartilages. S, V, S, V. Vocal cords or ligaments. N, X. Crico-arytenoideus lateralis. V. k, f. Right thyro-arytenoideus. N, 1, N, l. Crico-arytenoidei 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 respira- tion. These muscles are the seat of spasmodic affections producing suffocation. The pitch of the tones is regulated by the tension of the vocal cords. Its volume or intensity 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 are longer than m the female, in the proportion of three to two, which renders the male voice usually an octave lower Fig. 130. £60 PHYSIOLOGY The natural compass of voice in most persons 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 t_ie vocal cords, all of which are producible at pleasure, and without a greater variation of the length of the cords than one fifth of an inch. One of the most wonderful phenomena of vitality is the facility 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 ivcll-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 complete 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 extraordinary 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, nutrition, secretion, and calorification. Some physiologists regard innervation , or the production of nervous influence, and that property of the tissues called endosmose and exos- mose , by which fluids and gases are interchanged through the 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 other functions. Endosmosis and exosmosis are rather mechanical than vital processes, as they take place in unorganized as well as organized structures. THE INDIVIDUAL FUNCTIONS. 261 F>ig. 131. is an ideal represent- ation of the organs of digestion, opened nearly the whole length. L. Upper jaw. 2. Lower jaw. 3. Tongue. 4. Roof of the mouth. 5. (Esophagus. 6. 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 veying the bile to the duode num (13, 13). 14. Pancreas. 15, 15, 15, 15. Small intestine. 16. Opening of the small into 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 ali- mentary matter into chyle, which in its turn is converted into blood. The first process of the digestive function is mas- tication , by which the food is divided into fine particles by the cutting and grinding 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- Fig 131. THE DIGESTIVE SYSTEM. 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 receive a greater supply of blood, and there is a slight increase of temperature. The solvent property of the gastric juice was generally conjee* ired, bt:t sometimes denied, unti/ 262 PHYSIOLOGY. cl-early 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 introduce 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 agree 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 which 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 saline, 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 gastric juice is called pep sine ; its action is analogous to that 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 irritation. Chymification is that part of the digestive process in which the nutri- 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 facility, to be expelled as excrementitious matter. Hence the fallacy cf the doctrine lately advanced by Dr. Edward Johnson in his works on Hydropathy, and +y some other European authors, that the foeces were wholly a secre- tion, an error which must have originated from observations made on THE IN DI V1DU FUNCTIONS. 263 persons whose diet consisted almost wholly of animal and concentrated vegetable food. In the duodenum the alimentary substance receives the pancreatii juice from the pancreas., and is there also mixed with the bile from 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 nature and uses of the bile. Some physiologists regard it as in part a vital secretion, and in some way auxiliary 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 circumstance 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 innutritious 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 from it without pass- ing into the intestinal tube. When digestible solid and liquid alimentf are taken into the stomach together, the aqueous portion is absorbed before tfte 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 absorbed, and pass unchanged into the circu 264 PHYSIOLOGY iation. This is the case with metallic, mineral, and many earthy, alka line, and saline matters, with all medical drugs, with alcohol in all its forms, tobacco, and with many articles employed as seasonings or con- diments. Chylification 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 therefore 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 mass ; nor does the functional action of these vessels perfect or complete the process of chylification. The finishing elaboration takes place in the mesenteric glands, numerously distributed along the course of the lacteals, and formed by their enlargement 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 ol 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 effected by the reversed action of the muscular fibres, aided by the sympathetic and powerful contraction of the abdominal muscles. Hunger and thirst , the sensations of which are referred 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 comprises the heart as its grand central organ ; the arteries , which convey the blood to all parts of the body ; fhe capillaries , which connect the arteries and veins • and the veins , which return the blood to the heart. Commencing at the central point, the blood is received from aL parts of the venous system into the right auricle of the heart ; the auri- TIIE INDIVIDUAL FUNCTIONS. 266 cle contracts, and the blood is forced into the right ventricle ; the right ventricle, contracting, sends it into the pulmonary artery ; this artery divides into branches, which are ramified through the substance of the lungs , and bring the blood in contact with their innumerable air cells, where it throws off its surplus carbon, 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 heart ; from 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 the heart preventing the cur- rent from receding. The whole quantity of blood is estimated at about one fifth of the entire weight 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 — gradually 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 ventricles corresponds witl^the projection of blood into the arteries, causing the pulse . The apex of the heart, being near the walls of the chest, in the neighbor- hood 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 frogit 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 impu.se 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 cu tlets of the m 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 pulmonary artery. The capillary vessels are a network of extremely minute vessels intermediate between the arteries and veins. This structure exists i? all organic textures. The size of the capillaries is proportioned to that of the red particles of the blood, their diameters varying from ~ to ~ of an inch. They are not a distinct system terminating in open mouths, but merely fine tubes by which the arteries are continued ipto the veins. Fig. 132. Fig- 132 represents the anastomoses of the blood-vessels, which form the capillaries, as seen in the web of a frog’s foot by the aid of the microscope. 1, 1. The veins. 2, % 2. The arteries. In the capillary vessels all the organic functions take place. Their circulation 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 functio;-al process, and distrib* te the blood to the va- rious parts and organs, according to the necessities of the vital economy. The sum of the diameters of all the capillary vessels greatly exceeds THE INDIVIDUAL FUNCTIONS. 267 that of the arteries and veins, which enables the blood in them to move slowly, and even sometimes take a retrograde 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 effete 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 constantly 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 wo except ammonia, a of nitrogen and carbon, which appears to be ordinarily present in the proportion of one fourth of a grain 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 from 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 be 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 is found to exist already formed in the veins, and as animals placed in hydrogen or nitrogen still continue i 3 lYSIOLOttl. <368 to evolve carbonic acid, it appears clear enough tnat the greater part, if not all, of the carbonic acid gas expelled from the lungs is formed in the tissues , thus leaving the greater 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 decarbonization 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 ^n the blood as oxygen, but is rather a process of aeriform digestion, by which oxygen is converted into electricity, analogous to the process of alimentary digestion, by which food is converted into chyle. The nitrogen, which forms so large a proportion of the air we 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 organic economy, and probably is regulated by the sufficient, excessive, or deficient supply of the nitrogenous principle of the food. The precise chemical process by which the change of the color of the blood is effected in the lungs, is still an unsolved problem. It has generally been imputed to the presence of iron. Liebig supposes iron to exist in the form of a carbonate of the protoxide in venous blood ; and that in the lungs the carbonic acid is given off, leaving the protoxide, which, by union with half an equivalent of oxygen, is converted into the peroxide, and that this peroxide changes the venous blood into ar- terial. Liebig’s theory, however ingenious it may be, has been dis- proved by Mulder, who has shown that the color is retained when all the iron is removed. Respiration occurs in aquatic animals which do not breathe air. In them the respiratory organs are membranes prolonged externally into tufts or fringes, called gills, each one of which is supplied with arteries and veins, during the circulation of blood through which aeration is effected. In air-breathing animals the membrane .is or aerating surface is re- flected internally, forming passages or chambers \n which the air is re- ceived, and on which the capillary vessels are distributed. Insects have a series of tubes ramifying through the whole body, and carrying air to every part. In the human lungs the sides or walls of the air cells are formed of a thin transparent membrane, and the capillary vessels are placed be- tween the walls of two adjacent cells, so as to be exposed to the action of the air on both sides. The number of the air cells of the whole ,ungs is imn7>ense. M. Rochoux has estimatel them at six hundred millions. THE INDIVIDUAL FUNCTIONS. 2&J Fig. 133 represents the bronchial tube, and its di- vision into air cells, as much magnified. 1. A bronchial tube. 2, 2, 2 Air cells, or vesicles. 3. A bronchial tube and vest cles laid open. The capacity of the lungs varies greatly in different individ- uals. M. Bourgery concludes from his inquiries that the development of the air cells continues up to the age of thirty, at which time the respiratory capacity is greatest. Accord- ing to the experiments of Mr. Coathupe, about 2 66 £ cubic feet of ais pass through the lungs of a middle-sized man in twenty-four hours. At the average number of sixteen inspirations per minute, the amount of air received at each inspiration would be twenty cubic inches. Mr Hutchinson judges the capacity of the lungs by “ the quantity of air which an individual can force out of the chest by the greatest voluntary expiration after the greatest voluntary inspiration.” Dr. Southwood Smith, from a series of experiments, estimates the volume of air re- ceived at an ordinary inspiration at one pint, the volume ordinarily present in the lungs at about twelve pints, and the volume expelled at an ordinary expiration at a little less than a pint. He also concludes that in the mutual action which takes place between the air and blood, the air loses thirty-seven ounces of oxygen and the blood fourteen ounces of carbon every twenty-four hours. The lightness of the lungs depends on the residuary air they contain, and when the lungs have been once inflated by a full inspiration, no force or mechanical power can again dislodge the air sufficiently to make them sink in water. It is this residuary air which supports life a few minutes in cases of suf- focation, immersion, etc. The movements of the respiratory apparatus are partly voluntary, for the purposes of being subservient to voice and speech, and partly involuntary, for the purposes of aeration. The lungs themselves are entirely passive in respiration. When the walls of the chest are drawn asunder, and the thorax dilated, the external air rushes in to the air cells, distending them in proportion to the dilatation of the thorax, and keeping the surface of the lungs all the while accurately in contact with the walls of the chest in all their movements. But if air be ad- mitted into *he cavity of the pleura outside of the tings, as by a pene Fig. 133. 270 PHYSIOLOGY fcrating wound of the thorax, the lungs cannot be fully distended by in- spiration, but will lomain partially collapsed, although the thorax ex- pands, because the pressure of air from without the air cells balances that within. The diaphragm, by extending the rrjs, and pressing down the. ab dominal viscera, is the principal agent in inspiration ; in a deep inspira- tion the intercosta, muscles assist in the expansion of the chest by spreading the ribs, aided also, to some extent, by the muscles of the thorax generally. Expiration is mainly accomplished by the abdominal muscles, whose contraction draws down the ribs and compresses the viscera up against the relaxed diaphragm, thus diminishing the cavity of the thorax from below. Fig. 134. Fig. l 34 is a side view of the chest and abdo- men in respiration. 1. Cavity of the chest. 2. Cavity of the abdomen. 3. Line of direction for the diaphragm when relaxed in expiration. 4. Line of direction when contracted in inspiration. 5, 6. Position of the front walls of the chest and abdomen in inspiration. 7, 8. Their position in expiration. The connection of the respiratory function with sensibility, or the sense of feeling, is an interesting and as yet almost unoccupied field of inquiry. According to the experience of drown- ing persons — those who have remained from one to several minutes under water without breathing, and afterward been resuscitated — there is no pain after the complete suspension of res- piration. Although intellectual con- sciousness remains, and mental con- ceptions are greatly exalted and intens- ified, all sensations of mere bodily suf- fering are absent. The anesthetic effects of ether and chloroform appear to bear a close relation to the extent to which the breathing is sus- pended. A complete unconsciousness to pain is attended with an ex- tern ely feeble and sometimes almost imperceptible respiration. ACTION OF THE DIAPHRAGM. Absorption. — The absorbent system proper comprises two sets of vessels witi ‘heir glandular enlargements and convolutions — the lac* THE INDIVIDUAL FUNCTIONS. 271 teals and the lymphatics* The lacteals convey nutritive or new matter into the mass of blood, to replenish the tissues ; the lymphatics tak6 up and return to the blood the surplus nutrient materials, and also old or waste particles, in order that they may be used in the secretions, or got rid of at the excretory outlets. The function of the lacteals is called exle nal absorption, or the absorption of composition ; that of the lymphatics is called internal absorption , or the absorption of decomposi- tion . External absorption also includes the absorption which takes place from the surface of the body and mucous membrane of the res- piratory passages, as well as that performed by the proper lacteal ves- sels from the mucous surface of the alimentary canal. Internal ab- sorption, sometimes called interstitial, also comprehends that which Likes place from the component tissues of the organs, and the interior of short sacs, as well as that performed in the capillary vessels. The veins belonging to the external division also act the part of ab- sorbent vessels, but in a very different manner from the lacteals or lymphatics ; these vessels exercise a selecting and transmuting power over the elements subjected to their action; hence the chyle and lymph are always found to possess nearly the same general properties. On the contrary, the veins imbibe and carry along unaltered all fluids or substances possessing the proper degree of tenuity to move in the current of circulation. It is well known that many poisons, alcohol, tobacco, the virus of venomous reptiles, etc., exert a much more del- eterious effect when injected into the areolar tissue under the skin, than when taken into the stomach. In the former case they pass directly, unchanged, into the circulation ; in the latter event they are modified, and more or less decomposed by the action of the absorbent vessels before entering the general system. Alimentary absorption is effected mostly in the small intestines. The lacteals com- mence by villi in the mucous surface, each tube beginning in a single villus by r a closed extremity ; the trunk arising from each villus is formed by the confluence of a number of smaller branches, which anastomose freely with each other in the form of loops, as in fig. 135, never commencing in open extremi- ties. These loops are embedded in a mass of cells at the extremity of each villus ; these cells exercise the selec ing or transmuting power over the nutritive dements when full their contents are yielded 272 PH YSIOLOG *. to the absorbent vessels, either by a process of deliquescence or Durst ing, their place being supplied by fresh cells, and so the process is con tinued till the nutritive material is exhausted ; after which the villi, previously turgid, becomes flaccid, and the epithelium, which was re moved during the process of absorption, is renewed ; the lacteal vessels then become the interstitial absorbent vessels of the intestinal canal and act the part of lymphatics. Fig. 136 is a diagram of the mucous membrane during digestion and the preparation of chyle, a. A villu§, turgid and erect ; its protective epithelium cast oft' from its free extremity; its absorbent vessels, lacteals, and blood-vessels turgid, b. A follicle dis- charging its epithelial cells. Fig. 137 is a representation of the same mucous membrane when chylification is not going on. o. Protective epithelium of a villus, b. Secreting epithelium of a follicle, c, c, c. Primary membrane, with its germinal spots, or nuclei, d, d. e. Germs of absorb- ent vesicles. /. Vessels and lacteals of villus. The chyle in the lacteals is almost invariably of the same chemical composition, however diversified the character of the food from which it is formed. It is not, however, ah* ays of the same vital quality ; for that which is made of animal food, when taken from the body, under- goes putrefaction much sooner — in three or four days — while that which is selected from vegetable food resists decomposition out of the living organs for several weeks. Its milky color depends on the presence of minute corpuscles, called chyle globules. Usually it contains fatty, albuminous, fibrinous, and saline matters, in varying quantities, accord- ing to the ingesta. The lymphatics exhibit no essential anatomical difference in origin, structure, or arrangement from the lacteals. They are distributed Fig. 136. Fig. 19? CHYLIFICATION. LYMPHATIC ABSORPTION. THE INDIVIDUAL FUNCTIONS. 4/3 throughout almost every part of the body, and very numerously upon the skin. The lymph, an almost colorless fluid, which tne lymphatics convey to the thoracic duct, very closely resembles the chyle, the main differ- ence consisting in the color of the latter. Its source is a matter of conjecture. Dr. Carpenter supposes the matters absorbed by the lymphatics to consist of the residual fluid, which, having escaped from the blood-vessels into the tissues for their nutrition, is now returned to the former. Probably they also contain a portion of the decayed and worn-out particles of the structures. The lymph, like the chyle, con- tains peculiar self-coagulating corpuscles, and both fluids contain the same ingredients, though in different proportions, for the organic ele- ments are much more abundant in the chyle. The glandular laboratories, through which the laeteals pass, are the ganglia of the mesentery ; and those of the lymph-vessels are the lymphatic glands. In these ganglia both fluids are doubtless still fur- ther changed, elaborated, and fitted for circulation, nutrition, or expul- sion. That these ganglia exercise a supervisory function over the economy of nutrition, acting as sentinels to prevent the introduction of an enemy into the vital domain, is evinced by the fact that when any foreign, injurious, or poisonous element gains admission into the ab- sorbent vessels, whose presence in the general circulation would be immediately dangerous to life, these glands, in the language of some physiologists, “take on inflammation” to arrest its progress. In less ambiguous phrase, the glandular follicles contract their diameters, ob- struct the passage, attract an additional supply of blood, and thus hold the aggressor in check until the reinforcement of vital power can so change, modify, or destroy the invading foe, that its elements may pass along with impunity or with greatly diminished danger to the organism. The extremities of the veins are tie principal absorbents for taking up the really effete and decomposed matters of the decaying tissues, as well as the accidental impurities of the body ; although the lymphatics sometimes take up excrementitious matters, as bile, pus, venereal and other virus brought in contact with them. Absorption from the skin has been called accidental , because the fluids pass in by simple imbibition. The rapidity of this absorption is mainly influenced by the condition of the blood-vessels, being most active when they are most empty, and least so when they are full. When the epidermis is removed, as by a blister, he external' integument absorbs with great rapidity. Frequent bathing followed by friction, increases its absorbing powers. 274 PHYSIOLOGY. Absorption by imbibition is effected by both veins and lymphatics. In the mucous membrane of the lungs and stomach, the thin fluids are taken up by the veins, and it may be stated as a general law of the ab- sorbent system, that wherever a thin fluid is placed in contact with an extended surface, it will be taken up by those vessels which present the largest surface and the thinnest walls. It is difficult, however, to explain the absorption of fluids from serous cavities on the principle of imbibition alone. Probably the most clear and correct general view of the function qJ? absorption may be presented in the following summary : The venous extremities, acting as absorbent vessels, take up the greater portion of useless, injurious, or worn-out matters ; the lymphatic vessels return the unused or surplus recrementitious matters, and also serve as auxil- iary vessels, or special provisions to guard against obstructions when the functions of the veins are overtasked or imperfectly performed. The elements of the blood in the capillary system are exhaled through the coats of the vessels, and there undergo certain chemico-vita' changes. Such elements as are needed to repair the waste, and buiL up the structures of the body, are assimilated and become a component part of the body ; other elements are separated, and so re-combined as to form the secretions, and waste particles are carried back into the cir- culation to be changed or thrown off. If the processes of alimentation and exhalation overdo those of ab- sorption and depuration, accumulation takes place in the cellular mem- brane or serous cavities, of adipose or watery matter, and obstruction exists in the form of corpulency or dropsy. Hence obesity is as truly an abnormal or diseased state as dropsy. Nutrition.— Nutrition, more properly termed assimilation, is the actual accretion of the alimentary matter to the organism — the comple- tion of the class of nutritive functions. The food, masticated and insal- ivated in the mouth, acted upon by the gastric juice in the stomach, and the pancreatic juice in the duodenum, still further elaborated in its passage through the lacteals and mesenteric glands, and finally oxygen- ated in the lungs, is not yet fitted for nutrition. The nutrient process is not accomplished until the alimentary matter is subjected to the finishing action of the capillary vessels. It is here converted into the congenial elements of the several structures, becoming a component part of their substance. Though the arterial blood supplies the nutrient material to every part and structure :>f the body, yet this blood does not contain all the proyimrte elements of the body as such . For example, gelatin, whicfc THE INDIVIDUAL FUNCTIONS. 275 enters so largely into the composition of the animal structures, is never found in the blood in the state of gelatin. This shows again the power of the living organism not only to decompose and recompose the ele- ments of sustenance, but even to transmute one substance, which chemistry regards as a simple element into 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, ns 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 matter to their ultimate elements, or to a certa : n set of ultimate results or 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 ingredients, dissolved in water may be decomposed by an electric stream. 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 forms, 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 polarized, 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 nu- 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, as well as to energize the involuntary muscles, in the performance of this function. Were animals, like vegetables, “fixed to one peculiar spot,” and thf r sr 1rTT fov-ctional economy “to draw nutrition, propagate, 276 PHYSIOLOGY. and rot,” there would be no necessity for either a motory, 3r 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 embonpoint of persons who are called “high livers,” though indicative of excessive alimentation, denotes defective rather thin excessive nutrition When the whole body is loaded with fatty accumulations, assimilation is never as perfect, nor the structures as firm, round, and elastic, nor the body as powerful and enduring, nor as capable of sustaining depletion and prolonged fasting, as in a moder- ately lean condition of the system. In those abnormal growths called hypertrophy, there is an actual in- crease of substance identical with the hypertrophed 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 struc- ture is greater than the waste ; in the latter the waste is greater than the replacement. Cancerous and fungous growths proceed by a similar process of cell- development to that of the original structures, but from some disturbing cause, the nutrient 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 illustration of the law by which the primary atoms are arranged in the building op of the tissues, as represented in the u it. Fig. 138. In Fig. 138, A represents the blood- corpuscles as seen on their flat sur- face and edge. B. Congeries of blood- corpuscles in columns. In coagulat- ing, the corpuscles apply themselves to each other, so as to reseml'le piles of money. OOmrUSCTTLES OF THE BLOOr © Though the blood is the im- mediate source of all nutrition, many structures, as the ten- ions and ligaments, do not re- ceive red blood. The coloring THE INDIVIDUAL FUNCTIONS. 277 matter which surrounds the corpuscles, therefore, is not essential to the nutritive 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 human blood in living and in dead bodies. | Fibrin, ^ Albumen, > Ii solution, forming Liquoi Sanguinis. Salts, S Corpuscles, — Suspended in Liquor Sanguinis. Fibrin, Corpuscles, Albumen, Salts, Secretion. — Secretion literally means separation ; but the process by which a new substance is produced by a re-arrangement of the elementary matters contained in the blood is one of formation. Secre- tion, therefore, is not the separation but the production of a proximate element from the blood. Each organ or structure secretes or forms its own peculiar fluid, serving some special purpose in the animal economy. The mucus and serous fluids poured out on the surfaces 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 exhales a bland, slimy fluid, called mucus. This mucus serves to moisten and lubricate their surfaces, facilitate the passage of crude matters, and protect them a gainst the action of acrid and irritating 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, from which secretes or exhales a thin w T atery 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 fceces. Some of the excrementitious secretions are made subservient to organic purposes, as the bile and ear-wax ; and some of the organs secrete a nutrient and expel an effete material af the same time, as the 'ungs and skin. Crassamentum, or clot. In solution, forming serum. Living Blood. DeaJ Blood. m PHY SIOLOGY. There are three forms of secreting organs. The simplest form is that of the animal membrane, which is abundantly supplied with blood-vessels, and cov- ered with an epithelium, as the serous and synovia] 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 efferent 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 excretory duct. The cells, as in the case of nutrition, 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 glandulee 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 putrescent elements of the foeces ; the follicles of Lieberkiihn , 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 cateum and rectum, producing slight elevations on their surfaces ; the glands of Duvergny and Nabothi , in the vagina and cervix of the uterus in the female ; and the glands of Cowper and the prostate, in the male, The tonsils also are considered as a collection of lubricating mucous follicles- 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 ceruminous, 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 proper perspirable matter . The sweat glands have been estimated by Mr. E. Wilson at about seven millions. As their secretion is usually evaporated as fast as formed, most of the perspirable matter passes off in the form of in- sensible perspiration. Perspiration is sensibU \nly when excessive, or Fig. 139. GLANDULAR SECRETION. 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 odorous 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 axillary 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 has more fancy than fact about it. The glandular secretions are the lachrymal , or tears, from the lach- rymal gland, which lubricates and cleanses the conjunctiva; the sali- vary, formed by the parotid , submaxillary, sublingual , and pancreatic glands ; the bile, found in the liver ; the urine , found in the !cidneys ; the spermatic secretion of the testes, and the mammary 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 foetal 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 great extent, though the lungs and liver, skin and kidneys, most intimately reciprocate in functional duty. The lungs and liver are the special depurating organs for the surplus carbon and hydrogen; the skin and kidneys for the nitrogenous products of decomposition ; and the bowels throw off the more complex proximate elements Df waste matters and foecal secretions. The depurating as well as nutrient function of the lungs has already been considered. The skin is not only a cleansing organ, but, like the lungs, a breathing 280 PHYSIOLOGY. organ ; for it really absorbs oxygen, and throws ofF carbonic acid gas Next to the lungs the skin is the most extensive as well as important detergent structure of the body. The amount of solid matter eliminated from the body through this emunctory is, on the average, about 100 grains per day. The amount of fluid thrown off is more variable, de- pending on external temperature, quantity of drink, activity of the kidneys, etc. The estimates of the transpiration from the cutaneous and pulmonary surface in twenty-four hours are from If lb. to 5 lbs., nearly three fourths of this amount passing from the skin. The liver 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 extremities. Liebig has fabricated a singularly inconsistent hypothesis, which has satisfied himself and all others who are satisfied to echo his arguments without taking the trouble to examine th un, that the bi-le is a nutritive 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 nutritive 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 nitrogenous element of the taurine of the bile ! Such reasoning is extremely absurd, and the error is a most palpable one. It consists in mistaking a waste material for an aliment; a depurating process for a nutritive one. As well might one mistake putrid flesh for wholesome food, because it contains carburetted hydro- gen, which is also found in the fceces, or excrementitious matters of the bowels. The kidneys eliminate from the system a large proportion of effete saline, alkaline, and earthy particles, and tlie greatest portion of the surplus nitrogen. The average amount of urine excreted in twenty- four hours has been estimated at from thirty to forty ounces. Of course it depends greatly 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 with considerat le accuracy b* tb# TIIE INDIVIDUAL FUNCTIONS. 281 amount of urea in the urine ; a test, however, of no practical value in treating diseases. The “brick dust” sediment, “chalky deposits,” and “albuminous” appearance of urine, are dependent to a very great extent on the char- acter and purity of the food and drink. The long-continued employ- ment of what are very absurdly called “medicated waters,” containing carbonates of lime, soda, iron, and magnesia, chloride of soda, sulphates of lime and magnesia, muriate of lime, sulphur, sulphuretted hydrogen, iodine, hydriodates of soda and potash, etc., as well as all very hard and impure water, is a common cause of gravel, stone, calculous con- cretions, etc., and a prolific source of diseases of the kidneys and bladder. The total suspension of the urinary secretion is attended with rapidly fatal results, the patient manifesting symptoms like those produced by narcotic poisons. The bowels are the emunctories for such innutritious portions of the food as do not pass into the circulation, and are not taken up by the lymphatics or venous extremities, and carried to other depurating organs ; and also such waste and worn out particles as are secreted in the form of foeces. The quantity and character of the dejections de- pend much on the nature of the ingesta. As the contents of the ali- mentary canal pass along, their fluid portion is gradually withdrawn, and they acquire a firmer consistence ; they also become more fcecal in character as the putrescent elements of the blood are secreted by the various glandules along the intestinal tract. Calorification. — Many speculations have been indulged by chem- ists and physiologists, in relation to the production of animal heat. Since the publication of Liebig’s elaborate work on Organic Chemistry, the notion has become generally prevalent among the scientific circles, and from them it has been promulgated among the non-scientific people, that the production of animal heat is a mere chemical process, the lungs serving as a stove or fire-place, and the carbonaceous sub- stances of the food serving as fuel “to be burned in the lungs.” Accord- ing to this theory, fatty substances, animal oils, and other matters con- taining a large proportion of carbon, are not only useful but absolutely necessary to keep up the requisite degree of animal temperature. The position seems to me as almost self-evidently absurd, and it has certainly led many persons into the most egregious blunders practically, and at the expense, too, of their own common sense and common ob- servation. All the organic functions of tbs body — ta* vital processes — are in 2S2 PHYSIOLOGY. one sense chemical. They are not, however, such chemical decom- positions and re-combinations as are performed in a chemical laboratory They are not such as the chemist can ever demonstrate or imitate. They not only change the relative proportion of elementary matters but absolutely transmute elements into each other, reduce several of what we call elements to one, and separate one into several. All the chemico-vital processes — respiration, digestion, circulation, secretion etc. — are attended with the elimination of heat; in other words, latent caloric becomes sensible by these changes of matter. But all the organs, by virtue of their own specially presiding centres of nervous influence, are, to some extent, self-regulating in their temperature, while the entire body possesses a general self-regulating power. The principal organ whose function serves as a universal regulator and equalizer of animal temperature, is the skin. When in vigorous and healthy condition it throws off the surplus heat, or retains the deficient, according to the necessities of the organism. There is no need of a fire an»d boilers to warm up the blood, as the water is heated by the machinery of a steam-engine, and for this simple reason I think nature has not provided them. The error lies here. Liebig and his followers have mistaken an excrementitious or cleansing process for a nutritive or supplying one. They have misconceived the function by which the body rids itself of waste matters, and called it a useful and indispensable condition of vitality. They have supposed the chemical process by which nature throws off the effete carbon through the lungs to be a method of fur- nishing animal heat. This, I think, can easily be made manifest. According to the theory of animal heat I am controverting, fat, suet, tallow, lard, marrow, grease, butter, blubber, and fixed oils, should con- stitute healthful food ; and such is, indeed, the conclusion of Liebig’s followers. But fthe common experience of all mankind is against it. Common observation says that these articles, though to some extent sufferable, are not strictly wholesome ; and further, medical men gen- erally disallow these articles to their patients when they are very much reduced with disease, at the same that the animal temperature is very tow, and requires such food, if ever. Again, corpulent persons, who are surcharged with carbon, do not bear cold better than lean persons, who have little ; in fact they are, other circumstances being equal, more sensitive to it. But if fate and oils are useful as fuel for the pulmonary warming- pan, because of their larger proportion of carbon, alcohol would be oseful in the same way, on exactly the same principle. Accordingly, strange as it may seem, we find Pereira, in his able chemical work on THE INDIVIDUAL FUNCTIONS. 283 Food and Diet, adopting alcohol as an alimentary principle ! Alcohol an aliment, a food, a nutritive material! Can any thing be more ridiculous ? Now alcohol contains more carbon than most kinds of animal or veg- etable food, except animal oils or fats ; and, in the chemical theory we are considering, ought to be just as useful as an “ element of respira- tion;” and so by a single vagary of modern science we are thrown back to the errors of four thousand years ago. Pereira says : “ Alco- hol, therefore, is a fuel in tho animal economy, and by its oxidation in the lungs, must evolve caloric, and serve to support the temperature of the body.” Now let us hear his argument: “Alcohol is an element of respiration. Common experience favors this view. Coachmen and others take it in cold weather to keep them warm, and it is fami- liarly used to prevent what is commonly called 4 catching cold.’ In cases of extreme suffering and exhaustion from excessive exertion and privation of food, the cautious and moderate dietetical use of spirit has / on many occasions, proved invaluable. In Captain Bligh’s account of the sufferings of himself and companions, in consequence of the mutiny of the crew of the Bounty (in the South Seas, in 1787-9), he observes : 4 The little rum we had was of great service ; when our nights were particularly distressing, I generally served a teaspoonful or two to each person, and it was joyful tidings when they heard of my intentions.’ ” Here the pernicious effects of a positive poison are mistaken for the useful results of natural aliment! As long ago as 1787, the opinion was generally entertained that “a little rum” was a sort of elixir vitae, warming the body when cold, cooling it when hot, drying it when wet, and wetting it when dry, as well as sustaining it when famished, and regulating it when full. More enlightened observation has discarded these absurdities, and it is to be regretted that they should be revived again by medical philosophers. Though Pereira asserts and tries to prove the utility of alcohol in the animal economy, he allows it is injurious at the same time, thus involving his theory in still greater confusion. He says : 44 Though alcohol evolves heat in burning [in the lungs], it is an obnoxious fuel.” Does not this admission prove that the heat evolved by the use of alcohol is simply the result of the effort of the organism to get rid of it ? This would be the heat of fever or inflammation ; a heat much more calculated to wear out and prematurely exhaust the animal economy than to support it. And this view, I venture to say, is confirmed by all human experience. Moreover, against Pereira’s far-brought testimony in favor of the 284 PHYSIOLOGY. dietetic use of rum, we can quote any amount of controverting evidence Liebig himself admits that “the development of boat in the body, after the use of wine, increases without the manifestation of a correspond- ing amount of mechanical force. A moderate quantity of wine in women and children unaccustomed to its use, produces a diminution of the force necessary for voluntary motions. Weariness , feebleness in the limbs , and drowsiness, plainly show that the force available for mechanical purposes, in other words, the change of matter, has been diminished.” Rev. Mr. Scoresby testified before a committee of the British House of Commons, in 1834 : “ My principal experience has been in severely cold climates, and there it is observable that there is a very pernicious effect rn the reaction after the use of ardent spirits. In the case of a storm, or other sudden difficulty, I should most deci- dedly prefer the water-drinkers to those who were under the influence of any stimulant .” Sir John Ross testifies that : “ Having in the Arctic regions, in his own person, experienced the beneficial effects of abstaining wholly from spirituous drinks, he proposed to his men that they should try the same experiment, which was done with the most gratifying results. When men under hard and steady labor are given their usual allowance of grog, they become languid and faint, losing their strength in reality, while they attribute that to the contin- uance of their fatiguing exertions. He who will make the correspond- ing experiments on two equal boat’s crews, running in a heavy sea, will soon be convinced that the water-drinkers will far outdo the others.” Dr. Rush says : “ The temporary warmth produced by spiritous liquors is always succeeded by increased chilliness, rendering the body still more liable to be affected and injured by cold.” These authorities could be extended, but we have already enough for our purpose. All the facts we can find which bear at all on this subject, go to prove most indubitably that alcohol is in every sense exactly the opposite of an “element of respiration.” It is indeed a “fuel in the animal economy,” in the same sense in which any accidental combusti- ble substance creates a flame which burns our dwelling-house to the ground. The whole argument, pro and con , will apply equally to animal fats and oils, with this qualification. Greasy matters, though composed mostly of waste, useless, and excrementitious materials, which have accumulated in the cellular repository, because the process of aliment- ation was increased beyond that of elimination, are not strictly poisonous. They contain doubtless a very small quantity, yet very impure quality of substances convertible into nutriment. But, as food, they are to b* *e garded as next to venous blood in grossness and impurity. THE INDIVIDUAL FUNCTIONS. 285 They contain about eighty per cent, of carbon ; hence, when freely taken into the system, the lungs, as the principal excretory organ for effete carbon, has an additional duty to perform in throwing it off. This increased labor is, as a matter of course, attended with an in- creased temperature of the body, simply because there is a greater amount of matter than is natural or necessary to be disposed of. But this, as in the case of alcohol, is an extraneous, 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 organism 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 cancerous ulcerations, with evidences of bad blood, torpid brains, and glandular obstructions, clearly traceable to this habit, and curable by its discontinuance. The principal injurious effect, therefore, of animal oils and fats is not from their large quantity of carbon, but from their intrinsically impure char- acter. In all pure, Healthful, and natural 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 flesli-meat of animals, contain exactly the right proportions of carbon in their composition for perfect nutrition, respiration, and animal heat, however much their 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 lungs should be so obnoxious to the stomach, unless nature has made a very great blunder? The whole theory of a respiratory alimentary principle seems to me preposterous in the extreme. It is further urged, in favor of this wild conclusion from a false start- ing 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 £86 PHYSIOLOGY well as enormous quantities of flesh or fish, as they can catch it; and simply 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 very 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 tribes of men whose dietetic habits are similar, are a very inferior race, and in them nothing is developed scarcely, save the mere animal nature ; hence their 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 theory of the combustion of carbon in the lungs sufficiently to heat up tho 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 are good digestion, free respiration, vigorous circulation, proper assimilation, and perfect depu- ration, in two words — good health . The ordinary temperature of the human body ranges from 98° to 100° Fahr., varying but very few’ degrees aboye or below when the surrounding 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 tbe bare skin covered with varnish, the temperature instantly falls. Endosm^se and Exosmose. — Dutrochet discovered and Liebig has demonstrated certain facts in region to the interchange of dissim- ilar fluids in different parts of tbs anima structures, which facts to* TEMPERAMENTS. 287 gether have been called the laws of endosmosis and exosmosis. Accord- ing to a principle of these laws, whenever any animal membrane has one of its surfaces in contact with a different fluid, an interchange 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 imbibition , and is applied to the current 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 fluidfl must be of different densities , and that there must also be an affinity between 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 to the treatment of diseases, especially in cleansing the body from drug-medicines and other impurities, circum- stances which will be noticed more particularly in the therapeutic department of this work. Note. — T he reproductive function will be considered in Pari VIIL CHAPTER V. OF TEMPERAMENTS. 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- tinction based on the supposed preponderance of some one of the faui 288 PHYSIOLOGY elements — air, water, fire, and earth. Various 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 or mental temperament, existing when the cranium is most capacious, the sanguine when the chest is large, and the lymphatic when the abdomen 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 active temperaments ; the bilious and lymphatic are the inirri- table or torpid temperaments. The former dispose to more rapid motion and greater activity, with less power of endurance ; the latter are less easily excited to action, but more powerful and enduring. The former enjoy or suffer with the greatest 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. Fig. 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 anfi muscles, and generally delicate features, as represented in fig. 140. The Sanguine Temperament. — T he sanguine, or arterial tem- TEMPERAMENTS. 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. Fig. 143. NIJle’VS TEMPERAMENT. LYMPHATIC TEMPERAMENT. Bilious Temperament. — The bilious, sometimes called nervous temperament, is produced by the structural preponderance of th© 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 krge development of the abdominal viscera, particularly the digestive organs tt 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 «g. 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 — 25 290 PHYSIOLOGY. rod cheeks, thin flesh, light hair, and blue eyes, indicate 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 dark complexion, denote a combination nearly equal between the bilious and lymphatic. CHAPTER VI. RACES OF MEN. The division of the human fhmily 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 development of men, and the improvement and advancement of humanity. A classification of mankind into leading 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 are more or less prominent. The division of Blumenbach, who makes five principal races, is as useful and satisfactoiy as any other can be. These are named the Caucasian, Mongolian , Ethivpic, American, and Malay . Fig. 144 . The Caucasian Race. — The Caucasian race is remarkable for the highest physiological develop- ment, personal symmetry and beau- ty, and intellectual attainments. The fhief families of this race are the Caucasians proper, and Xh&Gcrman- ic, CtJic, Arabian, Libyan , Nilotic , and Hindostanic branches. In this race the skin is generally fair, the hair fine and long, and of various colors, tne skull iarge, round- ed, and oval, and the forehead broad Caucasian race or prominent, large and elevated RACES OF MEN, 291 The face is relatively small 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 hair, with a superiority of intellectual and moral power, love of the arts, science, and poetry. The progress of the human family seems to be made wholly through this race. The Mongolian Race. — The Mongolian l* 5 * variety includes the Mongol Tartars , Turks , and the Chinese and Polar tribes, which in- habit a vast extent of the earth’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 broad and flat, the skull ob- long, but flattened so as to give it a square appearance, and the forehead low. In moral development this race is decidedly Mongolian race. 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 the Islanders of the Indian Archipelago and the Pacific Ocean , constitute the principal families of the Ethiopic or black 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 ethiopac or black race. $92 PHYSIOLOGY. show, but very 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 this race have exhibited respect able talent. The American Race. — The Indian tribes , or “ Re a men,” who once occupied originally nearly the whole of North and South America , south of the sixtieth 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 tiie back part flat, large mouth, hard, rough features, with fine, straight, symmetrical frames. They are averse to cultivation, and slow in acquiring knowledge, sedate, proud, restless, sly, revengeful, fond of war, and wholly destitute of maritime adventure, and are rapidly disappearing from the earth*before the all-conquering march of the Caucasian. 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 dark brown skins, coarse, black hair, large mouth, broad, short noses, seeming as if broken at the root, projecting upper jaws, and protruding 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- men’s Land Fig. 148. Fig. 147. MALAY RACE RACES OF MEN. 292 If the opinion is correct that the stronger 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 order of nature. Origin or the Races. — Whether de 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 they 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 th‘13 question furnish any reason why the more powerful race should maltreat the more feeble. I admit that the process of extermination 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 finady 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 striving 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 faithfully executed, without our special interference. As far as the feebler races are capable of development arc improvement, they are entitle’ 294 PH r S10L0GY. to the same consideration as those who are more highly endowed in organization. Thbory of Population. — Philosophers have not yet been able tf 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 extraordinary counteracting causes be interposed. On this assumption, u 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. Malthus 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 first clause of his proposi- tion by adverting to the fact that poor folks have the most children, and the latter part by quoting the well-known historical data, that wealthy and luxurious families frequently run out, as have done wealthy and luxurious nations. The doctrines 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 warred 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 permitted evils, let us pause long before we 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 etarve, could healthfully sustain one hundred millions, and the soil of the U aited States is capable of producing l^iore than food enough fo* il! tiie inhabitants now existing on the globe. PART III. HYGIENE. Tiye 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 , temperature , 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 structure 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 derangement, which, indeed, constitutes ninety-nine- hundredtlis 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, ofi the absurd notion of “keeping up the vital powers till nature has timt to rally and others deal out “a little homeopathy” ever and anon. I am most thoroughly convinced that all of these “auxiliaries” are un- necessary; me ?t of their much worse than useless. Their apparent 296 HYGIENE. necessity, I contend, has its source in the ignorance of the practitioner. He does not fully understand the philosophy of vitality, the intrinsic character of disease, nor the scope and power of these hygienic agen- cies, if he regards them as at fault 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 happen, 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 was 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 always 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 L OF AIR. Yital Property of Air. — The physiology of the respiratory function explains the relation of an abundant supply of pure fresh ail 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 principle of the atmosphere. Ca rbon, nitrogen, 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, v 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 respiration. In dry wells, deep vaults, and other situations where carbonic acid gas, or other irrespirable airs, are liable to accumulate, the introduction of a lighted taper is an important precaution. If the flame be extinguished, it would be dangerous to life to 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 found 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 thirty 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 Vimps 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 alo.ae the cause of injury resulting from large gatherings of people in >11- ventilated places, for the iiTespira.de 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 sull 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 welfare of their offspring, the monthly importation of Parisian cuts, turns, twists, fits and misfits, Would soon oe substituted by “ short dresses,” loose as well iis short, or something r the way of clothing that w i i emancipate the lungs 298 HYGIENE. Fig. 149. fMTURAL WAIST. Fig. 150. UNNATURAL WAIST. from oppression “most foul, strange, and unnat- ural.” A reform in female dress would not only set free the breathing apparatus, but would confer an incalculable benefit on the human 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 industrious females, and sending them rapidly to premature graves. 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 ease, 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 circumference of the body around the lungs, just in that ratio will she lessen the number of her days, provided she does not die of violence or disease, which is a hazard 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. 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, Set 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 Cor its ridiculrus appearance. AIR.* 298 The contrast appears still stronger 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. Suclf was the model of female beauty ere sacre rigious 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 ave 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, may have its source in ignorance. Few sanatory circumstances are less regarded than those nuisances which fill the air with noxious effluvia. I know of no reason why 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 southern 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-melting places, graveyards, etc., from which are con- stantly emanating stains of ;on 4 'agioi anil death. I do not bejieva Fig. 151. VENUS DE MEDICIS. aoo HYGIENE. 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 impossible for the lungs to be fully expanded in a very impure atmosphere, because the air passages, irritated by the extra- neous particles, spasmodically contract to keep them out. The conse- quence of this is, those persons who reside permanently in an atmos- phere charged with foreign ingredients or miasms, find their lungs continually contracting, unless this tendency is counteracted by a con- stant vocal or muscular exercise calculated to invig v ate the whole respiratory apparatus and expand the chest. Change of Air. — The remarkable benefits frequently experienced when the inhabitants of crowded, dusty cities rusticate in the country for a few days, or when 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 was in the change itself more than in the better quality of the country 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 best , 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 matters, thinks there is so much virtue in “ modifications of different atmospheric influences,” that a change from a better to a worse air is 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 their children, when laboring under hooping-cough, to the Cowgate, a filthy street, which runs at right angles under one of the largest 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 by 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 were foolish enouga to practice it! Positions anv Habii i affec tin Respiration. — Sedentary AIR. SOI 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 confined to their sanctums, are proverbially 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 very 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 muscles 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 trunk of the body bent forward, is extremely hurtful, by overstretch- ing the 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 places, 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 th© 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, peevish, and effeminate. 26 §02 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 the Air. — There is one method of purifying the air which is accessible to all persons in all places. 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 unable to walk out. Sleeping Rooms. — Sleeping rooms are generally miserably venti- lated. Air of a pure quality, and abundant in quantity, is much more important during our sleeping than in our 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 ajar, 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 ; ner should the sleeper incline toward the face, with the Bhoulders 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 great nuisance of America;” and there is no question that, as usually managed, they do actually vitiate all the air of the 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 the evening are so many methods of consuming AIR. 303 the oxygen, and rendering the air irrespirable, it is well to bear in mind that the amount of ventilation must have a due relation to the number of lights 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 impoitant. £n 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 east offended or incommoded. Yet such things are not uncommon in 3ur 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 the 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 street of the city, and if we go into the country 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 great emporium, it is gently intimated, “ Gentlemen are par- ticularly requested not to smoke on this side of the boat;” still it always 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 cars, a few persons who c&> m HYGIENE. not, or think they cannot, bear fresh air, when the 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- kition apply to all rooms and apartments alike, whether in dwelling- houses or traveling vehicles CHAPTER II OF LIGHT. Relation of Light to Organization —The hygienic import- ance of light is not sufficiently understood by the people, nor its reme- dial influence sufficiently regarded by physicians. Whether it be a distinct imponderable entity, a property of electricity, or something else, it would be idle here to speculate ; but it is certain that the light which this earth derives from the sun and the fixed stars, has a power- fully modifying influence on all the functions of its animal and vege- table kingdoms. Some plants thrive best when exposed to strong sunlight, others in a moderate light, an-d 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 are 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 luminous, 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 phosphorescent 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; but during the night this process is reversed, so that they absorb oxygen, and gife out carbon; hence it is injurious and even dangerous to sleep at night in a situation Which is closely surrounded with dense foliage, and not well ventilated. LIGHT 305 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 ancemia , or hypeemia , 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 influence. The tadpole, for example, in- stead of developing into the frog, either continues to grow 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- rooms and rear buildings where the sun never shines, and cellars and 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 with animals and vegetables in like circumstances, often run into deformities and monstrosities, not more reproachful, however, to those parents who propagate under such disadvantages, than disgraceful to that city, state, or national gov- ernment wdiich either compels or permits any class of its citizens to live in such abodes. These facts show us that ligl tfc , and an abundant supply of it, is in 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, scrofula, or consumption, are much less manageable in low, dark apartments. And it is notorious that, during the prevalence of epidemics, as the cholera, the shaded side :>f a narrxw stre )t invariably exhil its the greatest ratio of fatal cases. 806 HYGIENE. “ The observations of Dr. Edwards, on the influence of light in pro- moting the perfect development of animals, led him to conclude that in 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 air as a means calculated to restore healthy conformation to children affected with scrofula, whose deviations of form do not appear to be incurable.” Pereira says : 44 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 mental stimulus in melancholy, lowness of spirits, and despondency ‘ Sanatory Inferences. — The inferences deducible from the fore- going considerations are sufficiently obvious. All persons, in order to acquire and maintain the best condition of health and strength, should he 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 greatest 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 7 health, by frequent 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 surface by too much or too tight clothing, which evil such exposures in some degree would counteract. Dwelling-houses ought to be constructed with especial reference to iglit. 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, which collect in and around low grounds and dark places, is very great. DRINK. 307 The sudden exhilaration and invigoration experienced by the pent* ap 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 strength of the natural light as to the greater purity of the air. CHAPTER III. OF DRINK. Nature’s Beverage. — Nature has provided no other drink 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 structures. In animals provided with a stomach for receiving aliment, it is the medium by which the materials of nutrition 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 beverage 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 last half century. Dr. Lambe, of England, has very ably argued the negative of the first position named ; but the majority of dietetic writers 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, can be healthfully sustained and nourished without water-drinking. It is also certain that those who eat much animai food, use salt, spices, and greasy dishes freely, and who have to employ a large proportion of concentrated farinaceous substances — which is indeed, the general plan of the dietary system of civilized society — 508 YGIENE. require a large amount of water to carry off the saline particles atJ other impurities, and allay the artificial fever which they produce, In either case the thirst is the safe rule of practice. Quantity and 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 it. 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. Writers are too apt to deduce general inferences from individual peculiarities. What is precisely right for one person may be exactly wrong for another. If the dietetic and other voluntary habits of all people were strictly physiological, we could give them 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 necessary to employ as drink bears to the kind of food. Thus, in one hundred parts (rejecting fractions) water constitutes, of gum arabic 17 sugar-candy 10, arrow-root ]8, wheat 14, rye 16, oats 20, barley 13 maize 18, 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, fresh lean meat of beef, mutton, veal, pork, deer, chicken, and pigeon 74 to 78, cod, haddock, sole, carp, and trout 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 rising in the morning, and half an hour or an hour before meals Persons who take habitually a tumble* DRINK. 309 of pure water at Shose 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. There are many morbid conditions of the system in which it is advisable to drink freely, even at meals, and without regard to thirst, but these will be more appropriately considered hereafter. One rule. 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 of 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 appears 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 very cold. It is well known that in the hot season, particularly in our cities, many laborers die veiy 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 way. 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 drinking iced- water, as far 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 degree of fictitious thirst ; for example, baker’s bread, and butter, stale salted meat, as ham or cod- fish, old cheese, plum-puddi ig, etc. Of course such persons feel a necessity for drinking freely, and as iced-water 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 m 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 adc/tion to the bad diet just mentioned, add the poison of intoxicating drinks. In fact, very few die in consequence of 310 HYGIENE, Irinking 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 hard ciders and rough brandies to harsh rums and strong gins — is to weaken and paralyze the nerves of the stomach ; and when these exhausted nerves are suddenly chilled by a large draught of cold water, it is not wona *rful 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 from use and fellowship by the total abstinence soci- eties, I need not dwell upon. They are poisons, in every sense inim- ical to the human constitution ; in fact, deleterious to every organizea thing in existence, and are produced only from the decay, destruction, and decomposition of tbe products of organized matters. They d1 E. salt water, is adduced in evidence of the same natural instinct. But it should be remembered that domesticated animals have domesticated tastes, and that civilized horses, sheep, cattle, and hogs, are just aa liable to acquire depraved appetites as civilized men. I have known cows to break into the “ sap-bush” in maple-sugar districts, and drink themselves almost to death on syrup, yet no one would pretend that sugar, molasses, or treacle, was a natural food for cattle, except as it exists in the juices of vegetables. It should be observed, 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 truth 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 — the less the better . I do not suppose a very moderate quantity is harmful to any appreciable extent. ^ very little may be so diluted by the fluids of the stomach, and so readily 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, rigidity of the muscles, producing general irritation of the mucous membrane of the alimentary canal, and loading the circu- ating 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 to me quite clear that nature has put the saline as well as the acid and alkaline elements of our food together in exactly the right proportions, so that the w r ants of the organic economy do not require us to make any extraneous additions. Probably those who have never tried the experiment w r ou!d be sur prised to learn how easily the appetite for very salt food is overcome. Many persons, on restricting themselves to less han 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 5T 00 D. 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 phos- phate of lime , which is the 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 4T8, barley OT to 0*6, oats 0T6 to 0*6, rice 0*4, garlic IT, casein 6*0, milk 0*1975, blood 0*03, bones 45 to 56, muscular flesh 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 iron exist in the system, and the manner in which they are introduced, are entirely unknown ; and it is question- able whether they are in any degree natural constituents of alimentary substances. Aliments, 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 “ compound aliments ,” a name predicated on the mistaken notion that the alimentary principles were really simple 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 made subservient to his nutrition* Hence the obvious propriety of treating this branch of our sui ject under the general divisions of animal and vegetable food. §. Animal Food. — Animal substances yield the alimentary princi- ples called proteinaceous , gelatinous , and oleaginous , to which may be added the sugar of milk. They are derived from flesh, blood, bones, cartilages, ligaments, cellular tissue, viscera, milk, and eggs. All the species of animals which human pow'er and ingenuity have been able to grasp — beasts, birds, fishes, reptiles, and insects, and every viscus or structure of each animal — brain, lung, heart, stomach, in m HY GIENE. testine, kidneys, skin, etc., has been more or less employed as human aliment. In the more civilized countries the mammals — r eal cattle, sheep , and hogs , afford the principal supply of food ; the deer, raboit, hare, elk, moose, buffalo, and bear, belong to this class, and are used to some ex- tent in many countries. Even the horse, dog, cat, rat, and mouse, are common food among the Kalmuck Tartars and sc me other tribes of the human family. Of birds those principally ealen are the common fowl, turkey, goose, duck, partridge, woodcock, and pigeon, though a great 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 water 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-frcg are occasionally eaten, and the of vipers was once in repute as an analeptic or restorative diet for invalids. Of fishes our brooks, rivers, lakes, and oceans furnish an endless variety, from the whale of a hundred 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 crustaceous ; and the oyster, mussel, cockle, whelk, scallop, limpit , periwinkle, etc. — the mollusks. The best animal food is, beyond all peradventure, that derived from the herbivora — beef, mutton, etc- Those animals which derive their nourishment directly from the vegetable kingdom will oertainly afford a purer and more wholesome aliment than animals who subsist on other animals — 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, 1 need only express my abhorrence. Although swine flesh and grease, 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 eruptive 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 them. 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 341 But thd quality of the food derived from herbivorous animals may be greatly varied by circumstances. Very young or very old animals ore less healthful than young, nearly full-grown, or middle-aged. Ani- mals which have been excessively fattened, or stall-fed, and those which have been hard worked, are deteriorated as food ; and animals that have been “ slopped” with liquid preparations, the refuse matters of the kitchen, or the filthy excrements of distilleries, are very un- clean and unhealthful. 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 very 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. Tlie 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 nutriment from any solid food except 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 always be TcilU l a llopathically — begging pardon of my “old* m HYGIENE. school friends,’’ if I have any — that is, bled in such a manner as to empty the vessels as cleanly as possible, and never executed by stunning, pounding, wringing 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, putrescent, and unwholesome. Dr. Dunglison utters the following flat contradictions on the same page of 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- ary 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 is 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 during 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 may be healthful food , says Dr. Dungli- son. Of such thoughtless and senseless gabble is the great 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 stuff 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 off the blood, was founded on correct 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 this 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 the Christian teachers of the present day. The sausages sold in the si: Dps under the name o: black pudding FOOD. 843 fii €; made of pig’s blood mixed with fat, seasoned with aromatics, and inclosed in the prepared intestines. Brando and Schlossberger give the following proximate composition of muscular flesh: 100 Parts. Water. Albumen, or Fibrin. Gelatli. Nutritive 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 determined >>y a reference to the physiological principles already adverted to. The fatty matters, next to the blood, are the worst ali- mentary suostances ; 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 should qualify our manner of expressing it. The kidney, whose function is to elim- inate from the body a large proportion of its most putrescent 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 m selecting aliments from the animal kingdom, just so far does their value depreciate. The dietetic character of animal food is also affected by the manner nf cooking. It is to be preferred 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 well cooked. Broiling , on all accounts, m the best method of cooking all flesh-meat. Boiling, taking care to skim off any floakksg particles of oil, is better than roasting ; and this again is better than 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 absolute identity of the chemical elements of pure flesh and pure blood. Th^ analyses of Piny fair and Boeckmann give the following results: HYGIENE. 544 Roasted Elements. Ox Blood. Dry Beef Boasted Beef. Roasted Ve&l. 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, 21-39 21-37 ) 24-310 24-91 24-72 Ashes, 4-42 4-23 \ 100-00 100-00 100-000 100-00 100-00 The milk of the mammals, though an animal secretion, can hardly be called animal food, in strict 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 churning, the globules of fatty matter unite, and form butter ; the residue is called buttermilk ; it consists of casein, serum, or whey, and a very small quantity of butter. Skimmed milk very soon becomes acid and curdy. The admixture of an acid or rennet (which is the infusion of the 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 separation of coagula, which has been called zieger, bracotte , 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 yielded varies from fivt> 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 affected by the ingesta, or the genera) 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 poisoned 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 fmm the body. Nursing mothers have little idea how mucl disease., pain, and miser ~ they inflict on their little ones, nor how fr<* F 0 D D. 345 quently they commit infanticide, by taking irritating aliments and dnsks, and injurious drugs 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 3 n the well-being of the human race, as I hope to at- tempt in a future publication, I am certain there would be a sudden and very radical revolution ir. 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 innutritious, 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 nutrition, 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 exceptional cases from morbid conditions are not rules for healthy persons. Butter, as prepared for the table, is 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 nutritive, 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. Meked and cooked butter is, wherever found, a very deleterious aliment. Sweet 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 ar e7en unpleasant effects as an aliment. The fresh curd of milk is perfectly wholesome, and pot-cheese, when made of milk 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 things in existence. It is also on> of the most constipating arti< les to m HYGIENE. the bowels that ran be found. It is a common fancy among med- ical men, and a co amon whim among the people, that old, strong, rank cheese, though itself very indigestible, stimulates the stomach to digest other things ; hence almost all the medico-dietetical works quote the old adage : “ Cheese is a mity elf, digesting all things but itself.” There is more poetry than truth in the doggerel distich. Old cheese occasionally undergoes spontaneous decomposition, 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 flesh of birds affords the most wholesome form of animal food. All of the species of the feathered tribes in common 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 the hawk and owl , 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-fleshed birds — chicken, turkey, partridge, quail, etc. — are very nearly as nutritious and digestible as beef. Chicken flesh is called the “ least stimulating of animal foods” by medical writers, but I think Hie assertion is wholly gratuitous. The dark-fleshed birds, as game birds, grouse, robin, woodcock, snipe, etc., are less nutritive 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 fumet, and an aromatic, bitter taste, most sensible in the back. In this condition it is said to be ripe , or high, and is much esteemed as a luxury.” This “fumet,” so highly prized, is the stench of putrefaction, as is the “ cadaverous smell” of carnivorous birds. Prof. Dunglison eulogizes this fumet still more extravagantly : “The solubility of game, grouse, etc., is amazingly increased, as weM as the luxury of the repast , by keeping it until it has attained the requisite fumet; which indicates that incipient putrefaction is diminishing its cohesion.” The luxury of putrefying animal flesh sounds strangely 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 physiologists do not consult nature and common-sense more, and cooks a \d refectories less, in seeking for the facts and principles of hygiene. FOOD. 347 The aquatic birds, geese and lucks , a~e strong, rancid, and oily, and extremely unwholesome. Ti e canvas- jack is considered one of the greatest 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 immediately killed, a fever or general inflammation comes on, which frequently destroys them. Particular parts of certain birds have long been celebrated as “deli- cate morsels” by epicures ; as the brains 01 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 charcoal. 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 tlieii stomachs delicate or indelicate, eat “diseased” livers? The eggs of oviparous animals, when fresh and rare-boiled, 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 writer, Mr. Pearson, states that there are “instances of laboring people, 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 hard 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 appears to be as high authority among flesh-eaters as Hoyle is among chess-players, says, “ the livers are counted delica- cies.” Sir Hans also tells us that the callepee , or under part of the breast or belly, baked ; s reckoned the best piece. Moreover *48 HYGIENE. 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, or 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 their 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 tribes of the human family are universally in a state of extreme mental and bodily abjection. The explanation of this fact is found in the food upon which the animals which they eat 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 , whitefish , bass , blackfish , had- dock, whiting , sole , turbot, etc. Salmon , eels , herrings, pilchards, sprats, mackerel, 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 greatly 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 correct, it would afford another argument against the sanatory na- ture of the food ; for it appears to be a law of the animal kingdom that the rapidity of propagation increases 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, “What- soever hath no fins nor scales.” A law similar to that of Moses was made by Numa Pompibus for the Homans. In tropical climates many species of fish are absolutely poisonous, especially at particular seasons, producing, when eaten, violent itching, colic, burning heat in the throat FOOD. S40 nausea, giddiness, blindness, 3old 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, shrimps, and prawns, are those most genera 1 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'i 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, clants, scallops , cockles, and even snails, are eaten 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 affections 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 fattened the “ most famous and excellent” snails, 30 8oO HYGIENE each variety having a park to itself. He fed them upon a pap made of sweet wine, honey, and flour; “and under this diet,” says Dr Dunglison, “they became 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 grub-worm was in repute as a “ delicacy” in the days of Pliny. Locusts, grasshoppers , and some species of spiders , have been eaten. In South America centipedes are eaten. The Bra- zilian Indians are fond of the white 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 alimentary principles. Vegetable foods are found in the form of the seeds, fruits, roots, buds, 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 useful of hu- man aliments ; yet it would be difficult to decide which of these is most necessary, for the perfection of nutrition requires both. The seeds commonly employed are the cereal grains — wheat, oats, barley , rye , rice, maize or Indian corn, and jnillel ; the leguminous seeds — peas, beans, and lentils ; the cupuliferous seeds — chestnuts , etc. ; and the oily seeds or nuts — almonds, walnuts, hazel-nuts , butter - *iuts, filberts, cashew-nuts, cocoa-nuts, etc. The most common alimentary fruits are the drupaceous or stone fruits — peaches, nectarines , apricots , cherries, etc. ; the pomaceous fruits — apples, pears, quinces, etc. ; the baccate or berried fruits — currants , gooseberries , whortleberries, cranberries , grapes, elderberries, etc.; the aurantiaceous fruits — oranges , lemons, limes, citrons, shaddocks, etc. ; the curcubitaceous fruits, pepones, or gourds — cucumbers, melons squashes , pumpkins , etc. ; leguminous fruits, legumes, or pods — of the tamarind, bean, etc. ; the synochus fruits — figs, tomatoes, etc. ; the sorosis fruits — mulberies, pine- apples, etc. ; the etaeno 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 , shal - 'Ms, asparagus, etc. Leaves and 'eaf-stalks furnish us cabbage , spinach, cauliflower , broc m 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 exhausting exercise, etc. Colds are more frequently pro- duced by unequal temperature than by extremes of either heat or cold. Thus, when a part of the body usually covered with clothing is exposed to a strong draught of air, when 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 wearing 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 great 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 supply of nervous energy for the restoration of the motive powers. Those who are exposed to cold, pure, out-door air, may eat very in- temperately, as respects both quality and quantity, 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 whole muscular system relaxed, and the digestfvo powers proportionately enfeebled. EXERCISE, 867 Mean Temperatures. — The following table of mean temperatures has been compiled from meteorological registers : Places. | Latitude Mean Tempera- ture of several years. Mean Temperature of different Seasons. Mean Tempera ture of Win- ter. Spring. Sum- mer. Au tumr. Warm- est Month. Cold- est Month. O / o / O J o / o / © / New York 40.40 53.78 29.84 51.26 79.16 54.50 80.78 25.34 Philadelphia 39.56 53.42 32.18 51.44 73.94 56.48 77.00 32.72 Washington, D. C 38.53 55.56 36.80 53.83 75.90 56.59 79.13 34.66 Cincinnati 39.06 53.78 32.90 54.14 72.86 54.86 74.30 30.20 Charleston, S. C 32.47 60.18 51.09 66.73 80.89 67.55 82.81 49.43 Natchez, Miss 31.34 64.76 48.56 65.48 79.16 66.02 79.70 46 94 St. Augustine, FI 29.48 72.23 59.29 71.47 82.73 75.15 83.94 56.60 Vera Cruz 19.11 77.72 71.96 77.90 81.50 78 62 81.86 71.06 Havana 23.10 78.i 8 71.24 78.98 83.30 78 98 83.84 69.98 Barbadoes 13.10 79.03 76.07 79.00 81.00 80.00 91.00 65.0 Cumana • 10.27 81.86 80.24 83.66 82.04 80.24 84.38 79.16 Quebec, L. C 46.47 41.74 14.18 38.84 68.00 46.04 73.40 13.81 Eastport, Me 44.54 42.44 23.44 38.58 60.54 45.43 63.52 20.91 Nain, Labrador 57.08 26.42 0.60 23.90 48.38 33.44 51.80 11.20 Newport, R. I 41.30 51.02 33.82 46 87 68.70 53.83 71.46 32.14 Geneva 48.12 49.28 34.70 47.66 64.94 50.00 66,56 34 16 Paris 48.50 51.08 38.66 49.28 64.58 51.44 65.30 36.14 Florence 43.46 59.00 44.30 56.00 74.00 60.70 Rome 41.53 60.40 45.86 57.74 75.20 62.78 77.00 42.26 Madeira 32.37 64.56 59.50 62.20 69.33 67.23 Algiers 36.48 69.98 61.52 65.66 80-24 72.50 82 76 00.08 London 51.30 50.36 New Orleans 30. 69.01 St. Louis, Mo 38.46 55.86 Jamaica 80.06 CHAPTER VI. OF EXERCISE. Necessity for Exerise. — To secure the full and perfect develop- ment of the body, nature has implanted among the mental propensities a special organ of motion. The phrenological organ of “ mirthful ness.” 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 their 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- lormal condition of the organism. 868 HYGIENE. It is true that a variety of social circumstances may operate to pro- duce an indolent disposition of mind and inactive habit of body, as ex- treme poverty, excessive wealth, grinding 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 nurse and schoolmaster but little trouble in keeping them “out of the way;” but in after life their parents may find it somewhat troublesome 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 illustrated 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 parts of the muscular system which 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 strong arms and chests ; travelers, dancers, etc., are disproportionately developed in the muscles of the lower extremities; 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. Varieties of Exercise. — For hygienic purposes there are many exercises equally advantageous. All that is necessary is that ail parts of the body be actively and frequently exercised, within the bounds of not producing fatigue amounting to exhaustion ; that is to say, a degree of fatigue which is not readily recovered from on resting. All exercises, however, to secure their full benefit, should be coupled with an object of either utility or amusement, otherwise the mind is apt to labor adversely to the body. Occupation — some useful business pursuit, which reorires and hence secures attention and labor during sevens EXERCISE. 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 all physiologically regulated neighborhoods. Among the active exercises which may be beneficially resorted to as pastime, are walking , running , leaping , dancing . Box- ing and fencing are physiologically 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 potatoes , 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 and fishing are highly recommended by some hygienic writers, but the ideas of gormandizing, and the exhibitions of cruelty 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, sivinging , etc., they are rather to be 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 trouble 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 contrivance, but even this can be advantageously superseded Iv giving the child “the largest liberty” to exercise in its own way. Plenty of room, a smooth floor, and a plsntif.il supph' of any kind of “plaything* ; which m HYGIENE. are not dangei’ous — 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 Exercising. — In regain 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 breakfast 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 partially empty. Vigorous evening exercises are 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, bu; 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, manner of life, dietetic habits, etc. John Wesley, with an active nervous temperament, and a rigi lly-plain vegetable diet, could perform mental and buddy labors almost Herculean. SLEEP. 871 and slet p but four or five of the twenty-four hours ; while Daniei 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 vegetable food, requiring less vital ex- penditure to appropriate it, and exhausting the organic economy less in disposing of its waste or innutritious 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 gastric irritation, exciting the brain to feeble and disordered functional action. Individ- uals of very studious habits, and those whose labors 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 great longevity were long sleepers, averaging probably at least eight hours. The statute of nature appears to read : Retire soon after dark, and arise with 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, when the nights are longer, more sleep is icquired. 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 much more debilitating 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 of over-sleeping, even to tho extent of very considerably increasing the stupidity and imbecility of mind, and indolence and debfaty of body, naturally and necessarily consequent upon those habits. 872 HYGIENE. Sleeping after Meals. — Some persons are partial to tLe siesta , 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 propensity to sleep.” I regard it as perfectly certain that there is no such propensity in man, except when his full meal has been an improper one. If he has slept too little the night 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 tco 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 than the least of two evils when sufficient sleep is not had at night. 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 Pfusons. — It has long been a popular whim that females require more sleep than males, and many physio- logical reasons, as whimsical as the whim itself, have been offered in support of the notion. I know of no sound argument 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 aid 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 course those whose business or pleasure obliges them to retire at late or ir- regular 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 back, and assign as a reason that the stomach and otherbed and condensed from LONGEVITY. m the gaseous element 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, broaden, 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 demonstrate 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 die better part of valor,” and try harder 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 every thing, and enjoy as he goes along. Hence he is always pur- suing petty expedients for momentary pleasure, instead of seeking per- manent and substantial happiness ii following out the laws of hu 890 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 opposes all new creeds, or innovations upon established usages. So far as society, or thy world, or the human family is concerned, he is useless, or rather worse than useless. But let the same person be well instructed 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 straightway look forward to a better and higher destiny, forego many present temporary gratifications, discipline his mind for the more ‘mportant 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 will seek and find his highest happiness in some pursuit which will be conducive to the general good. Special Means Conducive to Longevity.- -In strict truth there are no special means for promoting health and attaining longevity, ex cept in the negative sens© — the avoidance of special errors. The gen eral adaptation of all the hygienic agencies to the particular circuir 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 grave, the proportions of the solid particles of the body are constantly gaining upon the fluids ; natural death resulting when, provided no disease intervenes, 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 mainly from the materials taken into the stomach as food and drink, it follows 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, obstructing food, and all extraneous earthy or saline ingredients accidentally mingled with our food and drink, or employed as condiments, must necessarily abridge the term of our existence. All the early historians agree that the primitive inhabitants of the earth were frugivorcus , subsisting mainly, if not wholly, on fruits. But if the primitive inhabitants employed as food roots, and tender leaver and plants as well as fruits, they still had a LON JJEYITT. 391 kind of aliment remarkably fluid and unconcentrated as compared with the dishes generally eaten at the present day. And if, further, they employed any of the cereal grains — as flouring-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 nutriment, is best adapted to sustain permanently the integrity of the organism, provided it contain also the requisite elements for prolonged nutrition. Those who employ a diet largely farinaceous — those who make bread “ the staff of life” in their dietetic system, reqmire 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 centuries, directly calculated to disorder the human body, and shorten the duration of its existence. Concentration, stimulation, 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. Another advantage in employing a large proportion of watery fruits and vegetables is, in supplying the system in this way 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 iirpregnated 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 matters, 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 ramifica- tions of vessels, and render the fibres rigid and friable. The depurat- ing organs have the £ '.notional ability to secrete and expel from the body the surp 1 -'* saliir' and earthy matters to a certain extent; but if m HYGIENE. they are taken into the system 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 that a stimulating, concentrated, and even constipating and obstructing regimen, may produce a rapid development of the body it may produce extraordinary precocity in mind or body, or both But it is a kind of development unfortunate for its possessor and for society. It is a process which makes the chk 1 a giant and the man a dwarf. It may produce manifestations of maturity at twelve, and symptoms of decay at twenty. Besides, it always and invariably dis- orders the individual ; and if, haplessfy, 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 little doubt, I 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 an^ respect obstructing — a condition which obviously complicates the dan gers and aggravates the sufferings of parturition. In fact, this subject has been amply and practically illustrated during the last seven or eight years in the city of New York, where nearly all the mothers and in- fants treated on the ordinary or allopathic system have experiences great suffering, and been “ doctored through” many diseases ; wliil> all, as far as I have any knowledge, treated hydropathically, 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 theory, and a theory for a system, and then turning the system into a hobby , has undertaken to show that all kinds of fools 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 notion wheat is the very worst article of food known ; the other grains are highly deleterious, while all kinds of “ fish, flesh, and fowl,” and even ardent spirits and tobacco , are healthful, because they contain scarcely any phosphate of lime or other earthy matters ! As a specimen 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 generally misapprehended or misapplied by the medi- cal profession : 44 The peasantry of those parts of Ireland where wheaten-br aad, o* LONGEVITY. 398 Any kind of grain food is scarcely ever tasted, but where potatoes, fish, turnips, greens, 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 same external conditions, fresh air and exercise, and much better clothing and lodging, are enjoyed by the English, they are more bony, rigid clumsy, and stupid than the Irish.” I think the fine flour , with the greater portion of beer, beef, \ and plum-pudding, accessible to the English peasantry, explain these phe- nomena perfectly. Occupation as Affecting Longevity. — The industrial relations of individuals, though important, are less so than domestic conditions and circupistances, 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 favorably 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 remarked 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 di£t, they generally employ the very worst. Hard water is usually drank, and, in this country particularly, stale salted meats, superfine flour, greasy compounds of all kinds, and butter and cheese, constitute the essentials of their dietary system ; fruits and the more water v 894 HYGIENE vegetables being regarded almost entirely in the light of luxuries o t 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 U 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 natural 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 country. 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, rear buildings, garrets, cellars, etc., circumstances which will always very materially abridge the period of existence. It is true 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’, nurses’, 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 fact that, in the United States, and indeed in almost any other countiy, perhaps In all, wages are sufficient to emancipate the laborers from the thralldom of capital in a very few years, if the “ toiling millions” would but make* a judicious application of their earnings. There are some occupations necessarily unwholesome, and requiring special precautions on the part of those who pursue them. Miller® LONGEVITY. m 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 every particle of paint or metallic matter from under the finger-nails. Gold-finders are 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 true 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 coffee, 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, rarely 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 profitably and regularly expended, se mis absolutely indispensable to its safety as we .1 as to the good of sock ty; a duty the neglect of which has cause; so many sons of we&thy m HYGIENE. parents, who were so mistaught as to look with contempt upon honest toil, to turn out debauchees and vagabonds. But intellectual pursuits, or avocatiois which severely tax the moral powers and higher propensities, do not seem tc be inimical to high health and great longevity, when followed with a consistent regard to general hygienic precepts. Dr. Madden, in his “Infirmities of Genius,” has given U3 tabular statements which go to show that those literary pursuits in which the imagination is vigorously 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 irregular 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 abuse of the body for the use of the mind, has expressed the absurd opinion that “ a high range of health is probably incompati- ble with 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 effect. But, however satisfied and gratified teachers and parents may be with the 44 highest prizes” won by haggard faces, contracted chests, gaunt abdo- mens, and dreamy slumbers, the true physiologist can only see, in the not distant future, sure- wasting consumption, hydra-headed dys- pepsia, crippling palsy, or nameless debility, as the probable consequence of this working of the machinery of mind out of all proportion to the bodily development; he must lament, while short-sighted friends rejoice at the prospect. PART IV DIETETICS. Preliminary Remarks. — All intelligent physicians of at'* schools 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, aa from different views as to what is expedient to attempt in practice. One remark of the author of the u 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 are 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 frequently 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. 1 do not know that it is practicable or possible, amid the prevailing ignorance and error, to sustain a hydropathic establishment, or an? 24 398 DIETETICS. otliei public institution, on a dietary system strictly physiological. A majority who are compelled to resort to the water-cures, of course, have been more or less mistauglit; 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 current 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 tljroat, the beef-steak is too dry to swallow without gravy, the bread will not go down smoothly without butter, 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 way 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 greatest 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 extreme view, but not an uncommon reality, and these circumstances may justify, if they do not compel, hydropathic tables to be, to some extent, compromises with custom. Many 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 effect a cure. But the evil is not wholly on the 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 establishments are merely “watering places,” the table being wholly on :ie ordinary hotel plan. Thero is, too, some DIETETIC CHARACTER OF MAN. 390 difficulty always attending the preparation 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 their 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 others 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 irig the habits and appetites of his patients* so as to induce them inteb ligently to love and permanently to practice “ the better way.” CHAPTER 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 abstract of the positions and evidences bearing on the general proposition. The Bible Evidence. — We learn from 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 was appointed in the fol- lowing words: “And God said, Behold, I have given you every her^ bearing soed, which is upon the fao3 of ai t-2 3 earth and every tre^ m DIETETICS. in the which is the fruit of a tree yielding seed ; to you it shall bx for meat.” Certainly nothing can be more clear and explicit than this declaration, that the vegetable kingdom is the ordained source of man’s 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 contrary ! Those who 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 moveth 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 green 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, clear of his polluting presence, saving only a single family to preserve the race from utter extinction; and if then Jehovah had seen fit to reaffirm His original 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 preda- 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 apon. Or even if man were 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 all ? The inferior races of men fhar and dread the superior ; in fact, for all practical purposes, the weake : are “ delivered” into the hands gist ; and a host of others who could be named. But all 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 evei 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 countries, who use no animal food at all. The greater portion of the inhabitants of Asia and Africa use but an insignificant trifle of animal food. The millions of Hindostan and China use so little animal food that it may be regarded as a seasoning rather than a substantial part 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 h'Un the Carnal ham Mountains, the Spaniards of Rio Saladc , in m 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 tnd 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 af 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. The Laplanders, Ostiacs, Samoides, Tungooses, Burats, Kamt- schatdales, and Esquimaux, in the north of Europe, Asia, and America; the inhabitants of Terra del Fuego, in Southern America; the people of Andeman’s Island in the Pacific, the natives of New Holland and Yan Diemen’s Land, and the Calmuck Tartars, all possess a low, de- formed, and demi-brutal organization; some of them are stunted and dwarfish, others are coarse, 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 degraded 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 all animal, while they will con- tend that a due admixture of animal and vegetable substances is the golden mean between the two extremes; and in support of this position we shall be referred to the well-fed of the Anglo-Saxon race, and partie 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 satisfactory, 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 society, numbering be- tween 600 and 700 adult members, 203 have abstained from all kind9 of flesh for upward of ten years; 153 for more than twenty years' HYDROPATHIC COOKERY. 117 91 for thirty years ; 29 for forty years ; and 85 have abstained the whole of their lives. These vegetarians belong indiscrirni lately to all trades and professions, and have, as a body, always a much higher and more is.niform standard of health than flesh-eaters under similar general 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 fewer 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 society, 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 vegetarians ; they all have children, none of whom have ever used animal food ; they 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 aware 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 Digestive 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 very 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 whole Water-Cure system; hence it ought to be well under stood both practitioner and patient 416 DIETETICS It may be stated as a general rule, that the greater die necessity foi a change of dietetic habits, the more will the individual suffer tempor- arily in making such change ; the worse the physiological condition produced by dietetic errors, the jnore 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 triumphs. All persons know aow 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 01 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 wreck 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 system 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 day or of several kinds at a meal, will fsel usually a great iense of weakness, or rathsr a disagreeable craving s.nd want of satis- HYDROPATHIC COOKERY. m 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 liis 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, acidity, etc., also, those accustomed to stimulating condiments, as pepper and mustard, generally find nearly all sorts of food to feel heavy 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-occur occasionally for months. 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 regimfen of individuals, we must, to be useful, have regard to what is possible in practice, as well as to what is true in theory. Our advice is sought by thousands who have not the means to carry out a well-regulated plan of vegetable diet; and a well-regulated mixed diet is far preferable, thei apeutically, to a very bad selection of vegetable food. At ordinary hotels and boarding-houses, the fruits and vegetables ore 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 amount of disease in the human boclr. Here, then, is a predicament- 420 DIETETICS. Many persons find it convenient or necessary to take their meals a! 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 — impurity ; 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 far, therefore, it is expedient for a Watt»Cure patient, who intends remaining at an establishment a few weeks, and then returning to his former boarding 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 majority 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, comparatively 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 drag-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 life 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 indoctrinated in the true science of life, we should make the best we can of unavoidable evils. W e can and should at once reject all the immense variety 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 very best articles and preparations. That patient or that individual whose a )pelite cannot be satisfied, as far as flesh, fish, and fowl are concerned on seven dishes pe: week, with a change for every HYDROPATHIC COOKERY. 421 da* 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. Beef-steak, 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 loo fatty. Mutton chops , prepared in the same 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. Slightly 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 fatty 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 times the quantity of cold boiled potatoes and water, no butter or grease 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, hare, 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 are more dry and unsavory Hian fl*sh without gravies. If a gravy is em- 36 PIETETICS. i2Z ployed, it should be made of wutei , milk, a little salt, and thickened with a little flour or meal. The barn-yard fowl is the best kind of domestic poultry. The turkey does not differ 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 etiual advantage, taking care to skim off the floating particles of oil whei cooked in either of the last two methods. j Eggs, rare-boiled, are admissible occasionally fhey 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. Poached 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 article need uot 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 dietary system, as far as relates to animal food, is to simplify as much 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 feverishness, 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 are fond of them, and I regard them as entirely harmless. Boiled milk is regarded by some as more suitable for dyspeptics. No doubt it will feel more agreeable in cases wherein raw milk produces 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. Several cases of poisoning from this cause ha 73 been lately reported in the newspapers. Bvctsi should always be as fresh as possible, but moderateh 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 breakfast and supper there is nothing better than bread and butter But 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 healthfulness. All pure and undepraved appetences, how- ever, are satisfied with 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- ground, 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 article when they do not spoil it with grease, or shortening. Many of the New England house wifes 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 wheaY?n 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 stiff 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 an 3 the hulls of corn ca: Mully separated* If ground at as DIETET1 03 424 ordinary flouring-mill, the mi]l-stones should be sharp, so as to cut th$ seeds into fine particles. If mashed by dull stones, the bran appears in flakes or scales. The meal should never be bolted. Great pains should be taken to procure a plump, sound article of grain, and families would do well to keep a hand-mill, and grind 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-mill will answer very well, although it usually makes the meal rather too coarse and uneven. Wheat-meal makes the very best un J eavened bread. New meal is to be wet with pure soft water — it is important that the water be pure ; then formed into veiy thin cakes, and well baked in an oven, stove, re- flector, or before the fire on a plate or board. Indian meal, managed in the same manner, makes an excellent bread. It may be made thicker than the wheat-meal cakes. It is called in this country, Johnny* cake, or hoe-cake . The fine Indian meal often found at groceries and provision stores, does not make good bread or cake ; it is, when cooked, heavy, sticky, and clammy, whereas the coarse is light, dry, and porous. Oatmeal may be prepared in the same way; it is more pleasant made 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 warm 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 epal 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 rye and Indian meals. 8. Equal parts of rye, Indian and wheat-meals. 9. Two parts of rye-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 Boft-boiied 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 moderately tart apples, pared, cored, and stewed x» HYDROPATHIC COOKERY. 425 baked. 6. Three or four parts wheat- meal to one of West India pumpkin, 01 marrow squash, or cream squash. A fair article of bread 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 »f boiled and pounded green corn. I am satisfied ♦hat 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 the methods of preparing bread-food now in use. For one I am greatly in favor of the combination of meal with roots and fruits ; and the few experiments I have been enabled to make in this line have satisfied me 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 fruits can not be advantageously employed in this way, although I have never seen the experiment tried. I know it. may be replied to this, that people may as well eat the clear meahbread, and a due supply of the less nutritious fruits or vegetables with it. So they may. But if they will not , and will 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 breads may be made of any or of all the articles or com- binations mentioned above. But wheat, from its larger proportion of gluten, is greatly superior to all other grains for making fermented bread. The best ferment 'is 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 hop yeast than the following, 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 wheat-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 wif koep at the temperature of about 70° Fall., till it *26 DIETETICS. uecomes perfect light.” This yeast will keep from one to two weeks, if corked tight in & clean jug, a«d placed in a cool cellar. Yeast cakes, which may be kept for weeks or months, are made by stirring 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 current of air, or what is called a drying wind. Sunlight or fire seems to impair its 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, two inches wide, and three inches long, is sufficient for four quarts of flour or meal. They are soaked in milk or water until completely dissolved, and then employed like other yeast. Hard flour yeast , or rubs, is preferred by some to the former prep- aration. 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 how to make yeast without yeast, 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° Fall., 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 as the hop yeast, but it has the advantages of rising quicker, and of not imparting the sharp, harsh taste to bread that the former does, when not carefully managed. Miss Beecher (Domestic Receipt Book) gives a good recipe, with the exception of the distillery yeast, which 1 have substituted by baker’s yeast. I have also omitted the salt, which appears to be a kind of fixture in every preparation or thing mentioned in her book : “ Mash half a dozen peeled boiled potatoes, and mix in a haniful of wheaten flour [or meal], and after putting it through a HYDROPATHIC COOKERY. 427 colander, add hot 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 who 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 i3 not intimately mixed with every particle of the meal or flour by thorough kneading, the fermentation will 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, destroyed, and the acetous fermentation commences, which 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 degree 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 i»f domestic bread-makers fail. If it does not feel sticky and heavy, on the one hand, nor taste sotrr, m the other, it is pronounced good. But all really good bread must, in addition to these negative qualities, possess 428 DIETETICS. positive recommendation of being in every way delicious to th8 senses. Whether 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, yet 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, provided 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 hydrochloric 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 salt, 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 public bakers 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/in aliment; n fact I consider breads of all kinds essen- tially deteriorated, not only in flavor and consistence, but in pliysiologi HYDROPATHIC COOKERY. 429 ral properties, by tlie admixture of salt in any quantity. It is the very last place where salt should be used, if employed at all. All the cereal grains, wheat especially, contain considerable quantities, comparatively, of earthy phosphates, principally phosphate of lime, which seem to be 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 fight 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 the 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 the 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 be 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 wrung out of cold water. 9. Ik 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° Fall., 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 DIETETICS. ceeds slowly at 50°. moderately ai 60°, rapidly at 7 1°, and very rapidly at 80°. b. Boiled and Roasted Grains and Seeds. — Good clean wheat , 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 have 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 viciously-manurod farm. The contrast might remind one of pine-apples and pine shavings. Rye, barley, and corn are equally wholesome, prepared in the same way, but not as pleasant. It is difficult U 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 whcf 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 peas 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 water, 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 salt and milk, or afterward 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, amo ng whom wei 0 always a greater or less number of dyspeptics, and I have never seen 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 hard 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 , which is a mixed dish of boilec green corn and boiled stringed beans, is a delicious and wholesome food, when seasoned with a little milk or sweet cream, 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 wholesome. Roasted reheat , rice , buckwheat , oats , bartey , 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 grains much em- ployed in the preparation 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 rsed. Wheaten grits , or cracked wheat , 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 been 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 comes in contact with the fire. This obviates the necessity of constantly stirring to prevent them from burning on the vessel. They may be DIETETICS 432 managed very well in an iron pot with legs, so that the vessel can Btand on the range 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 market it is prepared from the Southern or white corn. The fine-grained 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 particularly 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 -ground, 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 stiff, and cooked about fifteen minutes. Oatmeal mush is a favorite with some persons, 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 farina 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 article 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 levers 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 cracked wheat gruel are the best. A couple of spoonfuls of flour or meal are sufficient 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 soups are desirable. Split peas, soaked over night, and then boiled until completely diffused In the water, make sne of the best dishes of this group. A pound of peas is sufficient for HYDROPATHIC COOKERY. 438 wo quarts of water. Garden beans , and common field peas, and the marrow fats, either green 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 preparation 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, ooarding-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. Cracked-wheat pudding is made by boiling the grits perfectly soft in water, adding a due quantity of clean brown sugar, or good New Orleans molasses, and milk, and baking in a moderate heat. Rye-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 hours. 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 tne 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-disk I— 37 134 DIETETICS. half full of apples pared and cored; sweeten with molasses cr Drawn sugar ; put the rice over the fruit as a crust, and bake. Cracker pudding, of Graham or wheat-meal crackers, is made in 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 nutritive, and their principal value is to fill the stomach and satisfy the appetite when but little 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 as 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 hours. If the apples are not very sweet, a little molasses may be added. Snow - ball 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 cut 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 three quarters of an hour. Custard pudding is a preparation in which eggs are much more wholesome than they are in other puddings, particularly the farina- ceous kind : Mix four eggs, well beaten, with a quart of good milk, and three table-spoonfuls of clean brown sugar; bake in custard 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 trouble. /. Pastry . — ‘All pastry is an abomination,” says Paris, w'th whom HYDROPATHIC COOKERY 435 th(3 majority of dietetical writers coincide. The expression is not too strong 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 front 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, hog’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, who 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 into pies; many kinds of pumpkins and squashes make delicious pies; some roots and leaves, as potatoes and sorrels, make very good and whole- some pies. A few specimens of the best kinds will 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 ^nd cranberries are too acid, in all stages of their growth, for this use, although I do not apprehend a sound storm ach well trained to a vegetable regimen w T ould experience any diffi- 436 DIETETICS. culty from their employment. Indeed, I know individuals who can and do use them without any apparent disadvantage. Strawberries, red raspberries, black raspberries , blackberries, whortle- 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 market affords for pie-making, and among the best squashes for this purpose are the cream and the pumpkin . Potato pies are 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, straining, 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. CusUird pie is one of the best ways of eating eggs, providing the pie is made of nothing but eggs, sugar, and milk, and a crust as herein advocated. g. Cakes . — But very few kinds of cake are agreeable or desirable to those whose appetites are under the guidance of a reasonable degree of reason ; and to all others no extent of variety and complication can give satisfaction. The following list comprises the best preparations of cake I am acquainted with : Wheat-meal cakes, made of fresh 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 Moderately 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- ferred, can be raised with yeast, but it should not, in such case, be eaten till the next day. * * Fine flour 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 and tender made in the same way. It is very good without the cream. It should be sweetened but moderately. Eggs are 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 of ginger omitted,” and also with- out alum and potash, can be made with rye flour, New Orleans mo hisses, and sweet cream, raised with yeast, or with sour milk and supei carbonate of soda, and baked in small, thin cakes. Griddle-cakes are made of buckwheat flour, fine flour and India* meal, wheat-meal, wheat and Indian meals, wheat-meal and rice, oi of rye-meal alone, or with either of the other meals. They may be raised with yeast, or with sour milk and super-carbonate of soda; the latter is the best method, because all fermented food is objectionable when 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 griddle without a particle of grease. Sugar, molasses, or milk, is their proper accompaniment for seasoning. Wheat-meal, with a very little coarse Indian, and three parts of rye- meal to one of Indian, make the very best, sweetest, 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 griddles are obliged to use a little oil of some kind to prevent the batter from 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, parsneps, turnips, ground-nuts, artichokes, comfrey, etc., are equally healthful per se , but of different degrees of nutritive power, and of very differ- ent degrees of adaptability to weak stomachs, or stomachs accustomed to the ordinary concentrated or mixed diet. The potato, ground-nut, comfrey, and artichoke, are callei mealy roots, the others watery DIETETICS. 1 Tuesday (8 oz. cooked meat, 8 oz. bread, vegetables. Friday > Mond ( Baked batter pudding, 4 oz. bread, 1 oz. cheese, or £ o*. i butter. r Pea soup, with legs and shins of beef, 8 oz. bread. In th< Wednesday...^ summer months, baked rice pudding, 4 oz. bread, 1 oz I cheese, or £ oz. butter. Thu rsdav ( Boiled suet puddings, 4 oz. bread, 1 oz. cheese, or £ o*. £ butter. 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. / Mutton broth, beef-tea, puddings, fish, meat, eggs, wine, Extru For the Sick .. .< strong beer, etc., or whatever may be ordered by the I medical officer. . 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 ' l A mince pie, 6d. Neto Year's 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, tean^ 8 oz. bread, 1 oz. butter. Fruit, consisting.of currants and gooseberries. Ie the month of October, apple pies in addition to the ordinary dinne*. i'he ordinary diet at the Edinburgh Hospital (Scotland), is. foi 460 DIETETICS. breakfast and supper — 1 mutchin of porridge, 3 gills of milk or beer or 51 oz. of fine bread, y nilk 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, groats, potatoes, and vegetables, and 5£ 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 supper are, ordinarily— 1 pint of oatmeal or rice gruel ; dinner — i lb. of meat, 12 oz. of bread, and 1 lb. of potatoes. A fall diet consists of | 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 healthfully 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 Able-Bodied Paupers. Breakfast. Dinner. Supper. Bread. Gruel. Pickled Pork or Bacon, with Vegetables. | Soup Bread. Meat Pudding, with V egeta- bles. Rice or Suet Pudding, with Vegetables. Bread. Cheeg^ Sunday 1 M 07.. 8 g pints. H 11 H H H u 1 1 oz pints. o oz. oz. oz. oz. a oz. o Tuesday \ fjr omm o 5 O 5 H 2 ¥ Friday ) Monday ) Men Thursday 3 Women- ...... 8 g 12 10 6 5 . c Men g 6 5 6 5 6 5 Wednesday J Womm 6 8 6 12 ¥ H Saturday | Womm *■2 4 10 In the above table, vegetables are not included in the weight speci- fied. Old people 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 gruel for breakfast. Children *above nine are allowed the same quantities as Women. The dietary system of the public institutions of the United States DIETARIES. 451 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 greater 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 supper — 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 . . . Coffee, with molasses boiled in it, and bread. The following dietary table of the New York Protestant Half-Orphan Asylum, furnishes a fair specimen of the diet provided for children in j>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; neat of two kino..-, .... >n^ralNr* pork frequently; vege- tables according to the season, pome ^ways. For supper — Tea and bread; no butter allowed, unless prescribed. 452 DIETETIC*? The dietary of the Blockley Alms-house (Philadelph ia) is very 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 whole : Breakfast . . . Bread, and rye coffee sweetened with molasses Supper Bread, and tea sweetened with sugar Vinner Monday Beef and soup. Tuesday Mush and molasses. Wednesday . . . t Thursday .... ) Beef and soup. Friday Herring, mush and molasses, 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 pork* each laborer is allowed 20 oz. of bread per day ; and all others over one year old, 16 02. 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 : Breakfast . . . Meat, hashed with potatoes, or cold, with bread and butter, coffee, milk, and sugar. Vinner Monday > Roast meat, beef, mutton, or lamb, with vegetables, rice, Tuesday > flour, bread, or fruit puddings. Wednesday. . . ) Saturday 5 Soup, with rice or Indian mush ; pastry on Wednesday. Thursday Corned beef, with potatoes, and other vegetables, and puddings. Friday 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 ; sugaj 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 strongly stimulate the blood-vessels, or excite the nervous system, if administered one day, and withheld the next ; keep the whole organism in a constant state of perturbation , one day partially exhila^tpr^ H -i. J 1 ^ ^rurally depressed. Another error is in allowing fun suna diet, as meat and bread, one day, and the next restricting the diet to slop food, as soup and mush, or DI3TAKI23. 453 mush and molasses, or both. The solid and nutritive materials, 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, pastry, and puddings are allowed, they are among the most unhealthfm 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 incrrviauals sub- jected to their punishments or charities, and as regards the discipline, order and economy in which the public are more especiaffy inter- ested. Every dictate of ti*ue 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 good 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 making 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 Dietary for a Water-Cure in Winter Standing Articles for the Table .- Brown bread, white bread, cold cracked-wheat, hard biscuits or GrahUm cracker's, water, milk, sugar, molasses or syrup, salt. Monday Breakfast . Cracked- wheat mush, baked potatoes, green apples stewed. Dinner — Beef-steak, boiled potatoes, pea-soup, apples. Dessert — Rice pudding Supper / Indian cake, stewed prunes. Tuesday .... Breakfast . Rye and Indian griddle-cakes, baked potatoes, dried apples stewed. 454 DIETETICS. Tuesday Dinner Mutton chops, mashed potatoes, boiled pars- neps, baked tart apples. Dessert — Pump- kin pie. Supper Indian mush, dried peaches stewed, Wednesday- .Breakfast . Rice gruel, cold potatoes browned, green apples stewed. Dinner . . - Corned beef, potatoes, cabbage, apples. Des sert — Indian pudding. Supper Milk toast, boiled apples sweetened. Thursday .. .Breakfast .Wheat-meal griddle-cakes, baked potatoes, green apple sauce. Dinner Boiled mutton, potatoes, white beans, stewed cranberries. Dessert — Apple pie. Supper Dry toast, dried whortleberries stewed. Friday Breakfast .Water biscuits, boiled potatoes, dried peaches stewed. Dinner Boiled halibut, sweet potatoes, beets, baked apples. Dessert — Custard. Supper Stewed figs, hominy. Saturday Breakfast .Rye-meal mush, cold sweet potatoes brown- ed, green apple sauce. Dinner Roast beef, potatoes, turnips, dried currants stewed. Dessert — Tapioca pudding. Supper Wheat-meal sweet cake, baked apples. Sunday Breakfast .Buckwheat griddle- cakes, dried apples and raspberries. Dinner ...Roast beef, potatoes, Lima beans, baked tart apples. Dessert — Bread pudding, dried squash pie. Supper 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 cun ants 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 matoes. Dessert — Strawberry pies. Supper . . . .Dry t<*ist, whortleberries. DIETARIES. 45S Wednesday . . Breakfast . 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, green coiu, 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. Supjier Hominy, blackberries. Saturday Breakfast . Boiled rice, peaches. Dinner Beef hash, potatoes, squash, green peas, to- matoes stewed. Dessert — Whortleberry pie. Supper Wheat-meal water biscuits, stewed black- berries. Sunday Breakfast . Oatmeal cakes, stewed green 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 eveu all the days of the week. There are many cases of indigestion, attended with extreme 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 lor 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, 01 plain bf ilec rice, with a little 450 DIETETICS. 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 dietary 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 or fresh curd, sweet cream, milk, water, lemon juice, sugar, syrup or molasses, or honey. Monday Breakfast . Wheat and Indian griddle-cakes, rice gruel. baked potatoes, stewed green apples. Dinner Mashed boiled potatoes, parsneps, squash, green corn, apples, grapes. Dessert — Bice pudding, custard pie. Supper Milk toast, cracked-wheat mush, potatoes, baked apples, stewed figs, blanc-mange. 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, green 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 4 . bl 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. Friday Breakfast . Buckwheat griddle-cakes, baked potatoes, stewed apples, grapes, cherries. Dinner Common potatoes, sweet potatoes, green corn, string beans, baked apples, stewed tomatoes. Dessert — Cracked-wheat pud- ding, whortleberry pie. Supper Rice gruel, dry toast, potatoes, boiled peaches or pears. Saturday Breakfast . Wheat-meal water biscuits, baked potatoes, oranges, figs, bananas, or grapes. Dinner Potatoes, pea-soup, parsneps, boiled cabbage, baked sweet apples. Dessert — Boiled rice, dried apple and green currant pie. Supper Oatmeal cake, cracker toast, potatoes, stewed apples. Sunday Breakfast . Rye-meal griddle-cakes, farina mush, pota- toes, bc :, ed peaches, pears, or apples. Dinner Sweet potatoes, common potatoes, turnips, asparagus, stewed tomatoes, baked apples. Dessert — B lane-mange, pumpkin or squash pie. Supper Plain biscuits or buns, cold hominy, potatoes, green apples stewed. The dietary for a private family only requires a little simplification in the matter of variety; there is as much room for improvement in this direction as any one is dispose*! Jo occupy. Those who see fit to drop off the superfluities or seasonings — salt, butter, cream, etc. — will experience, in due time, a permanent physiological advantage, amply compensating them for the temporary privation of accustomed indul- gences. But let me in this place urge what I have before insisted upon, and what is of vastly more importance to invalids, and even to well persons, than most people can be made to understand, that all seasonings or condiments, and especially butter and salt, are incompar- ably less injurious when added to the article of food after it is cooked, than when cooked into it The sweetness, digestibili! y, and nealthfu) 468 DIETETICS. ness of most of our ordinary vegetables, I repeat, are always very materially impaired by cooking them in salted and greasy water. This is one of the great errors of most Water-Cure establishments, which easily can be and ought to be corr ected. Let those whose appetites or whose judgments are determined in the employment of these things, put them on, not cook them in, their vegetable dishes or farinaceous preparations. The following catalogue of green fruits and vegetables as found in the New York markets, exhibits our ample resources for these articles during each month of the year. The list is a selection of the best articles in their seasons, rather than an enumeration of the whole : January . — Common potatoes, sweet potatoes, beets, cabbages, whit© turnips, yellow turnips, preserved greet, peas, preserved green Lima beans, pumpkins, apples, grapes. February . — Common potatoes, sweet potatoes, parsneps, beets, cab- bages, white turnips, yellow turnips, preserved green peas, preserved Lima beans, apples, grapes. March . — Common potatoes, sweet potatoes, parsneps, beets, cab- bages, white turnips, yellow turnips, preserved green peas, preserved green Lima beans, apples, grapes. April. — Common potatoes, parsneps, beets, carrots, cabbages, white turnips, yellow turnips, preserved Lima beans, spinach, apples, grapes May . — Common potatoes, parsneps, beets, carrots, cabbages, aspara- gus, spinach, apples, currants, strawberries. June. — Common potatoes, parsneps, cabbages, asparagus, spinach of various kinds, strawberries, currants, peas, string beans, cherries, gooseberries, apples. July. — Common potatoes, sweet potatoes, peas, beans, young corn, beets, squashes, sii nwberries, currants, gooseberries, whortleberries, cherries, raspberries, tomatoes, apples, peaches, apricots, water-melons, musk-melons. August. — Common potatoes, sweet potatoes, peas, beans, young corn, squashes, currants, raspberries, whortleberries, blackberries, to- matoes, apples, peaches, pears, apricots, water-melons, musk-melons, plums, grapes. September. — Common potatoes, sweet potatoes, beans, young corn, cabbages, beets, turnips, tomatoes, blackberries, apples, peaches, pears, water-melons, musk-melons, plums, grapes, pumpkins. October. — Common potatoes, sweet potatoes, beets, turnips, cabbages, squashes, pumpkins, apples, pears, plums, grapes. November. — Common potatoes, sweet potatoes, beets, turnips, pump kins, sqtiashes, cabbages, apples, pears, p3ums, grapes. DIETARIES. 459 December . — Common potatoes, sweet potatoes, beets, turnips, pre- served green peas, preserved Lima beans, squashes, pumpkins, apples, grapes. I cannot, perhaps, better conclude the dietetic department of this work, than by quoting the testimony of two eminent medical scholars and accurate observers, in favor of vegetable diet both.as a curative and preventive of disease. The first-named author practiced in his person and prescribed to his patients what he preached; the latter did neither. Dr. William Lambe (Water and Vegetable Diet in Consumption , Scrofula , Cancer , Asthma , etc.) remarks : “ It seems, moreover, highly probable that the inherent power of the living body of restoring itself under accident or wounds, is strongest in those who use mostly a vegetable regimen, and who are veiy sparing in the use of fermented liquors. This has been observed among the Eastern nations. Sir George Staunton says on this subject: ‘It is, however, to be remarked that the Chinese recover from all kinds of accidents more rapidly, and with fewer symptoms of any kind of danger, than most people in Europe. The constant and quick recovery from considerable and alarming wounds has been observed likewise to take place among the natives of Hindostan. The European surgeons have been surprised at the easy cure of sepoys in the English service, from accidents ac- counted extremely formidable.’ ” This felicity the relator attributes to the causes which I have mentioned. I have received the same accounts from other quarters. These facts are enough to Induce a suspicion that our diseases are much exasperated by our manner of living, and the full diet of animal food to which we are habituated. One would be apt to imagine, from the common practice of most of our physicians, and still more of our medico-chirurgeons, that excess and intemperance were the .regular methods of curing diseases. They have been laboring, during almost the whole of my medical life, to prove to the public that the doctrines of abstemiousness, inculcated by several of our predecessors, are a mere prejudice and error. Li almost all chronic diseases, to forbid the use of vegetables is a part of the established routine. If there be a little heart-burn or flatulency, all vegetables are instantly proscribed. Infants, even, are loaded with made dishes, and their breaths smell of wine and strong liquors. Nay, to such an extent are these abomina- tions carried, that when their stomachs revolt against these unnatural compounds, with instinctive horror, and the importunities of nature cannot be wholly resisted, a little fruit is held out to them as a sort of premium, and as a reward for forcing down the nauseous farrago which they loathe. <60 DIETETICS. The English surgeon, John A. Forsyth, somewhat celebrated as an author on medical and dietetical subjects, and a very accurate historica writer, observes, in allusion to the connection between the vegetarian food and the health of the early inhabitants of the earth (Dictionary of Diet ) : “ The decays of nature, in the expiring periods of life, were the only infirmities to which men were then liable; and though their limbs sometimes failed to perform their office, their health and appetite continued with them till life was no more. In this rude, but natural state, the food of mankind is said to have continued upward of two thou* sand years, during which period the cook and the physician were equally unknown . It is not easy to say at what period man exchanged vege- table for animal diet; but certain it is, that he no sooner began to feed on flesh, fowl, and fish, than seasonings of some kind became requisite, not only to render such food more pleasing and palatable, but also to help digestion and prevent putrefaction. Of these seasonings, salt was probably the first discovered ; though some are inclined to think that savory roots and herbs were first in use ; spices, however, as ginger, cinnamon, pepper, cloves, and nutmegs, by degrees came into use, and the whole art of cookery gradually improved, till it reached its present climax of perfection. Eating of animal food was evidently adopted as necessary to guard against famine, the consequence of the scarcity and bad condition of vegetable productions. We find, therefore, that in process of time, and to aid their mutual wants, as well as to protect the weak against the strong, the industrious from the indolent, men, by general consent, began to portion out to each other a certain meas- ure of land, to produce them their supply of vegetables. Reason soon after suggested the expedient of domesticating certain animals, equally to assist them in their labors and to supply them with food. Hogs, it is said, were the first animals of the domestic kind that appeared on their tables, as then they held it to ba ungp^teful to devour the beasU that assisted them in their labors.” GLOSSARY. GLOSSARY. In the following vocabulary will be found terms, not fully explained in the text : Abnormal , irregular, unnatural. Acetabulum , saucer-like cavity. Acute, of short duration, severe. Adipose, fatty ; from adcps, fat. Adynamic , relating to vital debility. Aeration, arterialization of the blood. Allopathy , “contraria contrarius curantur,” or, the practice of counteracting the symptoms. Anesthesia, deprivation of sensibility. Anastomosis, communication between ves- sels. Anhemia , bloodlessness, with debility. Anorexia, absence of appetite. Antiphlogistic, reducing, cooling. Ant-irritant, soothing, sedative. Apparatus, set of organs or instruments. Areolar tissue, cellular substance. Arterial, relating to arteries. Articular , relating to joints. Asphyxia, suspended animation. Atheroma, pulpous encysted tumor. Atony , want of tone, debility. Atrimatrics, medication with foul air Basilir, pertaining to the base. Biceps, a two-headed muscle. Bicuspids, two-pointed teeth. Bougie, a flexible dilating tube. Brachial, belonging to the arm. Bronchia , branches of the windpipe. Burse mucosa, sacs of viscid fluid. Calculi, concretions of gravel, stone, etc. Capillary, small, minute, hair-like. Cardiac, relating to the heart. Catamenial, relating to the menses. Cephalagia beadacho of any kind. a definition of the most important technical Cervical , relating to the neck. Cervix uteri, neck of the uterus. Chronic , of long and uncertain duration. Chylopoietic , chyle-making organs. Cicatrix — Cicatrization, a scar — scarring. Cineritious, cortical, ash-colored. Colliquative, profuse, exhausting discharge# Commissures, points of union between part#* Condyle, an articular eminence of bone. Contractility, the vlt«\J property of muscle. Convolutions , undulating windings. Corpuscules, the globules of various fluids. Cortical, exterior, belonging to the bark. Cuticle, the epidermis, or scarf-skin. Cutis vera, the inner or true skin. Demulcent , gummy, mucilaginous raedi cines. Dermoid, pertaining to the integument. Diaphoretic, tending to produce sweat. Diluent , tending to thin the fluids. Dispensatory , book of medical composition# Diuretic, increasing the urinary secretion. Dorsal, pertaining to the back. Dynamic, in biology, the vital force. Eclectic, selecting from all sources. Effluvia, impalpable emanations. Elasticity, property of ireolar tissue. Eiingual , destitute of a tongue. Elixir vile, alcohol and aromatics. Emmenagogue, promoting menstruation. Emollient, softening, relaxing, sootning. Encephalic , situate within the head. Endemic, prevailing over a neighborhood Epidemic, prevailing over a country. Epidermis , the external or scarf-skin. Epigastric, uporror near the stomach. GLOSSARY Epiploon, the caul or omentum. Epispastic, blistering the skin. Episynthetic, accumulative, collective. Epithem , soft or warm applications. Eructation , sonorous ejection of wind. Escharotic, producing a sore or scar. Expiration, breathing from the lungs. Facette , small, smooth surface bone. Facial , belonging to the face. Fasciculus , a small bundle. Faces, excrement of the bowels Fauces, the throat, pharynx. Feculent, relating- to the faeces. Fenestra, window-like. Filament, a fine thread, fibril. Foramen — Foramina, a hole — apertures. Fossa — a, a depression — cavities. Franum , a bridle of fibers Fumigations, odorous smokes or gases. Ganglia, convolutions of nervous cords. Gangrene, death, with putrefaction. Gastric, relating to the stomach. Gastrodynia , flatulent colic. Gastro-enteric, relating to the stomach and bowels. Glenoid, shallow articular cavity. Granulations, flesh-shoots of ulcersi Granule, a small, compact particle. Grumous , clotted or coagulated. Gymnastic, relating to bodily exercise. Hepatic , pertaining to the liver. Homoeopathy , ‘‘similia similibus curantur,” the doctrine that like cures similar. Humoral pathology, the doctrine of the fluids being the primary seat of disease. Hydropathy, hygienic medicine, the system of treating diseases by water, light, air, temperature, exercise, food, etc. Hygiene, preservation of health. Hypoglossal, under the tongue. Idiopathic, primary, original. Idiosyncrasy, functional peculiarity. Ingesta, food, drinks, condiments, etc. Inhalation, breathing into the lungs. Innominata, nameless, bones of the pelvis. Inorganic, without distinct organs. Inosculation, connection, communication. Inspiration, receiving air in the lungs. Insufflation, injecting gases or vapors. Intumescence , enlargement, swelling. Irritability, susceptibility to external im- pressions; the ultimate vital property. Irritant , causing painful excitement. Irritation, preternatural excitement iMchrymal , relating to the tears. Lamella — ce, thin plate or plates. Lamina — *her barxs 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 whole domain of life, through the medium of file 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 by 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, lithontriptics, 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 die end of life. But who cannot perceive that all this practice, as a part of the healing art, is absurd and ridiculous? Whoso 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, when 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, »rid mercurialize the patient down, and then, presto ! wine, tonics, and u generous diet,” to stimulate him up again as fast as possible, thus aoing and undoing interchangeably. Bathing, with appropriate air and exercise, and plain simple food, will effect a change of matter incom narably more ranid, ard without tlia destruction of healthful material* 12 THEORY AP PRACTICE. or the injurious “ dynamic force” of alcoholic poison. If there is sur- plus matter about or within the body, water will wash it away, and if there is a deficiency of organic material, pure food and good digestion are the natural means to supply it. Again, the water-treatment, by regarding the skin as the leading depurating function of the body, follows out the indications of nature herself, which expels the greatest 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 canal, where but a small quantity, comparatively, of waste or offensive matter is ever found, with horridly poisonous emetics and bowel-scraping 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 flu* 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, the stronger mercurial excitement will absorb, as it were, the lesser inflammatory action ; the latter will then 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 irreparable injury, with the ulterior possibility of a greater good. Blisters, issues, escharotics , and the end- less compounds in the shape of irritating ointments and stimulating Animents 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 all. 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, will manifest different phenomena from what are observed when one part or organ only is affected, because vital resistance is then distributed to several points instead of being concentrated at one. If a person h laboring und^r a fever, that con: motion of the orgai* PHILOSOPHY 0? WATEK-URE. 13 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 powers are making the principal effoi „ vo the surface, the introduction of a cathar- tic dose of epsom salts would divert some part of this vital 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 o remedial effect to the skin would be materially diminished. The seat of war would be changed, or the battle-field divided, but so far from being “ a friend in need,” th^ saline purgation, by drawing off and wasting 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 phenomena, 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 capillaries ; 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 effect 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 impression of cold water, cannot be called a morbid action in any sense. If we go out of a comfortably warm room into a very cold atmosphere, our 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 they soon ll 14 THEO-tS AND PRACTICE. appear more red and turgid, and feel warmer than before their expo Bure, for a few minutes, and then return to their usual appearance ano feeling So the slight disturbances of the circulation produced by ordi- nary bathing is merely an intensified contraction and relaxation, amount- ing to temporarily increased action, and followed by the same harmony of circulation as existed before. Atmospheric influences, vicissitudes of temperature, variations of exorcise, etc when not extreme or vio- lent, produce temporary disturbances of the circulation, which, so far from being morbid, are really sanatory, 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 structures and functions. But how different is the case if we take into the domain of life a substance 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 never 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 re. Familiar and melancholy examples of chemical incompatibility am 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, irrecoverably, some portion of the vitality itself. The impressions of drug-agents of all kinds are constantly destructive 01 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 w'ater to the body when hot, hot water when cold, etc., not to antagonize action, but to balance action; the grand 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 e Torts of nature, to counteract the vital powers, to suppress the organic instincts, to obstruct the vis medicatrix naturve , to embarrass the cure, and, in the majority of cases, to place the life of the patient in greater jeopardy than it w^ould be with no medication whatever. The true philosophy of water-cure, ii almost every essentia point PHILOSOPHY OF WATER-CURE, 1 * of doctrine, is diameti ically antagonistical to the prevailing theories of the allopathic schools. Some of the homeopathists have lately discovered that water acta on their favorite principle — similia similibus curavlur . It is to my mind inconceivable how water can produce, in infinitesimal or any other quantities, any other dynamic effects than such as are referrible to tem- perature, bulk, or solvency. Water is th$ 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- sons, 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 functions 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, haw , 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. Why tartar emetic or ipecac produces vomiting, why jalap or senna purges, why mercury or tobacco salivates, why opium or catnip 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 medial science dawned upon the world, for all that appears in the writings of the standard authors, or the teachings of .iving 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 understandings of reading and thinking ifl THEORY AND PRACTICE. neople, and just so soon as they are generally appreciated will the drug cystem 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 illustrations of them. The writings of Dr. Lambe, Dr. Alcott, Dr. Jennings, and Rausse, abound in teachings predicated on their recognition, while thq practice of Priessnitz and his followers is constantly demonstrating the correctness of the explanation which they afford. I will try to present this matter clearly, for I am most undoubtingly convinced that the individual who fully understands it will be exceedingly loth to swallow any apothecary drug, whether it go by the name of drug- poison or drug-medicine ; and he who has both philanthropy and intelligence will be as unwilling 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 strengthening medicines. Books on materia medica 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 incongruous set of materials, as quinine, arsenic. Doneset, 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 debility . Here is a paradox. A tonic medicine first strengthens , and then debilitates . How are these results to be ac- counted for ? When a drug-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 ; something which has no constitutional relation to any want or duty of liny part or organ, hence an intruder, 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 from the poisonous or me iicinal agent; but the stomach does not suffer alone ; the alarm is communicated to other organs, to all 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 made 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, and the exhaustion, being mt very great, is p PHILO SOP XY 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 administers another tonic ; no matter what, if it be a different one. It works like a charm! The vital powers, though jaded and half palsied, are not yet dead. A new enemy will startle them again; an unaccustomed impression will again arouse them to resistance. If the first tonic was wormwood, the second may be arsenic, or vice versa . After the second tonic lias spent its force, or, rather, after the vital powers cease to resist, a third one may 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 powdered .glass — as incongruous a medley as can be conceived — will produce tonic effects, 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 fat- tening the body. Why? Because when taken into the stomach, that organ being the point of attack, the vital powers are disproportionately directed to that organ in defense ; and if the doses are frequently repeated, a determination of nervous or vital energy is established to- ward the digestive function. The digestive organs may thus be tem- porarily invigorated at tlic 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 ast injury or disturbance to the organism. If a very large dose of ipecac, for example, is swallowed, so large as to prove immediately dangerous to life, or seriously destructive to the structural or functions integrity of the stomach, its action is met with such violence of resist 18 THEORY AND PRACTICE. ance as to produce severe spasmodic contractions of the muscular fibre* of the stomach and the abdominal muscles, by which the ordinary per- istaltic motion of the alimentary canal is reversed, and vomiting results. If the dose be smaller, a prr fuse watery secretion is poured cut 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 tlms we have a cathartic effect. If the dose be still smaller, it is largely diluted with serum, taken up by the absorbents, carried into the mass of blood, and finally thrown off by the skin, this being the manner in which 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 , purg- ing, sweating , and strengthening ; while each effect is attended with an absolute w T aste of vital power. It is w r ell known, too, that all drugs lose a degree of their potency by repetition; in other words, the vital resistance is gradually 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 unfrequently find twenty or thirty an inefficient dose after the vital resistance Las 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 against 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 certain sense — rendering evil for evil. If a blistering compound, 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 tine ikin, and the red, turgid, inflamed blood-vessels show the viflence of PHILOSOPHY OF WATER-CCJRE. 1 * 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 surface — 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 for the cure. The grand distinctive effects of homeopathic and allopathic practice are not to be explained on the principle of “ similia similibus curantur* nor upon the principle of “ contraria 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., are medicinally diaphoretic and diuretic ; in other words, the vital powers expel them through the skin and kidneys, the expulsive effort being denoted b} r 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 the special cause of disease — morbid matter — let us see what happens by the special introduction of a medicinal drug. Precisely this. If the 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 through 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 ; the 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 tne 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 off 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 iff *0 THEORY AND PRACTICE. to recover, if possible, from the factitious malady — the effect jf th« drug. We can more readily understand how vastly superior the homeo- pathic practice is, in all those cases of disease, as the simple fevers and exanthems, wherein the efforts of nature are directed especially to the skin, and wherein they are, 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 the 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 class 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 a simple fever the allopathic dose would interrupt the natural course of these remedial efforts ; but in a case of constipation from retained excreme ntitious matters, the homeopathic dose would work adversely. I am far from denying that, under certain circumstances, drug- medication, either homeopathically or allopathically, may do much more good than evil, though I contend that such is not the general rule ; but 1 insist that the true healing art contemplates a method of medi eating diseases on an entirely different basis ; and a true basis, I claim is furnished by the philosophy of the Water-Cure system, which aL jures drugs, and depends wholly on hygienic influences. There is nothing in medical experience more speciously delusiv> than the stimulating practice in cases of extreme prostration anc debility. When a fever, for example, “turns,” or completely subsides, the patient is weak and relaxed ; and if he has been severely drugged, he w r ill be very 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 body on mere stimulation until it can recover its balance, or in same mysterious 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 uncommon circumstance fora patient to be dosed with a quart of brandy, 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 remains in his bodj PIIIIOSOPIIY OF WATER-uURE. 21 ®nly 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 ordinary cases, until the cold stage of the paroxysm becomes permanent. When the fever is down — that is, in the cold stage — the patient is pale, cool or cold, the features sunken, and the pulse low, natural consequences of the previous febrile excitement. The organism now requires rest, quiet, perhaps nourishment. Rut the doctor, fearing this depression will end in death, kindles up the fever again. So lcng as the system will respond to stimuli, so long as 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 knowing 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 01 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 manner. 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 in a moment, like that from a Leyden jar, or a surcharged electric cloud. In very small doses the pure narccftics 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 the very Sampson of the allopathic materia medica — mercury. No 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 freely and so fatally in almost all the diseases incident to humanity. But how and why does mercury promote the rotiviiy of ai' the secreting organs? Because n THEORY AND PRACTICE. its operation is, although very slow and gradual, is chemically destructive to some of the constituents of all the fluids and sulids 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 neutralize or lessen 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 ol which must inevitably be universal ruin, to a greater or less extent, of the vital powers. 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 The Wet-Sheet Packing. — This process, the lien tucli of the Germans (fig. 164), is admi- rably 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 body 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 effect, and generally exerts a wonderfully sedative or sooth- ing influence on the whole nervous system. The first disagreeable sensation of cold is usually soon followed by a pleasurable warmth over the whole surface. It is capable of superseding, to advantage, bleeding, antimony, salts, hydriodate of potassa (iodide of potassium), calomel, ana opium, and a hundred other more or less injurious agents THE WET-SHEET PACKING. WATEll-CUIlE PROCESSES. 28 In fevers, and in all acute inflammatory disorders, it may be employed with a freedom exactly proportioned to the degree 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. Tn nearly the whole range of chronic complaints, there is one prev- alent morbid condition, ever varying in intensity, yet consisting essen- tially in a deficiency of blood in the superficial and capillary vessels, and an accumulation or engorgement in the large internal vessels, with consequent congestion in some one or 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 fixes 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 tempera- ment, and rapid though feeble pulse, and those laboring under great debility 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 time. Much of the comfort or disagreableness of the process depends on the skill and dexterity of the attendant. There is at least as much science in applying wet cloths to Tie naked body as in rubbing in ap M THEORY AND PRACTICE. ointment or putting on a blister. A person may be wrapped up so slowly, loosely, and unevenly by an awkward hand, as to find the whole affair from beginning to end exceedingly uncomfortable ; or the cloth ing may be so rapidly and nicely adjusted, as to give the patient an hour or so of actual enjoyment. Light cotton, hair, or sea-grass mattresses, or even straw, 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 pair 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, great 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 wrung out of tepid, or even warm water. On coming out of the 44 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 as dry as the attendant can conveniently wring it. Some persons, whose pores are pretty effectually 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 susceptibility, who very soon get warm in the wet sheet, and imme- diately after grow chilly again ; and in some cases, if they remain yet, half an hour longer, a comfortable reaction will come n again. Such persons should be taken out, if possible, during the glow upon the sur- face. If it so happens 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 they occur repeatedly the time should be shortened WATER-CURE PROCESSES. 25 A linen is always to be preferred for “ packing,” more especially in warm weathei. The wet sheet is not a sweating process, as generally supposed, all hough frequently a moderate, and occasionally a copious perspiration takes place. It is permanently either a cooling or a heating process, according to the degree of envelopment. When the object is to reduce fever or inflammation, the patient should be lightly covered, and the wet sheet frequently renewed. In chronic diseases, when the inten- tion is to produce reaction and develop the external circulation, an additional quantity of bedding secures this object. As a cooling pro- cess, it may always with safety be frequently repeated, until the force of the pulse and the preternatural heat are reduced to the normal standard. Under its judicious employment in chronic diseases, the skin gradually becomes softer, velvety, and more porous and delicate ; its structure more firm, and its functions more vigorous. The Half-Pack Sheet. — This is the application of the wet sheet as above to the trunk of the body only. It is milder, yet less effica- cious, than the full pack. It is only employed on feeble persons, who have not sufficient vitality for the whole sheet, or as a preparatory measure for the entire envelopment. The Douche. — The primary object of the douche ( doosh ) bath, fig. 165, is to arouse the activity of the absorbent system, and this 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 strength of the patient. Very nervous per- sons, and those subject to a determination to the brain, must resort to it 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 may be directed to the affected II— 3 Fig. 165. THE DOUCHE 26 THEORY AND PRACTICE parts ; in cases of torpid bowels a moderate stream may be applied to the external abdominal muscles. No strong 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 degree of impres- sion, from that which is scarcely appreciable, to one as powerful as the muscular system can endure, according to the size of the stream, its fall, pressure, etc. They may be vertical , oblique , horizontal, or as- cending. Those most generally in use are perpendicular streams from one to two inches in diameter Smaller streams, as inch and half inch are better in some cases The oblique and horizontal streams can be more conveniently applied locally when indicated, and in many cases, as 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 stream 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 extreme nervous irritabil- ity, and in spasmodic and bilious colic I have known excellent effects from streams 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 part of the body, the force being regulated by a stop-cock. The Rubbing Wet-Sheet. — This bath produces a strong and general determination to the whole surface. The shock is generally rapidly succeeded by vigorous reaction, which is further promoted and maintained by active friction. It is applicable in all cases wherein o strong diversion from the internal viscera, o; the mucous membrane ci the alimentary canal, to the skin, is required. It is more or less serviceable in nearly every condition of disease wherein the patient has sufficient reactive energy to prevent a permanent chill. In the primary stage of fevers, in the early stages of bowel complaints, colic* diarrhea, dysentery, cholera, etc , it is particularly valuable. In thess WATER-CCRE PROCESSES. 2T cases it should be applied frequently iur a few minutes, and the skin rubbed 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 follow the pack. The rubbing wet-sheet is an admirable bath for the sedentary and studious; for exhaustion consequent on severe mental exertion; for mental disorders, and many states of insanity ; for nearly all spasmodic and epileptic conditions; for delirium tremens; for night sweats watchfulness, nightmare, etc. When employed drippingly wet ( the anpping 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 carpeted 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 ordinary cases five 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 sheet is thrown around the neck, leaving the head out. It is succeeded by the drv rubbing sheet, or rubbing with dry towels. The Hip or Sitz-Bath. — The sitting-bath answers the several indications of tonic, derivative, and sedative. It is invaluable in weak- ness, irregularity, obstruction, and torpor of the lower organs of the pelvis and abdomen. Any com- mon wash-tub will answer for its administration, though it is more convenient to have vessels made for the purpose, the bottom raised a few inches from the floor, the back side raised to rest against. The water, as a general rule, should cover the hips and lower the sitting- 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 THE Oft Y VN'D PRACTICE. *8 baths Jire far the most frequently 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 the 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 liver, stoma t:h, bowels, spleen, and kidneys, hip-baths should be used very fre- quently, conjoined with the plentiful use of tepid or cool water in *njections. Debility of the external muscles of the abdomen, caused by 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 well be borne. A Hanket 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 greater 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 greatest derivative effect, the bath should be continued as long as reaction is vigorous, but not carried to the extent of producing the second chill ; if so, determination may take place to the internal organs instead of derivation from them. Derivative hip- baths should 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 yreat 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, usually called derivative, are really sedative ; no matter, though, so long as they work curatively. In a general fever, for example, when the whole body is preter- mit urally hot and turgid, a long-continued bath of this kind operates as a refreshing and fever-assuaging sedative. The temperature of the water, and its quantity, also have some influence 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-OURE PROCESSES. 29 The Shali ow-Bath. — This, as usually employed, is a power- fully alterative, mildly derivative, and moderafely sedative bath. It is sometimes used cool, seldom vea-y cold, but generally tepid, from G5° to 75°. The common shallow-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 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- ally 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 f ime, 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 nead,” 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 with decided benefit. When there is uniform 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 latter possibly 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 * nary shallow-bath a half bath, when the water is about one foot ia Fig. 167. THE SHALLOW-BATH. M THEORY AND PRACTICE. depth, so as to cover t e lower part of the abdomen, as well as the lower extremities. This is in elfect intermediate 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 sufif cient for the shock of the latter. It is specially adapted to those cases for 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 rules 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 The Plunge-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 a useful pre- caution, wets the head and chest, and then plunges into the water, either head-foremost or feet-foremost, as he fancies. The shock pro- duced is much ess than most persons vould suspect, while the reaction either of them. Fi?. l^P. GOING FROM PACK TO PLUNGE. WATER-CURE PROCESSES. 31 fe 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 b* 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 llox, 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 remaining in the bath varies from a very few seconds to two or three 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 orf the int’mate con- nection between the whole nervous system and the feet, manifested 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-batli, 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 *nd follow the cold foot-bath. The rules given for the regulation of the «itz-bath will apply to this A.m vessel large enough to admit the 52 THEORY AND PRACTICE and water enough to cover them ankle deep, will answer. The time 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 toes, 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 headache, and soothe the nervous system when unusually irritated, 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 water for three minutes before being enveloped. The Head-Bath. — The com- mon method of bathing the head is by folds of wet cloths, or a stream of water poured over the head. In all acute diseases about the head, attended with pain and increased temperature, those processes are suf- ficient, but in some chronic affec- tions a powerful derivative or sedative effect is desired. For this purpose the patient lies extended on a rug or mattrass (fig. 16 D), the head resting in a shallow basin or bowl, holding two or three inches of water, the shoulders being supported by a pil- low. It may be administered from fifteen to thirty minutes. When the pouring head-bath is employed the patient lies lace down- ward ; the head is held by the attendant and projecting over the side of the bed ; the bedding being protected by a sheet or blanket thrown a round the patient’s neck ; a tub is placed under the head to eaten the water. The water is poured from a pitcher or other co we menv vessel moderately but steadily for several minutes, or until the head is well cooled, the stream being applied principally 'o the temples m** n»ck part of the head. This process is excellent n all high few'**?* **** h? the early stages of colic and cholera morbus THE HEAD-BATH. WATER-CURE PROCESSES. 33 Fig. 170 represents a convenient vessel for a head-bath. Length from a to b, 11 indies; breadth from c to d, 8 inches ; depth, inches ; height from the floor, 7 inches. The t attorn is concave. The cold cloths, or pouring stream is 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 the eyes and ears, earache, partial or complete loss Fig. 170. VESSEL FOR THE HEAD-BATH 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. The Shower-Bath. — This bath is greatly misused by many per- sons, and is generally 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 the hands of competent persons; thinks it is a very good remedy indeed in many cases, but in this particular case it probably would not answer ; it might produce congestion ! Still the patient may, if disposed, try 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 inuen- 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 dr Tor, whc shakes his head poitentiously, looks “wondrous wise 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 t) commence on an invalid with. Generally patients require considerr ble preparatory treatment before they caa 34 THEORY AND PRACTICE take it to advantage. Although it is rmwe frequently prescribed than any other bath by the drug doctor, the hydropath would 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, as a daily bath, for years, not only without arp unpleasant symptom, but with uniform pleasure and advantage. But I have known many invalids with whom it w T ould 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 general rule is to direct patients to incline the head forward so as to let the shock fall upon the neck, spine, and shoulders. It may also be freely applied to the chest and abdomen. Its principal advantage is in affording a convenient morning bath; a good wash down after the wet sheet, when no ether bath is specially indicated, and also after the hot and vapor baths. In the stupor of drunkenness a smart shower of cold water often restores sensibility very promptly. The cold shower has recently been introduced into the penal transactions of our criminal code. Refrac- tory culprits are often brought to prompt obedience by its terrors. The prisoners are said to dread it worse than the old-fashioned, barbarous methods of flagebation. It is certainly more humane, but is liable to do injury to those who are extremely susceptible, with a tendency to head affections. This bath has long enjoyed considerable repute as a popular remedy for rackets and other cachetic affections of children. It is manager 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 old; he appeared to be “poorly,” without having any particular dis- ease for which a name could be found. The doctor gave it oil, rhu- barb, “ a touch of calomel,” elixir drops, worm seed, and strengthening things in abundance, but it stayed “ poorly.” Some kind neighbor ad- vised showering, and the mother concluded to try it. The next morn- ing witch happened tr be of a keen, blustering, November day, the WATER-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 ground, and then threw the pa l-douche over it at a single dash ! The result was a fever, which lasted the child a week. The child should have been placed in a tub in-door, and the water poured over it gently. The Cataract-Bath. — This is a pleasant yet powerfully excitant bath Dr. Johnson, from 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 string, these cylinders are tilted so as to dis- charge 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 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 th6 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 adding is thrown around to retain the animal heat. Very nervous and irritable persons should not be wrapped very tightly 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 five hours without sweating much. When the patie \t perspires with difficulty, exercising by extending the limbs forcibly, accompanied with deep, full inspirations, will very much accelerate the process. One, two, or three tumblers of watei are taken at intervals luring the envelopment. Dr. Johnson recom- mends a little allopathi auxiliary ir the shape of “ a pint of hot, weak, Fig. 17L 86 THEORY AND PRACTICE. black tea !” I would recommend the patient to abstain, teetotally, from all such nonsense. The patient should never remain long enveloped after sweating has become copious ; it is much better to perspire moderately and fre- quently. On coming out of the sweating-blanket, some form of cool of cold bath should be taken, as the plunge, douche, shower, shallow- 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 bettfer 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 great mistake ; sweating is not the rule, but the exception in water-treatment. 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 treatment 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 diseases. This condition is called plethora in medical books ; it means over-fullness, grossness 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 afflicted with that unsightly disorder, obesity , can be assisted down to the standard of normal 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 the 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 of invalids still who may find benefit from the dry packing ; those who suffer occasionally, and at irregular intervals, severe rigors or clidls, proceeding from enlarged liver or spleen, or slight ulcerations di* tuberculations of the lungs. Though it will not prevent the chibs, it will materially mitigate their severity, and thu* WATER-CURE PROCESSES. 87 indirectly assist the final removal of the cause. For this purpose the patient may be enveloped ac 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-batli. 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 taught, 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 equa*. 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, i9 from fifteen to twenty-five minutes. The “steam doctors” have brought vapor-bathing into unmerited d.srepute by overdoing it. Many patients have been “steamed” so long as to produce a degree of muscular relaxation and vital exhaustion, not fully recovered from in years. The process is, in their hands, usually accompanied with hot and stimulating drink®, “composition,” “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 vapor-bath can be contrived lr. many ways. The invention of Mr. Jeremiah Essex, of Benningtor, ^ r t., combines as many conveniences as any plan I have seen. 58 THEORY AN1> PRACTICE. Fig. 17SL Fig. 172 is an inside elevation of Mr. Essex’s bath, showing the ar rangement by which a person can take a cold or warm shower, or a vapor-bath at pleasure. The out- side casing is the box of the bath, which may have screen 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), can be of no in- convenience. C is a small circular vessel of water surrounding the tr ip, E, seen in section, and com- municates 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 into 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 forced up as in the COED SHOWER, WARM SHOWER, AND VAPOR- co j d s } lowe r. BATH COMBINED. To make a vapor bath, the pipe, M. seen partly 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 occasion- ally put into the vessel, so as to keep the vapor constantly rising from 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, coverol with blankets from the neck downward The \npo* TATER-CURE PROCESSES. 89 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 /alids as are obliged to k cep the bed. Fig. 173. e 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 is 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 then 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 pomt. 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, 6, 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 water, the patient 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-Bath. — This amounts practically to an out-door, coldk 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 rain-bath is excellent. The constant evaporation from the surface 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 the patient should be dressed in light, thin clothes during the walk, and on returning to his room be well rubbed with the dry sheet, and keep up moderate exercise for half an hour or so after dressing. Fountain or Spray-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 from 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 stronger impression of the douche cannot be borne, or is not indicated. Dyspeptics 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 affusion, 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 machines, holding two quarts or more, for shower- ing by hand, are made by most of the tinsmiths. 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 floor, is caL d affusion. It is as good as any other form of bath where its indication ‘s simply to cool the body, as in the hot stage o* WATER-CURE PROCESSES.. 51 fevers and active inflammations. Dr. Currie employed affusions ex- tensively, and with remarkable success, in the treatment of seal let fever, measles, small-pox, and other diseases, at Liverpool, England, half a century ago ; but, unfortunately, the medical faculty of the present day, who acknowledge the superior success of his practice, do not see fit t r imitate it. Affusions are performed with tepid, cool, or cold water, accoiding to the degree of morbid heat attending the disease. Towel or Sponge-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-treatment 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 7 time and place, whenever and wherever desired. The towel is preferable to the sponge, because its friction is more perfect and uniform. I should be unwilling to dress, on rising from bed in tho 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 warming 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 7 some German hydropaths, as not being Priessnitzian, but for no other reason that I can imagine. They 7 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- laying excessive nervous irritability, they are sometimes eminently ser- riceable. In cramps, colic, spasms, and :onvulsions, they operate ad* 42 THEORi* AND PRACTICE. mirably. It sometimes happens that a patient, while under treatment, will, without any unusual exposure, experience all the symptoms of a severe cold, feverishness, headache, sensitiveness to the atmosphere, chilliness, and various aches and pains All these disagreeable symp- toms can geneially be removed at once by a hot bath for ten minutes ; and if the bath is succeeded by a pail douche, shower or dripping 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 one 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 supports may be re- sorted to while the learner is getting accustomed to the ne cessary motions. Corks and bladders are convenient. Fig 174 represents a bladder, wel blown, and fastened over the shoulders by a rope passed un- der the chest. Large pieces of cork may be attached to each end of a rope and used for tl 3 same purpose. The supports Fig. 174. SWIMMING WITH A BLADDER. WATER-CURE PROCESSES. 43 Fig. 175. SWIMMING WITH THE PLANK. 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 effects of a sudden cramp, and he can practice with facility the neces- sary motions with the bgs 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 oe 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, fas- 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 with his legs, or by hold- ing it in his teeth, he may use all his limbs at once Fig. 176. 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 grade can be found, the learner can soon become a good swimmer, 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 of the breast, pointing for- ward, the fingers kept 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 sweep backward to the hips, the hands being turned downward and outward : then bring them back under the body, and with as little ra* 44 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, they are pushed straight forward; second, the sweep round to the hip3, 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 pupn 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 stroke 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 I would advise all new beginnera 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 strokes. The motion in the water should be as straight forward as possible, and the more the head is immersed the easier is the swimming. Ris- ing at every stroke — breasting , 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 natura, 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. 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 very nauseous. In leaping into the water, feet first, which is done from locks, bridges, and even from blunging or divijvu the yards and masts of lofln WATER-CURE PROCESSES. 45 vessels, the feet must be kept close together, and the arms either held close to the side, or over the head. In diving head foremost, the hands must be put together, as in the engraving (fig. 177), so as fo 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 hands are placed upon the hips, as in the 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 slowly. In swimming on either side (fig. 179), the motions of the legs have no alteration, but are performed as usual. To swim on 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 downward, 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, stretch out the lower arm the instant that a strike is made by the feet, and strike with the other arm on a level with the head at the instant that the feet, are urging the swimmer forward; and while the upper hand is carried forward, and the feet are contracted, the lower hand must be drawn toward the body. This method is full of variety, and capa- ble of great rapidity, but it is alsc 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. Fig. 178. TREADING WATER. 4b THEORY AND PRACTICE. Fig. 180. THRUSTING Fig. 181. ia ordinary swimming, but the hands and arms very differently. One arm, say the right, should be lifted wholly out of the water, thrust forward to ita 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 rapidity 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 from the greater exertion of more rapid methods, and especially when a long con- tinuance in deep water is unavoid- 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 line 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 rapidity. 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. FLOATING. are soon learned when onco the pupil has acquired con- fidence in his buoyant pow- ers. Floating (fig. 182) is so useful a part of the art of swimming, that it cannot Irt WATER- 'URE PROCESSES. too soon obtained. In salt water, nothing is easier ; and in fres most persons, it requires but the slightest exertion. The feet s be stretched out, and the arms extended upward, so as to be at as high as the top of the head, and under water. The head mu held back, the chin raised, and the chest expanded. The hands easily keep the body in this horizontal position, and by breathing ca fully a person may float at ease for hours. Could a person, unable swim, but have the presence of mind to take this position, he co scarcely drown. * To beat the water , the legs are raised out of it alternately whil swimming on the back, the body being sustained by the hands. While 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. Swimming under water should be done with the eyes open. If you would 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 drowning. Beating, and swimming under water should not be attempted until the swimmer becomes expert in the other processes. Eye and Ear Baths. — Various contrivances have been employed to bring the bathing processes to bear on the eyes and ears mere 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 without preternatural 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 the use of snuff, it may be employed perseveringly to advantage. For nose-bleeding, the water should be THEORY AND PRACTICE cold as possible. After the removal of soft polypi from the nostrils, water should be employed frequently to constringe the vessels ploying the nasal-bath, the water should be taken up by gentle, inspirations, not by a sudden jerking motion, as this often gives and increases irritation. he Oral, or Mouth-Bath. — Gargling the mouth with pure d water should not be omitted in inflammatory affections of the roat or palate. For sore or swelled gums, toothache, hoarseness, d all vitiated secretion^, cool or cold water should be frequently held n 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. The Arm-Bath. — For old ulcers, and recent or chronic swellings of any part of the arm, holding the affected part in cold water from fifteen minutes to an hour, will greatly assist in healing the ulcer or Absorbing the swelling. Eruptive and rheumatic affections, in fact, all morbid conditions of the upper extremities, attended with preternat- ural heat, should be treated locally, by holding the part diseased in cool or cold water, or wrapping it in wet cloths, to be frequently changed, until the temperature becomes natural. In erratic complaints, which are liable to change the seat of inflammation, as with gout, lheumatism, 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 be substituted. The Hand-Bath. — Habitual coldness of the hands, or numbness, i3 relieved by holding them frequently 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 ail cases, be that which feels most agreeable during its application WATER CURE 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 form 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 water 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 effect 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 Water-Cure system, the air-bath may be properly j*on II — 5 60 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 current. It is employed under precisely the same regulations as a cold-watei bath. It is certainly a very invigorating process, and rnay 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 agreeable. The air-bath has sometimes followed the w r et- 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 ha been practiced by some persons as a hygienic measure. There are few persons who cannot bear a moderate degree 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 very restless, dream-disturbed ’^dividuals, and it is said to conduce remarkably to quiet and refreshing sleep. 1 have known the experiment tried frequently, and always with good effect. Patients suffering from fevers and inflammatory disorders, under the popular practice, generally have their sufferings greatly aggravated 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 preternaturally 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, periodical headaches, hysterical convulsions, etc., when :he state of the system is net actively inflammatory, nor the local part preternaturally hot. In the latter case, cold applications are the most efficacious to alleviate 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, colic, tooth- WATEJI-2URE PROCj^SSEb. 61 ache, backache, erratic and irregular pains from various chronic dis eases, lumbago, pleurodynia, etc. But it must be recollected that all very warm or hot applications ara always for occasional, never for constant employment. They are to be regarded in every case as temporary expedients, specbilly 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 w^ell 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 pail to be fomented, and upon it is placed a double fold of thick flannel, dry. c: 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 effects 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 bowels, 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 pad . 52 THEORY AND PRACTICE. Rest , 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 machinery 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 affected, and covered with a dry cloth or other material, to retain the animal heat. A cooling bandage , or compress, is a similar wet 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 linen 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 weather, 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 moie 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. 58 will nevertheless be as prompt and even more perfect. When the skin is torpid and cold. Canton or soft, light, woolen flannel 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, ns 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 c 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, as 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 doth. 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 bo worn during the warmest part of the lay, 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 complaiu %re exceptions to th ? general rule and for all of these complaints this THEORY AND PRACTICE. LA bandage is appropriate. It is also serviceable in all chronic diseases of the liver, and in acu ;e diseases of the abdominal viscera, as inflammation of the stomach and bowels, cholera, dysentery, cholera morbus, diarrhea, etc., it is always employed with benefit. A great deal of ingenuity has been wasted in contriving abdominal compresses. But the best invention of all is three yards of common crash towel cloth. One half of this is wet, and moderately wrun^ • 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 sixteen 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 mismenstruation 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. Friction. — Hand-rubbing, towel-rubbing, rubbing 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 rule, 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, tlrat it should be active and rapid, rather than harsh or scraping ; rather magnetic than forcible. Some invalids, on the mistaken notion that the harder they are rubbed the more wiL they became vitally magnetized, keep the attendants at work, if they be good- nature I, and object not. zntil completely exhausted; henc« WATER-CURE PROCESSES. 55 the physician should always instruct 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- ter 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 strictly should we follow the test of his feelings in ad ninistering tepid, warm, cool, or cold baths. When the circulation is vigorous, 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 temperatures of water, after which the physician or patient can prescribe 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 D to 40°. Cold, to 55°. Cool, 55° to 65°. Temperate, 65° to 72°. Tepid, 72° to 85°. Warm, 85° to 98°. Hot, 98° to 115°. Vapor, 98° to 125°. 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 tern- oerature. But here, again, we have better guides than seconds and minutes, in the feelings of the patients and in the effects produced, ft 56 THEORY AND PRACTICE. is tiue 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 always 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 m an hour after a light, and two hours after a hearty meal 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 warm 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 agreeable. 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 school are wholly in error about it. The majority of people 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 checic the perspiration, and do immense mischief by driving il in f This is a mere phantasy. The matter of perspiration is a WATER-CURE PROCESSES. 67 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 off with 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 surface, 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 produe the greatest 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-Drinring. — 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, while under treatment, 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 appeal’s bilious, and the pores, as it were, glued together, cannot take, with profit, more than three to six tumblers daily. 1 n 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 >ff mainly by the kidneys. 58 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 transpiration, and the more water required. Those who use much animal food, salt, or other seasonings, grease of any kind, or concentrated farinaceous food, require a much larger quantity of water — other circumstances being equal, than those who restrict themselves 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 distressing chilliness of the stomach. Such in- valids should begin with half a tumbler, or even less, and gradually 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 extravagantly 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 follow the sensations of the stomach ; 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, as 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 warm water is employed, and for the latter cool or cold. On the first attack of acute diseases of the bowels, cholera, dysentery, colic, diarrhea, etc., copious tepil injections should be promptly resort- ed to. and succeeded, aftei the alimentary canal is well cleansed, by CRISES. 59 cool injections. In obstinate constipation from debility, cold injections should be 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 jr:st 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 gleet, leucorrhea, prolapsus, and menorrhagia, 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 the 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 effectual functional efforts of all the excretory organs, unattended with any great commotion in 60 THEORY AND PRACTICE. the organism, or strong determination to any me emuictory, nr sink- ing of the vital 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 may be called critical efforts ; and others, after one or several paroxysms of general or local excitement, attended with some profuse evacuation, severe boils or eruptions, a general feverish- ness, or an aggravation of old, half-for gotten aches, pains, or other local affections. Forms of Crises. — The most common forms in wnich crises, or critical efforts, present themselves are, diarrhea , boils , and general feverishness . Bads present all manner of appearances 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 distress of any kind in the bowels, but the evacuations are thin, watery, and frequent ; generally there are from three to six or eight motions in twenty hours. In persons who have been most sub- ject to piles, the motions will be most frequent, and attended with con- siderable bearing 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 ordinary diarrhea; if long contin- ued, there is, of course, some degree of languor, but then the dis- charges are very easily checked by hoP'sitz-baths and cold injections. Those who have long T 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 in T ariably beneficial, always being succeeded by a decided sense of improvement in the patient’s entire physiological condition The term “feverishness,” does not very well express the other coca- CRISES. 61 mon 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- tack of simple fever, but.tliey appear in a more disguised and irregular form. There is chilliness and heat, languor, depression, backache, headache, general 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 disturbajce continues from one day to a week, when, un- less aggravated by improper treatment, 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 far 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 satisfactorily 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 contend that cures car generally be made without crises, these being the ex- 6 82 THEORY AND PRACTICE. eeptions ; and stil. others regard the majority of the crises as the re suit 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 judgmen that some few cases are utterly incurable without the production of a decided crisis ; and I am fully convinced that in many cases crises are rendered unnecessarily and even dangerously severe by excessive or injudicious treatment — 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 safer gen- eral plan of treatment, especially in home practice, is to take the slower yet surer way — do only what 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 strictly physiological is the food taken, the less severe and distressing 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 says ( Hand-Book oj Hydropathy ) : “ This natural vital process is not to be regarded as 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 Aleppo boil, small-pox, measles, and many other well-known diseases, prove this to demonstration, and beyond the possibility of question. In all these cases the crisis is clearly the means of cure. Without such or Home similar 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 Gully 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 skin 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 kinds, 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 organs, 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, eruptions, 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 Dig 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 84 THEORY AND PRACTICE gential distinction between water smd medicine is, that the former drives the peccant matter out of the body ; the latter, however, drivea it into the body. 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 corporality and spirituality 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 morbidly 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 restoration 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 allopathic prac- tice, or we may direct, modify, intensify, and accelerate them, as is the legitimate province of hydropathic practice. But we must confess to the parodoxical proposition, that the symptoms of disease are the evi dances 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 compli- cation 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. Whai do we discover ? The whole mas3 of blood is thick, dark, viscid, 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 where it enters the duodenum, it corrodes its mucous surface ; the stomach has been so 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 foecal matters, and the rectum or lower bowel is full of hemorrhoidal tumors ; the mucous membrane of the throat and mouth is covered with an ery thematic 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 suffi- 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 become 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 the 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 with heat, and others depressed by cold — with impure 66 THEORY AND PRACTICE. secretions in many organs, and excrementitious matters choking up tho capillary vessels more or less in the different structures, it may well be supposed that the vis medicatrix natures would present many phases of irregular and disorderly action ; sometimes concentrating the whole •emedial 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 directions. These efforts are attended with waste or expenditur of organic force, and sometimes this expenditure for a time exceeds the replen- ishment; hence “reaction,’ 5 as it is called, fails, and the patient feels a temporary depression, in which condition he is very 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 strong impressions or 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 p/*o- volze a crisis , with the view of curing, as it were, at a single dash, com- mits a grave 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 very much exhausted in muscular power, experience very great 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 apparently 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. >f which I have seen many, p>-ove to us that tl 9 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. JNature 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 vital 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 propelled 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- tery above , or toward the heart. Its strength is determined by the de- gree of compression it will bear before it will cease to be felt by the finger 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 these respects. 68 THEORY AND PRACTICE A normally strong pulse resists moderate, yet yields readily to se- vere pressure. A preternaturally strong pulse is almost incompressible. A strong pulse is never very frequent, rarely exceeding 80, and never, per- haps, 90. A hard pulse offers nearly as great resistance at first as a strong pulse, but yields more easily and completely to strong pressure. A soft pulse feels full and round to the finger, but yields steadily and readily to pressure. A fall pulse gives to the finger the sensation of repletion or fullness. A contracted pulse is nearly 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 various 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 years, 105 ; three years, 100 ; seven years, 90 ; twelve years, 85 ; puberty, 80 ; 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 artery resembles a cord fixed at each extremity ; when it feels still harder and smaller, it is called wiry . 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 artery strikes the finger both abruptly and rapidly. 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 mor# forcibly. An intermittent pulse is that in wdiich a beat is occasionally missed THE PULSE. 6 ;* 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; filiform , resembling a thread, slightly vibrating; flickering , 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 imperfectly 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 hard ; 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 pulse is characteristic of high fevers and active inflammations. It is the kind of pulse which is said to bear 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 guise indicates a less degree of inflammatory action, or a great degree of irritation, without great 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. ro 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 degree of superficial capillary circu lation. Bleeding always permanently depresses this kind of pulse , but cold applications are generally very well borne. It is generally found in apoplexy, the hot stage of fevers, the incipient stage oi pulmonary consumption, etc. The contracted pulse indicates capillary obstruction and intense en- gorgement. Epidemic cholera affords an extreme 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 great 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. Thu3, in dyspeptic con- sumption — an affection which commences with a diseased liver and stomach, and ends with tubercles or ulcers in the lungs — the pulse will be moderately slow while the abdomen is the principal seat of disease ; it will gradually 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 egregious mistakes 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 preter naturally 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 dry, husky crugh, 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 pxdse indicates torpor, inaction, especially in the functicni THE PULSE. 7j 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- sionally to 40. A change in dietetic habits, if it be from highly-season ed, stimulating, or animal foods, to plain, simple, vegetable dishes, is always accompanied with a reduction in the frequency of the 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 ; bu*: usually denotes a greater degree 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 weak or 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 great 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, as coffee and tobacco. The intermittent pulse is extremely common with dyspeptics, nerv- ous invalids, sedentary persons, and those who are subject to constipa- tion, and also with old persons. 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 peculiarities, 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. < TjASSIFI cation of Fevers. — The nosological arrangements of fe- vers as found in medical books, are all, in my judgment, unphilosoph- icaJ and absurd. Without wasting any of my limited space in exposing their errors, I will at once propose a classification which shall, at leash make a nearer approximation to pathological propriety. Marsh Fever. Nosological Arrangement of the Simple Fevers . ( 1. Ephemeral . — One day Fever, Inflammatory . — Synochus — General Inflammation, C Yellow Fever, ( Ship Fever, 3. Typhoid. < Nervous Fever, Spotted Fever, ( Putrid Fever. Camp Fever, Jail Fever, ^ Hospital Fever. . ... . S Nervous Remittent, 4 . Remittent. J p utrid Rem it te nt. ( Quotidian — Everyday Ague, 6. Intermittent. < Tertian — Third day Ague, ( Quartan — Fourth day Ague. f Hectic F ever, « e / r ) Puerperal Fever, 6. Symptomatic, j Mesenteric Fever, { Milk F ever. Small-pox, Chicken-pox, Cow-pox, Measles, Scarlatina, Erysipelas, Miliaria, Plagu© 7. Eruptive. FEVERS. 73 From this arrangement I have excluded the “bilious fever” and the “ synochus,” 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 occasionally 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 Jen tier, professor of pathology in University College (Braithwaite's Retrospect, Part XXIII.), has lately classified continued fevers into typhoid, typhus, relapsing and fahricula. 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 terminates 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 drug-medicines as 30011 as they have recovered sufficient energy to make the effort; and this effort is what Dr. Jenner distinguishes as a distinct species of fe- ver, which he calls “relapsing,” and treats with another course of drugging. This explanation is confirmed, if not demonstrated, by the fact that the patients whose fevers are treated hydropathically, never have a re- inpsing repetition of the fever, nor any thing like it. II — 7 74 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 are supposed to bo among the predisposing and exciting causes of fever. In a genera] sense they may be summed up very briefly : local contagions or poi- sons, unhealthful food, impure water, vitiated air, personal uncleanli- ness, over-exertion, atmospheric vicissitudes, gluttony, intemperance, etc. Medical books are full 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 predisposing causes of inflammatory fever in the following words : • Plethoric habit of body, with a strong muscular system ; a good and unimpaired 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 !” It is of such stuff that many medical books are made. I only marvel that some transcendent genius has not re- corded human nature as a predisposing cause of disease ! Theory of Fever. — Since medicine became a system — t never was a science — theories of fever have, more than any other subject, displayed the genius of the great masters of the profession. The very names of all the different ones that have been written, would fill a v.e ume ; yet, at this day, we have m our medical schools no generally- recognized theory All is now as vague, indefinite, and unsatisfactory FEVERS. 76 as m “the dark ages;” and the existing op.nions of living authors re- garding the nature of fever, are speculations of the most chimerica. 1 character. Still, the whole subject seems simple enough. The reason why an explanation has never been found is, I apprehend, because it has never been sought in the right direction. A man who shoulJ 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 think on* some specific, strange, hidden, occult, myste- rious, extra-natural thing, substance, element, 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 book? and medical schools are so tinctured and mystified with the vagaries of medical professors, that the student of n^ dicine is morally certain tc 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 inflammatory , 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 typhus. There is less ability to react successfully, and the internal commotion is pro- portionally greater. The surface is less turgid, but the viscera suffer 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 mouth, bile in the stomach, etc. Then his fever may be called bilious . The man of impaired constitute n and weaF digestive powers, wh« 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 obstructing. 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 hos 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 nervous 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 peculiar it' es. This view of remittent and intermittent fevers is confirmed by the fact that enlargements and indications of the large glandular structures, thing off, I let the patient alone until jt 82 PATHOLOGY AND T H E R AP E U TI 0 S. 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 three or four tim°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 his inclination leads ; eat what he will, drink 'what 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 natural 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. * k 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 patient be ever so sick at the stomach, 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 cure 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 days, and that with your ;vet sheet, etc. ; I am sure this plan is a great deal easier, and much qi icker ; and again, these books give no direc- tions whe* co commence the treatment, which I am certain is a mate- FEVERS. 83 rial point. I am sure if iny mode is not employed as directed, at 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-lands, in Sciota county, Ohio, the most no- ted place for bilious complaints perhaps in the world. A physician whc had attended my family, being about to move away, I asked him whom I 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. Shew’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 time 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, f have employed the pouring heaa 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 *n ordinary fever, which has the advantage of always being convenient* 84 PATHOLOGY AND THERAPEUTICS. and may, fcr this reason, be preferred by those who do not well un- derstand the management of the wet sheet, or who have not conve- niences for the immersion or plunge-bath. Place the patient in a hip- aath — 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 maybe repeated as often as there 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 may be 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 be 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 by 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 fcecal 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 Uiis purpose they may be taken to advantage when the const*- FEVERS. 86 nation is considerable. Emetics are rarely necessary; 1 never pre acribe them, except there is evidence of crude ingesta recently taken into the stomach. In this case the patient should drink warm water 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 sickuess 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 this 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 bread 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 than 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 roup, panada, etc The fever will always sta ve out before the patient ii injured by ab§& 8 B6 P A T H 0 L 0 G*Y AND T II E R A P E U Ti C S. ftence, at least under hydropathic treatment, and the appetite will al- ways return when the system is capable of assimilating food. Local Complications. — Among the common incidents attending the progress of a fever treated in the ordinary drug way, are, ex- cessive irritability of the stomach, vomiting, diarrhea, hemorrhage from the liver, bloated abdomen, or tympanitis, fulling off of the hair, ab- scesses, boils, obstinate constipation, retention or suppression of urine, topical inflammations, dropsical swellings, etc. Most of these compli- cations are factitious, and owe their existence entirely to drug medica- tion, and are hence wholly unknown to the water-treatment. But as we are often called to patients who have been drugged, more or less, since the attack, we shall frequently have these incidents or accidents to manage. The stomach can generally be quieted by the free use of warm water, followed by bits of ice or sips of very cold water, and the cold compress externally. In a severe case apply also hot bottles to the feet and cold cloths to the head ; and if the head be very hot pour cold water on it for several minutes, until it becomes perfectly cool. Diarrhea may be checked by the hot fomentation or warm hip-bath, followed by cool or cold injections. Hemorrhages require the cold compress, cool or cold injections, and bits of ice or frequent sips of very cold water, with the hot foot-bath. Tympanitis requires the same treatment, with occasional hot fomentations. Abscesses and boils need nothing but the wet compress. When the hair inclines to fall off, it should be cut very short, and the head often wet with cold water, but not covered. Constipation is to be treated with tepid injec- tions, as copiously as the exigency of the case demands. Difficult urination can generally be obviated by the fomentation or hot sitz- bath, or these followed by the cold compress, or a dash of cold water upon the pelvic region. In extreme cases the catheter must be em- ployed. Topical inflammations and dropsical swellings each require cold compresses frequently renewed. Relapses . — I mention this subject only to contrast the condition of convalescent patients who have been through a course of allopathic drugging, with those who have had exclusive water-treatment. The former are always liable to relapses ; the latter never. Ephemeral Fever — Febris Ephemeris. — Some authors have dis- tinguished this fever into three species, acute . mild, and sweating; but the distinction is of no practical utility. diagnosis . — Rigors slight stages of short duration, mental functions ?carcely disturbed, terminat .ig in a few hours in a moderate sweat. FEVERS 87 The disease often disappears with a single paroxysm and seldom ex- ceeds two or three. Special Causes. — A slight cold, an indigestible meal, a debauch, over- exertion. Peculiarities of Treatment. — The wet-sheet pack for an hour, fol- .owqd by the dripping-sheet, or cold ablution, or free injection, with fasting for twenty-four hours, will always remove this kind of fever. Inflammatory Fever — Synochus. — The terms synoclia and sy - nochus are employed quite promiscuously in medical books. Generally, nowever, a distinction is made, the former term being applied to what is usually denominated inflammatory fever, and the latter to a form of fever which is regarded as a compound of inflammatory and typhus — inflammatory in the commencement and typhus in the end. The truth is, these forms of fever are but different degrees in the violence of the same essential type, which may be called inflammatory or high fever , in contradistinction to typhus or low fever. Diagnosis. — This form of fever is rather peculiar to vigorous con- stitutions, and to persons of active, out-door habits of life. It may be distinguished from all others bv th<* following assemblage of symptoms : Tongue generally white with red edges, pulse full, hard, strong , and quick, though never very frequent. Temperature of the body uni- formly high after the fever is fully developed ; eyes reddish ; urine scanty and high colored ; the whole surface preternaturally flushed and turgid ; the mental functions but slightly disturbed, or not at all. If this fever runs much beyond the ninth day, or if it is maltreated at the outset, the tongue becomes yellow, then brown, then black, and many symptoms of an original typhoid supervene. Like all continued fevers it is characterized by two exacerbations during the day; the first and mildest in the forenoon, and the second and severest toward evening. Peculiarities of Treatment. — Of this fever it has been well said : “The blood is on fire ; extinguish the flame, and the patient will be well.” The hydropathic treatment is more simple and direct than in any other form of fever. Wrap the patient in double wet sheets, rightly covered with bedding ; let him remain as long as he is com- paratively comfortable ; then wash him off with cold water. Repeat the process as often as the febrile heat increases. The immersion- oath and pouring head-bath, as practiced by Mr. Millar, are peculiarly adapted to this form of fever. In fact, a sufficient quantity of cold water applied in almost any manner, will finally effect a cure. Usually the bowels are constipated in the outset; hence free injections of tepid water are necessary, PATHOLOGY AND THERAPEUTICS. Yellow Fever — Typhus Icterodes — Synochus Icter odes. — Yellow fever is generally regarded as peculiarly contagious, though, I think, quite erroneously. Some authors, among whom are Dr. Good, have piaced it among the remittents, on account of the peculiar re- mission which occurs during its progress. Characteristics. — Partial or general yellowness of the skin ; parox- ysms somewhat irregular ; great tenderness or pain about the epigas- trium, or pit of the stomach ; type irregular, which irregularity con- sists in a marked remission of the febrile symptoms, occurring during the first day or two, usually about forty-eight hours after their access. In severe cases the eyes are intensely red ; there is extreme pain in the eyeballs, back, and limbs. The black vomit , so alarming to friends and physicians, does not always take place, and when it does happen, I believe it is owing more to mal- medication than to all other causes combined. Peculiarities of Treatment. — The excessive determination to the brain requires the constant application of the coldest wet cloths, or pounded ice, or the pouring head-bath. The stomach is usually ex- tremely irritable, and requires the cold compress. When retching or nausea is distressing, warm water should be freely drank for a short time, followed by sips of cold water, or bits of ice. The feet should also be placed in hot water for five or ten minutes. The bowels are usually severely constipated, hence a succession of warm water injec- tions should be promptly resorted to. The general treatment is the same as for inflammatory fever. Nervous Fever — Typhus Mitior. — This has been called “ mild typhus,” “low typhus,” and “slow fever.” It usually runs from six to eight weeks under allopathic management. Some cases are attend- ed with such prostration of the nervous system, that the patient either sinks or becomes convalescent in one or two weeks. Diagnosis. — Great disturbance of the mental functions; dejection of mind; frequent, weak, irregular pulse; tongue covered with a white, thick mucus : eyes suffused ; heat of the surface more or less unequal; frequent turns of muttering delirium; countenance peculiarly expressionless ; the skin is liable to irregular dryness and sweats ; the early symptoms are miid, and increase in violence gradually ; the evac- uations are not particularly offensive ; the urine is commonly whey- like. Peculiarities of Treatment.— -In the nervous form of typhus, the in- dications are rather to equalize irregular temperature and action than to reduce excessive. In son e cases the external heat is so high and FEVERS. 89 uniform, as to call for the wet-sheet pack; but more frequently the morl id heat is pent up, as it were, in the head and epigastric region, while tho extremities are either of the normal temperature or cold. Under these circumstances, the expectant plan of treatment, as it has been Called, is the best. Apply cold applications to the head, cold, wet towels, often changed, to the abdomen, and bathe the feet in warm water, or apply hot bottles to them; and whenever, under this man- agement, the preternatural heat of the body becomes general, sponge the whole surface frequently with tepid water until the febrile heat subsides. Nausea, vomiting, and diarrhea are frequent incidents, and require the processes already frequently named for those symptoms. Putrid Fever — Typhus Gravior. — This is a more violent and malignant form of typhus than the preceding. Jail, camp, ship, hos- pital, and several other fevers, usually considered as distinct species, nre but modifications of the putrid form of typhus, as influenced by local circumstances, and require no special pathological or therapeutic notice. The spotted or petechial fever, so called from purple spots ap- pearing on the skin before death, has prevailed extensively in many parts of New England and New York since 1806 . It has been very fatal, and was formerly denominated typhus syncopalis , or sinking typhus. Medical books also make a useless and groundless distinction between typhus and typhoid fever, on the vague supposition that the atter has its seat more especially in a disease of the mesenteric and Peyer’s glands. I reject this distinction as fanciful, if not puerile, and, as the reader will perceive, employ the terms typhus and typhoid in- discriminately. Diagnosis . — Attack sudden; progress rapid; rigors severe; early and great prostration of strength ; extreme anxiety and restlessness ; the countenance is expressive of anguish and horror; pulse hard, but small and rapid ; tongue dry and brown or black ; the skin imparts more or less of a peculiar stinging, prickling, or burning sensation to the touch ; the breath is hot and offensive ; there is ringing in the ears; throbbing of the temples; intense headache; ferrety redness of the eyes; the excretions of urine and fceces are dark and offensive. In the advanced stage, spots or blotches appear on the skin from ef- fused blood ; forming petechiae, maculce, vibices, etc. There is great exhaustion of muscular power, and the face wears a livid instead of a florid flush. Peculiarities of Treatment. — Perfect quiet, and abundance of fresh, unconfined air are indispensable. The bowels should be promptly moved by tepid inj eotions, to be followed by enema of cool water, to PATHOLOGY AND THERAPEUTICS 30 act as a tonic. In the early stages of a majority of cases of putrid fever, the morbid heat is sufficiently developed and uniform to demand the wet-sheet pack frequently repeated ; but it is generally necessary to apply hot bottles to the feet and cold compresses to the head at the same time. When the heat is too irregular, and the circulation too low for the full wot sheet, the abdomen should be frequently wrapped in wet towels, ana the whole body very frequently sponged over with cool or cold water. In other respects, the rules already given are suf- ficient to regulate the treatment. Remittent Fever. — Remittent fever is distinguished from contin- ued, by being attended w ih only one daily exacerbation of the febrile paroxysm, instead of two ; there is also a greater remission of all the febrile symptoms at the end of the paroxysm, though this remission is not complete as it is in intermittent fever. The remittent type of fever is common to hot climates, but rare in the temperate. It is also espe- cially prevalent in low, marshy districts, in the neighborhoods of stag- nant waters, in the vicinity of lands occasionally inundated, and in local- ities where the atmosphere is loaded with the effluvia of decaying ani- mal and vegetable matters. It is generally attended with great biliary disturbance, and in our southern and southwestern states it is often called • bilious remittent.” Sometimes it is called “ autumnal remit tent,” because it more generally prevails in the autumnal months. The nervous and putrid forms of remittent are distinguished by the same symptoms which denote the same forms of typhus fever ; a gen- eral disproportionate disturbance of the nervous system marking the former, and all the evidences of putrescency and extreme exhaustion manifesting the latter. All the general and special directions for treating the different forms of continued fever will equally apply to the same forms of remittent. It should be remarked that many cases of remittent fever — and the same is true of typhus fever — do not, on their first access, exhibit distinctly either the nervous or putrid type, although they always con- form more especially to one or the other as they progress. In all these cases, the character of the fever will approximate inflammatory synoclius, or high fever, and should be managed accordingly. Intermittent Fever — Ague and Fever.— Fever and ague seems to be especially connected with congestions in and functional derangements of the liver and spleen. Enlarged livers and spleens, called ague cakes, are very common sequelae of intermittents, although they are net unf*;^ quently de acted after protracted or repeated remit F EVtRS. 91 tents. What are called “chill fever’ and “dumb ague,” are disguised or imperfectly-developed forms of intermittent. Thi3 disease is com- mon to mia/smatic localities and new countries, where decomposing veg etation abounds, and places where the dense foliage and stagnant waters fill the air with carbonaceous and hydrogenous gases, are much more subject to it than those which have been longer under cultivation. It is very prevalent in many .parts of our Western States; and with the bad living which helps to produce it, and the huge doses of calomel, arsenic, and quinine given to cure it, a large proportion of those who “westward follow the star of empire,” find their constitutions irretriev- ably ruined. Diagnosis. — The intermittent type of fever is readily distinguished by the violence of the paroxysm, the regular succession of the cold, hot, and sweating stages, and the complete subsidence of all the febrile phenomena at the end of the sweating stage, this subsidence amounting to a periodical intermission of the disease. Peculiarities of Treatment. — Intermittent fever exhibits a variety of forms, as — quotidian ague , having an intermission about every twenty-four hours ; tertian ague, the intermission about forty-eight hours; quartan ague, intermission about seventy-two hours; to which some authors add sub-varieties, called irregular and complicated . These distinctions do not affect the question of treatment. The bowels should be well cleansed with tepid injections, and when there is much nausea, or bitter taste in the mouth, a warm water emetic is advisable. The wet sheet, or the immersion, must be resorted to during the hot stage, and the pouring head-bath when there is great determination to the brain, with severe headache. During the intermission, a hot bath, followed by the cold dripping-sheet, or cold shower, will generally soothe the nervous system, and mitigate the severity of the succeeding paroxysm. As the liver is always in a state of greater or less congestion, the abdominal bandage should be worn constantly. We find this disease under such diverse circumstances, and with so various complications, that there is room for considerable skill in its management. Recent cases are effectually cured by a few packs, or a single immersion, except when the causes have been a long time ac- cumulating. But frequently the liver or spleen is enlarged, or both may be in a state of congestion, and there is a dyspeptic condition attending it. Very often the skin is extremely torpid, and full of viscid, hardened, and impacted bile, the conjunctiva of a reddish-yellow, and, although sweating is easily produced, the real function of perspiration is scarcely performed at all. In these cases we may perhaps very soon “break the fits.” but to effect a permanent cure, the functional &2 PATHOLOGY AJNfD THERAPEUTICS actions of the liver, spleen, and skin must be established. U this is done, the feverish and agueish symptoms will exist in a more or less disguised form, or the disease will exhibit some other irregular form, and constitute a predisposition to glandular enlargements, dropsical ac- cumulations, chronic and spasmodic rheumatism, etc. These cases require an active treatment for several weeks; and in some few cases, where the constitution has been shattered by repeated fevers in mala- rious districts, and more especially when the patient has been repeat- edly cured by arsenic, quinine, calomel, etc., several months’ time are required to effect a cure. Regimen . — In continued and in remittent fevers, and in most other acute diseases, we have very little trouble abou* the diet, save keeping it away from the patient; nor much difficulty ir this vespect, for gener- ally there is no morbid appetite in the way. But with intermittent fevers, which may be regarded as chronic diseases with acute parox- ysms, the case is somewhat different. In those cases which linger several weeks, we must, of course, look to the nutritive function. Here we have not unfrequently to restrain the dyspeptic’s craving for accustomed stimulants, the hypochondriac’s rage for excessive quantity, and the epicure’s goading desire for tit-bits and seasonings. We cannot turn the patient off “old-school” fashion, with, “Eat and drink what you find agrees best,” and draw on the apothecary for the curatives, Dut it is our business to know exactly what will agree best, and so pre- scribe “ according to knowledge.” The best diet is wheat- meal bread, cracked- wheat mush with a very dttle milk and sugar for seasoning, a very moderate quantity of th* milder vegetables, and the free use of good, ripe, sweet apples, eitner baked or boiled. Grapes, tomatoes, prunes, and good dried fruits, are not objectionable. The crust of good sweet bread, and dry toast, or hard crackers, are excellent to improve the salivary and gastric secre- tions. Water should be drank rather freely, on account of the tendency to waste the serum by perspiration. Exercise should always be moderate. Over-exertion during the intermission always aggravates the subse- quent paroxysms. Sailing and carriage-riding are the most advanta- geous exercises. Symptomatic Fevers. — These are treated on general principles as far as the constitutiona disturbance is concerned, reference always being had to the primary affection. As ihey depend on a local patho- logical condition, they will be particularly considered under the beadf of the idiopathic diseases, of wb’ jh they constitute the symptoms. FEV ERS 93 Small-^ox — Ya,riola. — T he small- pox is a contagious eruptive fever, affecting both the skin and mucous membrane of the mouth, throat, stomach, and lungs. Its access is a fever; this is followed in three or four days by an eruption, which is papular at first, then ve- sicular, and lastly pustular ; the pustules are pointed at first, but after- ward become umbilicated. The eruption terminates in twelve to 3 venteen days in dessication and scabbing, leaving larger or smaller jregular cicatrices. Species . — This disease appears in three forms : 1 . Distinct small- pox — variola discreta. 2. Confluent small-pox — variola conjluens . 3. Modified small-pox — varioloid. The first variety is the mildest ; the eruption is regular, the vesicles distinct, and the fever of the inflam- matory type. The second variety is the most severe ; the vesicles are irregular and mixed, and mature imperfectly, and the accompanying fever is typhus. The third variety is the small-pox as modified by vaccination, or a previous attack. Stages. — The phenomena of variola are divided into four stages : 1. Incubation , or the latent period ; being the time that intervenes between the inception of the virus and the first appearance of the symptoms. This period varies from six to twenty days. 2. Invasion , which extends to the eruption, usually three or four days. 3. Eruption , the vesica ting and pustulating period, extending to the eleventh or twelfth day 4. Dessication , extending to the time of cicatrization, usually about the seventeenth day. The time from the third to the eighth day during which the papula? change to pustules, is called the period of maturation . Symptoms oj Distinct Small-Pox. — The attack is characterized by die usual premonitory symptoms of a violent fever, as chills or rigors, lassitude, headache, pain and weakness in the back and loins, tender- ness about the pit of the stomach, frequent nausea and vomiting, drowsiness, sometimes stupor, or coma, and with infants convulsions are frequent occurrences. These symptoms are succeeded by general heat of the body, dry skin, coated tongue, frequent pulse, and extreme restlessness, which continue until the eruption appears, when they partially subside. The eruption appears first on the face and forehead, in the form of nnnute spots or papulae, sensibly elevated above the surface of the skin. They are first noticeable about forty-eight hours after the occurrence of the rig >rs. During the third and fourth days the eruption extends to the sides of the nose, chin, upper lip, neck, and wrists, then to the trunk and thighs, finally covering the whole body. About the fifth day, little vesicles, depressed in the center, containing a colorless fluid. 94 PATHOLOGY AND THERAPEUTICS. appear, surrounded by an inflamed circular margin, one vesicle arising on the top of each little point or pimple. Usually the eruptive fevet further abates, or entirely disappears at this time. There is generally, though not always, an increased flow of viscid saliva, some swelling of the throat, with hoarseness and difficulty of swallowing, about the sixth day. On or about the eighth day, the pustules are completely formed and spherical, terminating in a point, and the vesicular fluid becomes puru- lent; the face and eyelids swell, and the mouth, nose, and fauces are covered with pustules. About the tenth or eleventh day from the access of the fever, or eighth or ninth from the appearance of the eruption, tho inflammatory areola surrounding the vesicle subsides, the contents change to an opaque yellow, and a dark spot appears on each pustule. Usually at this time the tumefaction of the face subsides and the hands and feet begin to swell. After the eleventh day the pustules become rough, break, discharge their contents, which, by drying on the surface, form small crusts. In a short time these crust? fall off, leaving the part of a dark brown color, which often remain? many days, and when the pustules have been very large, permanent indentations of the skin remain. About the seventeenth day, the sec- ondary fever , which comes on about the completion of the pustulation disappears, and the swelling of the hands and feet subsides. Symptoms of Confluent Small-Pox . — The eruptive fever is more intense, the strength is greatly prostrated, coma and delirium are fre- quent, and profuse diarrhea or salivation is often present. The eruption is preceded by an erysipelatous efflorescence upon the face, from which the pustules emerge on the second day, in the form of smak red points, which run together, and form clusters, resembling measles. The pustules are irregularly shaped, and contain a dark, ichorous mat- ter, instead of true pus. When the crusts begin to form, the whole face is covered with a general scab, which falls off from the fifteenth to the twentieth day. The fever does not cease upon the appearance of the eruption, but about the ninth day suffers a remarkable exacerba tion ; in very bad cases, the eruption becomes livid or black, and pe- techise, hemorrhages, bloody urine, and exhausting diarrheas occur. Should recovery take place, the pits or scars will be much deeper than in the preceding form. The patient frequently dies about the eleventh day. Symptoms of Modified Small-Pox. — The eruptive fevei, though generally severe, usually lasts but a single day. On the following day the eruption appears; first on the wrist and about the nose. Frequently a pimple on the ala of the nose gives an indication of the nature of FEVERS. $5 the malady. Tlie course of the disease is shorter, and the symptoms more irregular than in the other forms. Some of the eruptions pro- gress to perfect pustules; others die away without suppurating. As soon as the eruption appears, the patient is well, unless it is sufficiently extensive to keep up some degree of irritative fever. Diagnosis. — The diseases with which small-pox is liable to be con- founded, especially in its early stages, are — Chicken-pox — varicella , measles — rubeola; scarlet fever — scarlatina ; and erysipelas. Variola may be distinguished from chicken-pox by the pimples appearing on the back, the maturation of the pustules on the third day, and the ab- sence of suppuration and indentation, which characterize the latter dis- ease ; from measles, by the hoarseness, moaning, swelled eyelids and watery eyes, which attend the attack of measles, and the eruption appearing in crescentic clusters, not rising into visible pimples ; from scarlet fever, by the strawberry appearance of the tongue, and tlio bright scarlet efflorescence of the skin, which usually appears on the second day in the latter disease ; and from erysipelas, by the eruption or efflorescence being of a florid red color, and spreading from a par- ticular point over a large surface, in the case of erysipelas. Prognosis. — The result may be judged of by the condition of the body at the time of attack, and the intensity of the fever. It is generally favorable in the distinct and modified forms, and generally unfavorable in the confluent form. Dangerous symptoms are the pus- tules becoming flattened, livid, and interspersed with discolored spots, a sudden disappearance of the eruption, general pallor of the skin, with great anxiety and extreme prostration of strength, and complica- tions with local affections. Post-Mortem Appearances. — After death, dissection has shown the windpipe, bronchial vessels, lungs, liver, stomach, and intestines to be covered with pustules, with local inflammations in various organs ; the whole body runs rapidly into putrefaction. Causes. — Variola is produced by a specific contagion. Its nature has thus far eluded the recognition of our senses, and probably never will be detected by chemical analysis. The virus seems to act like a ferment in relation to some one or more of the elements of the blood, analogous to the process of saccharine fermentation. It is produced by subjecting the body to the effluvia arising from those who already labor under the disease, or by introducing a small quantity of the puru- lent matter of the disease into the system by inoculation. A doctrine has lately been started that the changes effected in the blood by the conta- gion of small-pox were a purifying process, analogous to the working of a barrel of beer. But the theory is refuted by the fact that all for 96 PATHOLOGY AND THERAPEUTICS. mentation is a destructive process, absolutely decomposing the saccharine and other fermented matter, and resolving it into its ultimate elements, Laws of Contagion . — It is communicated by contact, or through the atmosphere, by pustules, or substances imbued with the variolous mat- ter, and equally by the living or dead body. It is occasionally epidemic. Sometimes, though rarely, it occurs twice in the same person. Mortality . — From the statistics which have been collected, it appears that one in three or four cases are fatal. In the modified form, or in those who have been vaccinated, the mortality has been much less — about one in twenty. The periods of life of its greatest mortality have been under five and over thirty years of age; the ratio increasing below and above those ages, and being the least between them. Sequela. — Medical books describe a long catalogue of diseases as the consequences of small-pox, some of which are more to be dreaded than the disease itself. Among these are boils, abscesses , ulcers , gan- grene or sloughing of the skin , erysipelas , suppuration of the joints , hip disease , ophthalmia , blindness from opacity of the cornea , inflam- mation of the serous membranes of the chest and abdomen , tuberculated ’ ungs , consumption , mesenteric disease , and scrofula. Some of these sequelae doubtless result from frail organization, more from bad habits ot living, and still more from unfortunate medical treatment. Prevention. — Physicians are not at all agreed as to the propriety of resorting to vaccination as a protection from small-pox. The vaccine virus is the variolous matter modified by passing through the organism of the cow, or some other of the domestic animals ; hence the disease resulting from its introduction to the human system is called vaccinia or vacciola , cow-pox , kine-pox , and vaccine disease. There is no ques- tion that it is, to a great extent, a protection from the violence and danger of the natural small- pox ; at the same time there is danger of inoculating the patient with some loathsome and even worse disease, as venereal, or scrofula, from the impossibility of always getting a sup- ply of vaccine matter from healthy constitutions. In either way there •s a risk to incur, and it is a delicate matter for a physician to advise on a subject when both sides are hazardous. I am fully convinced that if people could bring up their children in strict physiological habits, the non-vaccinating plan would be altogether the best ; but in a city this seems next to impossible, and in the country it is pretty generally neglected. Children reared healthfully in relation to food, exercise, and ventilation, have little to fear from any disease, however contagious, they may have this, but it will not endanger life, nor produce much deformity nor serious injury. I have seen, within ttie last year, a most horridly loathsome case of scrofulous disease, in which the patient FEVERS 97 la e Hilly rotted alive at the age of fifteen, from unhealthy virus received ivtien he was but three years of age. Parents often find some one of their children tainted with morbid humors, unnke any other mem ber of the family, and which they are wholly unable to account for, except on the supposition of foul matter taken into the system by vaccination. My own practice would be to keep children as healthy as possible, and if the small-pox happen along, let it have its natural course. Those who have the means to do the same I would advise to act accordingly, while those who live, move, eat, and drink after the ordinary manner, would have a better chance at chances by resorting to vaccination. Treatment . — As in all fevers, whether eruptive or not, the tempera- ture of the body is the guiding principle in the treatment. To regulate the temperature and equalize the circulation, are the leading indica- tions. On the access of the febrile symptoms, the bowels, unless en- tirely free, should be moved by tepid injections. When the fever is fully developed, if the heat is not great, tepid or cool ablutions to the whole body will moderate it sufficiently; if the fever is severe, and the heat extreme, the wet-sheet pack should be resorted to, and resumed as often as it becomes warm, until the skin becomes soft, and the tem- perature near the natural standard. Give the patient as much water to drink as the thirst demands. Give no food save Indian or wheat- meal gruel, and not that unless the appetite calls for it. Nursing chil- dren mny take the breast as usual, if inclined. From the second to die fourth day, when the efforts of the organism are determined to the akin to produce the eruption, be cautious in meddling with the stomach and bowels. Thousands have been killed outright by an emetic or strong purgative administered at this critical period. At this time all the vital energies are aroused to throw the virus off through the surface, and if, by an irritating emetic or cathartic, this action be repressed, and the force or the disease directed to the stomach and bowels, death may be the speedy result. The principle here involved affords a satisfactory explanation of the superior safety of the homeopathic treatment, com- pared with allopathic, in all eruptive fevers, as has been frequently demonstrated in practice in the management of scarlet fever. After the excessive febrile heat is subdued by ablutions or packings, two cool or tepid ablutions daily, morning and evening, will generally be sufficient through the whole course of the disease. Should the ex- tremities at any lime become cold, bottles of hot water should be applied. There is often a strong determination to the brain, evinced by headache, delirium, convulsions, etc., when cold wet cloths should be applied. II— 9 98 PATHOLOGY AND THERAPEUTICS The secondary fever requires precisely the same medication as tin primary, though if the former has been well managed, the latter give* but little trouble. Ventilation is specially important ; the patient should be kept in a large, well-aired room, of even and rather cool temperature. Various expedients have been tried to mitigate the itching that often attends the dessication of the pustules, as well as to prevent pitting or scarring. None have, however, been found of much service. Washing the sores with cold cream is as harmless, and probably as useful, as any thing which has been suggested. Note . — The symptoms of small-pox, in the above article, are stated as they occur in patients whose habits of life pattern after the usual fashions of society. The hydropathic practitioner will often find them very materially modified in persons who have for a considerable time been accustomed to a hydropathic regimen, especially in children who have been trained on the principle of “ eating to live,” instead of that of “living to eat.” Indeed, in such cases many of the symptoms laid down in medical books as characteristic may be entirely wanting. I have a case at this writing under advisement, which strikingly exem- plifies the difference between an eruptive fever occurring in a very healthy or a very unhealthy person. Under judicious water-treatment, this frightful disease becomes di vested of most of its terrors, and there is little danger, except in a per- son of extremely gross habits and foul blood, of the skin being perma- nently pitted or scarred. Cow-Pox — Kine-Pox — Vaccinia — Vaccine Disease.— The vac- cine matter is usually inserted under the cuticle, by three or four punctures, in one or both arms. On the second day small, red, hard spots appear, which increase sensibly on the fourth , and on the fifth become small pearly vesicles, soon after surrounded by a pink or crim- son flush. On the seventh or eighth day the areola becomes circular or angular, and about an inch in diameter. The vesicle is uneven ; with a central depression. On the ninth day the flush is increased, hard, and tumid, often attended with an erythema over the arm or whole body. About the tenth day there is a slight febrile paroxysm. On the eleventh or tivelfth day the redness diminishes, the center of the vesicle is covered with a brown scab, which comes off about the twentieth day, leaving a deep, circular indentation, about an inch in diameter, with as many jits as there were cells in the vesicles. The vaccine virus is usually selected from the fiftf to the twelfth day. EE v ERS. 9n This disease requires no medication, save what s due to / ersDnal tleanliness, and “temperance in all things.” Chicken-Pox — Swine-Pox — Bastard-Pox — Varicella. — This disease is characterized by slight feverishness, followed, w’tliin twenty- four hours , by an eruption of small, reddish pimples, appearing first oh the back, very much resembling the first appearance of the eruption of small-pox. On the second day, the pimples become small vesicles filled with a colorless or yellowish fluid ; soon after a thin scab forms at the top, without pus. About the fifth day the eruption disappears, without leaving any mark or cicatrix. A daily wash of the whole surface of the body, with one or two wet-sheet packs, should there be at any time accidental feverish- ness, with a spare vegetable diet, is all the remedial attention it requires. Measles — Rubeola — Morbilli. — Nosologists divide this exan- them into two species, the common and the malignant — rubeola vul- garis and rubeola maligna . The first species is the mild form ; the second is the violent. Symptoms. — The early symptoms resemble catarrh, or influenza — cough, hoarseness, difficulty of breathing, frequent sneezing, itching of the face, smarting of the eyes and eyelids, nausea, thirst, etc. The eruption first appears on the fourth day, consisting of small red points on the face, thence extending downward over the body. These points do not rise into visible pimples, but are disposed in crescentric clusters, which feel a little prominent to the touch. On the fifth or sixth day the bright red color changes to a brownish hue, and in a day or two more disappears entirely with a mealy or furfuraceous desquamation of the cuticle. The fever rather increases with the eruption, and is attended with pneumonic symptoms, as cough, soreness of the chest, and oppressed respiration. It usually abates considerably at about the end of the first week. In the malignant form the eruption is earlier and more irregular, tfften receding and re-appearing, and of a dark or livid hue. The febrile symptoms are mor t severe, the abdomen is very tender, the head is delirious or comatose, the luugs are inflamed, and diarrhea and convulsions ofter occur. Peculiarities t f Treatment. — The mild form should be treated on prec sely the same plan as simple inflammatory fever, and the mabg nant form should be managed exactly like typhus fever of the putrid PATHOLOGY AND THERAPEUTICS. iOO type. Nothing brings out the eruption so promptly and effectually as the wet-sheet pack, and at the same time moderates all the symptoms of violent disorder in the circulating and nervous sytems. When the eruption comes out full and free, and the fever is not violent, occasional tepid ablutions are sufficient. When there is much soreness of the throat, several folds of wet linen should be applied. Severe cough, pain in the chest, or inflammation of the lungs, requires the chest- wrapper, applied very wet, and well covered with dry flannel. Diarrhea, when present, should be treated with cool injections. Scquelce . — Under allopathic treatment, this disease exhibits an appall- ng catalogue of consequences, as — Pneumonia, cynanche trachealis , bronchitis , consumption , chronic diarrhea , enlargement of the mesenteric glands , oph thalmia, abscesses in the ear, ulceration of the parotid glands, apthce and gangrene of the mucous membrane of the mouth . I appre- hend that these sequelse are to be attributed, in the main, to the drug- ging by which one poison is atttempted to be got out of the body by the introduction of a dozen others. It is certain that measles has been extensively treated in many different places in the Water-Cure way; and I have never yet known nor heard of a single death, nor of one of these resultant diseases. Scarlet Fever — Scarlatina. — This exanthem appears in three distinct forms or species: 1. Scarlatina simplex — simple scarlet fever. 2. Scarlatina anginosa. 3. Scarlatina maligna. Symptoms . — After the ordinary premonitory symptoms of general fever, a bright scarlet efflorescence appears, usually on the second day, first on the face, neck, and breast, extending downward over the trunk and limbs. At first the eruption consists of innumerable red points, between which the skin exhibits the natural color; these spots finally coalesce, so that in a few hours the red flush ‘ That form which is attended with eruptions, efflorescences, rashes, extensive ulcerations, rapidly-spreading gangrene, etc., is called ery- sipelatous, or erythematous. When it tends to the formation of a pre- ternatural membrane over the mucous surface, as in croup, tubular diarrhea, catarrh of the bladder, catarrh of the uterus, etc., it is called membranous , or membranific. When it affects mainly the glandular structures and mucous or seicus membranes, without febrile symp- toms in the early stages, as in tubercular consumption, internal dropsy of the head, and swellings of the conglobate glands, it is called strumous , or scrofulous . When confined mostly to the structures of the joints, as in gout and rheumatism, it is called arthritic. Inflammation is also divided into acute , subacute , and chronic. The first is attended with general fever ; the second is accompanied with occasional febrile paroxysms ; the last is without constitutional febrile disturbance. Terminations of Inflammation. — All inflammatory affections ter- minate either in resolution — a gradual subsidence of all the symptoms ; or in gangrene — the death of the inflamed part. But there are many results or consequences of inflammation which are usually called terminations by medical authors. These are exudation or effusion , suppuration , ulceration, induration , and adhesion. General Treatment of Inflammation. — The hydropathic man- agement of a visceral or local inflammation is precisely the same as that of a general fever, with the addition of the local appliances. The heat, pain, swelling, and all incidental accompaniments, are to be treat- ed exactly as we would treat the same symptoms when present as complications of a simple fever The regii ;en is also, in all respects* the same as for simple fevers. 112 PATHOLOGY AND THERAPEUTICS. Inflammation of the Brain — Piirenitis — Brain Fever. — This disease is also sometimes called phrensy. Some authors distinguish it into two forms — encephalites , when it affects principally the substance of the brain ; and meningitis, when it affects principally its investing membranes ; but as the disease, whichever structure is primarily af- fected, soon involves both, and as the treatment is in all respects the same, according to the vii.ence of the symptoms, this distinction has no practical utility. Symptoms. — Acute or excruciating pain in the head, throbbing of the temporal and carotid arteries, flushed face, eyes injected and bril- liantly reddish, contracted pupil, and a wild expression of countenance, characterize the disease when fully formed. These symptoms are ^receded by various cerebral and febrile disturbances, sometimes vio- lent delirium, at other times nausea and vomiting, or general con- vulsions. The bowels are usually extremely costive. There is also great intolerance of light and sound, incessant watchfulness, the skin is dry and hot, the pulse hard and quick, the tongue is dry and covered with a white fur, and there is intense thirst. Special Causes. — Exposing the head to a hot vertical sun, violent exercise, intense study, excessive passion, external violence, metastatic gout or rheumatism, and repelled eruptions, are among the most fre- quent of the exciting causes. Diagnosis . — Inflammation of the brain resembles, in many promi- nent symptoms, several other complaints, from which it is indispensable to distinguish it. From mania, it is known by the accompanying fever; from the delirium of inflammatory fever, by the delirium in the latter case succeeding instead of preceding the febrile symptoms ; from the delirium of typhus, by the suddenness of its attack ; from the cerebral irritation or determination to the brain arising from the effects of loss of hlood, by the pallor of the skin and countenance in the latter case ; and from delirium tremens, by the pallor of the surface and general tremor of the body and limbs which denote the latter. Peculiarities of Treatment. — In most cases, inflammation of the brain is attended with synochus, or high fever, and requires thorough general and local cold treatment. The immersion-bath is excellent; or the patient may be enveloped in double or treble wet sheets, while the head is cooled with pounded ice, cold cloths, or the pouring-bath. The extremities must be carefully watched, and if the feet are not hot, Ake the rest of the body, they should be bathed in warm water. The constipated state of the Lawels, of course, requires copious tepid injec- tions, In some cases where the whole scalp feels excessively sore and tender, cold water feels disagreea >le, and then tepid water is mor* VISCERAL INFLAMMATION. in soothing, and, by more rapid evaporation, will cool the head as effectu- ally as the cold water will in other cases. If a single sheet is employed for packing, it wiL require to be renewed several times a day. Inflammation 01 the Throat — Quinsy. — Under this head are included four distinct forms of inflammation of the throat, all of which are characterized by heat, redness, and swelling of the fauces, with painful and difficult deglutition. Symptoms. — The first form of the disease under consideration is the common quinsy, or tonsillitis of authors, called also cynanche or angina in medical books. It consists of a swelling of the mucous membrane of the fauces and tonsils, by which the functions of swallowing, respira- tion, and speech are performed with great pain and difficulty; the ac- companying fever is violent, and the disease terminates in a few days by resolution or suppuration. The second form is known as the malig- nant, or ulcerated sore throat. The attending fever is typhoid ; the fauces exhibit a crimson flush, with ulcerations covered with mucus, and spreading sloughs, of an ash or whitish hue. This form is fre- quently epidemic. In the third variety, the redness is more florid, and is most violent at the lower part of the fauces ; the swallowing is extremely painful and difficult. The fourth variety has been called quinsy of the oesophagus ; the difficulty in swallowing is felt below the pharynx, and the food is generally rejected when it reaches the seat of obstruction. Special Causes. — All of these forms of throat disease are most com- mon in spring and fall, which fact shows that sudden changes of weather, or “taking cold,” are their principal exciting causes. Peculiarities of Treatment. — The wet compress, consisting of several folds of linen wet in cold water, must be promptly applied around the throat, and frequently renewed. The whole body must be well rub- bed in the dripping sheet, or tepid half-bath, and then wrapped in the dry blanket, so as to produce moderate perspiration ; or the general fever may be treated with the wet-sheet pack. In the malignant form, small draughts of iced-water should be frequently taken, and the coldest water, or pounded ice, applied to the throat whenever the morbid heal is troublesome. Inflammation of the Larynx — Laryngitis. — This disease, in some of its symptoms, resembles quinsy, and in a still greater number , the croup. It consists in a suppurative inflammation of the membranes of the larynx, extending backward to the membrane con mon to itself an 3 the .esophagus, between which purulent matter is often formed Ill PATHOLOGY AND THERAPEUTICS. ft is a disputed point whether Washington, in his last illness, was attacked with this disease or common quinsy; but it is certain that he died of antimony and the lancet! Symptoms. — After the ordinal / symptoms 01 fever, the voice be- comes hoarse and indistinct ; the breathing labt nous, with a painful sense of constriction in the throat ; the fauces are swelled and turgid, Ihe swelling extending to the face and eyes, the latter sometimes pro- truding as in cases of strangling; the pulse is frequent, the tongue furred, and every attempt to swallow is attended with great distress, the muscles of deglutition being thrown into violent spasms, threatening the patient with instant death from suffocation. Diagnosis. — It is distinguished from croup by the existence of a con- stant and voluntary hawking, rather than a forcible and involuntary cough ; and from common quinsy by the absence of any considerable swelling of the tonsils. Peculiarities of Treatment . — There is no material difference in the therapeutic management required for this and the preceding malady, except that indicated by the danger of immediate suffocation. Ice- water gargles should be freely employed, in conjunction with cold wet cloths to the throat, and the general tepid-bath, or wet sheet; and if the extreme sense of suffocation is not relieved in a few hours, the patient should be put into a full hot-bath for ten or fifteen minutes ; if, however, this is impracticable, the hot fomentations to the abdomen should be resorted to occasionally, in connection with the general and local treatment already mentioned. Inflammation of the Trachea — Tracheitis — Cynanche Trachealis — Bronchlemmitis — The Croup. — This disease con- sists of a peculiar inflammation of the mucous membrane of the trachea, or windpipe, attended with a thick, tenacious, glairy secretion, which hardens, if the disease is not soon arrested, into a preternatural membrane, and produces death by closing up the air-passage in the larynx. In some few instances, however, it has been expectorated. A similar membrane is also sometimes formed in the bowels, bladder, or uterus, and cast off in the form of a tube, or of fragments resembling, and sometimes mistaken for portions of the mucous membrane. Symptoms. — The first stage is denoted by a ringing cough, to which many children are subject on taking cold, attended with little or no change in the breathing or voice. This may be called the premonitory stage. In the second stage there is a shrill, ringing cough, with diffi- cult breathing; the voice is altered, hoarse, and broken; the breathing is sometimes hiss :g and a other times creaking or crowing; the eye* VISCERAL INFLAMMATION. 115 are heavy, watery, and bloodshot, and many patients die before the disease progresses further. In the third stage the cough and voice are stridulous, the respiration is laborious and suffocative, and the case is generally regarded as hopeless. The cheeks, eyes, and nails mani- fest a purple redness; the complexion is often mottled, or the flush of the cheek is circumscribed; the pulse is very small and frequent. In the fourth stage the voice is whispering and low; the cough less fre- quent, and scarcely audible across the room ; the trachea is coated with effusion ; the face is leaden, the eye filmy, and the extremities cold, and final insensibility is gradually closing the scene. Special Causes. — The croup most frequently attacks children be- tween the ages of one year and twelve, though occasionally it occurs in infants at the breast; and very rarely in adults. Sudden alternations of temperature, especially going from a heated, ill- ventilated apartment to a humid atmosphere, or vice versa , with little or no attention to bath- ing habits, are among the. prominent circumstances which co-operate to produce this disease. Peculiarities of Treatment. — As the danger from this disease consists in the effusion which concretes into the artificial membrane, the treat- ment should contemplate the arresting of this secretion at the earliest possible moment. The whole throat must be instantly enveloped in several folds of very cold wet cloths, and these should be very frequent- ly changed until the respiration becomes free. If the fever is not very high, the whole body should be bathed in tepid water at about 70°, and then packed in the dry blanket, until the heat returns, or perspiration takes place. If the general fever and heat of the surface are consider- able, the wet-sheet pack is the best, to be renewed occasionally, and managed in all respects as for a common fever. Attention to the bow- els, cold extremities, irregular temperature, etc., is required, as in all febrile and inflammatory complaints. When called to a patient, after the partial or complete consolidation of the tenacious secretion, evinced by extremely painful and suffocative breathing, and constant but unavailing efforts to expectorate, warm water should be copiously drank, and the throat tickled with the finger or a feather, so as to provoke moderate vomiting. Nearly every case of croup can be cured by a prompt recourse to these measures on the first attack. But all treatment may fail in the third and fourth stages of ihe disease. The preternatural membrane has, in a few instances, been expectorated in fragments, and the patient recovered; but usually its formation is fatal. Inflammation of the Parotid Gland — Parotitis — Mumps.—* 113 PATHOLOGY IN D THERAPEUTICS. The mumps consist of a painful, unsuppurative swelling of une or both parotid glands ; it is contagious, and often epidemic ; it is often accom- panied with swelling of the testes in males, and of the breasts in females Symptoms. — The tumor is at first movable, but soon becomes diffused to a considerable extent; it increases till the fourth day, and often in- volves the maxillary glands in the inflammation. It is attended with but slight febrile disturbance, and gradually declines after the fourth day. Peculiarities of Treatment. — Very little medication is required in ordinary cases. Abstemious diet, the wet sheet whenever the whole surface is affected with feverish heat, and the application of a wet linen cloth, covered with a dry one, to the inflamed part, whenever this is very hot or painful, constitute the remedial plan. Whenever metastasis occurs to the testes or breasts, the full warm-bath should be employed, succeeded by wet compresses to the part affected, well covered, so as to produce the fomentation or poultice effect. Inflammation of the Lungs — Pneumonia — Pneumonitis—* Peripneumony — 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 lungs, or of their surrounding membranes, or of both. Medical authors apply the term pleurisy to the disease when it primarily attacks the pleura; and the term pneumonia , or pneumonitis, when the primary attack appears to be in the parenchyma, or substance of either or both lungs. The term jjeripneumonia notha, or bastard pneumonia , has been given to a modification of the disease, attended with a low, typhoid fever of the nervous type, which has sometimes prevailed as an epi- demic. Practically, all these distinctions are useless; for whether the inflammation 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. Symptoms. — 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 respiration. 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 the inflammatory or typhoid type. Dr. Shew VISCERAL INFLAMMATION. Ill in his Manual, mentions “no pulse” as among the symptoms, but this is most assuredly a mistake. Terminations. — 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 accord- 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 sitz-bath, should be employed once or twice in twenty-four hours. When the heat is unequally developed, the pulse low, the patient ex- treme! y 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, warm water- drinking, to the point of slight nausea, or even moderate vomiting, will 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 pericarditis - -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 marked 118 PATHOLOGY AND THERAPEUTICS with great anxiety and terror ; sighing, sobbing, and hiccough 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 a s for inflammation of the lungs. Inflammation of the Liver — Hepatitis. — Acute inflammation if 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 pai< 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 degree 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 of 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 erythematic. In the former variety the fever is high, o; inflamma- tory ; in the latter, low, or typhoid- VISCERIL INFLAMMATION. A9 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, wiry, rapid, and often irregular and intermitting pulse ; intense thirst ; restlessness and anxiety ; tongue red, parched, and of a gla/.ed appearance. Frequently the inflamma- tion extends to the bowels, attended with diarrhea and great tenderness of the abdomen, constituting the gas tro- enteritis of authors. Special Causes. — In a majority of cases gastritis is the effect of pow- erful irritants 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 whole abdomen, of the temperature 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 libitum 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 constant nausea, ard more or less vomiting of bilious and sometimes of highly offensive fcecal matter. The pulse is frequent, hard, and con- tracted. Special Causes. — Long-retained and hardened faeces ; constipating food; irritant 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 other 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 warm sitz-bath and cool injections may be occasional^ employed to advantage. Inflammation of the Peritoneum — Peritonitis. — Authors dis- tinguish three varieties of acute peritoneal inflammation : 'peritonitis proper, 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 affects principally that portion called the mesentery. Symptoms. — The usual accessory symptoms of general fever are succeeded by a sense of heat and pain in the abdomen, usually confined to one part, but gradually becoming diffused. There is great tender- ness 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 is. 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 increased by the erect posture, by 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 affected side, and bends the limb so as to relax the muscles of the groin. There is frequent desire to urinate, with great difficulty or inability to expel the contents of the bladder. The urine is generally bloody 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 else of the muscles of the back, hardened faeces in the colon. VISCERAL INFLAMMATION 121 Diagnosis . — It may oe distinguished from lumbago by the pain following the course of the ureter, 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 employed, 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. Symptoms. — 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 Treatment. — 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 treated 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 w'ater or bits of ice. The tenesmus requires copious injections of w T arm 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 thighs, and ao XI — I ' 122 PATHOLOGY ANT 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 menstruation, extraordinary mental emotion, astringent or irritating injections. Peculiarities of Treatment . — The treatment 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 part 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 the 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 erratic, often shifting its seat of morbid action from slight causes. The diseases included under the present head may bo grouped as in the following arrangement: Inflammatory, Articular, Lumbago, Sciatica, Muscular, Chronic. Gout — Podagra. — Dr. Good tells is (Study of Medicine) “thai the predisposing cause of a gouty diathesis, when It first forms itself in an individual, is plethora, or f he state of the system Toduced 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- Gout. - Regular, Atonic, Recede nt, •Misplaced. Rheumatism. < ARTHRITIS 123 ory and practice, many of them directly contradictory to each other, as the gout ; and I may add, there is no disease concerning the nature and treatment of which physicians are so little agreed.” 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 disagreement 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 by various symptoms of digestive derangement, and with coldness, numb- ness, and cramps of the extremities. The atonic or disguised form is attended with greater general debility and worse dyspeptic symptoms, while the affection of the joints is but slightly painful and inflammatory. 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- placed 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 the disease of the gourmand and the epicure. Wherever this diathesis prevails, there has nature 124 P^TIIOLOG* AND THERAPEUTICS. stamped, in painfully legible characters, the penalty of riotous living. A vegetable-eater and water-drinker has never, probably, been afflicted with 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 in such a way as to produce it. Yet we know this is very uncommon; and we must regard the disease as, in a general sense, the legitimate 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, are among its prominent causes ; and when to these are added con- centrated and constipating food, 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 secernent action, that chalky concretions are formed in and around the cavities of the joints, in the ligaments, tendons, and membranes, in the little mucous bags — bursce mucosa — which surround the joints, in the cellular substance, and even in the pores of the skin. The joints of the fingers and toes, more especially the latter, are frequently enlarged, hard, and tender, occasionally ulcerate, 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 to 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, eo managed as to produce moderate perspiration, followed by the shal- low tepid-bath. Water-drinking should be as copious as the stomach san bear without painful distension, and the diet should be of the *' hunger-cure” kind. To overcome the gouty diathesis requires a systematic employment ARTHRITIS. 125 of the water processes, with the strictest 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 shoulders, 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 treat- 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 efificacy. 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., eitz-bath. A foot-bath may be taken at either nine a.m., five to six p.m., or evening, or at all 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-baths 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 with 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. Cases in Gout . — While under treatment, 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 useful 126 PATHOLOGY AND THERAPEUTICS. once or twice during the latter form of critical disturbance, 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 sevt re, all active treatment should be suspended ; wet cloths, or cold water in any convenient way, may, however, be applied to swelled and painful parts during the crisis the same as at other times Hhfumatism. — 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. — Inflammatory rheumatism presents all the essentia' symptoms 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 great suffering. The articular variety has been called rheumatic fever , or acute rheu- matism. It differs from the former in being attended with much Jess 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 m 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 tho muscles of the diaphragm, or in the intercostal muscles between the ribs, when the pain is greatly increased by a full inspiration. This form has been called pleurodyne , pleuralgia , and spurious pleurisy by authors; and not unfrequently mistaken for real pleurisy, and the patient bled, leeched, and blistered not a little to his disadvantage. Chronic rheumatism is characterized by pain, rigidity, and weakness of the larger joints and surrounding muscles, accompanied with no regular ARTHRITIS. 12 ? 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 in any sense ciitical, nor exert any marked influence upon the course of Hie 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 almost identical with that of inflammatory fever. In some cases where the joint or joints most affected are 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 muscular, in addition to moderate general treatment, are relieved with the greatest facility by the hot fomentation to the parts affected with pain, stiffness, 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 indication 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 'f the allopathic school, so long will the hydropathic phyician be continually called upon to treat many 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, const? cite Hie best general plan of managing mercurial rheumatism . Some 128 PATHOLOGY AND THERAPEUTICS. limes the treatment 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 feels most agreeable to the part affected, may h» employed until the manifestations of mercurial action subside, when the regular treatment 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. Wherever 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 Hydropathy ) that u 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, eievates such symptoms of digestive derangement as heartburn, water-brash, flatulence, depraved appetite colic, constipation, teething, etc., to the rank of idiopathic maladies. 1 shall undertake to associate all these manifestations of one general morbid condition into a more natural arrangement, and treat of them in the present chapter. The propriety of thus grouping together several classes of diseases which have been usually considered not only as idio- pathically distinctive hit as demanding widely different and even oppc*- INDIGESTION 129 Bite methods of treatment, is enhanced by the fact that they are aQ really cured by the same general plan of hydropathic medication Diseases of Indigestion . Dyspep sla Morbid Appetite, Morbid Thirst, Heartburn, Flatulence, Constipation. Sick Headache. f Chronic Hepatitis, Liver 1 Jaundice, Complaint j Gall-Stones, t Duodenitis. Cholera ( Bilious, 1 Flatulent, Spasmodic, Infantum. Diarrhea Feculent, Bilious, Mucous, Milky, Serous, Tubular { Toothache, Tartar of the Teeth, Excrescent Gums, f Iliac Passion, Painter’s Colic, j Wind Colic, Colic < Surfeit, Constipated Colic, Constrictive Colic. ( Bezoar, Intestinal \ Calculu8> Concretions lScybalum . { Alvine Worms, Anal Worms, Erratic Worms. Hemorrhoids f Blind Piles, | Bleeding: Piles, j White Piles, \ Caruncular Piles. That the majority of the diseases named in the above table ar© symptomatic of indigestion all will allow ; but those who are accustom- ed to regard worms as natural to the alimentary canal, and those who consider the piles as a local affection, will object to the tabular arrange- ment. But I will venture to assure every physician who will carefully investigate the subject, that he will find the stomachs and bowels of children or adults infested with vermin in very nearly the ratio that foul secretions and crude ingesta evince disordered digestion ; r and if he will attentively study the history of hemorrhoidal affections, he will find them, in some form, almost as general as, and almost invariably preceded by, constipated bowels. Still greater will be the dissent of those who have imagined epidemic or spasmodic cholera to depend on specific contagion, ozone, electrical or magnetic states of the atmos phere, or planetary or other unearthly influences, to the idea that all the choleras of medical books are dyspeptic affections. But, whatever may be their predisposing or exciting causes, it is sufficiently apparent that the actual condition of the disease is that of extreme derangement and intense irritation of all the organs auxiliary to digestion. Dyspepsia. — Depraved appetite, unnatural thirst, flatulence, acrid eru stations, heartburn, or water-brash,, irregulat bowels, and sick head- m PATHOLOGY AND THERAPEUTICS. ache, are among the multitudinous symptoms of dyspepsia; yet the disease may exist with the absence of either one or the majority of hem. Symptoms . — Fastidious or irregular appetite, constipation, or diar- rhea, or those states alternating, sense of weight or other feeling of distress after eatfog, food digested with difficulty, depressed spirits, disturbed sleep, occasional pain or tenderness in the epigastrium, a feeling of languor, which is relieved by taking food, aversion to exer- cise of body or mind, are symptoms which, variously combined, desig- nate the disease. Usually there is occasional palpitation or throbbing of the heart, furred tongue, and slow, irregular, or intermittent pulse. Doctor Gully and some other authors distinguish dyspepsia into the nervous and mucous varieties. The term, nervous, is applied to the disease when occurring in persons of irritable temperaments, with a large development of the brain and nervous system *, and the term, mucous, is applied to the disease as it appears in persons of more tor- pid or phlegmatic temperaments. The former generally results from nental shocks, excessive emotions, intense study, violent passions, and is attended with great pain or uneasiness in the stomach, spasms, gnaw- ing or sinking sensations, capricious appetite, etc. The latter results more especially from sedentary habits and excesses in eating and drink- ing, and is attended w r ith torpid bowels, and but little actual pain in the digestive organs. Treatment . — No other disease presents itself under so great a va- riety of complications ; and although the principles which regulate its treatment are very simple, there is an unlimited opportunity for the exercise of skill and tact in the management of a dyspeptic invalid. Usually we have to deal with fickle tempers, despondent minds, strong morbid appetites with weak resolutions, all of which circumstances are aggravated by the patient having previously doctored with all sorts of doctors, and swallowed every thing he could read of in the newspapers in the shape of nostrums. All the resources of hygiene must be drawn upon, and adapted to the circumstances of each particular case. The nervous, feeble, rest- less individual, who is all activity with little strength, who has a con- stant disposition to move with no power to endure, must take moderate water-treatment, exercise gently, prefer sailing, riding, etc., to active walking, and sleep all that he is inclined to, even though it be late in tlie morning, or at other times of day ; while the torpid, quiet, but more enduring person should employ more powerful water processes, rise early, walk much, and practice gymnastics for amusement, unless Ue can fin amusement ir some light ki id of manual or mechanical labor INDIGESTION. 131 The diet should be more plain and simple as the disease is more ad* danced and serious. Regularity in the alvine dejections is of first im- portance. The patient should, if possible, go to stool at the same time of each day, and if the diet does not, in a very few day3, produce regularity in the discharges, cool or cold injections should be employed daily, soon after rising. As a tonic effect is always desirable, cool or cold water should be employed, whether the bowels are loose or con- 61 ipated, except when alfected with colL or griping. The sitz-bath and the abdominal compress are the important and ever-necessary local baths. The former may be resorted to two or three times a day, for ton or fifteen minutes, the temperature as cold as the patient can bear without producing a permanent chill, or disagreeable feeling of weak- ness and stiffness. The crash towel bandage is the best; the wet part should pass round the body, when it can be worn without unpleasant irritation or chilliness of the back; otherwise it should onty extend across the abdomen from one side to the other. Foot-baths should not be neglected when there is a tendency to cold extremities. The most important general baths are the partial or complete wet-sheet pack, according to the general heat and reactive power, and the tepid half or shallow-bath. The plunge or douche may be employed under the restrictions heretofore specified ; the dripping sheet is a good substitute for either of the other general baths when it is impracticable. The hot fomentation to the abdomen is serviceable whenever indi- cated by severe headache, spasms, general restlessness, nausea, vomit- ing; and sick headache is relieved by drinking warm water, followed by sips of cold, and, in severe cases, the abdominal fomentation. When sick headache occurs periodically, warm water should be copiously drank on its first attack, to dilute and wash away the offending bile oi other acrid fluids as soon as possible. A good combination of baths for full or active treatment in an ordi- nary case, would be the following daily : Tepid half-bath five minutes and pail douche ; wet-sheet pack, followed by moderate douche, plunge, or dripping sheet ; sitz-bath at 60°, ten minutes, followed, after an hour's interval, by a foot-bath at 72°, five minutes ; the first to be taken on ris- ing ; the second from ten to eleven a.m. ; the third at four to five r.M., and again in the evening. The wet girdle should be wet and reapplied after each bath, and again at bedtime. In protracted cases requiring long course of treatment, it is advisable to omit the wet bandage occa- sionally for a few days, and then resume it again. In many cases of dyspepsia there is a weak and relaxed, or a rigid and contracted state of the external abdominal muscles, especially fre auent in those who have been addicted to crooked bodily positions, in- f I 132 PATHOLOGY AND THERAPEUTICS. tense mental excitement, sexual abuses, or the use of narcotic stimu* lants, as tobacco and alcohol. The free indulgence in tea and coffee also conduces to it ; and fine, constipated food is among its producing causes. These cases require local manipulations, as kneading, pound- ing, rubbing, etc., the lower part and external muscles of the abdomen, not with sufficient violence, however, to cause pain. A trotting horse affords a good exercise. Climbing mountains, and walking rather fast over an uneven surface, are also peculiarly beneficial exercises. Liver Complaint. — 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 functional derangements may all be comprehended under the general term of liver complaint. Symptoms . — 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 hardness is usually obvious to the touch under the short ribs of the right side ; the countenance is sallow ; the bowels are costive; the stools are clay-colored; the patient is torpid, inactive, and desponding, and there are occasional attacks of jaundice. Dropsy fre- quently follows this form of diseased liver. It is also generally attended with a dry, husky cough, and a slight hawking, or spitting of a thick, tenacious mucus, especially in the morning, when the sputa appears dark and carbonaceous, 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 slow pulse , and the prominent hepatic or dyspeptic symptoms. Jaundice — the icterus of the books — has been commonly distinguished into the yelloiv and black , or green , according to the discoloration of the skin from impacted and partially pstrescent bile, to which some authors have added the subvar^ties of biliary — p educed by a resorption of NDIGESTION. 133 bile; gall-stone — resulting from obstruction 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 fantilc — 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 protracted, the skin turns greenish, brown, livid or lead en, blotches appear in different parts, and the discharges from the bowels are dark, pitchy, and bloody. The 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 form 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 inflammatory 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 irritating bile, and known by a sickening, sinking, gnawing sensation just below the pit of the stomach, with tenderness to external pressure, often so great 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. Warm water emetics are serviceable to deterge the biliary ducts, whenever nausea, bitterness in the mouth, and unusual sense of fullness in the right side indicate obstruction ; and if the bowels are costive, with general fullness and tenderness, tepid injections should be m PATHOLOGY AND THERAPEUTICS. freely employed until these symptoms are removed, when cool or cold f concrete saliva hardened by the earthy 136 PATHOLOGY IN D THERAPEUTICS. materials which it secretes. The remote cause is undoubtedly the excessive amount of earthy or 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 hardened 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 attended 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 introduced into the rectum have been ejected by the mouth. This is the disease called intros usception 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. Painter's colic — known also as Devonshire colic , colica poietou , and colica rachialgia — is so termed from the remote ( ause being the in- troduction of lead into the system, and hence mostly confined to paint- ers. In the neighborhood of smelting furnaces, pigs, poultry, 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 downward to the navel, back, loins, rectum, and bladder, and frequently extending to the thighs and lega From the navel it sometimes shoots with so much violence to each side INDIGESTION. 187 that the oatient feels as if some person were cutting him in two. The external muscles are extremely sore and tender, and can scarcely bear the slightest touch. Momentary relief is occasionally experienced aftei die vomiting of acrid bile and slime, but the pain soon returns. In about a week or less, if recovery takes place, relieving sweats appear, and the bowels discharge large quantities of excrement, con- sisting of hard lumps, or scybala, mixed with blood and dirt-colored mucus, after which the patient is convalescent. 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 flatulentia — 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 frequent attend ant 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 suffocation, 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, great 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 constricla — results from a permanent stricture existing in some part of the alimentary canal. Its symptoms are — a sense of stricture ; a fee mg of flatulence gradually passing off iS 8 PATHOLOGY AND THERAPEUTICS. by the stricture ; the bowds taidy, and discharging with difficulty small 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 great effort, and they are of an extremely slender caliber. Pa- tients have been known to subsist more than thirty days without any evacuation from the Rowels. Treatment . — The general management 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 circumstances, 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 periodical, 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 pic Juce 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 foeces in this, 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 management. The wet-sheet pack, cold or warm, according to the external heat or colduess of the patient, followed by the dripping wet-sheet or to we - wash 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 third variety — wind , or flatulent colic — the hot fomentation and a single mjecrion 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-musli, Indian gruel, hard wheat-meal biscuits, good fresh ripe fruits, etc. Cholera. — The group 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 known as cholera moibus — 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. The 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 fora of the dis* Base is rather peculiar to dyspeptics. St” anodic rholera — 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 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 lingers two or three days. The ordinary course of symptoms is, more or less diarrhea ; the discharges at first feuflent, but soon presenting the appearance of rice-water or gruel ; there are flying pains, or sense of coldness in the abdomen, as if purgative medicine were about to operate ; the countenance is pale ; there is nausea, vomiting, prostra- 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 water ; in most cases cold, clammy skin ; all these symptoms may appear successively or al 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- ing of white matters mixed with flocculi ; the features are sharp and contracted ; the expression of countenance wild and confused. The 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 at the wrist, arm, axilla, temple, or neck ; there is great restlessness, incessant jactitation, severe pain in the epigastrium, 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 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. Either of the above symptoms may be disproportionately severe, or it may be entirely absent. Those usually regarded as pathognomonic are, watery dejections, blue appearance of the countenance or sur- face, thirst, coldness of the tongue, and pulselessness at the wrist. The fourth variety — cholera infantum — is peculiar to infants, and prevails extensively during the warm season in nearly all of our cities. In ordinary cases t he diarrhea precedes the vomiting for several days ; but in severe ones vomiting also occurs from the beginning. The die- INDIGESTION. 141 charges at first are composed of ordinary faecal matters ; but, as the disease progresses, they become watery and variously colored, from a dirty white to a brownish, and sometimes greenish hue. Sometimes these discharges are frothy, like yeast, and mixed with the food, which passes 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 it: 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 have 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. Th e> flatulent 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 gross 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 drug-physicians regard and treat as though it were the essential disease, being a mere indicent, effect, or symptom of this general morbid condition. That debility and obstruction in the primary nutritive functions constitute the essential condition, while inflammatory 142 PATHOLOGY AND THERAPEUTICS action 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 Y r ork, in all the seasons — 183*2-34 and 1849 — that it has prevailed epidemically; and as far as T can learn — and I have taken no little pains to ascertain the fact — throughout the wide world. When I say that dietetic errors 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 generally 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, the warm bath occasionally, a greater proportion of animal food, and fine, constipating , farinaceous 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 cholera could occur,” rice, dried beef, bakers’ fine bread, with animal food two or three times a day, and the almost entire prohibition of fruits 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 true 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 tragical. A great variety of plans of medication, directly opposite to each other, have been tried 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; emetics of mustard, ipecac, antimony, and blue vitriol — iced-water, or bits of ice, to allay sickness at the stomach; cathartics, as calomel, castor-oil, colocynth, jalap, colchlcum, 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 effervescing draughts; mustard plasters and blisters to the stomach, caustics to the spine — large doses of opium and strychnine ; inhalation of oxygen gas — injections of saline INDIGESTION. i J. 3 solutions into the veins; galvanism and mercuria frictions — .ibacco, and the exhausted air-bath, etc., etc. In the early stage of the disease, a free injection of tepid or rathe? varm 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 surface should be well rubbed with a cold wet to we’, 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 degree 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 infantum 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 simple. Wheat- meal mush and rice, seasoned with a little sugar or milk, are the best articles. Diarrhea. — The group of diseases properly arranged under this head are characterized by frequent and copious discharges by stool, with a sense of weight and uneasiness in the lower belly, and without severe griping or tenesmus ; nausea and vomiting are occasional, but not usual incidents. All forms of diarrhea may become chronic, it which event there is great emaciation 144 PATHOLOGY AND THERAPEUTICS. In the feculent variety — diarrhea f usd— the foeces are of common juality, but simply loose and copious. The bilious variety — diarrhea biliosa — is only distinguished from the former by the bright yellow color of the discharges. In the mucous form — diarrhea mucosa — the dejections consist mainly }f, 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 has 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 lien tery-— 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 aquosa — the discharges are almost entirely limpid and watery. Tubular diarrhea is known by discharges 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 trachea in cases of croup. Its expulsion from the bowels often alarms the patient, who mistakes it for a portion of the bowel itself. In some instances, membranous tubes half a yard in length have been evac- uated. Treatment. — In a general sense, the treatment of diarrhea, when protracted or chronic, is essentially the same as for dyspepsia, of which il 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 — fisting. Bilious looseness is readily relieved for the time by one or two copious tepid injections. All the other forms must be treated on general principles ; the local irritation 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 m a restoration of the general health, for which purpose all the means recommended for the treatment of dyspepsia must be had recourse to. Sn all forms of chronic diarrhea the diet must be carefully attended to ; it cannot well be too bland and simple and the whole regimen in all respects, the same as for dyspepsia. INDIGESTION. 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 bezoardus , is frequently found in the stomachs of ruminating animals, 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 matter or animal secretion is closely agglutinated, having a glossy white or a bright metallic luster. These concretions were formerly regarded as 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, particularly 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 ambergris , 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 when 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 pui the patient on plain, unconstipati 'g, healthful fruit and farinaceous diet. Worms. — Pathologists are not all yet agreed whether invermina- tion — worms, or the larva? 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 *dnd ol 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 yarious kinds of animalcule, vermin, or insects. There is no manner of d ubt that worms are suspected, by physi- cians?and nurses, to occasion various ailments of children much often er than they really exist; but it is equally true that they do occasionally effect 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- malcule floatu: s in the atmosphere, and collecting, especially in damp places, on the alimentary materials, get an entrance into the digestive cavity, and, providing they find in foul secretions, retained excrementi- 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 naturae . 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 reared healthfully. Dr. S. Cooper anci 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~ tad-worm, long tape-worm, broad tape- worm, and fluke. The first and second varieties are much more com- mon than the others. The latter is rarely found in man, "hough the most common to domestic animals. Anal worms exist in or near the rectum or lower bowel. They excite a troublesome itching or irritation of the part, often preventing sleep, and sometimes occasioning pain or faintness in the stomach INDIGESTION. 147 The varieties found in this locality are tie ascaridcs , called also thread- worm, and maw-worm, the beetle- grubs, and the bats. 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 power 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 nostrils, 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 first 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 all 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 that the radical cure of worms must de pend upon removing the morbid conditi:^ which renders the aliment* PATHOLOGY AND THERAPEl TI^S. 1 48 ary canal tlieir 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 extra 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 unconcentrated 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 that 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 which will cure them. Still, they can do it, and should . Hemorrhoids. — Dr. 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 tumors 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 transparent; they frequently appear and disap- pear very rapidly. Piles often contain a cental cavity, filled with An d or coagulated blood ; and by repeated attacks of nflammation the swell 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-sized, 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 ti 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 a called white piles. When the hemorrhoidal vessels, which form or suppo2t the growing tumors, are so distended a3 to burst and bleed freely, it is denominated bleeding piles. And when warty excres- cences spread about the perinaeum, 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 of 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 greater 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 'urge a revenue, and the people so many shattered constitu- tions, are strongly aloetic, and hence peculiarly calculated to inflame and relax the vessels of the rectun^ 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 three and four inches. Dr. Good names “ peculiarity of constitution 1 ’ as one of the causes of pile tumors; and Dr. Copland (author of u 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 these eminent authors I consider eminently nonsensical. Nothing but the false philosophy ;i a false system could ever induce such erudite 150 PATHOLOGY AND THERAPEUTICS. and critical scholars to perpetrate such absurdities. According to my experience, nine ou; of every ten of relaxed, debilitated females, who must of necessity possess a very weak instead of very strong action of the sphincter, as well 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 homorrhoidal 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, grip- 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 surface of the lower bowel is so tender and irritable, that almost all food seems to act as a mechanical irritant; the patient, how T ever, 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 preferable, as in all other forms of indigestion. Hard warty excrescences around the anus, or scattered over the perinaeum, may be removed with entire safety and facility by the liga- ture, or knife, or clipped off with a pair of scissors. Removal by e:< - cision and by ligature has often been practiced in the other kinds of he-morrlioidal 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. u )on, there is not the least necessity for these surgica operations, FLUXES. 151 CHAPTER V. FLUXES. I adopt this generic term, not because it is clearly appropriate or distinctive, but because it is fa niliar. 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 : 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 common catarrh — cold in thehead 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 — influenza — 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, tbernomete/\ and hydrometer. Dr. Good very cautiously in putes its Dysentery Acute, Chronic. 152 PATHOLOGY AND THERAPEUTICS. specific cause to some “atmospheric intemperament;” 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 occult and inexplicable changes wrought it 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.” influenza is the most widely-spreading epidemic known, having some times extended 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 low 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 dry-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 warm water emetic should be administered. The general regimen is the same as for simple fever. Dysentery. — This iisease was called bloody flux 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 foeces are discharged with difficulty; mucous and bloody dejections alternate, or are variously diversified in color and consistence ; the at- tending febrile disturbance is considerable, 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 disease, 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 when the formidable array of drug-poisona which modern medical science has brought to bear upon this disease, and upon the patients’ constitutions, too — calomel, corrosive sublimate, sugar of lead, antimony, nitrate of si vor, opium, capsicum, oil of tur- pentine, mineral acids, etc. — is taken ; nto account. Chronic dysenteiy FLUXES 153 is attended w jth but slight fever, and that usually of the hectic type. Either variety maj 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 dysentery, 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 water 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 which 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 in two or three hours. I have seldom found any difficulty in curing this complaint in children, in a very few days, by two or three daily tepid washings 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, putrid sanies, or black, grumous, fetid blood and slime, the diet may be with propriety restricted, for a week or two, to rice or arrow-root. I have never known relapses, or U se]uelae,” which are so common nn I so formidable after an attack of this disease and a course of drug- treatment, occu in a patient who was treated hydropathically from first to last. 154 PATHOLOGY AND THERAPEUTICS. CHAPTER VI. CACHEXIES. Literally, the 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 transmitted 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 Marasmus r Tubercular, Catarrhal, Apostematous, Laryngeal, Hemorrhagic, w Dyspeptic. r Atrophy, J Anhsemia, I Climacteric, l Tabes. r Arabian Elephantiasis \ Italian, l Asturian. Hemorrhage < Epistaxis, Haemoptysis, Haematamesis, Haematuria, Uterine, k Anal. ( Simple Scurvy, Scurvy { Land Scurvy, l Sea Scurvy. 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 nosology, 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 thil disease and in Boston, Philadelphia Baltimore, and a majority of the CACHEXIES. 1-55 other cities of the United States, the mortality from this source boars nearly the same elation to the population. In most other countries 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 to 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, anc 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 stpongly-marked scrofulous diathesis, is more insidious in its approach, and more delusive in its progress than either of the other varieties. Many 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 Quantity 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 strikingly apparent until the disease has made severe inroads upon the constitution, and not unfrequently e body maintains its ordinary full- ness until the greater portion of the ungs is fatally occupied by tuber- cular formations. In those cases atti ided with but trifling expectora- tion, there is, of course, but little ub*. -ation; yet generally some por^ 156 PATHOLOGY AND THERAPEUTICS. tions }f the tubercles are ulcerating, and forming open, irregular cavi- ties in the substance of the lungs, while in other parts of the pulmonary structures, the process of tuberculation is going on. As the functional powers of the lungs become impaired, the pulse becomes frequent and feeble, the breathing grows shorter, irregular chills come on, succeeded by some degree of feverish heat ; and in the last stages, night sweats, diarrhea, swellings of the limbs, etc., denote the rapidly approaching fatal 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 character. 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 fatality, while others, equally respectable as practitioners and pathologists, con- tend that cures have 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 greater 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 attributable, 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.” Tin statement that they lose all their sickly children \a wholly gratuitous . CACHEXIES. 157 In the 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 apostematous variety is known by a dry 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 thre^ens 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 high 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 discharge 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, frequently streaked with blood ; there is also remarkable hoarseness, which occa- sionally 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, occur- ring only a few days, or at most a few weeks, before death. The hemorrhagic variety is characterize! by repeated attacks ol U 158 PATHOLOGY AND THERAPEUTICS. haemoptysis, or bleeding at the lungs. The coughing or expectoration of a large quantity of blood, may indeed be, and usually is, an acci- dental occurrence in a 1 * the other form® of the disease, especially the tubercular and the dyspeptic varieties ; 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 varieties of consumption. It is intimately connected with the next variet}^ — 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 cf pulmonary consumption which is preceded by protracted disease of the digestive organs ; the lungs are affected 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 more common than is generally supposed, constituting, in fact, a majority of the cases we meet with. It is seldom correctly diagnosticated, 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 carefu 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- ever the patient experiences habitual cough, be it ever so slight, and habitual expectoration, of whatever character, with shortness of breath, a sense of pain, fullness, weight, or uneasiness in the chest, with an increasing feeling of general languor or debility, the case is probably consumption, and shou.d thencefo th receive the closest scrutiny. 1 1 CACHEXIES. 159 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, still greater apprehension may be entertained. In the early stage of the dyspeptic variety, the cough and exp3ctoration occui chiefly in the morning, and are hardly noticed during the remainder of the day; the expectoration consists of a small quantity 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 diffused through it. The early symptoms in all forms of consumption are obscure and insidious; and those which attend its progress and mark its several stages are subject to very great diversity. But the general progress of the symptoms may be enumerated 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 frequency, 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, which may be variously colored — livid, deep black, light brown, light green, bright or dark yellow, hard and lumpy, or soft and sliredy, 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 PATHOLOGY AND THERAPEUTICS. instances of the dyspeptic variety I have known the 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, untii 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 fingers are shrunk, except at the joints, which become prominent ; the nails are bent for want 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, aptlious 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 emaciation 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-transparent, like cartilage, with black dots in their substance. They often augment by degrees till they attain half an inch in diameter; but usually, when about as large as peas, they begin to soften in the center, and finally open by one or more small apertures into the neighboring bronchia;, 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 the whole cellular substance is occupied by tubercles, with little appearance of excavations or open ulcers. Physiological Signs- — Mutki atten tion has, of late years, been be* ACIIEXIES. 161 stowed upon percussion and auscultation as means for ascertaining tha 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 instrument 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 lung3 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 erroneously with as without its assistance. I can name at least one person in the city of New York whose lungs were pro- nounced incurably tuberculated by an experienced professor 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 formation 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 iu 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 afta ' the first ; and IC/2 PATHOLOGY AND THERAPEUTICS. those few examples of cures recorded in medical works have confess edly recoveied “spontaneously,” or by “the efforts of nature,” at all events, without the benefits of drug-medication. Under water-tt-eatment some cures of apparently hopeless cases have been made; the majority, however, who have thus far sought the aid of the new system have deferred it too long, yet, although they have necessarily failed of being radically cured, they have, in nearly all instances, been greatly bene- fited, while in many cases life has been extended for several years. Practically, we are to regard the 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 every 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 lightly 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 open air — in walking, riding, sailing, etc. — as possible, without exhausting fatigue. Horseback exercise, I think, is not advisable after the disease is fairly 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, Madeira, 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 authors 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 sympatheti- 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 lattei will generally experience a temporary alleviation of symptoms. A great variety of muscular or gymnastic exercises can be employee to advantage ir expanding the chest Striking the elbows or backs o/ C A C IT E X I E S. i63 the bauds together behind the back ; making gentle circular motions with the hands while both arms 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 are 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 trifling 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 what agrees or disagrees with the stomach than the better or worse character of the pulmonary symptoms. Experience, there tore, 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 abandoning all animal food, save milk, and even this should be used a* 164 PATHOLOGY AND THERAPEUTICS. a seasoning rather than as a substantial part of the meal. Coarse bread, vvheaten 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 trifling load or irritation 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 minutes; the half-bath at 72°, five to ten minutes, and the hip-bath at about 65°, fifteen minutes, with the constant em- ployment of the chest-wrapper, constitute a plan of bathing which, with 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 stage, will usually shorten the duration of the chilis, 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 temperature of the water should be milder ; care should be taken, under these circum stances, to avoid any bath which occasions much of a shock to the system. For the benefit of such consumptives as are compelled to do the CACHEXIES 165 best they can with home-treatment, it may be stated that very little bathing is absolutely essential, if the patient will attend strictly to all the other resources of hygiene. One or two sponge-baths or towel-washings daily, and one 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 the 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 drug-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 ability 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 greater 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 system. Expectorants, which are given to facilitate the excretion fVom 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 they are as absu?'d and irratonal 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 not speak. If the fact that all the patients who are cured by them soon go to their graves, is not a sufficient commentary, and if the forty or fifty deaths in the city of New York returned weekly to the inspector’s office by the physicians under the head of consumption, do not suffi- ciently attest the fallacy 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 inflammation or other disproportion- ate affection of any particular organ or viscus, has long been recognized by physicians under the generic term marasmus. “ Leanness,” says Dr. Good, “is not necessarily a disease ; for many persons who are peculiarly lean are peculiarly healthy.” It is only when increasing debility accompanies gradual emaciation that the extenuation of the system is to be regarded as abnormal. The proximate condition upon which all the varieties of marasmus depends, is bloodlessness. The manufacture and supply of nutrient material is not equal to the waste, and this implies a primary fault in the digestive or assimilating functions, or obstruction in the capillaries. Symptoms. — In the first variety — atrophy — the complexion is pale, often squalid ; skin dry and wrinkled ; muscles shrunk and inelastic ; the appetite is feeble or capricious ; there is little or no fever. With infants or young children the above symptoms are preceded by flaccid- ity of the flesh, bloated prominence of the abdomen, irregularity of the bowels, and pendulousness of the lower limbs. To these symptoms succeed drowsiness and languor, chilliness in the morning, flushed cheeks, restlessness and general feverishness toward evening; the urine is scanty, the foeces dark, green, or pitchy, and highly offensive ; the skin is hot, dry, and extremely irritable, and the child is constantly picking the nose, lips, corners of the eyes, fingers, and anus. This form of marasmus has been variously termed, in medical books : in- fantile remittent fever , gastric remittent , inj. rutile hectic , worm fever , mesenteric fever , stomach fever , low fever of children, etc. In the second variety- -anheemia, ancemia, exsanguinity — the whole surface, and particularly the face and lips, are ghastly pale ; pulse fre- quent and feeble; dejections from the bowels irregular, black, and fetid ; appetite greatly impaired ; emaciation and debility extreme. The third variety — climacteric — has been railed, very incorrectly CACHEXIES 167 decay of nature. The term adopted is derived from the Greek phys- iologists. who divided the period of life into five epochs or climaxes, at each of which they supposed the body was peculiarly liable to some remarkable and sudden alteration for better or worse. It is character- ized by general decline of bulk and strength, with occasional renova- tion, subsequent to the middle period of life, without any manifest local disease. The fourth variety — tabes — has been known by the simple appella- tion, decline ; it is distinguished from atrophy by the presence of hec- tic fever. It appears at any age of fife, and is also characterized by the accompaniment of depressec spirits. It is the consequence of some lurking poison in the system, generally of a scrofulous or syphi- litic character, or of excess or intemperance in the exercise of the animal propensities, or indulgence of the passions When occurring from undue indulgence in libidinous pleasures, it has been called tabes dorsalis , from the great weakness which is experienced in the back and loins. The habit of self-pollution often induces this malady in bov* and girls, and sometimes even before the age of puberty. Special Causes. — Scarcity of food ; improper aliment, as baker’s sweet-cake, and distillery milk ; profuse evacuations ; scrofulous, scor- butic, or syphilitic taint ; mineral drugs, ns mercury, antimony, nitre, and potash; acrid narcotics and debilitating sedatives, as opium, alcohol, tobacco, digitalis, iodine, hydriodate of potassa; antiphlogistic medicines, as salts, vinegar, colchicum ; irritant drugs, as aloes, pr sparations of iron, nitrate of silver, arsenic; cold, damp, and impure air, as found in low basements, dark cellars, subterranean tenements, rear buildings ; depressing mental influences, as the loss of friends, or reverses of for- tune ; violent passions ; venereal excesses. Treatment. — In every case of genuine marasmus, the grand morbid condition is deficient circulation in the capillary system. Whether the nutritive functions are abnormally torpid, or the excretory organs pre- ternaturally active, or whether tile functions of supply and waste are both morbidly affected, the single indication of cure is the same — to augment capillary circulation. Of course, all the causes which are operating to produce or continue the malady are to be sought out and removed or counteracted, and all the resources of hygiene are to be applied to the general invigoration of all the organic functions; but the bathing appliances are few and simple. The dripping wet-sheet or towel-wash, and the half or shallow-bath daily, followed by as much friction or rubbing over the dry sheet as the patient can well bear, are the best water-processes, and in most cases all that are necessary. The temperature is a matter of considerable importance. It should be aa 168 PATHOLOGY AND THERAPEUTICS. cold as is consistent with prompt reaction ; the proper rale, as in all cases ot' feeble circulation, is to begin with water of a comfortable temperature, say about 80 °, and very gradually reduce it as the pa- tient becomes accustomed to the impressions. For very feeble patients one bath daily may be sufficient to commence with ; and such should take frequent exercise in the open air, by riding in a carriage if unable to walk. With regard to water-drinking and diet, the rules often heretofore intimated are to be observed. Inmost cases the strict or dry diet is the most desirable . The allopathic treatment consists mainly of stimulating food, as flesh- meat, soups, broths, etc., and irritating drugs, particularly the different preparations of iron ; and although almost every author of that school coincides in this plan of treatment as the only one to be relied upon, vet almost every case on record so treated resulted in death ! The form of this disease called anhcemia has lately attracted considerable attention in the medical profession because of its frequent occurrence in women soon after childbirth. One of the allopathic journals, a few months ago, related the particulars of six cases, all of which went down to death rapidly under the “tonic” and “supporting ’ system of iron and wine; and concluded the sad story of mortality with an “able argument” 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 great debility, and a variety of morbid 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- marked, highly offensive 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 off ; the nose is swelled and scabrous ; the lips tumid ; the nostrils preter- naturally dilated ; the lobes of the ears are enlarged and thickened, and beset with tubercles ; the external sensibility is so obtunded that pinching or puncturing the skin occasions no pain. At length the tubercles crack and ulcerate ; ulcerations also appear in the throat and nostrils; the breath becomes intolerably fetid ; the nose falls off; the palate is destroyed ; the fingers and toes become gangrenous, and drop off one after another. CACHEXIES. 169 The Italian variety is found chiefly among the Milanese and Vene- tian peasantry, who live in wretched hovels, breathe foul air, and eat gross and unwholesome food. The disease comes on with languor, listlessness, gloom, weakness and stupor in the lower 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 these 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 degree 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 well 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, fruits, and fariuacea, are all the details which need occupy these pages. Hemorrhage. — Occasional or accidental hemorrnages 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 relaxation of the coats of its containing vessels, or from both of these conditions together, constituting the hemorrhagic diathesis, that the affection properly pertains to the genus before us. A flow of \)lood from the nose, lungs, stomach, bladder, uterus, or anus, may result from, local congestion or incidental plethora — constituting the entonic 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 1I-I* PATHOL JG Y AND THERAPEUTICS. f.9 hemorrhages of authors. When the hemorrhagic diathesis has become established, nos«-bleeding is most common during the periods of youth and of senescence ; bleeding from the lungs occurs most frequently between the ages of fifteen and thirty-five ; and in .more advanced life the tendency is to more frequent hemorrhages from the abdominal and pelvic organs, In the first variety — epistaxu > — nose-bleeding — the quantity of bloou .ost is. in some instances, enormous. Examples are recorded of its continuance for several days, and even weeks, of the quantity of blood discharged amounting to ten, twenty, and even forty pounds. In the second variety — haemoptysis— 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 dyspnoea. 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. Wher the spitting of blood is from the cavities of the nostrils, it will cease oc 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 hcematemesis — 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 hcematuria — bloody urine — the hemorrhage is from the bladctef 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 hemorrhage 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 female* far advanced in life. CACHEXIES. 171 In anal hemorrhage the blood flows principally from the hemor- rhoidal 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 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. Haematuria 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 cantharides. Uter- ine hemorrhage is occasionally caused by polypi in the womb, or other structural derangements ; and anal hemorrhage is a very common symptom of hemorrhoidal 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, until the flow of blood is checked. For nose-bleeding, a cold stream or ice^ 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 part 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 jeat or inflammatory excitement, the whole body must be promptly cooled with the dripping-sheet or ablution. When llie extremities are preternaturally cold, rubbing them thoroughly, first 172 PATHOLOGY AND T II E II A P E UT 1 0 S. With cold wet cloths and then with dry flannel, is advisable. To accorn* 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 variety, 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 hygiene in their personal habits. It is character- ized by numerous small spots resembling flea-bites, chiefly on the breast, arms, and legs ; the visage is also pale. In the hemorrhagic variety — land scurvy — the spots are circular, of a purple hue, and of different sizes; sometimes in stripes or patches irregularly scattered over the arms, trunk, and thighs ; occasionally there is hemorrhage from the mouth, nostrils, or viscera ; and there is great 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 are 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. Treatment, — 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 supply 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 Small C ACHEXIES. 173 quantities of very cold water should be frequently taken into the stom- ach, and when the disposition to hemorrhage is great, cold water enema should be occasionally employed. Brown bread, wlieaten 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 ; i* is the result 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 gradually 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, hardening 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. — T he term 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 swine, 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 filthy 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 called scrofula, and pecul arly liable to develqp glandular swellings chronic ulcerations, tubercula' foimations, and via 174 PATHOLOGY AND THERAPEUTICS. ceral enlargements, whenever the exciting causes of disease are applied with ordinary intensity. The predisposition, however, under favorable hygienic influences, may 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 face, full upper lip, tumid alas 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. Symptoms . — 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 difficulty. In size these tumors usually range frcm 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 sequelae 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 so freely prescribed in all the above diseases, have a powerful influence A n 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, earthy, or saline — as digitalis, senna, potassa, nitre, epsom salts, etc., and all debilitating processes, as bleeding, leeching, cauterization, profuse e/acuations, etc., tend to produce a scrofulous diathesis where it did not previously exist, and aggravate it when already existent. The :aciij&xies. .75 scrofulous diathesis may therefore be either inherited or ingenerated. A combination of bad food, impure water, foul air, dark tenements, sedentary occupation, and poisonous drugs, is sufficient to produce the scrofulous diathesis independent of any hereditary taint. 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 abundance of pure fresh air, and plenty of clear sunlight. Sunshine itself is better than all the tonics of the allopatliist’s materia medica. The food must be restricted to the best fruits, 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 scrofulous affections, as well 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 — daily are sufficient. Wet 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. Cancer — Carcinus — Carcinoma. — The Greek word, carcinus, means a crab ; and the disease is thus named from the crab-like rami- fications of the dark distended veins of the cancerous tumor. Any part of the body may become the seat of this affection, although se- cernent glands are most frequently attacked. The breasts of females, uterus, testes, glans, penis, tongue, stomach, cheeks, lips, 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, cancriforin varices, intersected with firm, whitish, divergent 176 PATHOLOGY 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 sense 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 entirely 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 which 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 known 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 leueorrheal 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 surface it is obvious to the sight. In the stomach it is with difficulty diagnosticated. An acute and burning pain, tenderness of the epigastrium on pressure, nausea, rejec- tion of food, offensive fetor in the breath, are together strongly pre- sumptive, though not absolutely pathognomonic, of the disease. Special 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 virus, is evident from the remedies which are put most promi- nently forward in their books. These are, arsenic, henbane, and nightshade — the first, a powerfully corrosive poison, and the last two, deadly narcotics. The utter confusion 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 paragraph in relation to its treatment, found in Copland’s Medical Dictionary. After enumerating two or three hundred internal * emedies , all of which CACHEXIES. 177 have enjo} no a high r eputation, but which cannot now be depended on, comprising, m fact, nearly all the strong, pungent, powerful, and pois- onous drugs and chemicals 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 chlorurets, and many of the metallic salts; camphor, the balsams, and the terebinthinate substances ; ammoniacum, galba- num, and myrrh; and the greater part of the astringent, 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 employed. Abundance of fresh and pure out-door air is indispensable, and, as in scrofula, one, two, or three general baths may be employed daily. There is but iitt e to choose between the different kinds of baths : the dripping 178 PATHOLOGY AND THERAPEUTICS sheet, half-bath, or plunge, as either is most agreeable to the patient’s feelings. It is generally, however, important to deterge the skin thor- oughly, and keep up a good degree of activity in the cutaneous excre- tory process, by occasional packings in the wet sheet, so managed as to produce moderate but not: debilitating sweating ; or, in very torpid in- valids, the dry-packing, followed sy the dripping-sheet, with very active friction, may be substituted. The local treatment is a matter of more difficulty. Extirpation will generally succeed, if resort© 1 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 nitrate 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 treatment, deeming the latter useless without attention to the general health, this attention to be in all respecta •trictly hydropathic. I have not yet had ar. opportunity 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. It 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 melonose , or black 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 secretion 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 treatment is yet to be learned.” The majority of cases have thus far, under allo- pathic treatment, terminated fatally. 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, produced by the use of alcoholic drinks. Examples of sponta- neous combustion as having occurred in persons long accustomed to the immoderate employment of soirituous liquors, are too well authem 180 PATHOLOGY 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 electric spark, has ignited the inebriate body. It is a remarkable fact that the flame which decomposes and re- duces every fragment of the bodily structure to ashes, does not essentially injure the common furniture 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. The morbid conditions of the visual organ requiring attention in this place may be arranged as in the following table : The most common morbd affection of the eye is inflammation. Il CHAPTER VII DISEASES OF THE EYE. ( Acute, Chronic, Psorophthalmia, Ophthalmia \ Purulent, Trichiasis, Entropium, Structural Derange- ments affecting the < Infantile, t Granulated. ' Nebulae, Ulcers, Pterygium, Structural Affections Ectropium, of the Eyelids ' Hordeolum, Excrescences, Ptosis, Fistula Lachrymalia Sight Staphyloma, I D»l Closed Pupil, Cataract, Amaurosis, Strabismus. rEcchymosis, Injuries and Accidents < Extraneous Substances, I Burst Eye. { DISEASES OF THE EYE 18 'i may attack any of its structures, but is most frequently seen in the membrane covering the external coat constituting the ophthalmia proper , or ophthalmitis of authors. Sclerotitis, iritis, retinitis, etc , designate, in technical Latin, inflammatory states of the sclerotic, iris, retina, etc. As they should all 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 thcugh 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. Treatmerit. — 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 heely with tepid water injections. If the feet are cold, use warm toot-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 rapidly destructive, and requires prompt and energetic treatment. In addition to the pain, heat, and redness of acute oph- thalmia, it is characterized by the enormous swelling of the eyelids, 182 PATHOLOGY AND THERAPEUTICS. goon followed by the discharge of a large quantity of thick, yellowisn or greenish matter. Treatment . — If there be much general heat of body, the wet-sheet packing should be employed two or three times a day, followed by washing the surface in tepid water. If the body incline to chilliness, the sheet should be wrung out of warm water. The eyes are to be very frequently washed with pure soft water, warm at first, then tepid, and then cold — never very cold. Attend to the bowels as above. Infantile Ophthalmia — Purulent Infantile 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 progress 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 may in time occasion opacities of the cornea, by the irritation it causes, followed by blindness. The only chance of cure hydropath- ically is by a persevering course of general and local treatment. Mod- erate bathing, say a daily rub-slieet and douche, the local application several times a day of very 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 Stecks, or Opacities of the Cornea. — Nebulae are superficial deposits in the transparent 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- etanding inflammation, and are also sometimes produced by mecnani- ta\ and chemical irritants. The treatment is, in all respects, as tha preceding. DISEASES OF THE EYE. 186 Pterygium.— A small reddish triangular tumor, growing 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 projecting between the lids. It is the consequence of severe ophthalmia, and of badly-managed eruptive fevers, as the Bmall-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 destroyed. Closed Pupil. — Inflammation of the iris is sometimes followed by an obliteration of the pu* 1 Vision is often partially restored by form- ing an artificial pupil. Cataract. — This is an opacity of the crystalline lens or its capsule. Its progress 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 the 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 nebulae, specks, etc. Amaurosis — Drop Serene. — A total or partial 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 night labor, etc. Milton was a notable example of this affection. The defect of vision comes on gradually ; letters and other objects at first *ook 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 manifest* little or no change to the obserrar. Sometimes flashes of light appea* 184 PATHOLOGY AND THERAPEUTICS. before the eyes, and the head is often affected with vertigo, pain, and heaviness. Treatment . — Confirmed amaurosis is incurable. 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, sitz, 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 contraction 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 during 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 hairs, and bathe often in cool water. Entropium. — The eyelid is sometimes inverted, or turned inward It requires surgical treatment, 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 stye . It consists of a small in- flammatory tumor near the edge of the eyelid. It is very painful, but generally suppurates and heals in a few days. Frequent bathing of tli# DISEASES C F THE EYE. 1&5 affected part with water of a temperature most agreeable to the feel*- ings, lessens the pain and accelerates the cure. Excrescenses. — Wart-like and other trifling tumors sometimes form about the eyelids ; they are easily and safely clipped off with the knife or a pair of scissors. Ptosis. — A hanging down of the eyelid over the eyeball, from re- laxation or paralysis of the muscle, whose action elevates the lid. Frequent cold bathing, occasiona head-baths, gentle manipulations over the eye with the bare hand, and attention to the general health, are all proper, and generally all are necessary. Fistula Laciirymalis. — This is a stoppage of the tear passage, caused by obstruction from a thickening of its lining membrane. The tears, instead of passing off by the nose, run over the cheek, giving the eye a watery appearance, especially when exposed to wind or cold. In protracted cases a swelling occurs at the inner angle of the eye, sometimes forming matter. It requires to be treated on the same gen- eral plan as ptosis. Usually the general health is so disordered as to render a rigidly abstemious diet advantageous. In bad cases it may be necessary to probe the obstructed canal, or wear an artificial tube. Asthenopia. — Weak vision. This depends on constitutional or local debility, and requires the full invigorating plan before mentioned. Hemeralopia. — Day-blindness. A peculiar sensibility of the re- tina, by which the patient sees setter in the evening than in clear daylight. The Albino manifests more or less of this condition. It is irremediable. Nyctalopia. — This is the reverse of the former condition, the subject having natural vision in the daytime, but very imperfect in the evening, or twilight. Glasses sometimes assist this night-blindness to some 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 great convexity of f‘ae globe of tbe eye Flattening the eyebal’ by 186 PATHOLOGY AND THERAPEUTICS. pressing gently with the fingers across it, from within outwardly, tend* 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 two feet or more. The corner is too flat, 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 finally over- come in many persons 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 low^er lid (fig. 183 ), and remove by a piece of moistened paper. If the sub- stance be under the upper lid, place a bodkin across the lid, and draw Fig. 183. Fig. 184. 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 the eye. Inflammation is very apt to occur after these accidents, for which the eye should be well bathed with tep.d or warm water frequently, until the pain abates; then follow with cool, and. finally cold applications. I 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 ^normal affections of the organ of hearing may be con- veniently grouped under the general heads of inflammation and deaf- ness ; the kinds of the inflammatory affection 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 system- atic to recommend it; nor will it ejii brace two of the diseases belonging to the chapter, which must, therefore, be placed under a third head* thus : f External Acute Inflammation, Otitis <[ Internal Acute Inflammation, l Chronic Inflammation. From it it u k Deafuess “ tt tt tt tt tt Cold, Hardened Ear-wax, Excrescences, Abscess, Caries, Altered Membrana Tympani, Diseases of the Eustachian Tube Extravasation, Nervous Affection?. Dumbness, Senility. Promiscuous Earache, Foreign 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 otitis , the latter otorrhoea. 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 meatus, which gener- ally soon becomes thicker and puriform. Sometimes it is greenish, fgtid, 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 disturbance, consequent on the obstruction of the Eustachian tube, and the difficulty 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 sc ind. In some cases the face is flush- ed, the eyes are red and water} . 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 the usual termi- nation ; the second seldom occurs ; and the latter result .s extremely uare. Structural changes sometimes result from internal otitis, which partially or totally destroy the sense of hearing. DISEASES OF THE EAR. 18 ft 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 sequel®, 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. Chronic Inflammation — Otorrhcea. — A prolonged discharge, or running from the ear, is frequently the consequence of acute otitis, and often one of the sequel® of maltreated 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 structure. The patient, 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 oedematous. 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 ah, 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 THERAPEUTICS general constitutional condition demands, \rd the essentials cf the plan The rubbing wet sheet, with frequent hip and foot baths, as derivatives, make a good bathing arrangement. If t ho skin is obstructed or bilious, the pack sheet should be occasionally resorted to ; and it is more or less frequently useful in nearly all cases. After the general health has become substantially improved, warm, and then tepid, and then cool injections, should be thrown into the ear, it, 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, structural 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 the auditory nerves, from “taking cold,” frequently occasions deafness in one or both ears, for days, weeks, or months. It is curable by perse- vering 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 resuk 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 bead. 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 tase s, when they are hard and indurated. To detect their character DISEASES OF THE EAR. 191 die meatus must be examined with the ear speculum, or 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 should be subdued, and the general health restored, as already mention- ed, and then the fungus growths extirpated, after which, both tepid and cold injections should be employed for a considerable length of time. The polypi and other tumors can generally be eradicated by a pair of fine curved scissors, or a curved 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 affected with, and children of a scrofulous diathesis are very liable to, an inflammation of the periosteum, which generally results in inflammation of the bon} structure, and frequently 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 Tympani. — Neglected or maltreated inflammatory affections are occasionally fallowed 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. m 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, already described. It is worth 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 as 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 menu brane, effusion, constriction or obliteration of a portion of the canal These conditions cannot well be ascertained without explorations bj* ear forceps or catheters. Injections of warm water, and of air, have been employed to ascertain the nature and extent of any existing ob struction ; 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 thorough employment of all meas- ures conducive to the general and local health. Catarrhal affections, 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 inflammation 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 to the guttural part of the tube, the patient hears well at times, bu! only momentarily. His own voice sounds worse to him than the voices of others, and has sometimes a gurgling, crackling, or detonating sensation. The 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 cciurse, must be removed by ligature or excision ; though enlarged to»» DISEASES OF THE EAR. 193 sils can generally be reduced by cold gargles, and thorough general treatment, with a rigidly abstemious diet. Deafness from Extravasation. — External injury, violent 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 by 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 structural changes. The proximate causes of this form of deafness are numerous : it may arise from 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 affections 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 affections of this class, which, in fiict, are many, the prospect of cure depends entirely upon the degree 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 eases 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 especial^; important to avoid all concentrated and stimulating articles of food in these cases. 11—17 194 PATHOLOGY AND THERAPEUTICS. Senile Deafness. — Old age should not, in a natural development tend decline of the bodily functions, be subject to deafness, blindness, nor other loss of external sensibility, only in the ratio that all the phy- siological functions cease to perform their offices. But the usual habits of living tend to thicken the fluids and hasten these results premature- ly — the fine capillary vessels of the delicate 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 offer \h this relation, of preventive or curative efficacy, save a life in conformity with the 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 unattended with febrile irritation. Noises in the ear, and slight deafness, are fre quent accompaniments of otalgia. Treatment . — Fasting a day or two, syringing th^ ear with warm water, and a few tepid foot-baths, will generally soon remove the worst attacks. A warm or vapor bath, or a wet-sheet packing, 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 entirety free, copious warm water injections are advisable. Foreign Bodies and Insect* — Children at play occasionally put beans, peas, small pebbles, and other substances into the ear-passage. These may remain an indefinite time without trouble; but frequently inflammation and ulceration ensue, with a constant discharge of irri- 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 examination with the speculum, forceps, 01 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 management, to avoid injuring the adjacent structures. Insects and worms sometimes effect a lodgment in the meatus, pro- ducing awful suffering. There is little doubt that inattention to clean- liness, particularly in diseased or ulcerated states of the passage, attract? the animals to deposit their ova there, which in time are converted into worms ; and it is possible they may be generated there as they are in a morbid condition of the secretions of the mucous membrane of th^ ERYTHEMATOUS INF L AM M ATI C N S. 195 stomach and bowels. In either case they are unprofitable and danger- ous residents. When they can be seen, they should oe 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 ns oil of almonds, or a strong infusion of green 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-nife stations 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 the idea of a perfect nosological arrangement — and comprise, in the present chapter, (Edematous, Erysipelas, Gangrenous, Erythemas Vesicular, Anatomical, Chilblain, , Fret. Rasti Exanthem — Nettlerash. Icherous Exanthem 1 ^P^ a » Pemphigus 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 terminating generally in euticular scales, or vesicles, sometimes in ulceration . and more rarely in gangrene. In the (zdematous variety the skin exhibits a bright scarlet color; the affection spreads widely ani deeply through the areolar tissue, !96 V ATHOLO G Y AND TIIER AP EC. TICS. which often suppurates imperfectly, and occasionally sloughs and be- comes gangrenous. The swelling is principally caused by extravasated serum ; it is generally found in dropsical constitutions, and usually de- nominated, “ (edematous inflammation” 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 first attacked healing as the disease extends over the surface. 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 shining 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 extremities. It is 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 weakly infancy. 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 affected and the corrosive fluid produces tracts of sanious ulceration as the red ness advances. This and the preceding variety were called ignis sacer — holy fire — by the ancients, from the superstitious notion that 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, which arises from dissection. Unlike all the other forms of erythema, and, indeed, unlike most other inflammations originating from a local cause, it commences, at least in the great majority of cases, with a constitutional febrile disturbance ; the local affection first appearing about the shoul- der or axilla, while the injured part shows little or no inflammatory uction The characteristic symptoms, as well stated by Dr. Good, are ERYTHEMATOUS INFLAMMATIONS 197 Inflammation, wil h 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 probably 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 putrefaction, 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- similar to what happens in small-pox, measles, and other diseases dependent on a specific virus, or transformation 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 correctness of the opinion; for, it will 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 products 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 de 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 more 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 erythematic character, in some cases followed by a constitutional disturbance similar to that of anatomical erythema, And 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, bag, eto -pierce the skin and suck the 198 PATHOLOGY AND THE It APED TICS. blood. Whether the injury results mainly from poison, or the rritation of a rough, ragged wound, is not, in all cases, clear. The following cut exhibits Lie instrumentality by which these insects pierce, cut, and tear the fine capillary network of blood-vessels and nerves : Fig. 185. e b In Fig. 185, a is a representation of the hornet; b, the gnat; c, lancets of horsefly ; d, sting of wasp ; .. lancet of flea ; /, lancets of bug. The variety called chilblain , or pernio, affects principally the hands and feet, 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 — -fret, 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 bright red color, the cuticle is eroded, and the exposed skin oozes a limpid and acrimonious fluid ; the discharge is often peculiarly offensive. The whole theory of its nature, advanced by Dr. Good, in his elaborate “Study of Med- icine,” is in the following words : “ It is an erythema 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 habits, and always considerable uncleanliness of the skin as a consequence of such habits. 1 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 erythematic 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. The indications of cure are, therefore, sufficiently obvious. (Edematous erythema is rarely found except as symptomatic of some primary malady; but when occurring idiopathically, 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 measures. 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 facts that erysipelatous erythema frequently attacks chil- dren soon after birth, and that children are sometimes born with it, we may reasonably infer that the malady is closely allied to the voluntary habits, especially the dietetic habits, of the patient, 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- tion 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 very cold, so as to produce a tonic and constringing effect. 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 affected parts, with 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 te«£< 200 PATHOLOGY AND THERAPEUTICS. ing the new system in a case of erythema arising from dissection ; no? do I believe that all cases could be cured by hydropathic, or any other means. Some anatomists who become thus affected are among those whose physiological habits, especially in the matter of eating and drinking, are gross and unhealthful ; hence they may have that degree of putres- cency of blood which can offer but slight resistance to the destructive action of the infectious principle ; an 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 by 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 would employ the warm wet-sheet, and apply hot bottles to the feet. Water-drinking should be insisted 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 from 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 instantly , 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 very soon after the serpent’s fang has been withdrawn, has prevented all injurious consequences — the mouth being defended by a wash of olive oik 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 not 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 antispasmodie, 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- tribute something to the safety of the patient. The general treatment is, of course, precise 1 }’ the same, whether the system is poisoned from EH TTIIEM ATOUS INFLAMMATIONS. 201 the ingenerated virus of a dead corpse, or tlie venomous secretion of th« living reptile. The irritation or poison resulting from the stings or bites of insects is mosj 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 oftener, 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 stomach 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 while 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; ma ignant , or black thrush , is seen most frequently as a symptomatic affection in typhus and malignant 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 l ack ; chronic thrush is attended with great emaciation and hectic fever the eruption 202 PATHOLOGY AND THERAPEUTICS extends through the whole length of the alimentary canal, the edges of the tongue are affected with pimples, superficial blisters appear within the mouth and fauces, and the stomach is at all times troubled with a sense of heat and soreness. Diarrhea 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 grease of any kind; pork gravies; 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, strictly vegetable diet, save the article of milk ; with a strict avoidance of all the producing causes, comprise the remedial plan. Pemphigus — Vesicular, or Bladdery Featr. — 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, transparent 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 mouth 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 treated 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 so malignant that all persons affected by it diet. ” and yet, in allu- ERYTHEMAT jUS INFLAMMATIONS. 208 eion to his bleeding and sweating, recommends it, “ with the most san guine hope that t will effect a speedy cure.” Yaws. — Rubula and frambcesia 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 run into fungous excrescences, and in their granular surface, as well as size and color, resemble the raspberry, from which their name is de- rived. These tumors, 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 body, 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 can 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 varieties — 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 tubba, or crab-yaws , 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, with a strictly vegetable and rigidly simple and abstemious diet, are the proper therapeutic appliances. 204 PATHOLOGY AND THERAPEUTICS. CHAPTER X. SPASMODIC DISEASES. There are a variety of diseases, whose most prominent phenomena are: irregular muscular contractions, 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 thu present chapter in the following manner : Comatose f Convulsion, Spasm •) E l ,,le P^’ l Hysterics. Synclonic Spasm Suffocative Spasm r Tremor, Delirium Tremens, Shaking Palsy, < St. Vitus’ Dance, Raphania, Barbiers. \ r Cough, Dyspnoea, Asthma, J Laryngismus, Incubus, Bronchitis, Sternalgia, , Pleuralgia, r Hiccough, Sneezing, Clonic J Palpitation, Spasm Nictitation, Subsultus, k Stretching. Constrictive Spasm 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 suffocative 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 snatches ; and the constrictive spasm is an irregular form of muscular contraction producing rigidity. Convulsion. — Deaths from convulsion fits, especially among ih* 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 intimated is conspicuously frequent and fatal in infancy; pregnant women are also, after the sixth month, during labor, and immediately afterward, liable to the disease then denominated puerperal convulsions. Symptoms , — The muscula* agitations are violent, and with very young children the spasmodic movements are extremely rapid ; the fingers 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 uccurs 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 constipation which they produce. Treatment . — The first thing to be done in a convulsion-fit is to expose the 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 £06 PATHOLOGY AND THERAPEUTICS. by acrimonious secretions, tepid injections shpuld not be omitted. Afte*- the spasms are overcome, the prophylactics to employ in the intervals are brown home-made bread, and milk, potatoes, squashes, pumpkins apples, etc., and a daily bath or universal wash-down. Epilepsy — Falling-3 jkkess. —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 movements 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 preeursive symptoms, 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 epileptica . 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 face 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 lethargic 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, internal 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 animal propensities, or in the use of stimulants and narcotics, frequently SPASMODIC HSEA8ES. 20 / occasion an attack ; confirmed drunkards are pecul arly liable to it ; in a few instances the disease ha* arisen from worms. Prognosis. — The chance of cure will be favorable ur 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 from 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 more frequent in the female, and most disposed to shoFv itself during the menstrual period. Symptoms. — The precursive signs, which, however, do not always exist, are — a sense of nausea or sickness, flatulency, palpitation, do- oression of spirits, weeping, crying, etc., without any assignable cause; 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- sion, giving the idea of a 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 an extraneous body were pressing there ; 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 variously agitated, the fists are firmly clenched, the breast is spasmodically beaten, the muscles of the chest are 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 delirium. On the cessation of the spasms, 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 being 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 tea and coffee. Treatment . — A hysterical paroxysm is almost the only disease in the treatment of which allopathic and hydropathic practitioners 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-makers are kind enough to tell us they do no good ! Says Dr. Guy, author of a Medical Jurisprudence : “ Cold affusion is the only remedy which can be relied on, and is worth a whole phar- macopoeia of antispasmodics.” Drs. Hooper, Good, Cojper, Neill, Smith, and Copland — all accredited authors of the drug school — rec- ommend the cold-water practice. Av.d Dr- Alfred Smee, F.R S-« SPASMODIC DISEASES. 209 Burgeon to the Bank of England, etc., gives the following directions, illustrated by a plate, both of which are worth copying : Fig. 186. “Place the head over a basin, and pour water from a jug over the head and chest till the patient becomes chilly and revives. Never use any thing but cold water for the hysterical fit, 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 bowels are more or less constipated, and the diet must be regulated accordingly. Tremor — 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 far 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 — Dru^karl’s Delirium. — “This di8ease. , ‘ PATHOLOGY AND THERAPEUTICS. 210 says Dr. Doane, “is unfortunately very frequent in tlie United States ;* to which may be added, that hardly a day passes without some suicide or murder being chronicled in the newspapers as committed under its influence ; nor can any different result be expected, so long as our law- making representatives authorize and commission by special license, one class of our fellow citizens to poison all the other classes by selling them intoxicating drinks. Symptoms. — Delirium, during which the patient recognizes those about him, answers questions rationally, and does hurriedly what he is told to do; the hands, lips, and muscles generally, 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 unlikely places after something on which his mind is intent. There is frequently 'profuse 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 extremely 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, and tea. 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 other 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 foul, 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 serviceable. 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 all of them may be alternated. When the patient is too irritable or restless to permit any general bath to be employed in the ordinary way, wet towels may be applied to the chest, abdomen, Rnd thighs, and frequently renewed; and copious cold water injections may be thrown SPASMODIC DISEASES. 211 up the bowe 9. In all cases cold water may be drank to any extent the thirst demands. It relation 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. — Tne 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 affected, there is no absolute loss of muscular motion, nor of sensation, one of which, or both conditions, being alwayr present in genuine pa- ralysis. Symptoms . — “ Permanent agitation of the head or limbs 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, commonly 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 will; 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 tne closing scene, the power of articulation is lost, the ordinary evacuations are involuntary, and coma with slight delirium occurs. Special Causes . — Long exposure to damp, unwholesome vapors, nervine excitants, as ardent spirits, strong tea or coffee, narcotic poi- sons, as tobacco, nightshade, etc. ; metallic vapors, especially mercurial ; drastic purgatives. Those who are employed 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 whola £12 PATHOLOGY AND THERAPEUTICS nervous system, the simple indication of cure is to strengthen 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 course 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 twice 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! “The remedial process,” says Dr. Good, “is not very plainly indicated;” yet he recommends vesicatories and other stimulants to the neck ; setons , caustics, and even the red hot iron applied to different parts of the spine ; and for internal remedies, prussic acid and arsenic!! Dr. Elliotson treated 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. Chorea — St. Vitus’s Dance — Chorea Sancti Viti. — This dis- ease is characterized by “alternately tremulous and jerking motion of the face, legs, and arms, especially when voluntarily called into action, resembling the grimaces and gestures of buffoons.” 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 hay ing danced a whole week or whole month together. Symptoms . — The disease appears most frequently from the eighth tfi SPASMODIC DISEASES. 213 the fourteenth year; and attacks boys and girls indiscriminately, but chiefly those of weak or impaired constitutions. Its approaches are slow, 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, the head, and the trunk of the body, are each at different times, and in different degrees affected ; the patient walks un- steadily, his gait resembling startings 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 and vacancy, giving the patient afatuitous appearance. Special Causes . — Repelled eruptions ; lead ; mercury ; constipation ; narcotics; 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,” says 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 secondary. 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 great 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, wil? re sufficient. Raphania. — This disease was first descrrued by Linnaeus, and so named because he supposed it to arise from eating the seeds of a spe- cies of wild radish, the raphania raplianistrum. 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 different vegetables in a state of disease or decay, or in a particular stage of putrefaction, may gen- erate the poisonous element. 214 PATHOLOGY AND THERAPEUTICS. Symptoms . — The disease commences with cold chills and lassitude, headache, and anxiety about the praecordia; these are followed by spasmodic twitching, and afterward rigid contraction of the limbs or />ints, 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 which the physicians have been unable to assign a name' and which strikingly resembles the disease before us. If it is not identical so far as its causes are concerned, it is sufficiently similar in character to be appropriately treated 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. Symptoms . — 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 iarynx. In a later period of the disease, the legs swell, and subsequently the whole body becomes bloated and oedematous, 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 transitions 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 debility, or the bad habits which cause the debility. Treatment . — A daily ablution and half-bath, plain food, regulated exercise, according to the strength, and cold injections, would seem adapted to the therapeutic indication, which is essentially tonic SPASMODIC DISEASES. 213 Cough. — There are three kinds of cough which are ranked as idio rrathic diseases by authors — common cough , dry cough , and hooping - cough. They are all attended with a sonorous and violent expulsion of air from the lungs, from a spasmodic or convulsive action of the respi- 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 me 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 face becoming turgid and purple from suffusion, and the 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 agitation, 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 hissing. It is generally a disease of children, and the danger is in the inverse ratio 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. Sequelae. — 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. Treatment. — All forms of idiopathic cough may be very easily man- aged. Cold water should be freely drank ; the diet must be plain and rather abstemious ; and one or two ablutions daily, followed by thorough friction or active exercise, are, in the majority of cases, amply reme- dial. When the system is inclined to feverishness, the pack, prolonged sufficiently to produce moderate sweating, may be necessary ; and when there is an inflammatory state or fixed soreness of any part of m PATHOLOGY AND THERAPEUTICS. the chest or lungs, the chest-wrapper should be applied. When the paroxysms of hooping-cough are very severe and suffocative, a warm water emetic is advisable ; and in bad cases a tepid half-bath and foot bath should be added to the daily processes. The allopathic treatment of cough affords a melancholy reflection fof 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 them all are tartar emetic and opium; while henbane, deadly nightshade, poison hemlock, and prussic acid, are in the next highest class of remedies ! Dyspncea. — 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 two varieties, chronic, and exacerbating — the orthopncea 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 asthma by the breathing being permanently yet irregularly affected; whereas in asthma the difficulty is recurrent with considerable intervals of perfect ease. Special Causes . — Irritating dust, or pulverulent particles to which stone-hewers, glass-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, as 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 be 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 most cases by promoting absorption ; and where patients have been exposed 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 as to produce free perspiration she was cured in ten days. Asthma. — This affection is, too, much more frequently a symptom- atic than an idiopathic affection. Its pathognomonic characteristics are: recurrent 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 constriction 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. Sjwcial Causes. — Nearly 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 frequent 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 cured 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 true 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 IT — 19 218 PATHOLOGY AND THERAPEUTICS. digestive powers and rjervous system ; and that emetics, especially of lobelia, have entirely suspended the symptoms of the disease in th8 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 processes. 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-wrapper. Asth matic 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 tumblers 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 ail cases the diet should be simple and unconcentrated, and in those cases connected with or caused by diseased livers or spleens, or primary dyspepsia, 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 paroxysm 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 breathing 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 breath, anl a shrill, croaking sound of the SPASMODIC DISEASES 2ie voice, or crowing inspiration, somewhat analogous to ;*r jup ; 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 oedematous 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 wet-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 plan of a safe and successful treatment. Incubus. — Authors distinguish two varieties of incubus, one of which is called nightmare, and the other dayma * e. The ancient Anglo-Saxon name for this affection was elf-squatting — eif 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. Symptoms. — 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 affrighted. 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 ia deep and violent; and the intellect is undisturbed. The nightmare is the more common form ; it occurs during sleep, which is interrupted with a violent struggle and tremor; the pressure un the chest seems to be that of some hideous monster or phantom ; it is usually preceded 220 PATHOLOGY ANH 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 imme- diately arrest the paroxysm, which, by the way, seldom lasts a full 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 quality 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 suffocation 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, progress, 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, pulmonary 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 chest, and shortness of breath, which do not, for a considerable time, attract much atten- tion. The first difficulty which is generally noticed as of importance^ SPASMODIC DISEASES. or»i Adi is a sense of roughness, witi 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 some degree of hoarseness of voice, with 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 oi 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 ; in a few instances the breathing is rattling or wheezing, owing to the air struggling through t lie viscid mucus accumulations in the bronchi; and sometimes, though rarely, the voice is scarcely altered, while the breathing, on the slightest disturbing causes, become-s painfully spas- modic, in consequence of the tenacious, glaring secretion becoming con- creted upon the lining membraue 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 ten, coffee, and tobacco consumed by our people is a special ^vuse of the increasing prevalence of this disease among us. Treatment . — Nearly all that has been said in relation to the man- agement for consumptives will 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 water. 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 2,22 PATHOLOGY AND THERAPEUTICS. as frequently and as cold as the patient can bear without disagreea- ble or prolonged chilliness. Precaution is necessary also, to avoid greatly disturbing the circulation or 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 natural standard, the pack should be resorted to daily, or tri-weekly. Those patients who are particularly troubled with short breath, and are easily fatigued by exercise, should walk regularly 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 careful treatment from six to twelve months, while 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 any one of its ingredients, 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-treatment — as few unprofessional persons 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 treatment 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, expectorants, laxatives, tonics, refrigerants, stimulants, antiphlogistics, demulcents, cathartics, emollients, rube- facients, mucilages, vesicatories, revulsants, counter-irritants, diaphoretics, diuretics, se- datives, bitters, alteratives, attenuants, antispasmodics, narcotics, diluents, enemata, ano- dynes, and narcotics. 2. Processes of Medication. — General bleeding by the lancet ; local bleeding by leeches , topical depletion by cupping; lancing the gums (in children) ; blisters applied to various parts ; burning the skin by hot turpentine; cauterizing the skin by moxa burnings; pus- tulating the skin by ointment of tartarized antimony ; leeches applied over the sternum, leeches applied behind the ears ; leeches applied below the occiput ; cupping on the nape of the neck ; issues ; setons the warm-bath ; sponging the body with warm water and vin- egar sponging with a wars: lotion of nitro nuriatic acid ; astringent gargles ; cooling SPAS IODIC DISEASES. 223 gargles ; antiseptic gargles ; demulcent linctuses ; lotions of common salt and water : semi* cupium , pcdihmvium ; poultices ; liniments ; and fomentations. 3. Fumes and Fumigations. — Of tar, camphor, benzoin, amber, frankincense, myrrh, etorax, cloves., sulphur, assafoetida, and various turpentines and balsams : also the smok- ing ofbalsarn of tolu. 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 doses ; 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 ; olive oil ; white willow bark ; Iceland moss; Prussic acid; aloes ; senna ; creasote ; preparations of steel ; carbonate of soda; bi-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 erf zinc ; sulphate of quinine; sulphate of alumina; flowers ol 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 ; trisnitrate of bismuth ; salt- petre ; squills ; decoction of squills ; tincture of squills ; infusion of squills ; oxymel ol squills ; tincture of hyoscyamus ; colchicum ; infusion of colchicum seeds ; digitalis ; chlorate of potash ; tartrate of potash ; chlorate of lime ; columbo ; decoction of Peruvian bark ; infusion of marrabium; chloride of calcium ; liquorice ; mezeron bark ; cinchona ; uva ursi; gum arabic; oil of turpentine ; myrrh ; vinegar; marsh mallows ; decoction ol 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 wing to non-arterialization of the blood from interruuted respiration CHAPTER XL DISEASES OF GENERAL TORPITUDE C atal epsy — Trance . Lethargy — Deep Sleep. 240 PATHOLOGY AND 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- sion of the mental and corporeal functions characterizes the access of the disease. Symptoms . — These vary with the producing cause. In asphyxia from suffocation , as in hanging or drowning, the countenance is turgid, and suffused with livid blood ; the eyeballs are protruded, •‘^taring full ghastly, like a strangled man ; His hair upreared, his nostrils stretched with struggling.” When the asphyxia is produced by inhaling carbonic acid — choice- damp — -or other irrespirable gas or mephitic exhalation, the countenance is pallid, the whole surface is also pale, and death often takes place in- stantly, save when the deleterious aura is largely diluted with common 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 putrefying corpses of cerr. etaries; and of the negatively injurious gases— those which do not sup port respiration — are hydrogen and nitrogen ; some of their com- pounds, however, with sulphur, carbon, and phosphorus, are abso- lutely destructive. The fumes of mercury, lead, and various other metallic substances, when highly concentrated, operate with as sudden fatality as the fumes of charcoal. In electrical asphyxia, which is produced by a stroke of electricity or lightning, the limbs are generally flexible, the countenance is pale, and the blood is incoagulable ; usually the limbs do not st ffen after death, and the body becomes rapidly putrescent. Sometimes no external in- jury whatever is observable ; but in other cases the skin is vesicated, the hair is scorched, and the body more or less lacerated and torn. When the disease results from intense cold — 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 as the period of exposure is extended ; and when this is joined with fatigue, the torpor and drowsiness often become irre- sistible. Various narcotic poisons, as cicuta, tobacco, and Prussic acid, when * taken in large quantities, and also the anaesthetic agents, as ether and chloroform, in extreme doses, will produce asphyxia, attended with *total insensibility and universal muscular 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 tilling 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 underwater 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, well- ventilated room, and sur- rounded by no persons ex ;ept 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 perse veringly rubbed by the warm 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 ihe 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 till 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 THERAPEUTICS. the lungs ; and if the bellows can be attached to a tube, an** this in- troduced into the larynx, the effect will be better still. Fig. 187. 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 ground of its impropriety, but because the blood will seldom How if the jugular is opened. Samuel Cooper dissents in part. He says : “Bleeding ought never to be employed in 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 cold 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 tided 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 bath to the head, aro the most im- portant processes DISEASES OF GENERAL TORP.TUDE. 2&5 Here again, many 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 abstraction 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 stroke 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. Symptoms. — 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 duration 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 conversation ; amusements of the laughable kind; regular employment or occupation, with a daily bath and plain food. CATALEPSY.—The only essential distinction authors make between PATHOLOGY A ;i ^ THEPvAI EUTIDS. U 4 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 with 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. The 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 awakens and recovers sensation and speech, constituting the coma somnolentum of authors ; and in a third variety — the typhomania 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 wandering ideas, and, during sleep, possessing a belief 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. Apc^exy. — T his disease is one of the results of a constipated, ob- st» ;ed, 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 even then wo almost invariably find inattention to the functions of the ex- creting organs or outlets of the body among the predisposing circu m stances. DISEASES OF GENERAL TORPITUDE. 245 This view is simple enough, and not difficult to understand. But in medical boohs 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 ; while others con- demn all bleeding arid 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. Symjitoms. — The distinctions which authors make of this disease, into sanguineous and serous , entonic and atonic 1 simple and congestive , etc., are unimportant, as they relate only to the greater or less debility of the patient at the time of attack. Sometimes the disease comes on suddenly without the least premonition ; sometimes the attack is pre- ceded by a sudden paralysis of one side of the bod} r , 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 may 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. Treatment. — J he first thing to be done is to remove the patient to a 246 PATHOLOGY AND THERAPEUTICS, cool, spacious, well-ventilated apartment, hosen all the clothing about the chest, remove eve~y thing from around the neck, and place him in ftu easy and nearly upr ; ght posture, as in fig. 188. not fomentation, which may be resorted to every 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 nand 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 resting, 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 paisy as modifications of one essential disease ; “ apoplexy being a universal palsy, and palsy a partial apoplexy.” Symptoms . — Paralysis may be attended with 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 occasional sense of weakness, and troublesome but transient feelings of numnness being the leading admonit ons ; and these are often ob- POSITION IN APOPLEXY. Fig. 138. Follow the preparatory measures with the cura- tive processes, which con- sist mainly of the pouring head bath ; wa v m water and warm cloths to the feet, and occasionally hot fomentations to the abao- men. 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 DISEASES OF GENERAL TORPITUDK 247 servable in a single finger, in one eye, 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 th e, paraplegic variety the lower part of the body is paralyzed on both sides, or any part below the head. When not caused by some focal injury, it is almost always preceded by costive ness. Particular or local palsy is confined to particular limbs, or to a par- ticular part of the body. When 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 which 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 functional, which point, however, is not always easy to determine. But in either case the plan of medication is obvious, and the same. Some few cases are attended with a difficulty of respiration, and the indications of cormpres- eion 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 discomfort; 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 cot:. 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 affected 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, fullness, or turgescence may exist in any part or organ in temporary obstructions, congestions, or inflammations ; but the pres- ent chapter is limited to those affections of the internal viscera in which the enlargement is chronic or permanent. It includes the following Varieties, which make the species of Dr. Good’s genus parabysma : Hepatic — Enlargement of the Splenic, “ 44 Pancreatic, 44 ' 4 Mesenteric, 44 44 Intestinal, 44 . 44 Omental, 44 44 Complicated, 44 44 Liver ; Spleen ; Pancreas ; Mesentery ; Intestines; Omentum ; Various Organs. Enlargement of the Liver. — The structure and functions of the liver, as described in the physiological part of this work, explain the reasons why the liver is more subject to chronic enlargement than ant VISCERAL TURGESCENCE 24$ other jrgan in the body. The morbid alterations of structure which constitute its intumescence are various, as simple swelling, tuberculai formations ; hydatid growths ; hardening, or induration ; softening, 01 fatty degeneration ; and that result of bad living and putrescent blooo which pathologists have called black ramollis semen t , 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 been called gin-liver, in which the biliary portion of the liver is both hypertrophied and indurated, 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 fVilfilling 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 oack, or shallow’- bath, or both, wffiere 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, will be advantageous. I may just observe, er passant , that there is some slight discrepancy in the opini us of standard medical authors regarding the treatment of 250 PATHOLOGY AND THERAPEUTICS. the malady under consideration Thus, Dr. Elliotson recommends iodii e and mercury as the principal remedies; but Abercrombie says that the mercurial practice uniformly sinks the patient in a very rapid manner. Enlargement or thi Spleen. — Pathologists seem to be generally of the opinion that structural disorders of the spleen occasion but very little mischief t@ the organic economy. I think differently. It is true 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 resuP 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. Symptoms . — It is known by an indurated tumor in the left hypo- chorylriurn, 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 muscular strength ; his features have a dark, bilious, or mahogany hue ; the skin is dry, the lips are pale, and the patient is not infrequent- ly morose and desponding. Special Causes ‘-The disease often appears after obstinate intermit VISCERAL TURGESCENCE. 251 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 immoderately administered in intermittent 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 hypo- chondriac region ; and in all other respects 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, scirrhus 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 symptoms 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 — u chewing it all the morning, an£ 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- ular 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. — In some cases the induration is confined to the coats of the intestines ; and in others adhesions unite the intestines to the wa Is of the abdomen and to each other. Symptoms. — The into nescence may be round or elongated, haid ox PATHOLOGY AND THERAPEUTICS 252 circumscribed; but is movable by pressure made with both hands; the action of the bowels is irregular; 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 structure 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 knotty and un- equal ; the respiration is but slightly disturbed ; but there is usually acute pain, thirst, nausea, and vomiting. A diseased liver is the com- mon starting-point of these structural monstrosities ; and our only chance of cure is to employ assiduously, in the infancy of its malady, all the remedial appliances recommended under the bead of enlargement of that organ. ' CHAPTER XTII. . DROPSICAL DISEASES. The character of a dropsical affection may be defined: a pale, indo- ent, and inelastic distention of some part or of the whole body, from accumulation of a watery fluid in the areolar tissue or other natural cavities. There is however, one exception to this definition, in the case of internal hydrocephalus, which, though usually regarded as a dropsical disease, is, in reality, a strumous inflammation of the brain DROPSICAL DISEASES. 258 The principal forms of disease belonging to the chapter before us may be grouped : Cellular $ General — Anasarca, Dropsy of ( External Hydrocephalus, Dropsy < Local — (Edema. the Head ( Internal Hydrocephalus. Dropsy of the Spine — Spina Bifida. Dropsy of the Chest — Hydrothorax. Dropsy of the Abdomen — Ascites. Dropsy of the Ovary — 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, ( Uterine. < Puerperal Tumid Leg, Inflammatory Dropsy j Tropica , Tumid Leg . 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, antiplilogistication. But as neither quinine nor bleeding effected a cure, a third party has lately entered the field of controversy, 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 treatment of dropsy, which has proved even worse than its bad predecessors. Cellular Dropsy. — This affection 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 er puffiness ‘of the skin, 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. 22 254 PATHOLOGY AND 1 HERAPE UT1CS. Special Causes . — All the causes of general debility predispose to dropsy. Intemperance, repe led eruptions, exhausting discharges, sup- pressed evacuations, and structural or functional obstructions of the kid- neys, skin, and liver, are among tin frequent causes. (Edematous swellings of the limbs are often symptomatic in mismenstruation, 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 obstruction or debility is the leading proxi- mate condition. As a general rule, 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 wide 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. The 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 writers 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 albumin- ous , or ammoniacal , or alkaline, or acid , or saline , it is all the same as fer as the treatment is concerned. Diofst cf iHh’ Heat — Hydf :>ps Capitis. — External dronsy 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 cedematous 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 Vanced stages it is attended with languor, drowsi- ness, costiveness, vomiting, coma, frequently convulsions, and some- times strabismus. The second variety — the cephalitis prof unda of Good’s nosology — comes on gradually and insidiously ; the precursive disturb- ances are languor, inactivity, loss of appetite, feverishness, 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, 't violent convulsions occurs. Hydrocephalus is peculiar to infancy, an 1 some- times commences in the foetus. Special Causes. — Scrofulous, scorbutic, or syphilitic taint; re A 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 accumu- lated within the coats of the spinal cord, protruding externally in con- sequence of some portion of the vertebral column being defective. Jft £56 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 health, and “ trust to nature.” Dropsy of the Chest — 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. Symptoms . — With a constant sense of oppression 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. — Hypertrophy of the heart, aneurism, scirrhus of the stomach and liver, and other organic derangements, frequently pro- duce hydrothortfx. 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 general, 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 cavity 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 encysted form the size of the abdomen enlarges gradually and steadily, without experiencing any sudden increase, de- crease, or change in the swelling ; whereas 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 th« DROPSICAL DISEASES. 257 latter disease; from tympanites , by the dullness on percussion, and by the fluctuation ; from retention of urine, by the dribbling of water in the latter 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 sidG 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 obstructed 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 frequently 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, eartila ginous mass. Symptoms. — The tumor commences on one or both sides of the iliac region, and gradually spreads over the abdomen; its surface is 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 ter affect the general health ; the operation cannot be relied on to cffei a permanent cure, but with attention to the general health, 158 PATHOLOGY AND THERAPEUTICS. may keep it in check so that the patient may enjoy comfortable health foi an indefinite period. In many cases the operation requires to be re peated several times. Extirpation of the ovary has been successful in a few cases ; but the majority have not long survived it. Fallopian Dropsy. — Dropsy of the Fallopian tube is extremely rare; in its early stage it is known by a heavy, elongated swelling of the iliac region, spreading transversely, with obscure fluctuation. The quantity of fluid is generally greater than that accumulated in the pre 'ceding variety; and the prospect of cure is still less promising, although the same measures are applicable. Dropsy of the Womb. — This disease — the hydromelra of the old authors is generally the result of some structural affection of the ute- rus. In some few cases, when the orifice of the uterus is closed, wa- ter collects in its cavity ; sometimes a large cyst, or cluster of hydatids, originating between its tunics, is discharged, accompanied with severe flooding; and occasionally the fluid accumulates in its cellular tissue, by which the organ is distended to an enormous size, while the whole abdomen appears anasarcous. Symptoms . — Heavy, circumscribed tumor or protuberance in the hy- pogastric region, attended with obscure fluctuation, and progressively enlarging ; the mouth of the uterus is thin and yielding, and the com- plaint is unaccompanied with pregnancy or ischury. Treatment. — The general remedial plan is the same as the preceding varieties. When the mouth of the uterus is closed, the water may be evacuated by the introductiqn of a canula. Dropsy of the Scrotum — In some cases the fluid is contained in the tunica vaginalis, or surrounding sheath of the testis ; sometimes in the cellular membrane of the scrotum ; and in a third variety the fluid has accumulated in the tunica vaginalis of the spermatic cord. Con - genital hydrocele is that form of the disease in which the communica- tion between the cavities of the peritoneum and tunica vaginalis is in- closed, the fluid collecting within the latter. Sy?nptoms. — The vaginal , or first named variety, is the proper hy- drocele. The intumescence is soft, transparent, and pyriform ; it is unattended with pain, and enlarges gradually. In some cases the tu- nic is so distended and transparent that a candle may be seen through its contents. Treatment. — In recent cases, very cold sitz-baths and the ascending douche, each repeated sevwal times a day, or refrigerating local appli- DROPSICAL DISEASES. 269 cations of icea-water or pounded ice, in connection with the genera, treatment recommended for the preceding cases, will often effect a cure. When the cas* has been of long standing, the operation, to be described hereafter, will be necessary. Emphysema — Inflation — Wind-Dropsy. — This affection, which is caused by an accumulation of air in the natural cavities, differs from dropsy proper in the distention being elastic and sonorous. Sometimes the disease results from external injuries penetrating the lungs ; some- times the air is formed by a process of putiefaction or decomposition; and sometimes it is secreted directly from the blood. Symptoms. — In the cellular variety — the pneumatosis of Sauvages — the distention is sometimes limited to particular parts of the body, and sometimes extends over the whole surface. It is marked by a tense, glabrous, diffusive intumescence of the skin, which crackles beneath the pressure of the fingers. When arising from a wound in the chest, which penetrates the lungs — traumatic emphysema — the inspired air may rush into the cavity of the chest, the cellular membrane of the lungs, and even become diffused throughout the areolar tissue, pro- ducing a universal inflation, which is attended with violent palpitation and extreme danger of suffocation. Occasionally the inflation is con- fined to one side of the. chest ; it is then called pneumo-thorax ; and this form is sometimes produced by ulcerations which destroy some part of the pulmonary structure. When arising from fish-poison, mushrooms, or other venom, the disease is accompanied with extensive signs of pu- trescence and impending mortification. In tlio abdominal variety — tympany — there is a tense, light, and equable distention of the belly, which distinctly resounds to a stroke of the hand. When the uterus is inflated with air, there is light, tense, circum- scribed intumescence in the lower part of the abdomen, obscurely son- orous, and accompanied with occasional discharges of wind through the mouth of the womb. Treatment. — All the varieties of the disease before us are, happily t very rare, with the exception perhaps of tympany, and this is mostly a symptomatic affection. The general plan of treatment is the same as for dropsy of the same structure or organs. In emphysema from wounded lungs, the operation of puncturing between the ribs is some- times attended with benefit, and the dripping-sheet, followed by dry rubbing or hand friction, is probably the best of the strictly hydrothera' peutic processes. When occasioned by poison, the wet-slieet, so man- aged as to produce moderate diaphoresis • sips of iced-water, copious 260 PATHOLOGY AND THERAPEUTICS. injections, etc., on the plan recommended for anatomical erythema , should be resorted to. In the abdominal and uterine varieties, copious cold injections by means of the pump and vaginal syringes, are to be frequently employed ; the spray-bath and the ascending douche are also valuable assistants. Inflammatory Dropsy. — This term is rather awkward, but, un- fortunately, I cannot find in the whole range of pathological nomen- clature any more appropriate one ; and I do not care to invent new technicalities, especially as we have already a vast superabundance. The term comprehends the two diseases, elephant leg , which is pecu- liar to hot climates, and phlegmasia dolens , which is peculiar to lying- in women, both of which are characterized by a tense, diffuse, inflam - matory swelling of one leg. Symptoms. — In the tumid leg of childbirth, which has been variously denominated puerperal swelled leg , hucnemia sparganosis , phlegmasia dolens, phlegmasia lactea , ecchymoma lymphatica, anasarca serosa , cru- ral phlebitis, and cruvitis, the attack usually comes on in the second or third week after parturition ; the intumescence is pale, glabrous, equa- ble, elastic, and acutely tender; to the touch there is a sensation of nu- merous irregular prominences under the skin, and it is accompanied with a constitutional febrile disturbance of the hectic type. In a ma- jority of cases the attack commences with pain in the groin of one side, accompanied with fever, and followed by a swelling, which ex- tends down the thigh and leg to the foot, and in a day or two the whole limb is double its natural size, hot, smooth, exquisitely tender, and moved with great difficulty. The fever usually begins to decline in two or three weeks, but in some cases runs for six or eight weeks, causing extreme emaciation. In a very few instances both limbs are affected simultaneously ; and in still rarer instances the arms have been attacked ; in many cases the affected limb has remained enlarged and weak through life. It may be added here that a disease very like the one before us, if not identical, has sometimes affected the male sex. The second variety, the Barbadoes leg, hucnemia tropica , elephant leg, is common to hot climates, especially the West Indies, Arabia, and the Polynesian Isles, where it is called yava-skin , from the supposition that it is caused by drinking a heating beverage called yava ; “and like the gout among ourselves,” says Dr. Good, “is regarded in a sort of honorable light.” It is known, however, in temperate climates, and a few cases have occurred in the United States. The limb is hard, livid, and enormously misshapen ; the skin is at first glabrous, but afterward becomes thick, scaly, and warty ; in some places bulging out, and in DROPSICAL DISEASES. 2dl others deeply indented ; the attending fever is irregularly erratic ana intermittent, which eventually subsides, and the disfigured limb be- comes insensible, and only troublesome from its weight and bulk, which, however, is regarded in some semi-civilized countries as a badge of honor, as the gout is in places where the inhabitants pretend to be wholly civilized. Special Causes . — The puerperal variety is unquestionably owing to a condition of body which may significantly be termed the constipated diathesis. The general pressure on the blood-vessels and lymphatics during pregnancy, and the inflammatory condition of the whole system, which are the common consequences of the ordinary method in which females are fed and doctored through pregnancy and delivery, are ex- actly calculated to produce this and many other diseases of the lying-in period. The complaint under consideration, though very common in allopathic practice, has never been known, and probably never will be, where the patie.nt has, through the term of gestation, lived and bathed hydropatliically. The second variety is as clearly among the penalties which merci- less and unrelenting nature has attached to the use of debilitating stim- ulants, and impure, unhealthful, and obstructing food, with inattention to the subject of a clean skin. Treatment . — Puerperal swelled leg must be treated precisely as an acute inflammation. The wet-sheet pack, or frequent tepid ablutions of the whole body, and the constant employment of cold wet com- presses to the local affection, are the leading measures of treatment ; cold water may be freely drank ; and cool injections are generally nec- essary. The food must be of the kind called “ fever diet” in this work. Medical authors — and they have elaborated many ponderous treat- ises on the subject — are singularly at variance, and as it appears to me, singularly ybofo’sft, in their notions of the nature and treatment of this disease ; while their practice, or the disease under their practice, or the patient under both, has been singularly unfortunate. The second variety can only be successfully medicated in its early stage. The pack and dripping-sheet, the leg-bath and leg-douche are the most important processes, with due attention to simplicity and pu- rity of food. Amputation has been tried, but in most cases tetanus, or a gangrenous ulcer has followed ; perhaps, however, because the gen- eral health was notduiy oarea lor previously to performing T ne opera' tiom, 262 PATHOLOGY AND THERAPEUTICS CHAPTER XIV. DISEASES OF MIS-OSSIFICATION. The title of the present group of diseases is taken from the most prominent symptom, which, though indicative of an excess, deficiency, or mal-assimilation of the bony structure, does not very well express the essential nature or proximate cause. It includes • Rickets — Rachia — Rachitis. Cretinism — Cyrtosis — Cretinismus. Mollities Ossium — Softening of the Bones. Fragilitas Ossium — Brittleness of the Bones. Osthexy — Ossification of soft Structures. Exostosis — Bony Tumor. Rickets. — This disease is probably of modern date. The first ac count we have of it was published by Glisson, as it occurred in Englani in the middle of the seventeenth century. Symptoms . — The malady sometimes exists at birth, but more fre- quently the first indications are observed from about the eighth month to the third year. It is preceded by a paleness and puffiness of the countenance, and a yellow, sulphur hue of the cheeks ; the body at length emaciates, the flesh becomes flaccid, the lower limbs grow thin, while the head increases in bulk, the forehead becomes prominent, the spine bends, the belly is tumid, and the joints are loose and spongy The mental faculties are usually clear and often precocious. Special Causes. — Hooper says the causes of this disease are, “ bad nursing, bad air, bad food, want of cleanliness.” It is certainly the most philosophical discourse on oetiology I have ever read in an allo- pathic book. He might have gone farther back, and told us as truth- fully that bad air and bad food, and inattention to personal cleanliness on the part of one or both parents, produce the predisposition to it — the rachitic diathesis . r i treatment . — One or two dailv ablutions, pure air. plenty of sun- shine, good mother’s milk, abundant cold water-drinking, and brown bread, hominy, wheaten grits, potatoes, and good fruits, are all that need be named among the remedial agencies. More or less deformity will always exist. DISEASES OF M I S - 0 S SIF IC ATI 0 N. 263 Cretinism. — The essential differences between this disease andlne preceding, are the tendency to goitre or enlargement of the thyroid gland, and the small size of the brain, with thick skull bones, which characterize the present affection. Symptoms, — The bony derangement chiefly affects the head and neck ; the body is stinted ; the skin is wrinkled ; the complexion is wan; the countenance is vacant and stupid; the cranium* bulges out, particularly in the occipital region, while the crown and temples are depressed ; the sensibility is blunted ; all the mental faculties are feeble or idiotic; the moral affections seem to be wholly wanting; and a ma- jority of the miserable sufferers are both deaf and dumb. Special Causes. — Cretinism was first noticed about the same time that rickets first appeared ; it has prevailed severely in the low lands of Switzerland, in the secluded valleys of the Alps, and other damp, shaded, or confined places ; hence the causes of rickets and cretinism cannot be essentially different, nor need we add any thing to the treatment named for the former. Mollities Ossium. — A general flexibility of the bony structure, formerly denominated spina ventosa , is commonly found in the early periods of life, as fragility or brittleness is peculiar to later age. Its immediate cause is, of course, deficient assimilation of osseous mate- rials, but its more remote and more important cause must lie farther back, in some derangement of the primary nutritive functions. Symptoms. — A bending or crooking of the bones in different parts of the body, on slight exertion, with little or no pain. Treatment. — Medical books, in consideration of the deficienc}^ of earthy matter in the bones, have undertaken to remedy the difficulty by introducing phosphate of lime, alkaline carbonates, etc., in libera? doses, into the stomach ; and, although such practice may seem very reasonable to those who cannot look beyond a chemical fact to a phy- siological law, it has never, to my knowledge, been productive of the least benefit. The rational curative measures are the same as for rickets. Fragilitas Ossium. — I n this affection the substance of the bones becomes so brittle that it is apt to break on slight exertions. The im- mediate cause is a deficiency of the materials of the gelatinous struc- ture; and the general treatment is the same as for the preceding variety. Osthext. — This term imports an ossific diathesis , a bonj habit o4 m PATHOLOGY AND THERAPEUTICS. body. The disease consists in a superfluous secretion and deposit of ossific matter, by which th* soft parts are more or less indurated or obstructed. Authors divide this affection into the parenchymatous and vasculai varieties, as the bony material accumulates in the substance of organs or in the coats or membranes of vessels. The kidneys and bladder are most liable to calculus concretions, for the reason that they are espe- cially designed to secrete from the blood and expel from the body the greater portion of effete alkaline and saline matters ; hence gravel and stone may result from too great a portion of earthy material in the food, or from deficient elimination of its excess in consequence of functional obstruction or debility. Ossific deposites are also occasion- ally found in the brain, lungs, thymus gland, substance of the heart, structures of the eye, muscles, etc. The vascular form most fre- quently affects the aorta or other large arteries, and the mitral valves ; but in some instances the pleura and other membranes, the trachea, and various cartilaginous structures ossify. In all these cases the symp- toms are exceedingly obscure, and the treatment cannot be better expressed than by the general phrase — attention to the general health. Exostosis. — Calculous or bony tumors may be seated immovably on a bone, or on the periosteum, or pendulously in a joint, or fixed or movable in some fleshy part of the body. These affections are gen- erally sequelae of gout, rheumatism, syphilis, etc., but sometimes appear in persons of ordinary, though, of course, not perfect health. They are all cases for surgical treatment, and are only to be cured by extirpation or amputation. CHAPTER XV. DISEASES Or SENSATION The diseases of the present group are somewhat incongruous in a nosological point of view; but as they are susceptible of a generic definition, no direct violation of pathological propriety is committed in the arrangement. They may be distinguished by darting or local pains, occurring in paroxysms with irregular intervals, or by perverted sensation, without fever, inflammation, or structural change. They are all symptomatic of nervous exhaustion, functional obstruc DISEASES OF SENSATION. 265 tion. malformation, or local accident or injury ; and it is only when the primary morbid condition is too obscure to be recognized, that they are to be treated as idiopathic maladies. The following are all that require special consideration : Cephalalgia — Cephaljea —Headache. — The unbiassed and in- telligent student, who will diligently labor through the various attempts which have been made by medical authors to define, describe, arrange, classify, expound, and medicate the single and seemingly simple sub- ject of headache, will find enough of confusion confounded to convince him that a system, as baseless as the fabric of a vision, has engaged the minds of many medical philosophers, rather than a careful and correct observation and arrangement of the phenomena of truth, nature, and common sense. The ordinary and every day causes of headache are, indigestible food, overloaded stomach, constipated bowels, torpid liver, inactive kidneys, obstructed skin, oppressed lungs, acidity, flatulence, violent passions, suppressed natural evacuations of all kinds, and their consequences, thick blood, irregular circulation, etc., etc., to which may be added the direct effect of stimulating drinks or nervines, or their sudden withdrawal after the system has been accustomed to their use. And the pain of headache will be acute , chronic , periodic, throb- bing, local , or general, etc., according to a multitude of circumstances which bear upon each individual case. All this is plain and straight- forward. But let us see what the books say. Much learning has surely made them mad. Thus Sauvages divides headache into acute, chronic, and partial ; the acute he subdivides into plethoric, catamenial, hamorrhoidal, dyspeptic, febrile, throbbing , intermittent, puerperal, in- flammatory, catarrhal, nervous, hysterical, and the metallic ! the chronic he subdivides into syphilitic, scorbutic, arthritic, remittent, melancholic, plicosc, and serous ; and the partial he subdivides into^ams in eyes, sock- ets, and frontal sinuses, purulent, r cphralgic, and the lunatic hernia ania. Frank divides headache into four species, cephalalgia, cephalrea, hemi- crania, and clavus ; and in respect to their nature he subdivides these into inflammatory, rheumatic, gastric, arthritic, scorbutic, periodic, scrofu- lous, carcinomatous, syphilitic, and nervous. Dr. Good divides head- ache into stupid, chronic, throbbing, megrim, and sick. Dr. Burder Sleeplessness, Restlessness, Cephalalgia, Neuralgia, Syncope, Morbid Sight, Morbid Hearing, Antipathy, V ertigo, Morbid Smell, Morbid Taste, Morbid Touch. U— 23 PATHOLOGY AND 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, cerebral, 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 cold, the wet-sheet pack should be employed. If the stomach is exceedingly irritable, and troubled with obstinate nausea and vomiting, warm water-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. Neuralwa — 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 affected. 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 paroxysms, 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 supposition that 3ome concealed ulcer or caries occasioned the pain. When the. foot is attacked, there are racking pains about the heel, darting toward tho ankle and bones of the tarsus. In nerve-ache of the breast the sharp darting pains usually divaricate from a fixed point in the 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, coffee, 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, belladona, Prussic acid, henbane, strychnine, 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 distribution 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 torpid, and frequently the bowels, skin, kidneys, 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-rubbing. The temperature of the water should be reduced as fist as possible — taking care, however, to avoid aggravating 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 warm. Local baths, as compresses, half, hip PATHOLOCrY AND T H E R A P I U Ti C 3. 7t>8 and foot-baths, should be first employed, followed by the half or full pack, dripping-sheet, plunge, and douche, as the morbid sensibility diminishes and the strength 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 diffi- 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 When 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 walking, 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 fidgety 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 irritable temperament, often suffer severely for want of free and fre- quent exercise of the whole muscular system. Worms and some kinds of skin 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, particularly 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 medication must be directed to the removal of the existing cause, whatever that may chance to be. Antipathy. — A feeling oi interns repugnance or horror at f Ji€ DISEASES G1 SENSATION. 209 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 outter 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 # mother during the period of gestation. The only chance of cure seems to be, in gradually accustoming the patient to the object of antipathy. Vertigo. — D ifferent forms of vertigo are known by th.* terms diz- ziness , swimming of the head , blind headache, and nervous Junting fit ; it is a frequent accompaniment of headache, and is owing t j the same exciting and predisponent causes. Symptoms . — 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 falling, with some degree of mental con- fusion. In some instances the dizziness is combined with illusory sounds, as whispering, murmuring, ringing of bells, beating of drums, roar of cannon, etc. Special Causes . — The immediate cause cr 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 sudden 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 ail cases the bowels must be kept entirely free by plain, coarse food £70 PATHOLOGY AND THERAPEUTICS. and 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, ioss of blood, or inanition, quiet and sleep are among the leading reme- dial agencies. Syncope. — Swooning and faintmg-fit are the principal 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. Dr. Good says — I quote to contrast, not to commend his treatment : “ 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 spirit 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 afi of the above allopathic notions. Morbid Sight. — Ingenious nosologists have certainly displayed more analytical than philosophical talent in giving us a list of nearly six hundred Diseases of the eye ! Dr. G 'od has reduced the for mi da- DISEASES OF SENSATION. 271 d .f dst 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 eye. 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 imaginary qualities, constituting the ocular specters and the muscee 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 little 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 special 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 affection 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- terna! meatus with warm or tepid water, followed by cool or cold, and file occasional employment of the head-bath, with a moderate doucl e dj? upper portion of the spine, are the appropriate local measures 272 PATHOLOGY AND THERAPEUTICS Morbid Smell. — Acrid, obtuse, and absence of smell are, lik« analogous conditions of the other senses, usually among the symptoms of fevers and local affections. But with some an extreme 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 deprivation of the sense is often produced by irritants, pungents, errhines, and poisonous vapors, as “ cephalic snuffs,” tobacco dust, cigar smoke, etc. Catarrhal affections, when long continued, always deteriorate the sense, and all high-seasoned dishes and compli- cated 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 sometimes so malformed originally, or so perverted by disease or bad dietetic habits, as to be painfully acute or morbidly obtuse; to remedy which nothing is more appropriate than frequently holding eold water in the mouth and employing an exclusively farinaceous and fruit diet, the 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- naturaliy acute, or insensible, *>r illusory. Its principal deviations from the normal condition are known as soreness , itching, heal, and coldness * The first variety 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 r ISEASES. m CHAPTER XVI MENTAL DISEASES. The i elation between mind and body is so intricate and intimate that a morbific impression upon either may produce a manifestation of mor- bid phenomena 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 : 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 dnd every conceivable shade and degree of mental peculiarity, from a disproportionate activity of a single fac- ulty or propensity, constituting a one-idcaism or an all-absorbing 'pas- sion , whose possessor is merely a monomaniac , to the most violent and extreme derangement of several or of all the mental powers, consti- tuting craziness, lunacy, or idiocy. The malady before us presents two distinct features, which authors have ranked ns species of disease : melancholy , in which there is a to- tal or partial hallucination, accompanied with extreme dejection, fear, and false apprehensions, while the wi.l is way Vard and domineering Insanity \ Madneag . Melancholy, £74 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 m when the patient is mute and re-tiring ; erratic, when he is roving and restless ; malevolent, when he is morose or misclr.evous, 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 him a president, king, prophet or the Messiah; despond - enU when he is abjected and depressed; and demented or chaotic , when the mind sinxs 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 principles 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. Good : “ Concerning therefore the remote or even proximate cause of the disease, we have yet much to learn. F rom the view we have taken in the proem of the close connection between the mind and the braip, 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 hitherto to no purpose 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 machinery, 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- cal character of the brain. The nervous influence and the electric 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; these are generally strong menta. ©notions, operating in con* MENTAL DISEASES. 275 section with an organism physiologically unsound. Intemperance is the most frequent 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 the 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 water 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 the forms of excited, depressed , and fitful or eccentric passion. The divisions of the first are innumerable, as ungovernable joy, self-love or self-conceit, pride, 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 , find 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. Special Causes. — All the causes of insanity may be among the pre- disposing or exciting causes of the species of menta. pravity under con- sideration • to which may be added debauchery, gambling, ingratitude. 27(5 PATHOL 0U5J 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 insanity, should beadded 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. Hallucination — Illusion — Alusia. — In this affection the imag- ination overpowers the judgment. It embraces two varieties, one of which is called sentimentalism , 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 sentimentalism manifests every conceivable form of extravagant mis-judgment, as uncalled-for acts of gallantry, rampant and unrestrainable 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 murder 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. Nove. reading is, perhaps, the most potent and most com- mon cause. “ Perilous adventures, love-lorn catastrophes, the stories of magicians, knights, enchanted castles, imprisoned damsels, melting MENTAL DISEASES. 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.” The second variety is more 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 structural 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 misa flections 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 mentaJ 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 oowels, etc., and the general debility and relaxation of fibre often ex- tends to the uterus and its appendages, producing prolapsus, antever- sion, retroversion, and a variety of other local complaints. These cases require the special treatment which will be mentioned here- after. 24 276 PATHOLOGY AND THERAPEUTICS. Re very. — Absence of mind, mental abstraction, and brown study , are the usual forms in which the misaffection of mind, termed revery, is exhibited. They are sometimes induced by bodily infirmity, but are more frequently the acquired habits, resulting from a loose, irregular, and superficial education — an education in which the mind is stuffed with words instead of being taught to think and form ideas for itself. This, combined with corporeal inactivity or indolence, is the principal reason why so many 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 offices 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 variety 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 which 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 inane of Darwin. The treatment will be readily inferred from the general principles of cure indicated in the preceding remarks. Sleep-Disturbance. — Sleep-walking, somnambulism, and sleep- talking 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 brain. 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 somnambulific manifestations. In some cases of somnambulism, which have been clearly traced 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 exercise clairvoyant powers, as in reading with the eyes shut and closely bandaged, hear- ing and conversing coherently while entirely unconscious, etc., while the voluntary r luscles unaided by tin external senses, have performed MENTAL DISEASES. 279 rarious feats of locomotion, as climbing, walking securely 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 definition 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 imbecility, is divided by authors into various forms, the chief of which are stupidity, forgetfulness, credulity , and feebleness ; while 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 minority, that we are to name them as leaves or branches of the great arbor 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 their own name at the post-office ; and instances are recorded ni 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 va ^80 PATHOLOGY AND THERAPEl ~LCS. riety ot accidental circumstances or voluntary habits, as habitual drunk enness, excessive indulgence in enervating pleasures, onanism, or self- pollution, violent and protracted emotions of mind, external injury of the brain, loss of blood, etc. It has been produced by the excessive use of the lancet in females after delivery, in brain diseases, and in va- rio s forms 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 dripping-sheet, douche, shower, plunge, spray, or fountain, cata- ract-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. All the diseases which make up the present chapter, have, as theif most prominent symptom, some misaffection of the voice or speech, although some of them differ very greatly in every other particular. They may be thus grouped : CHAPTER XVII. DISEASES OF THE VOCAL AVENUES. Compressible, Cartilaginous. » Dissonant Voice 3, Polypus Dissonant Speech Stammering, Misenunciation Catarrh — Coryza. — When this affection is confined to that par* 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 Symjitoms. — 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 sniffing 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 tiie 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 enlarges in wet 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 early stage frequent sniffing of the coldest wa ter will often arrest the tumor. When it becomes troublesome frorr bulk, extirpation is necessary. The soft kind may be removed with the ligature or forceps ; the lat- ter is generally 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 spongy bones, these may be removed by a skillfu surgeon. Rhonchus — Rattling in the Throat. — Snoring and wheezing, which are the chief varieties of this affection, are symptomatic of other diseases, as apoplexy and asthma, or of gross feeding, a plethoric habit, corpulency or obesity, or of an obstructed skin, by which the lungs are oppressed with vicarious duty, or of atony or debility of the abdom- inal muscles, which are important agents in the respiratory 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 health. 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 every case of obe- sity on earth, by proper exercise and diet, sans all the bleedings and the purgatives. Speechlessness — Aphonia — Dumbness. — Inability of speech may result from destitution of tongue — and this may be congenital or accident- al — constituting the elingual variety ; or from paralysis of the nerves of the tongue or glottis, in consequence of some violent injury or shock, form- ing the atonic variety ; or, from congenital deafness, or deafness ac- quired in early life, making the variety called deaf- dumb ness. Special Causes. — When the inability is not organic, its most fre- quent causes are severe and protracted colds ; violent shocks, as of lightning or electricity ; vehement emotions, as of terror, anger, fright, narcotics ; mephitic exhalations ; poisoning from eating mushrooms, and sometimes shell-fish ; metallic vapors ; mercurial medicines, etc. There are also many cases of partial or complete loss of voice, the cause of which is almost always overlooked or unthouglit of by the at- tending physician : I mean cases of weak voice resulting from mere debil- ity of the muscles of the loins and abdomen. In these cases there may be a moderate degree of general health, with an extreme relaxation or ri- gidity of these muscles, so that the balance of action between them, the diaphragm, and the laryngeal muscles, is lost ; the diaphragm descend- ing when it should ascend, and vice vc~$a. DISEASES OF THE VOCAL AVENUES. 283 Treatment . — We have no special remedial resources m the majority of cases which depend on incurable malformations or structural le- sions ; nor can we in the majority of cases dependent on functional derangement, do more than attend carefully to the general health, trusting nature for the local medication. In that form, however, de- pendent on muscular debility, we can invigorate the affected muscles by the wet compress, frequent hip-baths, various manipulations, as knead- ing, pounding, thumping, and a variety of exercises which call the weakened muscles into vigorous play, as dancing, jumping, riding a hard-trotting-horse, and vocal gymnastics, as reading, speaking, and de- claiming by the elementary sounds of the letters or words, etc Dissonant Voice. — The chief depravations of voice have been ranked under the heads of whispering, in which the voice is weak and scarcely audible ; immelodious , when it is habitually rough, nasal, squeaking, whizzing, guttural, or palatine ; and the irregularly alter- nating harsh and shrill voice which is peculiar to the period of puberty. Sjiecial Causes . — The last named variety can hardly be regarded as a disease, save when complicated with some accidental abnormity. The other varieties are caused by most of the circumstances which produce the atonic loss of voice, to which may be added over-exerting the vocal apparatus, as in loud speaking or singing, or in straining the voice while the bodily attitude is crooked or distorted, or when the abdominal muscles are so weakened that the main effort at expulsion is thrown upon the muscles of the throat, chest, and diaphragm. In- deed, a misuse of the respiratory muscles, or in other words, a vicious habit of exercising the voice in early life, which has its origin in bad training or bad health, is the most common cause of unharmonious, un- musical, and unpleasant voices in after life. Treatment . — The special management in all forms of voice wherein there is no “ concord of sweet sounds,” consists, in addition to such appliances as particular complications may demand, in a regular system of voice-training or vocal gymnastics. Ordinary ingenuity will suggest a thousand variations of the general plan to suit individual cases ; but this general plan is, 1. An erect bodily position; 2. Opening the mouth freely and fearlessly in every attempt to read or speak ; 3. Reading and speaking slowly, and pronouncing every syllable distinctly, and even giving every letter its full and appropriate sound ; 4. Pro- nouncing the different elementary vowel and consonant sounds of our language, at first slowly, and then as rapidly as possible, taking care to have every sound distinctly enunciated ; 5. Hallooing with a full pro* longed sound, as by the word over: 6. Laughing by pronoune- 284 PATHOLOGY AND THERAPEUTICS. ing hah-hah-hah as rapidly as possible, observing that the abdominal muscles contract — that is, spring out, as it were — at every enunciation; 7. Declaiming on the sea shore in the face of a strong wind, with peb- bles in the mouth, a la Demosthenes, etc. Dissonant Speech. — Stammering has been called a sort of St. Vitus’s dance of the vocal organs. Its principal varieties are called hesitating , in which there is an involuntary and tremulous retardation in the articulation of peculiar syllables ; and stuttering, which is an in- voluntary re-pronunciation of some syllables or words, alternating with a hurried and convulsive pronunciation of those which follow. Mis enunciation is that form of imperfect speech in which the sounds are articulated freely, but inaccurately pronounced ; the princi- pal varieties of this affection are vicious or incorrect pronunciation of the letters r and l ; substitution of soft for harsher letters ; multiplica- tion or omission of labials, or exchanging them for other letters ; mis- employ ment of dentals, and mispronunciation of gutturals. All of these errors and imperfections of voice are sometimes the result of organic malconformation ; occasionally, as in the case of stam- mering, of a constitutional irritability of some of the muscles concerned in articulation ; more frequently of a want of correct education ; and still oftener of a careless or depraved habit ; and even in some cases of an exceedingly silly affectation. Many stammerers who talk with great difficulty, read with great facility, and all of them stammer most when they undertake to speak most deliberately, and least when their attention is so engrossed with the subject that they think nothing about picking out single words, or arranging sentences with a view of obviat- ing the infirmity of speech. ( Treatment . — All that has been said in relation to the vocal treatment of the preceding disease, applies with equal force to this. The stam- merer cannot weH be too slow and deliberate in his voice exercises, nor should he attempt much conversation while under the remedial discipline, and he must exercise also the mental qualities of firmness find perseverance. Every expedient which he can devis£ to expand the lungs and augment their retentive capacity, will facilitate his im- provement; as, for example, deep, full, and prolonged inspirations and expirations, during which he may to advantage count one — two — three — four, etc., taking pains to of en wide the mouth, and “speak loud and plain” each monosyllable he attempts to utter. The various forms of misenunciation, besides the vocal exercise^ herein intimated, could with propriety be referred to a judicious course of lectures on ©locution, nor would the lessons of the singing master be without value. DISEASES OF THE SEXUAL FUNCTION. 296 CHAPTER XVIII. DISEASES OF THE SEXUAL FUNCTION. The integrity of the function whose morbid affections we are about to consider, in its importance to the progressive improvement an i well- being of the human race, cannot be over-estimated ; yet, unfortunately, with regard to several diseases comprised in the present chapter, we have to regret, as in the case of several preceding maladies, that they are alarmingly on the increase. This is especially the fact in regard to those female diseases known as mismenstruation and prolapsus — diseases of rare occurrence in the days of our grandmothers, and then scarcely known, except in the married relation ; but now pre- valent among all classes and all ages of females above mere infancy. These complaints are attributable to four general classes of causes ; sedentary habits, concentrated and stimulating food, enervating drinks, and unphysiological dress ; and as the refinements, and luxuries, and bad fashions of society increase, these natural and necessary conse- quences must extend correspondingly. It is a painful reflection, too, on the popular medical system of the day, that its professors, who claim to be the conservators of the public health, content themselves with dosing and drugging, bleeding and poisoning, and talking technicalities to this class of invalids, instead of teaching them how to live healthfully. Soundness and purity fn the reproductive organism are indispensable to a perfect and vigorous or- ganization in the offspring of sexual intercourse; and if mothers and daughters could be imbued with the right moral principles and physio- logical truths, there would soon be an end to these artificially produced, but not the less afflictive and lamentable disorders, which are presented in the following tabular arrangement : Mismer.Btruation <{ Obstru cted Me nstruatio n — A m e norrh oea, Laborious Menstruation — Dysmenorrhaa, Excessive Menstruation — Hemorrhagic, Vicarious Menstruation, Irregular Cessation of the Menses, Chlorosis — Green Sickness, Leucorrhea. Spermatorrhoea. m PATHOLOGY AND THERAPEUTICS. { Syphilis, Gonorrhoea, Gleet. f Prolapsus, 1 Anteversion, Genital Displacement^ Retroversion, j Inversion, ( Excrescence. Inordinate $ Satyriasis, Lust c Nymphomania Mismenstruation — The catamenia secretion may be obstructed in its discharge, laborious and painful at the usual period, excessive in quantity, vicarious in its locality, irregular in its final cessation, or at- tended with general derangement of health at the period of its first ap- pearance, which several circumstances constitute the several species of the disease before us. Symptoms . — Obstructed menstruation — the amenorrhea of authors — is distinguished into retention when the menstrual flux is obstructed at the period of its accession; and suppression , when the obstruction occurs regularly at the usual periods of recurrence. The former variety is char- acterized by an cedematous swelling of the feet and ankles at night, and a swelling of the eyes and face in the morning ; the latter is attended with headache, difficult breathing, and palpitation. Both varieties are attended with general languor and many dyspeptic symptoms, particu- larly a capricious appetite, and not unfrequently a longing for innutrient and injurious substances, as clay, slate-stone, charcoal, etc. In many cases there is a harassing cough, with symptoms of a general decline. In laborious or painful menstruation — dysmenorrhea — the flux is ac- companied with great and sometimes excruciating pain, not unlike the bearing-down pain of labor, generally attended with some degree of ac- tual hemorrhage, and frequently with an expulsion of fragments of a membranous concretion, like that of croup or tubular diarrhoea. In some instances this membranous concretion is thrown off from the en- tire surface of the uterus at once, in the shape of a small bag filled with a fluid which has been mistaken for an early abortion. In excessive menstruation the catamenial secretion is superfluous in quantity, and attended with an actual hemorrhage from the menstrual vessels. The hemorrhage is known by the fact that the fluid discharg- ed is coagulable, which is not the case with the pure catamenial flux. It exhibits two subvarieties, in one of which the discharge is excessive, from too frequent recurrence, and in the other from too copious a flow at the proper menstrual period. The ordinary flux may be from fom DISEASES OF THE SEXUAL FUNCTION. 287 to six ounces, but it is subject to much diversity, and can only be re- garded as morbidly in excess when accompanied with marked symp- toms of general debility, as paleness, cold extremities, cedematous feet, fatigue on slight exercise, etc. Vicarious menstruation is characterized by a transfer of the catame- nial secretion to a more distant part or organ. The eyes, nostrils, ears, sockets of the teeth, nipples, stomach, lungs, rectum, bladder, and abraded or ulcerated surfaces, have been the seat of the transferred dux. The irregular cessation of the menses, at the term of its natural ces- sation — usually called the turn of life — which in this climate is, on the average, at about the forty-fifth year, is accompanied with symptoms of spurious pregnancy, dropsy, or glandular tumors ; the menstrual dis- charge is irregular ; sometimes profuse with long intervals ; and at others trifling in quantity, but returning every ten or twelve days, and often succeeded by leucorrhcea. Chlorosis , or green-sickness, though elevated to the rank of a gen- eric term by some authors, is merely a condition of imperfect or defi- cient menstruation, occurring about the age of puberty, and complica- ted with so great general debility that the sexual power or propensity is partially or completely lost. The name is derived from the pale, livid, and greenish cast of the skin, which all chlorotic patients mani- fest more or less. Special Causes. — In addition to the general causes already intima- ted, mismenstruation maybe induced by repeated colds, especially from an exposure of the feet while the rest of the body is well clad, pro- tracted anxiety, grief or fear, local injury, masturbation, excessive ve- nereal indulgence, repeated miscarriages, etc. Retention of the men- ses is sometimes owing to an imperforate hymen, requiring for its cure a transverse section of the membranous obstruction. Treatment. — Fortunately almost every form, state, and stage of nns- menstruation is curable by the thorough application of our whole system. The majority of cases, however, require several months 9 , and many of them two or three years’ treatment to complete the cure But fortunately 7 , again, those cases which require a long treatment, can be managed mostly at home, and with very little expense or neglect of ordinary duties or labors. The general plan applicable to all forms of the disease except excessive menstruation is, a morning fail-bath, as the plunge, dripping-sheet, or towel-wash, two or three hip-baths daily, one or two foot-baths, the abdominal bandage, frequent and varied out- door exercise, and a plain, solid, rather dry, and unstimulating dietary. The water should in all cases be as cold, yet no colder, than is followed 283 PATHOLOGY AND THERAPEUTICS by quick reaction and a comfortable glow; and, as a general rule, slioit baths, frequently repeated, are more efficacious than long ones with greater intervals. Hip and foot-baths should always be preceded and succeeded by active yet not exhausting exercise, and the walking foot- bath, when practicable, is always to be preferred. A great variety of exercises can be advantageously employed, as walking, riding, jump- ing the rope, dancing, shuttle-cock, graces, etc. And those who can find the same recreation and entertainment in light work, as sweep- ing, dusting, spinning, washing dishes, picking berries, milking the cows, etc., will find exactly the same remedial effects as from amusing and agreeable plays. When the body is full, sanguine, and plethoric, the wet-sheet pack should be employed daily or tri-weekly for a month or two ; and when the whole system is in the opposite condition, called atonic, an- hsemic, torpid, etc., the tepid shallow-bath, followed by active and pro- longed rubbing, should be substituted. In cases of excessive menstru- ation, the hip-baths should be colder than in either of the other varie- ties, generally from 55° to 45°. In the variety, irregular cessation, care must be taken not to disturb the circulation with any powerful shock ; the treatment in the main should be mild, the water generally tepid or but moderately cold. The exercises, too, in the last two varieties, should be very moderate. Vaginal injections are useful in all cases attended with considerable relaxation, hemorrhage, or leuc jrrhoea ; while in all other varieties, the horizontal douche or spray, applied to the hips, abdomen, and loins, is a valuable auxiliary. When the catamenial periods are attended with much pain, as in dysmenorrhea, warm applications must be employed until relief is ob- tained, after which the regular treatment may be resumed. These should consist of the warm foot-bath, warm sitz-bath, hot fomentations to the abdomen, the full warm-bath or even hot-bath, followed by the dry pack, according to the severity of the pain. In some cases the pain is agonizing for one, two, or three days, and the only endurable rendition for the patient is to remain dry-packed, or closely covered up in bed, so as to keep the body warm and perspirable until the secretion takes place. Drinking warm water very freely often proves relaxant and sedative in these cases. The propriety of suspending a part or the whole of the treatment during the menstrual period, not only in the complaint before us, but in all cases, is somewhat unsettled in the code of hydrotherapia. Some practitioners, at least in all ordinary cases, pay no regard to the monthly flux, while others suspend all active or very cold treatment. It is true DISEASES OF TIIE SEXUAL FUNCTION. 239 the menses are frequently partially suppressed or wholly suspended for several months bv the former practice, yet it seldom happens that any permanent injury comes from it. My own opinion, derived from considerable attention to the practical point under consideration is, that patients who are not much reduced in flesh, blood, or temperature, can take full treatment through the catamenial disturbance, not only without injury, but often with benefit ; but that those who are emaciated, pale, and cold, with torpid livers and clogged up skins, and a tendency to headache or “ rush of blood to the head,” will be better off to take no treatment, save a tepid wash-down daily, and such local soothing appliances as particular exigencies call for, from the first decided indi- cations of the menstrual effort, until it has nearly or quite subsided. There are few diseases in which regimen should have a greater prominence among the curative measures. With respect to water- drinking, I have always recommended those of full habit and well ex- panded lungs to drink rather freely — four, six, or eight tumblers daily — and the thin and feeble to take two or three tumblers in the fore part of the day, and at other times only according to actual thirst. The diet cannot well be too strict, and as constipation is almost always connected with mismenstruation, it should have especial reference to this circumstance. Brown bread, unfermented bread or cakes, cracked wheat or rye meal mush, with a moderate allowance of the best vegetables and good fruits, constitute the best dietetic plan. Very little animal food, if any, should be taken, and even eggs, butter, and milk, had better be avoided. Leucorrhea. — This disease is indiscriminately called Jluor albus and whites in medical books. It affects more or fcss nearly all females who are the subjects of mismenstruation, and sometimes oxists antecedently, and at others subsequently to the menstrual period of life. It is most frequently the immediate result of local irritation. It has been for a long time, and is yet a question among medical authors, whether this disease is ever infectious, and communicable to the male urethra by the act of copulation. Two years ago, a “professor of diseases of women and children,” in one of our city colleges, and an ex-professor of the same branch in another orthodox school, were called upon in a court of justice, to give testimony on this very point. The latter professor testified that he had actually known such infection to result from leu- sorrhoea, in his own emphatic lauguage, “ again, and again, and again ;” while the former declared that he did not believe it was possible ! Both medical gentlemen, of course, swore conscientiously. It is a general law in pathology — so general that I believe there are no exceptions *-« I T— 25 290 PATHOLOGY AND THERAPEUTICS. that all abnormal secretions are bland or acrid, precisely according tc the less or greater grossness or impurity, or inflammatory condition of the general system ; all morbid discharges from mucous surfaces may become, as is often seen in the case of catarrh or coryza, so acrimo- nious as to excoriate the surface wherever they come in contact with it; and the mucous surface of the vagina may readily, under circum stances of extreme irritation and high inflammatory excitement, se- crete an icherous or infectious matter, which will produce in the male urethra a running analogous to gonorrhoea or gleet, though, of course, not as violent nor inflammatory as in true gonorrhoea, nor infectious like it. I have known cases of this kind under such circumstances as pre- cluded all idea of impropriety on the part of the wife, by whom the husband became diseased. These facts ought to be well understood by the practitioner, so that the woman, though she may not be an exam- ple of strict personal cleanliness, may be exempted from the charge of moral impurity. Symptoms . — The discharge is usually of a yellowish-white color, verging to green ; but sometimes it is brownish, or slightly red, vary- ing in consistence from a thin limpid fluid, to a thick, tenacious, ropy mucus. It is usually accompanied with weakness or pain in the back, and some degree of “ spinal irritation when of long standing, it is attended with a sense of heat, and itching or smarting ; and in still more advanced stages, the discharge is highly acrid and offensive, often excoriating the whole surface of the vagina. In the form called labor, the discharge is slimy and tinged with show of blood, and is only regarded as morbid when excessive. The whites of advanced life generally appear soon after the cessation of the menses ; the dischaige is thin, acrid, fetid, and excoriating, and is sometimes combined with incipient canqer or polypus. Special Causes . — The same general range of morbid influences which predispose to, or excite mismenstruation. contribute to the pro- duction of leucorrhoea, to which may be added mechanical injuries and irritations, as pessaries, repelled eruptions, voluptuous excitement, and uncleanliness. Treatment. — Dr. Good remarks, in relation to the drug-treatment ol leucorrhoea, “The general remedies which have been had recourse to are almost innumerable a sufficient acknowledgment that they have generally proved either useless or injurious. The general hydropathic plan of medication is the same as for mismenstruation. The local treatment requires more especial attention. Hip-baths and vaginal in- jections are always among the leading measures, and the temperature of the water for either purpose must be regulated by the condition of DISEASES OJ?' I II E SEXUAL FUNCTION 291 the patient. In some cases the diseased surface is so irritable that quite warm water proves the most available sedative. It is always safe and generally necessary to commence these baths with water at 80° or 90°, and gradually reduce the temperature to 60° or 50°. The vaginal syringe in severe cases should be employed two, three, or four times a day. Whenever the discharge is excessive and blood-colored, indica- tive of actual hemorrhage, very cold water should be thrown up the vagina, and cola wet cloths laid over the abdomen. Spermorrhea. — Seminal misemission, or an involuntary flux of the seminal fluid without copulation, is often the result of libidinous ideas, especially if to this cause is added the irritation of a gross or highly animal diet, or the still more inflaming and exciting influence of wine, coffee, etc. Not unfrequently the gross and debasing habit of self-pol- lution, induces such a degree of nervous exhaustion and morbid irrita- bility, that the emission takes place on the slightest libidinous excite- ment ; and sometimes a thin, degenerate, muco-seminal secretion oc- curs unconsciously during a dreamy or even a profound sleep. Treatment . — When the general health is fair, and the patient has not been guilty of a concupiscent life, one or t-wo daily cold baths, ac- tive out-door exercise, or what is better, regular and laborious occupa- tion, and a plain vegetable and fruit diet, will speedily effect a cure. In constitutions worn down by previous diseases, exhausted by riotous liv- ing, or undermined by abused amativeness, the cure requires a strict and persevering observance of all the laws of hygiene, that the patient may out-grow rather than doctor out his ruinous ways. Unfortunate- ly, however, there is no class of patients more fickle, vascillating, and unreliable ; the mind partakes of the bodily degeneracy, and it re- quires a combination of rare and favorable circumstances to keep them from running after every fooush and whimsical impostor who ad vertizes to cure them with a single bottle of bitters, which, moreover is “ pleasant to the taste.” These patients seldom need very active or very cold water-treat- ment. A daily towel-bath, one or two tepid or moderately cool hip- baths, and a rigidly simple and abstemious diet, afford the best chance of recovery. Salt, sugar, and even milk can be dispensed with to advan- tage. The evening meal should always be light and as dry as possible, and the patient should avoid sleeping on the back, the preferable posi- tion in bed being a gentle inclination to one side. Venereal Diseases. — The affections the genital organs which result from impure sexual intercourse art among the most loathsome 292 PATHOLOGY AND THERAPEUTICS. in appearance and the most deplorable in their consequen; es that af- flict degraded and erring mortals. Symptoms. — Venereal affections appear in two distinct forms, syphi- lis, or pox, and gonorrhoea , 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- nicated at the same time. Gleet is simply a urethral running; and, though often a sequel of gonorrhoea, may exist from irritation uncon- nected with venereal taint, and be excited by stone in the bladder, leu- corrhoea, 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. Syphilis commences with one or several small pimples, or chancres, on some part of the genitals, which gradually fester, and finally termi- nate in spreading or deepening ulcers, filled with an exceedingly acrid and corroding matter. If this matter is allowed to be absorbed, the glands of the groin 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. Gonorrhoea — 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. Treatment. — 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 six of water. In all other re- spects both forms are to 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 eases; 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, while warm or very warm quiets the irri- tation, and relieves the pain and irritation at once. Inordinate Lusi — We need not dwell long on this affection. Authors have applied the term satyriasis to an ungovernable sexual passion in the male ; and the term nymphomania 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 furor is, gross, high-seagoned 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’* period, than in youth or middle age. The cure will readily be 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 Displacements. — The ti*ue pathology or proximate con- dition of these affections is but little understood by the medical profes- 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, or falling of the womb ; but in some books the term relaxation is applied when the descent is only to the middle of the vagina ; procidentia, when the uterus descends to the labia ; and pro- lapsus, when it protrudes externally. Retroversion is that form ol dis- placement in which the fundus uteri descends toward the sacrum, the os uteri or mouth of the womb inclining toward the pubes. Ant ever- 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 while 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 the 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 PATHOLOGY AND THER APEUTICS. creased mucous secretion, which increases by degrees until it acquires the character of an obstinate leucorrhcea. When the uterus is retroverted 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- enced 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. Iu 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 walking, sense of weight or fullness in the pelvis, with many of the symptoms of prolapsus, and is attended with much less difficulty in evacuating the urine and feces than retroversion. Inversion is known by the organ hanging down externally; it is usu- ally the result of violence 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 pro- lapse, In this case the bladder, being deprived of the expulsory aid of the 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- wifery 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 ; the yielding or elongation of the ligament being itself an effect of the displacement. The natural supports of the uterus are the vagina and the abdominal muscles ; if the former is greatly relaxed the uterus will descend, and the ligaments, being kept constantly on the stretch, will finally elongate more or less ; and if the abdominal mus- cles are greatly debilitated, they do not contract vigorously, so as to keep up equable and uniform compression in all the various positions of the body, hence the uterus is liable to fall forward or backward, or incline laterally; and when both are badly relaxed and debilitated, we find both conditions of displacement — falling down and tipping transversely across the pelvis. In corroboration of this view of the subject, I mav DISEASES OF THE SEXUAL FUNCTION. 295 advert to the fact, that all the cases of uterine displacement we meet with 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 resources of hygiene must be discriminatingly adapted to each in dividua; 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 hall-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 which are most serviceable in these cases. To these I would always add occasional packs when the patient has a good legrep 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 wlie i 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 runs! be strengthened by active yet gentle manipulations, and the re- 296 PATHOLOGY AND THERAPEUTICS. taxed fibres of the vagina constringed by injections of a small quantity of very cold water. The patient should commence walking, or increase her usual amount of exercise, as soon as the organ is replaced, and gradually extend the excursions or gymnastics, as the muscular strength improves. When the uterus is inflamed and enlarged, and the parts painful and tender, the replacement should not be attempted until these symptoms have been partially subdued by the treatment. In some cases an appropriate instrument is necessary to effect the replace- ment, and when the vagina is extreme!) relaxed, the uterus will have to be supported with a piece of soft sponge inclosed in a delicate cap- sule of India rubber, until the requisite musculai contraction can be induced. The inverted uterus should be restored as soon as possible after the accident which induced it, or its contraction will render the operation impossible. The treatment of the excrescent variety comes within the province of the surgeon ; and of the various operations proposed for its removal the ligature is the best. CHAPTER XIX. DISEASES OF THE URINARY ORGANS. The various forms of mismicturition, which consist in morbid seer©' tions or discharges of urine, are : Destitution of IJrine — Suppression. Retention of Urine — Ischuria. Painful Urination — Strangury — Dysuria. Saccharine Urine — Diabetis. Incontinence of Urine — Eneuresis. Unassimilated Urine — Urinary Diarrhoea. Erratic Urination — Vicarious Urination. Urinary Calculus Destitution of Urine. — In this affection the urine is not secreux by the kidneys ; there is no sensation of fullness or uneasiness in the bladder, nor any desire to urinate. The excrementitious elements of the renal secretion are more 01 less thrown off by the other ernun^ Gravel, Stone. DISEASES OF THE URINARY ORGANS. 297 lories, but not sufficiently to prevent great constitutional suffering, evinced by general torpitude, apepleptic symptoms, etc. Most of the 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 cold to the loins and abdomen. The bowels should also be moved by copious inject) ns. Retention 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 tho 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 cantharjdes, or Spanish flies, and is attended with a scald- ing sensation. It is also occasioned by 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 liip-baths ; in severe cases the full warm-bath may be necessary. Saccharine Urine. — Diabetis , termed water-flux, or urinal dropsy , by the authors, consists in a free or profuse discharge of urine, of a 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 i9 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 fact they have made us acquainted with is, that the skin is always in a condition of ex- treme torpitude. Treatment . — This disease has terminated fatally, with very few ex- ceptions, under allopathic treatment. Instead of dosing the kidneys or stomach, as has been and yet is the custom of the drug-doctors, we should 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, the 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 measures 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 pofatoes, 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 urine, local irritation, atony or debility 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. Unassimilated 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 undergoing 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 oi impaired digestion, the urine is impregnated with a matter resembling chyle. This affection 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 *$tlet is not an unfreq lent occurrence. It is an evidence of the vis mcd • DISEASES OF THE URINARY ORGANS. 299 icctrix nature, 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- faces and fistulous openings. The medication is the same as in the preceding direases. Urinary Calculus. — Accumulations of calculous matter in the urinary cavities, are eithei renal 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 occasional 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 making water, with a difficulty of discharging it ; there is acute pain at the extremity of the 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 com- nleted. WTien the stone becomes large there is a dull pain about th» 300 PATHOLOGY AND THEJR, AP EU TIC S. neck of the bladder, and the rectum is affected with a troublesome t© nesmus. Special Causes . — Hard water, the free use of salt, alkalies, especial* ly the ordinary employment of saleratus ; strong 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 the leading causes. There 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 purposes,” occasion many of the cases of gravel and stone we meet with in young children. Treatment . — To alleviate the suffering, the warm hip-bath, and 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 hereafter. Note . — The success which has attended the diuretic treatment of calculous affections, in the hands of some physicians who have made this branch of the profession an exclusive business, is corroborative of the pathological and therapeutical views above advanced. The treatment of these “ gravel doctors” consists mainly in the free use of vegetable diuretic drinks — 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 SKItf. 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 : . ( Rose Rash, Gum Rash, Cutaneous Rashes <( Lichenous Rash, Pruriginous Rash, I Millet Rash. Blains < Water-Blebs, Herpes, Rhypia, Eczema. Macular Skin ' Veal Skin, Mole, Freckles, I Sunburn, Orange Skin, Piebald Skin, Albino Skin, w Cyanosis. Cutaneous Vermi nation f Lousiness, J Insect Bites, Worms. f Dandruff, Scaly Eruptions '~- 802 PATHOLOGY AND THERAPEUTICS. arms, often fading and reviving; usually appearing in the spring or au- tumn. Gum Rash — stropkulous — is peculiar to early infancy, and con- sists in an eruption of red or whitish pimples about the face, neck, and arms, interrupted by irregular patches of inflammatory blush, and man- ifesting several sub-varieties, called red gum , white gum, tooth rash , wild-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. When idiopathic, it is produced by sudden and extreme alternations of temperature, drinking very cold water after violent exercise, etc. Gum rash is produced by coarse woolen clothing, uncleanliness, 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 other single cause ; and when a torpid liver is connected with an obstructed skin, and both of these conditions with a high sum- mer temperature, we have the causes of its worst forms. Dr. Good remarks : “ So far as I have seen, the varieties of this disease depend upon a peculiar irritability 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 excretories, or rather of their mouths or extremities, which are ob etructed by hardened mucus.” This is a roundabout but very delicate Way of representing the idea of a dirty 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 as barbarous, unphilosophical, absurd, pernicious, etc. I havo used these terms deliberately, conscientiously, and, in my own estima- tion at least, understandingly. But if I were to express an honest opin- ion of the ordinary drug-medicatior in the whole range of skin d is- DISEASES OF THE SKIN. 303 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 affections of Hie 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 die internal parts, 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 standara 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 ; 1 . 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. The 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 to 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. Leprosy — lepra — lepriasis — presents patches of smooth laminated scales, of a circular form, and of different sizes, surrounded by a red- dish prominent circle, with a central depression scattered generally #04 PATHOLOGY AND THERAPEUTICS. aver tlie surface. Its principal sub-varieties are the common or white leprosy, and 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. Psoriasis — 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, Dut 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-variety of this affection has been called grocer's itch , baker's itch , etc. It fre- quently affects the hands of grocers, bakers, bricklayers, washerwomen, and bleachers, especially in the spring and fall. Ichthyiasis — -fish skin — is a harsh, papulated, watery 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 incrustations, 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 ordinary 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 lepers under the Mosaic dispensation. Treatment. — The principal point of difference in the management of cutaneous 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 temperature 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 two hours — using two or three thicknesses of the wet-sheet, followed by a thorough rubbing with the dripping-sheet. Of course, when there is no preternatural or feverish heat, due precautions must be taken U DISEASES OF THE SKIN. 305 lecure proper reaction or a comfortable glow after each pack. Dan- druff of the body can always be cured by a persevering 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 bathed once or twice a day in very cold water. Blaijss. — T hese affections consist in roundish elevations of the cuticle, containing a watery fluid. In water-blebs — pompholyx — 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, sometimes bursting and healing in three or four days, but occasionally forming 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; ringworm , when the vesicles have a reddish base, and are united in rings; rainbow-worm, when the vesicles, which unite in small rings, are surrounded 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 off and repro- duced. Eczema — heat eruption — consists in minute, distinct, but closely crowding vesicles, containing a transparent or milky fluid, attended with troublesome 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 44 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 [ an: sorry to sa}* 1 cannot divine the meaning m PATHOLOGY AND THERAPEUTICS of. Indigestible food and intoxicating liquors are the ordinary causes of water-blebs. Tetter is generally owing to acrid bile, thrown upon the surface. Rhypia almost always affects children who have been reduced by bad nursing and bad drugging. Heat eruption is 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 mercury. Treatment. — In addition to the general plan of treatment recom- mended thus far for skin diseases, the digestive function, being more particularly implicated in the diseases before us, requires some special additional attention. In all the varieties of tetter or herpes, free water - drinking, frequent hip-baths, and the abdominal girdle are appropriate In the sordid 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 eruption 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 the aggregated scabs form a thick, rigid casing around the affected limb so as to impede its motion. Sometimes the disease commences with a puffy swelling of the face, with oedema of the eyelids, very much re- sembling erysipelas, but without its smooth polish. Porrigo — scabby scall — tinea — consists of straw-colored pustules, which concrete into yellow scales. Its principal sub-varieties are, the milky scall, or crusta lactea, which chiefly affects infants at the breast, the pustules commencing on the cheeks and forehead, and often cover- ing the whole face with a continuous incrustation ; and the scalled keacl — tinea capitis — found 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 forms have been cnlled lupine , honeycomb, fur fur aceous, ringworm, etc. Ecthyma — papulous scall — is characterized by large, distinct pus- tules, raised on a hard red base, and terminating in hard, greenish, or dark-colored scabs. It occurs at all periods of life, from the earliest infancy to advanced age, arr is very often symptomatic of other disease* DISEASES OF THE SKIN. 30T Scabies — itch — is an eruption of minute pimples of a papular, pustu- *ar, vesicular, or mixed character, accompanied with intolerable itching; it is found chiefly in the flexures of the joints or between the fingers, and is highly contagious. It is one of the most complicated of the cu- taneous diseases, presenting many sub-varieties, the principal of which are the papular or rank itch , the vesicular or watery itch , the purulent or pocky itch , the complicated , in which the disease extends over the body, often affecting the face, and the mangy itch , which is produced by handling mangy animals. Special Causes . — Most »f the forms of humid scalls are owing to the combined operation of two sets of causes, one of which is nega- tive and the other positive. The negative causes are the absence of water, soap, flesh-brushes, and coarse towels , the positive, are gross and irritating food, as fried pork, salt ham, sausages, old cheese, fried cakes, and cooked and burnt fats of all kinds, and acrid or stimulating drinks, as hard cider, acid wines, and ardent spirits. Some forms of humid scall, which are confined to the hands and feet, are occasionally produced by severe exposures to cold or wet; a remark which holds true also of some forms of dry scall which are confined to the ex- tremities. Mothers ought to know that their dietetic habits may induce these and many other cutaneous diseases in their offspring while nurs- ing, and even before birth. Treatment . — Thorough and frequent ablutions, with a plain vegeta- ble diet, and the constant use of wet compresses when the skin is abraded or ulcerated, comprise the general remedial course. The patient should be kept in a moderate uniform temperature, and when the hands or feet are deeply cracked, sore, and exposure is inevitable, the sores should be anointed occasionally with olive oil or sweet cream, taking the precaution to wash or soak the part in warm water before applying it. Parents, as they value the future health of a child, should avoid all repellant lotions, ointments, or all-healing specifics, in all forms of skin diseases. They may indeed smooth the skin, but the disease will be only transferred to an internal and more vital part. The whole system of allopathic medication is calculated to drive the disease in ; but all rational practice will contemplate the exact contrary. On so simple a disease as the common itch, which is always cured as soon as the skin can be made clean, nearly the whole force of the apothecary shop has been spent in vain ; and the disease has been cured by two or three thorough soap-sudsings , after sulphur, lead, mercury, arsenic, tar, turpentine, human and animal urine, chalybeate waters, gunpowder and whiskey, gin and salts, and white and red pre- cipitate ointments l ad been used without success. $03 PATHOLOGY AND T HE R AP L'U II C S. Cutaneous Vermination. — The cuticle may be infested with the common louse , which mostly inhabits the heads of uncleanly children ; the crab louse , which is found chiefly about the groins, pubes, and eye- brows of unhealthy persons, producing extreme itching ; the common flea , whose eggs are deposited on the roots of the hair and on flan- nel; the chiggre , a West Indian flea, not more than one fourth the size of the common flea, which deposits a bunch of minute eggs in the feet of dirty persons, sometimes occasioning ulceration and mortifi- cation ; the tick, of which there are several varieties — the domestic tic , itch tick , and harvest bug — whose bite occasions an itching and smarting pain; the Guinea-worm of the Indies, the gad fly , which is common to quadrupeds, but sometimes burrows in the mucous mem- brane of human noses ; and the hair worm , which, by the way, in- volves a disputed point, whether the infestment is a live animal , or merely a morbid growth of real hair . Personal cleanliness is the best preventive of these intrusive crea- tures, and cold compresses are the best remedies when bitten by any of them. The second variety, crab louse, is often excessively troublesome. Medical books tell us that strong mercurial ointment is sure death to them ; and the same may be said of strong soap-suds, or a sufficient amount of cold bathing and friction without the soap. Macular Skin. — Simple discolorations of the surface are generally the result of depraved secretions, retained excretions, the introduction of drugs or foreign substances in the body, blows or bruises, or of ex- posure to strong cold winds or hot sunlight. Sometimes, however, a change in the color of a part or of the whole skin takes place, which we are unable to trace to either of these causes ; and one example — cyanosis — is frequently owing to organic malformation of the heart. In the veal skin variety the skin is marked by white, shining, per- manent spots, the superincumbent hairs falling off and never reappear- ing. The mole is a permanent, circular, brown patch, sometimes slightly elevated, and crested with a tuft of hair. Freckles are yellow- ish-brown dots on the cuticle, resembling minute lentil seeds, and often transitory. Sunburn is a tawny discoloration from exposure to the sun, which disappears in the winter ; orange skin is mostly confined to young infants whose mothers were affected with torpidity of the liver during gestation, but it sometimes appears in adult life from biliary ob- struction. Piebald skin is a general marbled appearance of the cuti- cle, with alternate patches of black and white. Albino skin is a dull- white state of the cuticle, with rosy pupils, weak sight, and white or flaxen hair ; it is usually found among negroes, but is sometimos knowe DISEASES *) F TIIE SKIN. BOO among the white races ; it is sometimes congenital, and in some instan ces the adult black and also white, have changed to Albinoes. Cyanosis — blue disease — cyania — is known by the whole skin being more or less blue, the lips purple, with general dullness of mind and debility of body ; it is always congenital. Sjiecial Causes. — Severe fevers have been followed by various per- manent discolorations ; even a black man has been transformed into a white man by this cause. In some cases, spotted and motley-colored skins are hereditary. Mineral medicines often produce livid spots or a universal dingy, bluish, or dark appearance of the skin. Nitrate of sil - ver is a very common cause. When administered for several weeks, it frequently produces a deep tawny and uniform discoloration, ap- proaching to a black, being deepest in the parts most exposed to the light. Sometimes, however, discoloration from this drug appears in patches, and sometimes one half of the body is affected. The blue disease is generally owing to some malconformation of the heart, the most common of which is a communication between the two ventricles, thus rendering the decarbonization of the blood imperfect, and giving rise to the venous or carbonaceous discoloration. Nitrate of silver has also produced a bluish tinge of the whole skin, closely re- sembling cyanosis. Treatment. — Most of these affections are unimportant trifles, and many of them are unalterable for the better. Yellow skins, blotches, motley appearances, etc., when induced by a diseased liver, can be often cured by restoring the functional action of this organ. When the skin is discolored by drugs, a persevering employment of the wet- gheet, with a course of free water-drinking and plain vegetable diet, will do all that can be done in the way of medication, although it will seldom wholly remove the difficulty. The blue disease is incurable , its subjects are feeble and short-lived ; and all that can be done to pro- long existence is found in plain, quiet, simple habits of life. Morbid Sweat. — Profuse perspiration, when not a symptom of some acute disease, is an evidence of debility, and requires no atten- tion, save a course of tonic bathing and regimen. Bloody sweat, though regarded as an idiopathic disease by some authors, is usually a vica- rious affection, as in mis-menstruation, or the result of vehement emo- tion, violent exertion, or intense agony. Partial sweats are, I believe, always symptomatic. Colored sweats, which may be green, blue, black, or yellow, result from obstruction of the liver or kidneys, or from some metallic or mephitic impregnation. Scented sweat ma} r be rank or fe- tid, sour or a 'rid, sulphurous or musky, saline, aromatic, etc. Most 310 PATHOLOGY AND THERAPEUTICS. of these varieties depend on the dietetic habits of the individual, in con nection with the amount of bathing practiced. Some persons, who never or but seldom bathe, and eat strong food, are exceedingly disa greeable to the olfactory nerves of others. Many persons who exer- cise much on foot, wear flannel stockings, and bathe rarely, have a horribly offensive scent, which becomes intolerable on exposing the feet to the fire. I once had a patient who exhaled from the axillae a strong musky, or rather blue-dye odor, for which he could assign no probable cause. Sandy sweat , known by a reddish sandy material concreting on the surface, indicates great deficiency in the functional action of the kidneys, or great excess in the saline and earthy matter taken into the system with the ingesta. The proper treatment, I trust, is sufficiently obvious in all these cases without further remark. Morbid Hair — Trichiasis. — Even the hairs of our heads may be- come deranged by our physiological transgressions, although, next to the bones, they are the most indestructible of our bodily constituents. The bristly or porcupine hair , is usually regarded as an effect of gross nutriment connected with general habits more congenial with perfect animal than progressive human nature. Matted hair — plica polonica — the hairs becoming vascularly thickened, inextricably entangled, and matted together by a glutinous secretion — is supposed to result from covering the head too closely, as with a thick woolen bonnet or leather cap, with little or no attention to combing, washing, or in any way cleansing the head. Extraneous hair — trichosis — is most commonly noticed in bearded women, and has been imputed to excessive men- struation, the excessive use of pork, shell fish, and other gross foods. Forlcy hair — the hairs of the scalp weak, slender, and splitting at their extremities — is a common complaint, depending for its immediate cause on defective nutrition in the bulb or root. Gray hair , when not “frosted by age,” may be produced by fright, terror, grief, excessive brain labor, violent fevers, etc. Baldness may result from the same causes as gray hairs, and sis often the consequence of skin diseases. It is far more common in males than in females — which fact seems to corroborate the physiological notion which some have advanced, that the common practice of cutting the hair and shaving the beard is a source of bodily infirmity. Aerated hair — patches of bald spots in the scalp or beard — is probably owing to some obscure skin disease or pre- ternatural excitement of some portion of the brain. Miscolored hair — the hair changing to blue, black, green, or spotted — occasionally re- sults from fevers, terror, heating the head, mineral and metallic va- pors, etc. Sensitive hair is usually owing to cerebral excitement: and POISONS. 811 this is usually owing to wounds or injuries of the head, and febrile or inflammatory affections. The hair, in some instances, is so acutely sensitive that the slightest touch, or the cutting of a single hair, gives exquisite pain. Treatment . — Cutting the hair short, and frequently bathing the .vhole head in cold water, is the general restorative process in these deviations from health — some of which, however, are not curable. In ';ases of excessive sensibility or tenderness, tepid or moderately warm water should be employed. In the plica polonica. the hair should be cut very close, the scalp frequently washed with tepid water, and de- rivative hip and foot-baths directed. And in all cases the general reg- imen must be physiologically regulated, and such bathing appliances brought in requisition as the general health and particular circum- stances indicate. CHAPTER XXI. POISONS. So general is the employment of substances for chemical, mechan- ical, and medicinal purposes, which are poisonous to the living organ- ism, whether taken into the stomach or applied to the skin ; and so nu- merous are the emergencies wherein relief must be either immediate or impossible, that a work of this kind would be sadly defective with- out a brief consideration of this branch of pathology and therapeutics. Toxicologists have usually classified poisons according to the king- doms from whence they are derived, as mineral , vegetable , and ani- mal. Some have arranged them according to their action on the ani- mal economy, and others have merely distinguished them into general and local. Christison, who has written the most elaborate work on this subject, divides them into irritants , narcotics , and narcotic-acrids. The first embraces all poisons whose principal symptoms are those of irritation or inflammation ; the second produce stupor, delirium, spasms, paralysis, etc. ; and the third, as the term implies, produce either or both sets of symptoms, according to the dose and other circumstances. But what are poisons ? This is a problem not yet settled among medical men. In its broadest sense, the term must comprehend every thing foreign to the natural constituents of the human body, and even these constituents themselves, when their constituent elements are in PATHOLOGY AND THERAPEUTICS. unnatural relations or proportions; every thing, in a word, which is not properly food, drink, or atmosphere. This latitude of definition will include the whole materia medica of our allopathic friends ; and in truth, almost every poison known is an integral part of that materia medi- ca. Established usage has, however, restricted the ideaofpuw^ to the sudden, prominent, and immediately-dangerous effects of these articles, while their equally morbid yet more slow, gradual, and remote consequences are called diseases . Were I to attempt — what no toxicologist has yet accomplished— a satisfactory and philosophical arrangement of poisons, I should base it on the allopathic materia medica, as tonic poisons, stimulant poisons, emetic, cathartic , diaphoretic, expectorant, vermifuge , and eschar otic* poi- sons, etc. ; but whether such a classification would be pathological or therapeutical , is a question I am willing to submit to “ future genera- tions.” In the present chapter, the effects of Iccrge or poisonous doses will be chiefly considered, and small or medicinal doses only incident- ally alluded to. Acids. — The nitric, sulphuric , muriatic , or hydrochloric, phophoric t oxalic , and acetic acids, are corrosive poisons ; and whether taken inter- nally or applied externally, produce redness, inflammation, vesication, and ulceration. Symptoms.— -When swallowed, a burning sensation in the throat, ex- cruciating pain in the stomach, and gaseous eructations are usually the immediate effects. When taken in extremely large doses, the sensi- bility may be so suddenly destroyed that the pain will be deceitfully slight. All the symptoms are most severe when the poison acts upon an empty stomach. Treatment. — All alkalescent matters are chemically antidotes ; there is, however, a choice, for the reason that some alkalies are themselves extremely corrosive. Chalk and magnesia are the best. A solution of nard soap answers very well. Slaked lime, or carbonate or supercar- bonate of soda may be given ; and in the absence of all these, a remedy may be found in the common plaster of an ordinary room, which may be beat down in a moment and made into a thin paste with water. The patient should drink as much water as he can swallow conveniently. The stomach-pump is not necessary. Alkalies. — Caustic potash, saleratus, quick-lime, salt of tartar, pearlash, soda, sal ammoniac, carbonate of ammonia, or smelling salts , and spirits of ammonia, or hartshorn, are the usual alkalies from which accidental poisoning results. POISONS. 33 3 Symptoms. — These do not differ essentially from those produced by the strong acids. Treatment. — Of course, all acids are antidotal. Vinegar, lemon- juice, or any of the stronger acids, largely diluted, may be given. In the absence of acids, any of the fixed oils, as olive or almond, by con- verting the alkali into a soap, will neutralize its corrosive effects. In other respects, the treatment is the same as for acid poisons. The resulting inflammation, in all cases of poisoning, is to be treated pre- cisely like inflammation from other causes. Neutral Salts. — The most virulent of the preparations commonly known as neutral salts is nitrate of potash — saltpetre, nitre , sal-prunelle . In the apothecary-shops mistakes are often made, by which this article is put up for sulphate of soda, sulphate of potash, and other saline lax- atives, so that the patient gets poisoned. It produces stinging pains in the stomach, and the usual symptoms of a violent cholera, with cold- ness, debility, and great exhaustion of the nervous system. Other neu- tral salts in common use, as Glauber and Epsom, are not dangerous ex- cept in excessive doses ; the symptoms then are drastic purging and great debility. Treatment. — We have no direct antidotes in the cases before us, and our duty is chiefly to combat inflammation. When nitre has been swallowed, warm water must be freely taken, and the stomach-pump employed if practicable. Wet bandages to the whole abdomen are called for, and the warm-pack is often serviceable. The effects of the other neutral salts are to be counteracted by cool or cold injections, and warm hip-baths. Mercury — Hydrargyrum. — The most actively-poisonous of the Salts and oxides of mercury in common use, are calomel , turpeth min- eral, corrosive sublimate, red precipitate, cinnabar, Vermillion, and cy - anuret. Of these, red precipitate 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 fact, among the “curiosities of medical literature,” that the standard books recognize fifty-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 have been a long time II — 07 §14 PATHOLOGY AND THERAPEUTICS. continued, there is a griping pain in the bowels, with a tendency to di- arrhoea. When the system is slowly and gradually saturated with the poison, the effects are distinguished by the general term salivation, the symptoms of which are general fever, tremors, foeted breath, brassy taste, sore 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 ; tho 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 — Arsenicum. — The arsenical preparations from which poisoning occasionally results are, the 'protoxide , or fly-powder ; arse - nious acid or white arsenic , commonly called ratsbane ; arsenite of cop- per or mineral green ; arsenite of potass , as in Fowler's solution ; arseniusetted-hydrogen gas , which is evolved in various chemical opera- tions ; and several sulphur ets of arsenic, as realgar, orpiment , and king's yellow. Symptoms. — In a great majority of cases there is violent irritation and inflammation of the whole alimentary canal ; a burning pain in the throat and 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- vulsions, paralysis, insensibility 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 puffiness of the whole face, called in medical parlance cedema arsenicalis , and POISONS. 815 attended with redness of the eyes, and followed by gripings, nausea, purgings, and a gradual sinking of the vital powers. Treatment. — 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 hydrated 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 support large evacuations of blood” — the same as to say, the patient must be bled on theory, although it will kill him in practice. Antimony — Antimonitjm. — 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 is extensively diffused amonp us, being a common ingredient in candies, lozenges, cough mixtures, drops, and syrups, etc. The popular preparations of the regular pi mrmacopieias, James' powder, and Plummers' pill , 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. Symptoms. — Small doses produce scarcely any obvious effect save general debility. Large doses produce epigastric pain, vomiting, 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. Treatment. — 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 m PATHOLOGY AND THERAPEUTICS. our bathing appliances must be gentle and of moderate temperature. The warm-bath is excellent to check excessive evacuations when a large dose of the drug has been taken. Medical books recommend astringents, as tea, nutgall, cinchona, etc., on the supposition that tannic acid is antidotal to tartar emetic. But 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 sulphurets, are energetic poisons. The acetate — sugar of lead — sac - charum saturni , 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 deutoxide : white lead — carbonate of lead ; and Goulard's extract — the diacetate. Milk, molasses, and even pure water, may acquire a poi- sonous 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 constringe the circulating vessels, re- duce the pulse, diminish the temperature of the body, produce dry- ness 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 \w ; the saliva is often bluish. The extreme effects are lead-colic. Excessive doses produce more or less gastro- enteritis. Treatment — 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 salts 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. Copper — Cuprum. — The salts of copper have been much em- ployed in the manufacture of culinary vessels, and to color candies, sweetmeats, and preserves, from which frequent poisonings have re- sulted. The preparations in common use are mineral green - — the nydrated oxide ; blue vitriol — the sulphate ; natural verdigris — the carbonate ; and artificial verdigris — the mixed acetates. Symptoms. — These are quite various. In small doses they are POISONS 31* 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, griping pains, and giddiness result. Very large doses produce convuh gions and insensibility, with the usual symptoms of gastro-enteric in- flammation. Treatment. — Wheaton flour, milk, and the white of eggs, are here our antidotes again. Vinegar has been a popular prescription, but it is actually injurious. Bismuth — Bismuth um. — There are two preparations of this metal in common use ; the first is the trisnitrate, which is extensively used m medicine, and known by the various names of oxide of bismuth , subnitrate of bismuth, and magis*ery of bismuth ; the second is the tartrate of the metal, and is extensively used in the cosmetic art under the name of pearl white . 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, may 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 occasionally misapplied to the human stomach. Symptoms. — Applied to the skin, hair, or nails, nitrate of silver stains them black ; tc an ulcerous surface it produces a white film ; and to a mucous membrane, smarting pain, and inflammation, which lasts 518 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 skin, which is very difficult to remove. In some cases the whole body, internally and externally, has beet: blue-dyed by the medicina 1 operation of this drug. The discoloration results from a chemical 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 writers on materia medica tell us with sufficient coolness , that 44 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 medical 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, ha \e 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, very freeiy 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- poeias 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 31 $ oones, that common chalk, mason’s mortar, or plaster of Paris are nat- ural foods I As iron was the first mineral introduced 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 Ipliicles, 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 subsequently 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 medicinally in the forms of filings ; black oxide , or ethiops martial ; sesquioxide — the red oxide , peroxide, or crocus martis , various preparations of which are known as carbonate of iron . vitrioli , brown-red , rouge , etc. ; hydrated sesquioxide ; ammonio- chlo- ride; iodide ; sulphuret , cr common iron pyrites ; ferro-sesquicyanide , or Prussian or Berlin blue ; ferro-cyanide of potassium , or Prussiate of potash ; sulphate — green vitriol — sal martis — copperas ; f err o- tar- trate of potash ; acetate ; persulphate ; pernitvate ; ferro-tartrate 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, and 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 sulphate and chlorate of iron, in large quantii^s, produce great heat, weight, pain and uneasiness in the stomach, with nausea, vomiting, and sometimes purging and hemorrhages. Treatment — We have no chemioa. antidotes except the alkalies, 820 PATHOLOGY AND 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 nwriated tincture of iron. Against all the other prepara- tions we must trust to warm-water vomiting, the stomach-pump, and the usual means for counteracting inflammation. Zinc— Zinc um. — The compounds of zinc are analogous to those of copper in their action on the system, though somewhat less violent. The preparations in common use are the oxide — flotvers of zinc ; im- pure oxide , or tutty ; chloride — muriate, or butter of zinc ; sulphate, or white vitriol ; acetate ; carbonate , or calamine ; and cyanide . Tlie treat- ment is the same as in cases of copper poisoning Manganese — M an g an e si um . — The binoxide 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, but less injuri- ous than lead, and they are to be counteracted like those of the pre- ceding poisons. Iodine — Iodinum. — 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 prostration 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 potass a, which is extensively used in 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 corrosive. Unfortunately we are without antidotes once more, and must trust to the principles of treatment already 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 power fid irritant, and its acid is corrosive. The antidotes are demulcents and al- kalies — albumen, gluten, milk, magnesia, etc. StLPHUR. — Various forms of this artic.B are familiarly known 83 POISONS 82! 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 foi an ordinary diarrhea. Chrome — Chromium. — The chromate of potass, and some othei 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 dryness and thirst ; and when large quantities are swallowed, nausea, vomiting, griping, 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 chloride 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. — There 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 stomach- pump; the albumen of eggs and gluten of wheat are always harmless. 522 PATHOLOGY, AND THERAPEUTICS. and in some eases might be serviceable ; hence it would be at least pru- dent to emplo}^ them in all cases as auxiliaries. Among the most dan* gerous may be named the oxide of osmium and hydrochlorate of palla- dium, which are nearly as active as arsenic ; the hydrochlorates of rhodium and iridium are rather less violent ; the salts of molybdenum are comparatively feeble ; uranium and cobalt are more active ; tung - stein, cadmium, nickels cerium, and titanium, in their various prepara- tions, are among the weakest of the metallic poisons. Narcotics. — These may be medicinally and toxicological!/ divided into the pure, stimulant, and acrid. The pure narcotics produce 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, leLuce , 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 , camphor , cocculus indicus, nux vomica , St. Ignati- us' bean, etc. The acrid narcotics produce violent irritation 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' paisley, 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 as for apoplexy. The extremities must be kept warm with ho 1 bottles, gentle but persevering friction applied to the surface, and the cold pouring-bath 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 as from colchicum or elaterium, the ;old :andage and hot foment®- POISONS. 323 lions may be necessary, and may alternate with advantage, and small quantities of very cold water are to be. frequently thrown up the rectum. Acrids. — T here are many aromatic and pungent vegetable sub- stances not usually regarded as poisonous, but which, when taken ifc large quantities, produce severe irritation, and even fatal inflammation of the stomach and bowels. Of this class are the essential oils , as pep- permint , spearmint, cloves , cinnamon , and capsicum ; various balsams , a s Tolu , copavia , Canada , and Peru ; many condiments, as pepper , mustard , horse-radish , cloves , and 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 treatment is limited to soothing irritation and combating inflammation, premising, however, that the offending material i3 in all cases to be got rid of by emesis, catharsis, etc., as speedily as possible. Mushrooms. — T he fly agaric, pepper agaric, deadly agaric , bul- bous 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 aud frequent pulse, delirium, dilated pupil, and stupor, followed by cold Bweats and death. Treatment . — Here again the scientific treatment of the books is emi- nently calculated to make a very 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. — T he kinds of “sea-food” from which poisoning most frequently happens, are, the crawfish , mussel , old-wife , yellow- billed sprat , land-crab , gray-snapper , dolphin , hyne , conger-cel , blue- parrot fish , smooth-bottle fish , groover , rock-fish , barracuda , king-fish , Spanish maikerel, porge-e , i meita , blower, tunny, etc. The syrup* 324 PATHOLOGY AND THERAPEUTICS toms of poisoning usually appear in an hour or two after eating them, but sometimes in a few minutes after the meal is finished ; a weight at the stomach is at first felt, with slight vertigo or headache ; these are followed 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 are poisonous, are, the copper-head, moccasin , viper , black viper, water viper , rattlesnake, Spanish or blistering fly, potato fly , tarantula, scorpion, hornet , wasp, bee, gnat, and gad-fly . All the symptoms are those of violent internal and external erythematic in- flammation, and the treatment may be found also under that head. PART VII SI RGERY. fJiriMTiONS. — Surgery is either medical, mechanical, or oj erative. According to the old school system, medical surgery 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 ii applied to the replacement of displaced parts. Operative surgery con templates the removal of mechanical or chemical obstructions, 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 instrumental machinery which the in- ventive genius and manufacturing interest of the age has brought into use. The common pocket-case of instruments, with tooth-forceps, liga- tures, lint, adhesive plaster, sponge, bandages, male and female cath*- 28 526 SURGERY. ters, the stomach-pump, and the pump-syringe, are all that emergen- cies demand 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, emetics, anaesthesia, haemastasis, and transfusion. The 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 perforated 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 . The Ligature. — Various kinds of strings or ligatures are em- ployed to arrest 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 surgeon’s Jcnot — the first knot having two turns — must be tied, as this prevents the first knot from slipping while the second is being tied. The bleeding vessel should be gently 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 temporarily prolapsed parts, as the uterus. Adhesive Plaster. — This is employed to retain divided parts in proximity ; to afford mechanical support to relaxed and distended ves- sels, as varicose veins; to excite absorption by compression, as in indo- lent ulcers, and protect abraded surfaces. In dressing wounds, it is ap* plied in narrow strips, with interspaces for the discharge of matter. Foj SURGICAL APPLIANCES. 327 Email cuts or abrasions, the collodion is the most convenient article, and for very small wounds or sores the gummed-silk or court-plaster 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 i harpie, 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 pledgets. 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 te 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 smoothly 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 will result from obstructing the circulation. Figure 190 shows the manner of applying the roller to the lower extremity. It is about two and a half inches wide ; and, commencing at the extremity of the great toe, takes in the second toe at the second S2§ SURGERY. turn, the third toe at the third turn, and so on ; compresses are placed in the depressions around the ankle so as to preserve equal pressure , Fig. 190. APPLICATION OF THF ROLLER. each layer overlaps the preceding two thirds or more of its width, and the whole is applied smoothly from the toes to the knee. Just above the ankle, where the limb is tapering, it has to be folded over itself, and its direction frequently changed to preserve its evenness of appli- cation. Splints. — These 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 course, be shaped to the part to which they are intended to be applied, and padded with lint, 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 potash — potassa fusa — is in general use as a strong , and the sesqui-carbonate of potash as a mild caustic. Nitrate of silver — lunar caustic — nitric acid , and sulphate of zinc , are frequently em- ployed. Preparations of antimony , arsenic, and mercury, 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 uately this necessity is of rare occurrence. SURGICAL APPLIANCES. 329 Sutures. — Stitching divided parts together is much less practiced how 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 be well applied. The curved needle should always be passed from within the wound outward, and take up but little more than the skin. The twisted 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. twisted suture. Fig. 191. 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 th6 artery beyond is suppressed, by turning the screw. A Fig. 192. TIiE TOURNIQUET 830 SURGERY. good substitute for the common tourniquet may be made in a moment F ig. 193 . in various ways. A handkerchief, tied twice around the limb, may be twisted with a stick until the pressure stops the current of blood handkerchief ligature in the 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 or 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 without 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 system, 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, can be readily and harmlessly produced by the internal and external use of warm water. Emetics. — In many cases of rigid muscular contraction, to facilitate the reduction of a dislocation or the replacement of the fragments of fractured bones, powerful and injurious doses of tobacco or tartar emetic are administered to induce greater relaxation ; or the patient is kept for a long time in a state of excessive nausea. Warm water, taken copiously into t^e stomach, assisted by tickling the throat occa- SURGICAL APPLIANCES. 331 signally, will answer all the purposes for which so many deathful 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 to lessen or obviate the pain in nearly all cases of parturition. They art 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 eth^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. Hemastasis. — 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 efficacious. Transfusion. — In some cases of excessive loss of blood, life has been preserved by opening the vein of a healthy person, or of a sheep, and 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. CHAPTER II. WOUNDS. Distinctions of Wounds. — 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, by a sharp-edged instrument, as a knife, razor, axe. A punctured wound is made by a sharp-pointed instrument, as a needle, awi. A penetrating wound is a larger puncture, as by a bayonet. A contused wound is occasioned by a blunt instrument, as a stone, club, which injures the parts below the surface, the skin remaining entire. A lacerated wound is inflicted by an instrument which is both blunt and rough, and which tears the integument as well as injures the parts beneath it. Gunshot wounds include all injuries accruing from substances impelled by the explosive force of gunpowder, as leaden bullets, cannon balls, stones, etc. They partake of the character of both punctured and lacerated wounds. Poisoned wounds are the injuries inflicted by in- sects, reptiles, rabid dogs, etc., whose stings or bites are accompanied with the introduction of a specific virus. General Consequences of Wounds. — Bleeding is the only alarming symptom in incised wounds, which can generally be healed b} 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 injury, 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 pain is generally in the inverse ratio to the danger, for the reason that the more destructive the injury, the less power has nature to give the alarm. The danger of wounds, other circumstances being equal, depends on the actual health, or physiolog- ical state of the system at the time the wound is received. The most trivial scratch, or the simplest cut, lias been followed by bad sores, loss of limb, and even life, 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 dif- WCU^ DS. aaa ficulty. Spirit-drinkers and beer-bibbers are notoriously liable to ex- treme inflammation, 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. £ 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. When the bleeding is from the upper extremity, the brachial artery must be com pressed above the middle of the arm; and if from the lower, the femoral artery should be compressed just below Poupart’s ligament. The congestion and in - THE common compress. flammation which may attend all wounds merely require frequent changes of the water-dressings ; and when the inflammation of a wound has extended to the neigliDoring glands, producing painful Fig. 195. S34 SURGliRY. swellings, these should be kept well covered with several thicknesses of wet cloths. The lodgment of foreign substances in wounds is to be ascertained by introducing the finger or a probe, and extracted if possible ; not, however, until a s I 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 fungous or proud flesh, 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 irritable 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 cok 1 streams and cold wet compress. The general treatment of poisoned wounds has been detailed in tht 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 a temporary suspension of consciousness. The extent of the injury cannot be known, nor is it material that it should be until the patient “ 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 be drawn off by the catheter. NJU HIES. $86 The old practice of bleeding, which I am sorry to know is also a common practice with modern allopaths, has no better effect than tc lessen the patient’s chance of recovery. Indeed, this has been the opinion of some of the best European 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 lotting 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 is depressed it must be raised by a lever ; or if this is impracticable, the operation of trepbi ning will become necessary. The head should in all cases be kept thoroughly cooled with wet cloths or the pouring-bath, and derivative treatment, especially tepid, hip, and foot-baths should be frequently employed, caution being taken to secure prompt ,'eaction. 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 wrapped 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 £36 SURGERY. measured by the extent of surface destroyed. Authors make three, four, five, and sometimes six degrees of burns; but the smallest nam* ber is sufficient, for all practical purposes. The first is rubefaction, or redness ; the second, vesication , or blistering; and the third, disorgan- ization , in which the skin 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 carelessness in hand- ling camphene, burning fluid, tea-kettles, coffee-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 flame should be suffo- cated by covering the patient with a blanket, carpet, or some similar Fig. 190. 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 warm water will often feel the best. But the rule is invariable : follow the sensations of the patient. When the skin is 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 off, the roorr should be kept quite warm, and all applications should INJURIES, 837 then be moderately warm. The best covering in 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 maybe 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 sffme 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 indifferent.” 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 great nervous prostration .” On this basis the professor recommends warm brandy and tincture of opium to get up reaction ; and then antintony, Dover' s powder, 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 great 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 sequels of burns and scalds, are contractions of the skin 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 II — 29 538 SCTRGERr. Partic UI.AR Wounds and Injuries. — Venesection— phlebotomy— is a wound made by puncturing a blood-vessel with die pokit of a lan- cet, a ligature having been previously applied between the contem- plated wound and the heart. Some one of the veins or the inner side of the fore-arm, near the elbow, is usually selected ; but occasion- ally the external jugular vein, the veins of the foot, and the temporal artery are opened. The consequences of this operation are, i. Loss of blood, which is irremediable. 2. Ecchymosis — 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 douche 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. Lock-jaw — 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 which the operation is the exciting cause ; this requires the wet-sheet pack, with wet cloths to the inflamed part. 6. Fainting — which results from the abstraction of a large quantity of blood, or from a less quantity sud- denly withdrawn by making a large orifice ; the treatment has been described under the head of Syncope. Leeching and scarifying are among the common injuries which modern surgeons are fond of inflicting upon afilicted humanity. The usual morbid consequences are, inflammation of the skin and adjacent blood-vessels — erythema and phlebitis — langerous hemorrhages , and un- seemly scars . For all theke " accidents,” the coldest water is the best remedy. Wounds of the throat , of which throat-cutting 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- pipe, 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 End the patient will manifest short breath and ilooiy expectoration INJURIES. 339 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 possibly save 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 longtime 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 shalloiv 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 CHAPTER IV TUMORS. Every tumor <4 a morbid swelling ora new formation — an increased or perverted 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 may also arise from capillary obstruction, and this is induced by many 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 obstruction, 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, fibrous, carti- laginous, osseous, encysted, fungous, indurated, scrofulous, malignant , pulsating, vascular, etc., according to the structure affected, and the form, character, and consistence of the swelling. The older surgeons divided tumors into sarcomatous or fleshy — com- prehending those which are composed of fatty, fibrous, medullary, fungous, or other substances softer than bone ; osseous or bony ; osteo- sarcomatous — when involving both the bony and fleshy structures; and encysted — containing a fatty or fluid substance within a globular cyst, as in the case of wens and hydatids . Adipose tumors are collections of fatty matter inclosed in a cyst or sac of condensed cellular membrane, which renders them also encysted tumors. When filled with a suefr-like matter, they are called steato- mous ; when containing a honey-like substance, meliccrous ; 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 surrounding structures. They may be 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 tumor? do not reappear after having been entirely removed. TUMORS 341 Fibrous tumon are composed of capsules of greater 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 these 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 morbid developments of erectile tissue called ncevi materni , or aneurism by 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 part 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 — Iox\thus. — This affection is a stationary, tubercular, un- s-uppurative tumor, generally found upon the face. It comprises the varieties called stone york ) and carbuncle l fate, or rosy drop — gutla Fig. ’ 197 . m SURGERY. rosea . Stone pock is a pimply eruption of hard, red tumors, which are sore to the touch, and ooze a little fluid at the tip, or a gf ub-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 “hard drinking.” Treatment. — Few invalids, distinguished by the carbuncular variety of the whelky tumor, can be expected to submit to water-treatment ; and, moreover, these patients have the same reason to regard their “ roses” 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 eruption of inflamed tubercles on the scalp, and on the bearded portion of the face. These tumors often ul- cerate and discharge au ichorous or glutinous matter. They are con- nected with uncleanliness in either the positive or negative sense — bad diet or drink, or the absence of water, and may be cured by thorough local and general bathing. , Warts — Verucc^. — These are rather excrescences than tumors ; some are smooth and apparently filled with fatty matter; others, called seed-warts , 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 effectually removed by caustics — potassa, nitrate of silver, nitric acid, or nitro-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 wart. The acid may be repeated until the troublesome and unsightly excrescence is entirely destroyed, which will usually reqnire but a few days. TUMORS. 343 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 true skin, so that it can be taken oft 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. Onyxis. — This distressing affection, sometimes known by the dis- tressing synonym of onychogryphosis , consists in an incurvation of the toe nail from a bruise or the pressure of a tight shoe, producing in- flammation 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 without 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 warm, 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 yielo to the other measures of treatment. 344 SURGERY Ganglions. — These are encysted tumors, formed of a viscid, albu minous fluid, resembling the white of an egg, and varying in size from a pea to that of an egg. They are hard, globular, and without discol- oration of the skin. Sometimes the cyst is loose, but in most cases it communicates 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 the course of a tendon, and usually appear on the wrist, hand, and top of the foot. In their treatment 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 compress, 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 may be punctured with a lancet or couching needle, and the fluid 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 suppuration, is a method recommended by some authors ; it is applicable to cases attended with ulceration or induration. Ranula. — This is a small tumor under the tongue, resulting from obstruction of some one or more of the excretory ducts of the sub- maxillary or sublingual glands. It may be cured by clipping off a small portion with a pair of sharp scissors ; and, if it does not disap- pear in a few days, touch it with nitrate of silver or sesqui-carbonate of potash. i Epulis. — A small tubei^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 grows 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 gum 3 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 removal of the tumor as soon as its character is ascertained. The adjoining teeth must be finst extracted. Sir Astley Cooper pre- fers the knife ; but the cauterizing process as recommended by Dr. Hill is, I think, far preferable; it consists in destroying the tumor to Ys base, with every portion of the diseased structure, by means T U M 0 II S. 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. Bronciiocele. — This tumor, commonly called goi.tr e, or swelled ruck , 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 freely 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 m the periosteum, and effusion takes piace be- tween it and the bone, constituting the worst or malignant form — the true felon ; in the tendinous whitlow the inflammation commences in the sheath of a tei ’on; and in a variety called cutaneous , t’ae effusion SUE, cE EY. m occurs in the subcutaneius 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 the firmness and inelasticity of the skin and other structures where it is seated, wmch act upon the inflamed vessels like a tight bandage, pro- ducing a most distressing sense of pressure ; and hence it is that when die 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 he promptly cured by immersing the whole arm in very cold water, The arm-batli, 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- bath, will 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. Fig. 198. ARM-BATH IN WHITLOW. 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 hardy scirrhous , indurated tumors — occult cancers — and in their latter stage, open ulcers — carcinoma. But it is equally true that indurated or scirrhus tumors often remain for an indefinite period in a condition of cartilaginous and almost stony hardness, without evincing any tendency bo cancerous ulceration ; and not unfrequently, when irritated or in- jured, degenerating into other malignant tumors, very different from true cancer. A scirrhus tumor, therefore, is not per se the proof of an approaching cancer. Indeed, some authors have grouped together scirrhus , medullary sarcoma , fungus hcematodes , 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 acirrhus is uneven to the touch, the skin leaden and wrinkled, with ir- TUMORS 847 regularly dilated veins, and twinging, gnawing, or lancinating pains, the 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 the gnawing or lancinating kind. They present, also, a smooth and more rounded surface, with 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 treatment recommended for bronchocele. But the canceroid 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 ilour. 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 off, 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 flour, 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 IT^matodes. — This term means bloody fungus ; the dis- ease is sometimes called medullary sarcoma, spongoid inflammation , encephaloid 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 purplish or red soots 348 SURGERY. and adheres firmly to the distended and lobulated mass. Ulceration soon comes on ; dark-colored fungous growths sprout out irregularly and at several points beyond the surface ; the whole mass becomes exceedingly vascular, the top being much 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- pearance 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 internal structure is changed to a brownish, fleshy mass. When the swelling opens on the surface, large quantities of pus, of a more or less icherous 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, after 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 w T ell covered with wet compresses, and, when practicable, the cold stream or pouring-bath should be fre- quently applied ; the cavity should be washed out once or twice a day with tepid water ; and, if there are fungous growths appearing, a solu- tion of the mild caustic should be applied daily, filling the cavity, after each application, w r ith pledgets of lint. Carbuncle — Anthrax. — This affection is sometimes called a ma- lignant boil. It commences with a livid, red swelling, attended with a TUMORS. 349 burning, smarting pain, followed by vesication ; the ulceration at pears in the form of several fistulous openings, from which a thin, acrid fluid exudes, excoriating the adjacent surface. The disease always indicates a very depraved or debilitated state of constitution, and rarely occurs in any but aged persons. It is generally located in some part of the back or on some portion of the head. Treatment . — The best management in the most malignant fbrms is, without doubt, the cauterization plan recommended for the preceding disease. There is much less pain attending the application of caustic in carbuncular than in cancerous or malignant fungous tumors. But the less virulent cases, wherein the fetor is moderate and the gan- grenous tendency slight, may be cured by thorough packing, a rigid diet, and wet compresses. Lupus — Noli-me-Tangere. — Lupus literally means “the wolf:’’ and noli-me-tangere, “don’t touch me” — terms expressive of the ra- pacity and abhorrent nature of this excrescence. It is a malignant disease, usually about the nose and mouth, commencing as a small tu- mor, and progressing to a foul ulcer. Its first appearances are various, hs a small dark sore, tubercle or vesicle, or a large, prominent wart. The lupus ulcer is known by a purple margin and depressed center, which exudes a tenacious pus, or an icherous matter ; the exposed surface has a fiery red appearance, and the pain is of a pricking or smarting kind. When occurring near the eye, it will, if not arrested, destroy that organ, and may extend to the brain. The general health is not usually much affected. Treatment . — In the early stage, when the disease appears in the shape of warty excrescences or tubercles, the knife or caustic may be employed indiscriminately. When it commences as a superficial, red, angry sore, the mild caustic will be sufficient. When it has extended over a large surface, or penetrated deeply, the strong caustic must bo freely applied. Aneurism. — An aneurismal tumor, in its strictest sense, is a preter- natural dilatation of the coats of an artery, forming a pulsating swelling, which eventually ruptures and destroys the patient -by hemorrhage. The term is also applied to enlargements of the cavities of the heart. In the true aneurism the coats of the artery form the pouch or sac of the tumor; when the sac or covering is formed of effused lymph, into which the blood has escaped from the artery, it is called false aneu- rism ; sometimes the. blood is poured into the cellular membrane, con- stituting the diffused aneuiism ; and when the effused blood, in conso- 85C SURGERY. qi:. ence of a rupture of the internal and middle coats of an artery, makes itself a channel between these and the oute'* coat, it is called dissecting aneurism. Aneurismal varix — varicose aneurism-^ -is a dila- tation of a vein in consequence of a gush of blood from a neighboring artery, and is generally produced by venesection.” Ncevus is a dila- tation of the small arteries, producing a red, shining spot on the skin ; when these vessels are larger, the affection is called aneurism by anas- tomosis. Diagnosis. — Aneurism, when external , is known by a pulsating tu- r^or, which beats synchronous with the artery where it occurs; it may be diminished or emptied of its contents by pressing on the affected artery above the tumor. Internal aneurisms, which occur in the heart or large vessels of the chest and abdomen, are extremely difficult to distinguish. Aneurisms of the heart are divided into active and pas- sive ; the former is really a hypertrophy or thickening of the parietes of the organ, by which its cavities are diminished ; the latter is the true cardiac aneurism , attended with an enlargement of its cavities. The symptoms in all these cases are exceedingly obscure and variable, and are common to nervous and dyspeptic invalids, as well as the result of various tumors and visceral enlargements not connected with any struc- tural lesions of the circulating system. The most prominent, however, are, a strong and constant beating or pulsatory motion above or below the sternum, when the bowels are not constipated ; a dull, heaving, beat- ing, or boring sensation about the spine ; and a double beating, or some other uniformly irregular character of the pulse at the wrist. Special Causes. — Injuries; blows, fills, violent exertions, mental excite- ments, and above all, obstructing, concentrated, and greasy food, which thickens the blood and increases the labor of the heart and arteries in propelling it. Treatment. — In the early stage of aneurismal tumors, compression, when it can be managed by an experienced operator, is the best reme- dial resource. In other states and circumstances, the ligature is neces- sary. The most approved operation is that of tying the artery with a single ligature above the tumor. After dissecting down to the vessel affected, the blunt end of an aneurism needle, fig. 199, should be work- Fig. 199. ARMED NEEDLE FOR LIGA'ING .‘V ANEURISMAL ARTERY. 1 7 M 0 It S. 851 ed around the vessel to separate it from its accompanying vein or nerve ibis may be done by pushing rather than cutting, to avoid wounding the the nerve or vein. The ligature is improper in false aneurisms of large extent, after the pulsation has ceased in the tumor, and when caries or gangrene exists in the vicinity of the disease. After the obliteration of the cavity of the diseased vessel, the anastomosing vessels in its vicinity will enlarge to maintain the necessary circulation. In varicose aneurism the vessel must be tied both above and below the injury; this double ligation is necessary also in localities where there are numerous anastomosing branches, as on the dorsal surface if the hand and foot. The constitutional treatment is of first importance in all cases of or- ganic diseases of the blood-vessels. The diet must be simple, bland, and opening; all violent exercises of body or mind strictly avoided, and all bathing appliances must be mild and gentle, so as to prevent any shock to the circulation. Vaiiix. — Varices or varicose veins are tortuous, knotty, elongated thickenings and dilatations of the coats of these vessels. Varicose en- largements are most frequently found in the lower extremities, the great saphenal vein and its branches being the affected vessels; the spermatic and hemorrhoidal veins are also very liable to become vari- cose. In many cases the valves of the veins are destroyed ; the af- fected vessels are liable to inflammation ; and the lower limb is partic- ularly disposed to ulceration, which bleeds easily and heals with great difficulty. Varicose ulcers have existed twenty and thirty years, ren- dering the limb almost useless. Treatment . — Compression with the common bandage or roller, when skillfully managed, will often cure varices of the lower extremities. Surgeons have experimented largely in several processes — cirsotomy or incision, extirpation, ligation, and cauterization — but with very poor success in all. A plan for obliterating the vessels by the combined ac- tion of caustic and compression has been successful in many cases. It consists in the application of caustic to one or two very small portions of the distended veins at a time, so as to produce ulceration and ulti- mate adhesion, the part being, meanwhile, dressed with adhesive plas- ter or the wet roller. As soon as one dilatation or knob is obliterated, the caustic may be applied to another, and so on. I regard this prac- tice as perfectly safe provided due attention is paid to bathing and dieting. White Swelling — Hydrartiirus. — This formidable disease con? SURGERY. R52 moniy affects the knee-joint. Authors make two varieties, scrofulous and rheumatic, as it appears in persons predisposed to, or afflicted with, either of those complaints. Symptoms . — The swelling comes on very slowly, and is attended with little pain at first. Gradually the pain increases till it becomes intense, especially 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 this condition it may remain for 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 the 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 matter collects, and is discharged at various sinuous open- ings. Extensive caries of the bone often ensues, with hectic fever, soon terminating in death. Special Causes . — Repelled eruptions, local injury mercurial and antirnonial medicines, syphilitic taint. Treatment . — This is one of the maladies which the popular ‘-heal- ing art” does not pretend to heal. When the joint is very painful, it should be bathed in warm 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 thq 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 surfaces, 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- stitutional treatment, in which the packing-sheet should be the leading process. The regimen must be such as has been heretofore recom- mended for scrofula. Hydrops Articuli. — This is usually regarded as a result of rheu- matic disease, and hence called rheumatic white siveUing. It consists in a distention of the synovial membrane and capsular ligament by serous effusion, which renders the limb lame and stiff, though not very painful except from exercise. Sometimes the effusion extends along the tendons of the muscles. The warm or cold douche, wet bandages. TUMORS £53 the p ack-sheet, copious water-drinking, and frequent injections to keeo the bowels entirely free, are the remedial measures. Varicocele — Circocele — 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 requires no speckil attention, save a careful regard to hygienic habits; occasional sitz-baths, or the ascend- ing douche, with the use of a suspensory bandage. Hematocele. — This 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 produced 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. The 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 hydrocele • but the oval shape of the tumor will readily distinguish it from that af- fection which is pyriform. The morbid mass consists in part 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 “let alone” system, unless its bulk or malignancy cre- ates great inconvenience or suffering, in which case extirpation is the on’y »'©medy. • 854 SURGERY. Polypi. — The most common situations for polypus tumors are the nose and vagina, although they may grow from any introverted mu- cous surface. For all practical purposes, it is sufficient to distinguish them into soft and hard , although surgical 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 powdered 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 away such parts as may be conveniently detached. The powder should be applied with a camePs-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 from 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 die double canula , fig. 200, afte* which it is to be drawn Fig. 200. tight enough to cut off the circulation and strangulate 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 b} r ligature, the tu- mor may be destroyed by a solution of the caustic potash, introduced through a silver catheter ; or the powdered caustic may be applied b> means of pieces of fine sponge, with threads attached to withdraw them TUMORS SS5 Nodes. — A majority of bone tumors are included under the term exostosis, and the term node 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 ( Cooper's Surgery ), “ I believe that true 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 many 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 ; aftef which the cold treatment may be employed as above. 356 SURGERY. CHAPTER ^ ULCERS. Ulcers are purulent solutions of the continuity of the animal tex- ture. In a general sense, they are distinguished into the benign, or healthy , 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, scrofulous, inveterate phagedenic, virulent, sordid, caco ethic, carious , varicose, etc. Many tumors, if not arrested in their early stage, become ulcers, as cancer carbuncle, 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 irritable ulcer is very tender to the touch ; extremely liable to bleed ; its discharge is slight, and of a thin, ichorous, or sanious ap- pearance ; its color is dark or purplish ; its granulations are imperfect and spongy ; its edges are ragged and everted ; the parts around are red, swollen, 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 is 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. General Treatment of Ul:ers. — The constitutional treat-men/ ULCERS. 857 is always of primary importance in chronic ulcerations of every kind In all matters of regimen the patient must be held to a strict accounta- bility to physiological law. The whole sk.n must have, at least, one thorough daily ablution or packing. The local medication will vary ac- cording to the character of the ulcer. The healthy ulcer needs not hing . 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 still 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 bile, as some authorities have it, is a small phlegmon, seated in the dermoid texture, and tending to a pointed tumor which sooner or lat^ 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-brush daily, are seldom troubled with such affections. Fever Sores. — The most common form of chronic ulcers are anown as “ fever sores," “ brand y sores," 44 whisky sores," etc., and some- 858 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 bard 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 warm water or the warm fomentation ; when hot and inflammatory, the cold douche should be applied to the whole limb daily. Callous or fungous 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 — and thoroughly wetted with cold water after 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 never dangerous to cure hy^ropathically. Caries and Necrosis. — These terms are often employed synony- mously ; but in strict surgical parlance, caries is an ulceration of the bony structure, analogous to gangrene of the soft parts ; while necrosis is the death of the bone, analogous to v lortif cation . Caries usually attacks the spongy bones, as the vertebrae ; and necrosis as generally affects 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 — analogous 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 regular apex or point, but is more distressing than ordinary inflammatory swellings, especially at night. The part is hot, somewhat livid, and sometimes comes on suddenly and progresses rapidly to suppuration. ULCERS. m 1 The pus is dark, sanious, and foetid, 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. AVhen 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 far as any thing can be lenowrt, it seems to be 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., see ins 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 mercury.” 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 Nathan 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 the 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, strammonium, etc., poultices, to help “ digest” the affair; 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 whiter or darker thaa 4 MO SURGERY. natural — the caustic should he applied to it. “The mild caustic,” say? Dr. Hill, “ has a peculiar effect on diseased bone, and seems to exert a stronger influence than the bi-carbonate, or even the pure alkali — caustic potash — without any injury to healthy parts.” When there are several openings they should be converted into a single ulcer if possible ; for* which purpose the caustic, knife, or ligature may be em- ployed according to circumstances. Dead bone and fungous growths may be dissolved by passing tents, charged with the sesqui-carbonate of potash, into the sinuses, and pushing them against the morbid struc- ture. Sometimes new bone is formed around the dead part, inclosing it in a shell, and producing a preternatural enlargement of the part ; an opening, however, is usually left in the new formation, through which purulent matter issues. This opening must be enlarged by caustic sufficiently to allow of armed tents or caustic solutions to be passed through a tube or syringe to the dead bone, to effect its disso- lution. After every vestige of disorganized matter has been removed from the ulcerated cavity the ulcer will heal kindly ; yet the bone will generally remain preternaturally enlarged. Fistula in Ano. — Any abscess about the rectum, opening either within or without the anus, or both, is known by the term , fistula in ano . Fistulse are so common in this situation, that some physicians, whose practice, “from being general is confined to a particular branch of their profession,” have selected “diseases about the anus” as the particular field which is to engage their “profound attention.” Fistulas in ano are usually connected with piles, and both have habitual costive- ness as their common cause, although the former is sometimes occa- sioned by wounds and injuries. When there is an open communication between the rectum and the cutaneous surface, the fistula is called complete ; and incomplete or blind when it communicates with but one ; the latter is called blind internal or blind external fistula, as it opens into the bowel, or upon the exter- nal skin. In a majority of cases the fistulous pipe, or sinus, is tortu- ous and branching, several distinct openings being internally connected. The sinus is lined with a semi-cartilaginous, or callous growth, having the secreting property of mucous membrane, from which exudes a thin, yellowish pus; this indurated surface is generally extremely ten- der to the touch. Treatment . — The “ standard authors” on surgery are surely not well posted in the matter of curing the disease under consideration. Their plan of laying the ulcer open with the knife is always barbarous, generally unsuccessful, and sometimes fatal. More than twenty years ULCERS. 361 ego a self- constitute cl reform school of medicine in the city of New York, published to the world (Dr. Beach's American Practice of Med- icine) a successful method of treatment; vet we do not find the regular professors adopting or commending it, perchance on account of its ir- regular origin. The main features of this method consisted in substi- tuting the ligature and the caustic for the knife and the scarificator. The first process is to subdue the inflammation and overcome the irritable condition of the ulcer, for which purpose frequent warm hip- baths, with the wet compresses, must be employed ; after which the exact state of the cavity may be ascertained by the probe. The com- plete fistula may be ligated by passing the threaded probe from the ex- ternal to the internal orifice, the string being brought down by the fin- ger introduced into the rectum. The ligature is to be tied as firmly as the patient can well bear, and tightened a little daily. Dr. Hill's meth- od — the best extant — of tightening the ligature is, before tying, to let the ends of the string pass trough a large vial cork, separating three fourths of an inch where they emerge, and passing over a little wooden roller, fitted to radial grooves cut on the end of the cork, fig. 201 . These notches will hold the stick, after turning or twisting to tighten the string. While the process of ligation is going on, the caustic powder must be inserted by means of pledgets of lint to act upon and dissolve the cal- lous or cartilaginous growths. If several sinuses exist they must all be managed in the same way, and every callous fissure must be thoroughly cauterized. The part should be frequently bathed or fomented with warm water when painful, and several folds of wet cloths, covered with dry, kept constantly applied, being retained in place by a T bandage. When branching sinuses lead into or from the main one, they should be enlarged, and all the callosity along their course destroyed by the armed tent. A blind internal fistula should be opened with a pointed probe or the caustic, at the point nearest to the external surface, thus converting it into a complete fistula to be treated as above. The blind external fistula can often be cured by the armed tent alone ; but if this fail, the threaded probe can be passed through the bottom of the sinus mto the rectum, and the ligature applied. It will usually take several months’ time to cure bad cases of this af- fection ; and during the whole course of treatment the patient’s diet should be extremely simple, the hr wels kept entirely free by injections, 11—31 Fig. 201. FISTULA LIGATURE. m2 riURGERY. and he should keep very quiet, resting much of the time in the hori- zontal position. Fistula in Perineo.- — A sinuous ulceration in the perineum is generally the result of a stricture in the uiethra; the urine, thus ob- structed, 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 gull a 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 introduced before he rises, so that the bladder may be 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 fistulee 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 strictured, 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, sometimes produce it. Symptoms . — The spasmodic stricture is known by the sudden stop- page of the stream after it has reached the irritable spot ; there is alse a desire to urinate frequency and hurriedly. In the organic stricture the stream becomes crooked, 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 biad* ULCERS. 363 lor. The constant habit of straining often induces hernia or piles ; and when extensive ulceration has taken place, rigors and hectic fevex are the precursors of a fatal termination. Treatment . — The first measure is to relieve the bladder. When ine stoppage occasions a tense, round, painful distention above the pubes, the catheter must be employed ; the gonorrheal inflammation 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 potash, 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 gonorrheal or gleety discharges, so a majority will get well by reproducing the discharge ; and this may gen- erally be done by the persevering employment of warm baths and fomentations. 564 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 fistulae, all callous formations must be removed by caustic ; and the constricted intestine must be mechanically dilated. A piece 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 g*r\oves in the rectum, extending upward from the orifice. The edges of the crack or fissure become thickened and hardened, and constantly exude a sanious fluid. These should be removed by caustic, as in the case of fistulae, 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 are entirely healed, the canuia or tube may be removed. Fistula 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 which the tears are discharged 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 sd obstructed as to re- quire piobing, and the application of a tent. ABSCESSES £65 CHAPTER VI. ABSCESSES. An abscess — aposteme — imposthume — 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 lined 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- ed, a sensation of weight and throbbing continues in the part, 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 & fluc- tuation 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 fasciae and dense fibrous tissues, do not readily point, but they are attended with greater constitutional disturbance ; and severer hectic symptoms, as shivering?, night-sweats, small, frequent pulse, etc. A sense of weight and cold- ness in the part wiil also succeed the acutely throbbing pain ; and not ^infrequently 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 tfhe chest, with difficulty of lying on the sound side. Treatment . — In a few instar ces the matter has worked its way intc the bronchial tubes and been expectorated, followed by recov^rv 566 SURGERY When any thing 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 tube ; to prevent which, the patient may incline, after the introduction of the canula, on the affected side ; or a valvular instrument may bo 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 him. 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 Absci ss.— 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 clays thereafter suppuration takes place, beginning in several distinct parts, and forming many sep- arate sinuses, all of 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 most 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 produced, 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, .s the local appliance. Water may be drank freely, but the diet should >e 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 tumor 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 earty 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 opening may be ma le to it with caustic potash. After the abscess is 368 SURGERY opened, moderate compression should be kept up, and the water-dress ing continued. Note . — Sometimes the swelling of a lumbar abscess in the bend of the groin 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 ic 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 feraoris ; 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 affect the groin, and may be severe. Extensive ulceration has generally taken place when purulent matter makes its appearance ; this may be discharged at several points, although the abscess commonly opens in the groin. In some cases the head of the femur is not destroyed, and anchylosis 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 destroyed, 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 they are 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 w r ork its way inte the rectum qv urethra. HERNIA, OR RUPTURES. CHAPTER VII. HERNIA, OR RUPTURES. The terms hernia and rupture are commonly employed as synony mous; but writers who are strict in the use of language, apply the former word to all protrusions of the viscera or parts from their nat- ural cavities, while the latter term is limited 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 Hernije — These are innumerable. They may in volve the brain , lungs , stomach , intestines , bladder , the different poi 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 PouparUs ligament, are the places where hernia? most frequently appear. They are met with occasionally at all points of the linea alba, at the foramen ovale, the ischiatic notch , in the perineum, and in the vagina. Technology of Hernia. — This is derived from their contents and locality. A protrusion of the brain is called encephalocele, or hernia cerebri; of parts within the thorax, pneumatocele ; of the stomach, gastrocele ; of the intestine, enterocele ; of the omentum, epiplocele ; of both, enter o- epiplocele ; of the liver, spleen, bladder, uterus, etc., hepatocele, splenocele , cystocele, hysterocele , etc. Abdominal herniae are distinguished according to the aperture from which they escape. A' or near the navel they are called umbilical — exomphalos, or empha - locele ; through the linea alba above the umbilicus, epigastric ; through the linea alba below the umbilicus, hypogastric, infra-umbilical, or cceliocele ; through the abdominal ring, inguinal, or supra-pubian, 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 canal, femoral, or mero - cele; through the opening which gives passage to the infra-pubian ves sels, infra-pubian ; through the saci '-ischiatic notch? ischiatic hernia 370 S L RGERY. through the levator ani, and appearing at the perineum, mesoscelocele, or perineocele ; through the narietes of the vagina, coleocele , elytrocele ; and through the diaphragm, diapkragmatocele , etc. “ Veniral hernia '' 1 includes all forms of abdominal protrusion, 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 ventro-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 is 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 hernise, 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 ring. Hernia is called reducible when the displaced part is attended with no disturbance of the genepl health, and is susceptible of being easily replaced ; when incapable of replacement, from its size or from adhe- sions, 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 Hernial — Surgeons tell us that blows, falls, violent exertions, as lifting, wounds, dropsy, abscesses, pregnancy, straining at stool, hard riding, 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* HERNIiE, OR RUPTURES. 371 fined society, scarcely ever go to stool without being obliged to strain dangerously, to respond to the 44 solicitation of nature.” And when this straining has been kept up for years, it is not remarkable that very slight accidents should cause the 44 bowels to gush out” of their natural inclosures in the shape of hernial protrusions. Some have estimated "he subjects of hernia to be one eighth of an entire population. Diagnosis of Hernia. — In a reducible hernia the tumor may ap- pear gradually 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 will 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 ft 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 hernice 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 er 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 affected, 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 foecal 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 cessation of the pain , denote the existence of mortifica- tion, and the approach of death. General Treatment of Hernia. — When the hernia is reduci- le, 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 parts so altered, that it is advisable merely to support the tumor with a 572 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, which should be so managed as to obviate the least tendency to con- stipation. 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 suddenly becomes incarcerated, and in all cases of strangulation, the first attempt at relief should be by tli8 taxis, or hand operation. The taxis can almost always be successfully performed by any one who has a clear idea of the mechanism of the part and the existing obstacles. The patient is to be placed in a horizontal posture on the sound side — these directions apply particularly to inguinal and femoral her- nia, other varieties not requiring special instructions — with the hips elevated, the chest inclined forward, the thigh of the affected side flexed upon the abdomen, and drawn toward the 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 com- pressed with one hand, while the forefinger of the other hand presses as much of the tumor as possible up to and within the point of protru- sion ; the returned portion is to lie retained while the middle fingei pushes up another portion, when the forefinger may be again em- ployed for still another portion ; the middle finger holding the part it has brought up or the ring finger may be used, while the others are botli occupied in holding the advantage gained. In this way the whole tumor is to be removed. In the external inguinal hernia , the pressure must be directed up- ward and outward , along the course of the spermatic cord ; but in fern- oral hernia it is to be directed first downward and then backward. In umbilical and ventral hernia the pressure is to be made directly back- ward. 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 constriction around the neck of the sac, etc. ; but these things should not discourage us. We have in cold water or ice a suitable auxiliary for the first-named complication ; its assistance will often enable us to suc- ceed at once. When the part is excessively tender and irritable, hot water must be brought in requisition. The full warm hath, or local fo- mentations. cr both, may be employed, and these may be followed b> HERNIAS, OR RUPTURES. m a reapplication of the ;,old process. Our “old school” friends, on their 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 bringing about relaxation and quietude ; but warm water externally, and inter- nally by injection, may be made to produce any degree 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 within, and which is not mentioned in any other work with which I am acquainted. A large cup, or any convenient vessel, may be applied to the abdomen, covering 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, w r hen 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 w T ith 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 u* 32 m SURGERY. introduced, fig. 203. and passed up to the neck of the sac to find Fig. 203. the stricture, which may be at the internal or external ring, or at both pla< es ; 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 up Jiat- Fig. 204. wise, along the finger, and pushed on through the stricture. Its edge Fig. 205. is then turned up- ward, cutting no mor© than necessary to ad- mit the finger, figure 205. The cut must always be made di- rectly upward, pand- lel to the linea alba, to avoid the epigas* trie artery. Afte? CUTTING THE t'TRICTUR S' HERNIJE, OR RUPTURES. 375 the stricture 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 Hernia. — 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, sheath, or cavity, where the rupture presents. Professors Morrow and PI ill, of Ohio, employ an irritating-plaster — compounded of bloodroot, mandrake, wake- robbin, pokeroot, tar and rosin — large enough to cover the whole canal 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 is adjusted as tightly as the patient can bear, the compressicrti 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 protrusion must on any account be allowed to take place during the treatment. Should the 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 bj T simple flour to the surface, over whie> SURGERY". warm wet cloths might be applied. It is contemplated, by this plan of treatment, to excite a purulent discharge from the surface covered by the plaster, and eep up the suppuration from four to six weeks. The principle upon which this cure is predicated is clearly correct ; and a score of physicians, all understanding the principle, might find a score of ways to apply it successfully. It can matter but little what the irritants are, provided they produce precisely the proper degree of irritation, and do not poison the system from absorption. An as- tringent plaster, made of the extracts of hemlock, white oak, green ozier, and the common or rock break, with the occasional application of a few drops of oil of eggs , in combination with the pad and truss, constituted the empirical but rather successful plan of Hurlbutt's treatment of hernia, for which he obtained a patent. Umbilical and Ventral Hernial — Infants are most subject to umbilical hernia; the protrusion is generally imputed to straining while crying, when the abdominal bandage which is placed around the body is too loose . This is one among many great errors which have crept into professional men’s minds. The truth is, that this bandaging the body is just what produces the rupture in a large proportion of cases. It is this that makes the child cry and strain ; and the tighter the abused infant is girded with it, the more it will cry and strain, and the more liable it will be to have a rupture. It sometimes occurs in parturient females from the muscles giving way during the powerful contractions upon the gravid uterus. Treatment . — The protruded portion of bowel can generally be re- duced very easily by the hand, after placing the patient on the back, with the shoulders moderately elevated, and the thighs flexed upon the abdomen. A sufficient degree of adhesive inflammation to effect a radical cure may be excited by a modification of the plan proposed for t^e preceding varieties. A much less amount of external irritation will usually answer the purpose, and the pad of the truss, by which the compression is made, must be so adjusted that the pressure will keep the sides of the aperture constantly in contact. Dr. Hill gives the following directions for the mechanical treatment, which I copy as the best extant: “Take a circular piece of the thick spongy portion oi sole leather, of the proper size to cover the opening, and extend from one and a half to two inches all around it. Excavate the fleshy side of the leather, so as to make it regularly concave, the center of the de- pression being about half an inch below the plane of the circumfer- ence. Place the patient in the position for reduction, and bring the parieties of the hole in the muscles in contact, so as completely U DEFORMITIES. close the orifice, by pressing from 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 fint, wet in a strong decoction of white-oak bark. This application should be just large and thick enough to fill the excavated surface 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, unless 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 through the pad and cotton.” One or two weeks will often suffice 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 interrupt the adhesive process. CHAPTER VIII. DEFORMITIES. The deformities which result from accident, disease, or malconforma* 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 Leporinum. — This is a fissure in the upper lip, which may 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. double hare-lip. Treatment . — The operation of tying ty the twisted suture is the 378 SURGERY. only remedy. The edges of the fissure are raised with the fingers or forceps ; a fiat piece of wood is placed between the lip and gum ; and the edges are then pared off from both sides upon the wood with a scalpel or bistoury, leaving the edges straight like the shape of the let- ter V. The bleeding ran be stopped by sponging with cold water, after which a thin sewing needle is passed through and across the fis- sure near its lower extremity ; the needle must penetrate nearly to the inner surface of the lip, which will keep the inner edge together while the ligature secures the outer edge. After this needle is secured by the thread two others are to be introduced above at proper distances, 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- 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. 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, though very apt to exist in the imagination of nurses. When the frenum linguce is extended to the tip of the tongue, firmly holding this “unruly” member to the floor of the mouth, and preventing the child from sucking, it is a 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 than deformities ; yet it is sometimes advisable to excise them. The proper instrument for doing this, fig. 207, has an angular or rounded Fig. 207. INSTRUMENT FOR EXCISING THE TONSILS 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. DEFORMITIES. 379 SPECULUM APPLIED TO THE EYE. Squinting- -Strabismus. — In the majority of cases of permanent b juinting, the difficulty is owing to a disproportionate contraction in the recti muscles, one being too much relaxed and the other preternatu- ralfy 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> oo* hitched to the conjunctiva midway between the margin of the cornea nnc internal canthus, by which the ball is rolled outward, ns represented in fig. 209, and the handle then held by an assistant. The operator next raises the conjunctiva with 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. After the opera- tion, the eye requires to be kept covered for a day or two with a w< Fig. 209. OPERATION FOR STRABISMUS. cloth. Superfluous Fencers 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 ma}' readily be got rid of by means of the ligature or knife. Web Fingers.- These only require division by the scalpel, and 580 SURGERY. be prevented from reuniting by a piece of oiled silk kept between tho fingers until cicatrization takes place. Wry Neck. — 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 the muscle has been completely divided, it will snap back. The hemor- vhage can be prevented by the ordinary compress. Spina Bifida — Hydro-Rachitis. — There is a possibility of curing some cases in which the membranous covering is rather thick and firm, by means of a linen compress and bandage, applied moderately tight, and so adjusted as to press the tumor down to a level with the surface. If inflammation exists, tho 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 predisposing and proximate causes. Fig. 210 is a representation of a single curva- Fig. 211. DOUBLE CnF?AT”R& DEFORMITIES. 381 tore 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 sets of muscles out of balance. In double curvatures the misposition 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, £g. 212, and I introduce the subject in this place for the especia* pur- Fig. 212. SALIVATION 882 3 U R G E II Y. poses of protesting against its cause, and against the treatment which' 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 Medica ), 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 car be given or regarded to regulate its administration” 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. 383 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 evated. In the second variety — talipes equinas — fig. 214, the heel is more or less elevated, the patient walking on the ball of the foot or on the 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 vulgus — 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 contraction of the the outside of it, the heel being ek Fig. 215. TALIPES CALCANEUS SURGERY. $84 muscles of the calf of the leg and the adductors of the foot ; ttie seo ond variety is usually owing to a contraction of the gastroc n «mii 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 variety 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 by 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 of a 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 Tails, or is not applicable, the operation of tenotomy — a division of the contracted tendon or tendons — is the only chance. A division of the tendo achillis is sufficient in a majority of cases of the first variety. 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 so to put the tendon firmly on the stretch, this is cut through, when 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 tibia! muscle can be most readily divided about two inches behind and above the internal malleolus ; the anterior tibia!, 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 fingers or toes over-riding each other. The fingers are also contracted from in- flammation, and a “club-hand” is sometimes met with. Some of tne cases may be relieved by an incision through the skin ; but others re- quire the operation of dividing the tendon or muscle affected — tenotom y mi, otomy. DISLOCATIONS. 885 CHAPTER IX. DISLOCATIONS. Technology. — A displacement of one bone from its natura articu- lation with another is called a simple dislocation, when unaccompanied with external laceration or fracture ; and compound and complicated , 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. Symptoms . — 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 may 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 great 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 cf the shculder, the II— 33 SURGERY 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 contrive some way of diverting it, at the moment when extension has been carried to 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 S3 simply 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 limb out of place as much as possible, in fhe 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 had 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 off it by extension made in any oblique direction, the instant this ridge i§ passed, the head will rush back into its natural cavity. So, also, in dislocation of* the femur on the dorsum illi, we do not attempt to draw the bone in a direct line with the acetabulum, but we carry it below, round its back and elevated margin, and no sooner does it reach 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-joint. 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 bring the bon^ sufficiently downward, and place it in the neighborhood of the articulation, the muscles will replace it with as much ease as that which originally dislocated it. 44 The bone appears, as it were, sucked violently into the socket, even DIALOG AT) ONS. 387 at the instant of its sustaining the greatest 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 oi gaping, or from a blow on the 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 as 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- dislocation of the jaw. gers on the sides and under sur- face of the jaw; then press doivnward with the thumbs, and forward and upward with the hands; the thumbs must be removed as the joint slips in its place. Fig. 216. 3URGEHY. *88 Dislocation of the Clavicle. — The collar-bone may be dis- Fig. 217. placed at its sternal or scapular extremity ; in the former case it is pushed foiward or backward, and in the latter generally up- ward. Fig. 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 the shoulder backward and slightly Cl AVICLE BANDAGE BEHIND. CLAVICLE BANDAGE ANTERIORLY. 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. Fig. 219. geoos 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 different 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- nary 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 drawn inward toward the sternum. In reducing it, the surgeon, standing behind the patient, places his knee between the shoulders, and draws them both backward, until the clavicle sinks into : *ts place. The arm-sling and clavicle bandage are so applied as to keep the nrm pressing slightly up- ward and backward. Some degree of deformity will always exist after these accidents. 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 Fig 220. 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 support 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 luzc tion, fig. 221, the head of the humerus can be plainly felt, and g 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 <590 SURGERY. head, which, when the arm is rotated, can be observed to move. The elbow is thrown further back than in the downward luxation, the arm is much shortened, and there is great difficulty in moving the arm in any direction. In the backward luxation , fig. 222, the projection of the head of the Fig. 221. Fig. 229 FORWARD LUXATION. BACKWARD LUXATION. bone is apparent at first sight, and when the elbow is rotated it is seen to move. It may also be felt by applying the finger just bel< w the Fig. 223. DISLOCATIONS. 391 «pine of the scapula, and the change in the axis of the limb is quite ob- vious. This variety of dislocation is extremely rare. Treatment . — 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 the surgeon, sitting be- fore him, puts his unshod heel on the head of the bone in the axilla* and presses it upward, while he pulls steadily and firmly on the arm until the head of the bone slips into the glenoid cavity. By this simple 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. 224. counter-extending bandages so applied as to let the arm pass thro iga them. For the extending bandage, a wetted roller, placed around the arm above the elbow, with straps or slips of doth 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 gradual and steady extension upon it, an equal amount «92 SURGERY of force being employed in producing counter-extension at the same time. After the strain upon the muscles has been continued for some time, the surgeon, resting his foot on the chair, pushes his knee into the axilla and presses up the head of the bone, while he presses down on the acromion with one hand ; making also slight rotation upon the arm. There is another inethci by which a majority of recent dislocations can be easily replaced without waiting for the regular surgeon. Placs the patient in a chair, fig. 225, extend the luxated arm as far as possi Fig. 22f>. REDUCTION OF RECENT LUXATIONS. ble from the side, then, with the knee in the axilla — the foot being sup ported on a chair, and the heel raised so as to press the knee upward — grasp the humerus above the elbow with the hand, pressing down upon 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 luxation , the extension is to be made obliquely down- ward and slightly backward. The resistance is usually stronger than m axillary dislocations ; 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 its cavity. In other respects the management is the same as for the pre- ceding variety. DISLOC ATIC NS. 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 slowhv 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 days, 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, and laceration. Sur- geons distinguish five varieties of dislocation. Both bones of the fore- arm may be pushed backward , or to one side ; the radius may be dis- placed forward; the ulna alone may slip backward over the condyle 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. ELBOW LUXATION BACKWARD. fig. 226, the posterior projection is 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 tendons, 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 backward. In the outiuard dislocation, fig. 227, the projection of the ulna is still greater; the co- ronoid process is fixed at the external condyle ; ancj the Hat head of the radius forms a projection outside and behind the elbow, with an abrupt cavity above lateral bisloca- it. In the inward luxation, fig. 228, the head of TR,N 0Lrrvv ’ ARD - the ulna is displaced behind or jver the internal condyle, projecting i* *94 SURGERY. Fig. 228. LATERAL dislocation INWARD. that direction, while the external condyle is made equally prominent on its side by the radius occuyping the place of the ulna. When the ulna is dislocated backward , the olecranon can be easily felt behind the humerus ; the arm cannot be straightened, nor can it bo flexed to more than a r ; ght angle ; the forearm and hand are also tw ; sted inward. In dislocations of the radius forward , fig. 229, the foream: is more or less bent, but in attempting to flex it further, it is suddenly stop- ped before it 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 band is pronate, and cannot be turned. Treatment . — The first variety is easily re- Fig. 229. FORWARD LUXATION OF THE RADIUS. BACKWARD LUXATION OF THE RADIUS 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 DISLOCATIONS. S98 nerus, and to bring the coronoid process out of the posterior fossa, so that it can pass over the condyles, while the arm is bent slowly and Bteadily with considerable force. This form of luxation can generally be reduced with the aid of suitable hot water relaxant processes, a long time after the accident. The second variety is mainly reduced by bending the arm over the Burgeon’s knee, as in the preceding case ; less pressure, however, ia 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 part of the oper- ation, the fixed radius acting like a lever to push the humerus back into 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 upward . It will facilitate the reduction to have the arm slightly bent. In the fifth variety extension is to be made upon the radius, and counter -extension 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 both bones 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 both bones are displaced back- ward, they project over the carpus; the carpal bones are thrown for- Fig. 231, BACKWARD LUXATI IN AT THE WRIST. ward and upward under the flexor tendons, in front of the forearm, This luxation is represented ir fig 231. These luxations may be di^ 896 SUEGEKY. tinguished from sprains, or strains , by the more sudden occurrence and more uneven appearance of the swelling. When the radius alone is displaced, the external or thumb side of the 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 the wrist. When the ulna alone is detached, which more fre- quently happens, the connecting ligament is necessarily ruptured ; the hand is twisted, the bone projects at its back, from where it may be easily pressed down ; but when the pressure is removed, the deformity will 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 thatjohst 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 treatment 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 splints 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 Metacarpal 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 cpmpresses and bandages. Luxations may occur at any of the phalangeal joints, and the smaller none may project over or under the larger, constituting the posterior Fig. 232. POSTERIOR PHALANGEAL LUXATION. DISLOCATIONS. 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. REDUCTION OF DISLOCATED FINGERS AND TOES. easily affected; but if a long time has elapsed since the accident, the extension may require to he 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 inquires great extending force, during which i f should be flex- ed toward the palir of the hand. It should also be wej covered with wet tape before the clove -hitch tape is applied. Dislocations at theHh**Toint. —The head of the femur may be displaced upward on the dorauw oi 34 Fig. 235. 398 SURGEK Y fth© ilium, fig , 236, 3r downward , into Fig. 236. the foramen ovale, fig. 237, or Fig. 237. DOWNWARD LUXATION. UPWARD LTJXATK N. backward luxation forward luxation DISLOCATIONS. 899 backward, into the ischiatic notch, fig. 238, or forward, 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. Symptoms . — In the fust variety the 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 patietit 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 of 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. 400 IURGERY. In the back v ard luxation, the head of the femur can rarely be felt the 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 great toe, and the limb is shortened from half an inch to an inch, fig. 242. In the forward and upward luxation, the head of the bone is at once discovered in front, and a little above the level of Pou part’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, but 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, und their resistance powerful, it is always prudent to relax the whole Fig. 242. Fig. 243. DISLOCATIONS. 401 muscular system before attempting reduction. An admirable and ?ery 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- sition by pillows ; while in the pack the patient should drink abundant- ly of warm water, and after being sufficiently relaxed for the opera- tion, he should be kept well covered in flannel blankets to retain 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 upward displacement the patient is laid on a table, or placed Fig, 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 fastened to some unyielding point. A wet bandage, of eight or ten turns, is applied around the limb, above the knee, and to this the extending straps are attached. These are to be drawn upon by the assistants in the direct line of the limb ; or, what is better, attached to a pulley, so stationed that the extension may draw in a direct line with the fastening of the counter-extension. The force is to be steadily increased as long as the 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 head of the bone reaches the edge of the socket, when the surgeon rotates the limb a little, and elevates the head until it enters the aceta- bulum. The snapping noise, as the head of the femur slips into its socket, wtnn the extension is made by ma aual force, is not always 02 SURGERY heard when the force is more steadily and gradually applied by the pulleys; henje it is sometimes necessary to ascertain the fact of its replacement by actual measurement; and until this point is settled the extension 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 44 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 kind , 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 ©f the upward. The patient is placed on the back, the thighs sep- Fig. 245. areted, fig 245 ; a folded cloth is placed over the perineum, so that when the ends are drawn upon the force will bear against the innef dislocations. 403 and back surface of the bone. Another strong band is passed transverse- ly around the pelvis, above the acetabulum, the front end passing over the former strap, so as to give to it a more upward direction. The force is then applied, as in the former case, and as the head of the bone be- gins to rise, the surgeon passes his hand under the opposite leg, and, seizing the ankle of the affected one, brings it gently, yet firmly, to- ward the other; by all of which movements combined, it is brought into its socket The third variety, dislocation backward into the ischiatic notch , is the most difficult of all to reduce. The patient is placed on his sound side Fig. 246. REDUCTION OF BACKWARD LUXATION. on a board or table, fig. 246, with the affected thigh drawn over the middle of the other. Extension and counter -extension are made in the same way as in the first variety, with the addition of a strap around the upper part of the thigh, which is carried over the shoulders of an assist- ant, to raise the head of the bone at the commencement of the opera- tion, out of the notch, or impart a lifting direction to the extending force, The surgeon may also press the trochanter forward with his hand. In reducing the forward and upward luxation, the patient is placed Fig. 247. ** EDUCTION OF FORWARD LITXATI DN 404 SURGERY. on his sound side, the counter-extending force fixed somewhat in front of a line with the body, the point of extension being as much behind, fig. 247. The forces are intended to be so arranged as to draw the limb backward as well as downward . The lifting strap is to be era- Fig. 248. OUTWARD LUXATION OF PATELLA. ployed as the extension progresses, an assistant pressing down on the pelvis, as the surgeon raises the head of the femur over the pubis and edge of the acetabulum. Dislocations at the Knee-Joint. — The pa- tella may be displaced outward , inward, or up- ward ; and the tibia may be dislocated from the femur forward , backward , or to either side ; the lateral displacements, however, are only partial. Symptoms . — The outward dislocation of the patella, fig. 248, is more frequent than the inward ; but in either case the knee is partially flexed, and the joint immovable ; the patient also complains of a sickening pain in it. The upward displacement, which is attended with rupture of the ligament 5 is perfectly obvious to the sight. In the forward dislocation of the tibia , fig. 249, the head of the bone is seen and felt above the LUXATION FORWARD. LUXATION backward DISLOCATIONS. 406 front of ^.he condyles, these being perceived in the popliteal space. There is also numbness of the foot, from pressure on the nerves and popliteal artery. In the backward luxation, fig. 250, the limb is sensibly bent, and somewhat shortened; the condyles project; and the flexure of the limb is backward instead of forward, the foot being drawn forward. In the lateral displacements one condyle of the femur rests on the head of the tibia, where the other condyle belongs, the displaced on# projecting externally or internally, as in fig. 251 and fig. 252. Fig. 251. ' Fig. 252. LATERAL. LUXATION EXTERNALLY. LATERAL LUXATION INTERNALLY Treatment . — To reduce the outward dislocation, the patient is placed in a recumbent posture, the limb raised by the heel, to relax the ex tensor muscles, and then the displaced bone is pressed down to its place, the force being applied to the edge most distant from the joint. The upward dislocation is easily reduced, but with difficulty kept n its place, on account of the rupture of the ligament. The roller , skill- fully applied from the toes to the groin, will generally answer, and this may be assisted by a straight splint fastened mder the Wi de length of the leg. All the varieties of luxated tibia are reduced by the same plan, which is chiefly that of simple extension. The pelvis is fixed, and a Dan^age placed round the ankle by which the extension is made. While the assistant pulls upon the ankle, the surgeon presses upon the separated head of the bone with his hands. 406 S URG ERY. Dislocations at the Ankle. — The ankle joint may be displaced inward , outward, forward, or backward. The accident is frequently complicated with fracture. Symptoms. — In the inward dislocation, fig. 253, which is the most common, the foot is turned out, and a tumor is formed by the internal malleolus pressing strongly against the skin, which seems ready to burst; the joint, however, is still movable. A depression may gen- erally be felt about three inches above the ankle, in which case the fibula is fractured. The outward dislocation is known by a corre- sponding deformity on the other side. In the forward dislocation, fig. 254, the foot is shortened, the heel elongated, and the toes point down- ward. The backward dislocation, which rarely occurs, is manifest to the sight. Treatment. — The manner of reduction is essentially the same in all cases. An assistant, holding the foot by the heel and toes, flexes the leg to a right angle with the thigh, and, while the thigh is held fast by another assistant, just above the knee, makes extension at the ankle, the surgeon at the same time pushing the end of the tibia into its place, Fig. 253. Fig. 254. FORWARD LUXATTOir. FRACTURES. 407 Splints and bandages are necessary, and wet cloths must be frequently applied, as there is usually considerable inflammation. Dislocations of the Foot. — When the tarsal or metatarsal bones are displaced, the nature of the injury is obvious. Reduction is ef- fected by extending the foot and pressing upon the displaced bone at the same time. Compresses and bandages are necessary. Dislocations of the toes are managed precisely in the same way as dislocated fingers. CHAPTER X. FRACTURES. Technology. — A fracture is called transverse when the bone is bro- Ken directly across ; longitudinal when it is split lengthwise ; and oblique when broken in other directions. When the fracture is not accompanied with an external wound, it is called simple ; when the soft parts are so lacerated that the fractured bones protrude, it is termed compound ; when occurring in connection with a dislocated joint, it is termed complicated ; and when the fractured bone is divided into sev- eral fragments, it is called comminuted. General Management of Fractures. — Although a few genera, principles are applicable to all cases, so great is the diversity of circum- stances attending these accidents, fhat much must be left to the sound judgment and mechanical skill of the operator. A great variety of splints, bandages, and other apparatus have been invented, all intended to keep the injured parts in contact until the broken parts of the bone unite. The process of re-union is as follows : Coagulable lymph, fibrin, and blood, thrown out by the vessels of the part, form a material which slightly glues, as it were, the bones together soon after the injury; in the next place, a provisional cartilage is formed around the parts like a capsule, firmly supporting them; this gradually hardens, by ossific deposits, into a bony ring, called the provisional callus , which binds the parts still more firmly together. After this the proper substance of the bone is formed, the ossific process going on for several months or a m SURGERY, year ; and when it is completed, the provisional support is removed by absorption. The period at which the reparative process commences and termi- nates, varies with the structure of the bone, age, and habits of the in dividual, etc. The provisional union ordinarily begins between the sixth and tenth day, and is completed in four to six weeks. The soon- er, however, that fractures are adjusted, the better ; and about the sixth or seventh day, when the “ knitting” may be expected to com- mence, the part should be examined and accurately adjusted, if need be ; after which it only requires to be kept quiet. Great care must be taken to have the part easy and quiet from the sixth to the twelfth day —in old persons for eight or ten days longer — after which slight mo- tion may be allowed. The symptoms of the provisional ossification, “ knitting of the bone,” are itching and prickling sensations in the part. Fractures of the Cranium. — Any of the bones of the skull may be crushed , the fracture extending in different directions from a central point; or cracked through one or both plates in a straight line. The skull bone may also be bent without being fractured. In the case of fracture, a crepitus can be felt through the skin ; and if any portion of bone is driven in upon the brain, symptoms of compression will be present. Treatment. — All the constitutional and local measures heretofore recommended for compression must be employed in conjunction with the appropriate treatment for any degree of inflammation that may at- tend. But if the symptoms of compression continue after the inflam- mation has subsided, the depressed bone must be elevated by trephi- ning, which should only be attempted by a skillful anatomist. Fractures of the Nose. — These accidents, though occasionally severe, are not usually dangerous, and their nature is apparent from the p. 055 resulting deformity. They can be adjusted by pushing out the depressed bone by a silver cathe- ter, or some similar instrument, introduced within the npstril, while the fingers support them on the outside. Fracture of the Lower Jaw. — The accident commonly occurs at the middle of the chin, fig. 255, although it may take FRACTURES. 409 place in any part. The crepitus felt on moving the bone will deter- mine the exact locality of the fracture ; a depression may also be felt at the place. Treatment . — The adjustment is effected by elevating or depressing until all the teeth are arranged properly with respect to each other and to those of the upper jaw. Should one of the condyles be displaced at the same time, it must be reduced previously to setting the broken t)one. The jaw must be secured — the mouth being kept shut — by Deans of a strip of adhesive plaster, two and a half inches wide ex- Fig. 256. SURGERY. *10 tending from ear to ear over the chin. The plaster should be spread on fine leather, as calf-skin ; and over this a jandage of strong muslin, two yards long and two and a half inches wide, split from each end to within six inches of the middle, is to be applied. A hole is made in the renter for the chin ; the two lower ends are brought up over the top of the head, and the two upper ends are carried horizontally round to the back of the neck ; several turns with each pair are then made, over and around the head, where they are fastened at their ends and also at each crossing. In the absence of adhesive plaster the com- press and roller, fig. 256, will answer all purposes. The compress under each ramus is held by an assistant until fastened by the first turns of the roller, which is an inch and a half in length and four or five yards long ; the first vertical turns are repeated over each other several times, followed by the horizontal ones above the ear over the occiput and forehead, and, lastly, several turns below the ear and lip, Pins or stitches are applied wherever the roller crosses or changes direction. Fractures of the Scapula. — When the body of the bone is fractured across, there is scarcely any deformity, but a crepitus is easily recognized on pressure. The only surgery required is a bandage so applied as to restrain those motions of the chest and shoulders which affect the fractured bone. When the acromion process is fractured, a depression is manifest ; the separated portion of bone is drawn downward and forward ; and, on pressing the arm upward, a crepitus may be felt. The adjustment consists in pressing the head of the humerus up, by which the frag- ment is carried to its place, and securing it by the clavicle bandage, omitting the pads or compresses under the arm. When the neck of the scapula is broken, the head of the humerus can be felt in the axilla, as in dislocations, and the acromion appears very conspicuous from the depression beneath. The fracture may be distinguished from dislocation by the crepitus perceived on pushing the arm upward and outward, with the thumb placed on the coracoid pro- cess, and the fingers in the axilla. The parts can easily be replaced end held in apposition by the clavicle bandage and a wedge-shaped pad under the arm. Fracture of the Clavicle. — A fracture of the collar-bone, which is usually oblique, and occurs near its middle, fig. 257, is readily de« tected by passing the finger along the edge of the bone. Crepitus oe* ^ ars on moving the shouldei . .? 11 A C T U It E S. 411 The adjustment and dressing are essentially the same as in the case of a dislocated clavicle at its scapular extremity. The surgeon, placing Fig. 257. FRACTURED CLAVICLE. his knee between the sho aiders, draws them both back until the parts of the broken bone come into their proper position, and, while the shoulders are kept back and the arms down, by suitable apparatus, or the hands of assistants, the bandage is applied. Fracture of ike Sternum. — The breast-bone is never broken, except by great force directly applied. The accident is manifested by a depression at the injured point, and pain and crepitus which attend the movements of the thorax in respiration. Its adjustment requires the roller around the chest, so applied as to stop all motion ; the res piration being carried on wholly by the abdominal muscles. Fracture of the Ribs. — The ribs may be fractured at their ver- tebral or sternal extremity. The formei case is frequently accompa- nied with dislocation. The latter, though generally called “ dislocation of the cartilage,” is really a rupture, and a rupture is much more like a fracture than a dislocation. A depression and crepitus may be de- tected by passing the finger along the rib. f the cartilage 13 torn from the rib, this bone will project. Treatment — In a majority of cases a broad Toller, applied around the chest so firmly as to prevent all motion of the intercostal muscles, will be sufficient. When a rib projects, the compress must be ap- plied ; and tapes, carried ovei the shoulder and fastened to the roller, near the spine and sternum, are necessary to prevent it from slipping 412 SURGERY. down. In extensive or complicated fractures, stiff adhesive plaster, or even gum-shellac cloth, or wetted pasteboard, fitted to the part, are useful additions. Preceding the operation of pressing the bones or cartilages down to their proper position, the patient should in all cases be directed to take a rather deep inspiration, and also to hold his breath as long as possible during the adjustment. Fractures of the Spine. — The transverse processes of the ver- tebrae may be broken off without serious inconvenience, and may be treated like fractured ribs. When the body or articulating surface is fractured, the injury is irremediable. Fractures about the fourth ver- tebrae of the neck cause instant death ; above the lumbar vertebrae, they are fatal in a few days ; and when these are fractured, the patient seldom survives long. Paralysis affects all the parts whose nerves are derived from the spinal cord below the point of injury. Fractures of the Pelvis. — These are only produced by extreme violence, of a crushing kind. They are always dangerous. The pa- tient should be placed in an easy horizontal position, and handled as little as possible. The nature of the injury will aid the diagnosis as to the particular point of fracture ; and generally crepitus can be felt by placing the hand on the crest of the ilium, while motion is made at the spine or lower extremities. A roller around the pelvis, with a strap under the nates, and attached to a pulley over the bed, so that the pelvis can be raised without effort on the part of the patient, con- stitute the principal surgery. Fractures of the Humerus. — This bone is usually fractured near its middle, but may be broken near either extremity ; when fractured near the neck, the injury is not easily distinguished from disloca- tion. Symptoms. — A fracture in any part of the shaft, as in fig. 258, may be detected by the obvious deformity ; the parts of the bone are drawn out of line ; the patient experiences pain at the injured point ; he is unable to move the limb ; and a crepitus can be noticed by rotating the lower portion of the arm, while the upper part is fixed. The di- rection and extent of the fracture may be ascertained by tracing from the condyles upward with the finger. Fracture of the neck , fig. 259, seldom occurs except in old persons. By rotating the arm below the elbow, a crepitus will be felt. The roundness of the shoulder is not diminished, as in dislocation. FRACTURES. 411 Fig. 258. FRACTURED SHAFT. Fig. 25S. Fractures near the condyles, fig. 260, are liable to be mistaken foi dislocation of the forearm. When the fracture is above the sondyles, Fig. 260. FRACTURE ABOVE THE CONDYLES. the arm will be shortened ; and in all cases the grating of the broken pieces can be felt ; the motions of the elbow are but little impeded ia fracture, which is not the case in dislocation. 414 SURGERY. Treatment. — When the shaft has been broken* sufficient extension must first be made ; the fractured arm is next to be accurately adjusted, so that the appearance and length of the limb will compare well with its fellow; the roller is then to be applied — the parts being held in jux- taposition, meanwhile, by an assistant — rather loosely from the elbow to the shoulder ; two or four splints — four are better — about a quarter of an inch in thickness, are then placed at convenient distances, so as nearly to inclose the arm ; the roller is then continued down over the splints, and back and forward, until the splints are sufficiently secured ; the forearm and hand are lastly to be suspended in a sling from the neck. When the neck of the bone is broken, a wedge-shaped pad in the axilla is necessary ; the shellac or pasteboard splint should be applied on the outside and over the top of the shoulder, and the whole fastened by the clavicle bandage. In the case of fracture above the condyles, after the proper adjust- ment, the roller is to be first applied loosely around the arm and fore- arm, and then over two angular splints, which should reach nearly from the shoulder to the wrist, one being applied on the front and the other cn the back of the arm. When the condyles themselves are fractured, the separated portions of bon© are to be pressed together, and a splint or cloth cap applied, reaching to the wrist, preceded, of course, by the roller. Some degree of deformity will always exist after these injuries. Fractures at the Elbow Joint. — Fig. 261 represents the olecranon process broken off and drawn up on the back of the arm, attended, ?f course, with a rupture of the ligaments. The patient can bend the arm easily, but cannot straighten it. There is also great pain at the point of injury. Treatment. — The inflammation must first be subdued ; "hen the arm is to be bandaged rather tightly from the ends of the fingers to the elbow : the broken end of the bone is next to be brought to its place, and in- cluded in the turns of the roller, which should be continued half way up the arm ; the roller is then turned back and passed above, and the elbow joint about a dozen times in the form of the figure 8 ; after it is continued upward, including the whole arm. Lastly, a strong splint is to be placed in front of the joint over the bandage to prevent flexiop Fip. 261. Fit ACTUItES 415 The coronoid process is sometimes fractured separately, attended necessarily with a backward luxation. It impedes the bending of the elbow. Its adjustment only requires the flexure of the forearm, and its retention in that position by proper bandages and splints. This fracture, and also the two preceding, unite by a ligamentous, instead of bony **unnection. Fig. 262. Fractures of the Forearm.- -Both bones may be fractured to- 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. When 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 trace 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 appears very much like a dislocation, fig. 265; Fig. 263. kJ \ FRACTURE OF THE ULNA AND RADIUS. FRACTURE OF THE RADIUS. out, on moving the hand, the styloid process of the radius moves with '% which is not the case when the bone is dislocated. Fig. 264. 116 SURGE R r. Treatment . — In the first variety — -fracture of both bones — the most important point in the treatment is to keep the bones apart. After ad- Fig. 265. justing the bones, by making the necessary extension at the wrist &ie arm should be bent at a right angle, with the thumb midway bet’ ,een pronation and supination ; the loose roller is to be applied, and this, fo T 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 nand to the elbow. When the radius alone is fractured the hand may hang loose, 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 splints 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 fracture 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 in three or four weeks to prevent anchylosis, no great exer- tion should be made by the hand for several months. Fractures 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 ftvnur may be frac- tured within or without the capsular ligament; the trochanter majw F R A C T U R E S. 417 FRACTURE WITHIN THE CAPSULE. Fig. 267. may be broken obliquely; and Fig. 266. the shaft at or near the tro- chanters, in its middle , or near the condyles . Symptoms . — The fracture within 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 several 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 jrepitus is more easily felt. When the bone is fractured obliquely through :he trochanter major , the leg is everted, a little shortened, and a fissure can be felt between the shaft and trochanter. 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 between 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 the broken parts slip- FRACTURED NECK 0* TH k FEMUR *18 S U R ?t E R Y. ping by each other; and this may be the case also in transverse frac- tures. The condyles of the femur are seldom broken except in old per- sons, and the accident is not unfrequently fatal. Treatment . — Sir Astley Cooper, in speaking of the various methods for treating fracture of the neck of the femur within the capsular liga- ment, says : *• Baffled 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 length ; 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 degree 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 power. A high-heeled shoe should be next employed, by which the halt would be much diminished. Our hospital patients, treated after this manner, are allowed in a few weeks to walk with crutches ; after a time a stick is substituted for the crutches ; and in a few months they are 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 any, 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 leathern strap should also be buckled around the pelvis, including the trochan- 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. Liston’s plan, applicable to all cases, as detailed in his own lan- guage, is as follows : “Whether the fracture is suspected to be within or without the joint, either entirely or partially, tne broken 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, some to be attached to the i»* ? it A C T U R E S. 419 jured limb, 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 board, 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 the 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- justment of the pads. The apparatus is retained by bandaging, fig. 268 , a common roller is applied round the limb, from the toes to near the knee, so as to prevent infiltration, which would otherwise follow Fig. 268 . 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 to 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 during 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 A fie' its removal, great care must be taken a first in moving ths 120 SURGERY. limb and putting weight upon it; it should be accustomed to its forme* functions very gradually.” Another convenient mode of fixing the thigh bone, is the concave double-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 glance. Fig. 269. The oblique fracture of the trochanter major is managed precisely like the preceding case. When the shaft is fractured, the most important point in surgery is 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 coves one third of the thigh, and perfectly adapted to the surface. All the splints are to be firmly fastened with a roller, when the limb should be 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 head of the tibia will press upon the condyles, and sa cured with rollers and splints. Fracturh of the Patella. — This bone is generally brokea transversely ; the upper fragment is drawn up by the rectus femorii. F K A C T U It H S. 421 the patient cannot straighten the limb ; and the fissure between the broken portions can le seen and felt, fig. 270. Treatment . — The usual method of adjustment is to secure the limfe in a perfectly straight position by a Fig. 270. 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 are 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, fractured patella. compresses, and paste-board splints. 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 fblly 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 with the inner edge of the patella. In oblique fractures, 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 foot is then to be 36 THE ROLI PH SURGERY £2 fixed to 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 splints. Any ingenious mechanic can make a ma- chine in an 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 fibula is sometimes broken about three inches above the ankle, ac- companied with partial or complete dislocation of the ankle, fig. 272. The internal malleolus, by projecting, forms a tumor, and when the foot is moved, crepitus can be felt just above the external malleolus. Fig- 272. The tibia is sometimes fractured near its lower end ; it may be transverse, extending through the fibula ; but is generally oblique with the internal malleolus also broken, fig. 273 The foot is turned im ward, and the crepitus is felt on the inside. Treatment . — In the first variety the dislocation must be reduced be- fore the fracture is adjusted. The fractured parts are to be kept w PARTICULAR OPERATIONS. 423 place by one splint at the back of the leg, another along the fibula, the foot-boaid, 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 circumstances 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 inflam- 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 structure of a mint, very gentle or passive motion should be made at the joint as carry .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 P, 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 instri* 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 instrument, 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, norover 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 off very gradually, so 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, when the inflammation is so intense that the “ordinary means” fail; but as the hydropath has ample and extraordinary means to subdue inflammation, he 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 Laciirymalis. — 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, which may be seen on drawing the lids outward, the patient sitting erect, and the surgeon standing behind. The point of the instrument is pressed rb* PARTICULAR CPERATIONS. 425 rectly downward, fig. 274, until it enters the sac, which will be denoted by a flow of tears and mucus. The opening should be slightly enlarged out- wardly as the knife ib withdrawn. A probe, curved a little forward and in* ward, is then introduced, and, if neces 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. Ever - sion is often cured by a removal or divi- sion of the tarsus. Anchyloblepharon and Symblepharon. — The first of these terms is applied to a growing together of the eyelids, whi vh 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 Mssected 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 — n ay 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 artificial 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. — These terms have been lately applied to an operation for the formation of an artificia. pupil. Expe- rience does not justify it except in cases of complete blindness. Fig. 274. 426 SURGERY. Otoplastice. — One of Taliacozzi’s operations for forming a new e&r out of the scalp of the back part of the head is so called. Chjiilo, and Genio-Plastice. — These are still other taliacotian operations, either performed or proposed, to restore lost parts of the fips and chin by taking the integument adjacent. Couching. — This is one of the operations for curing blindness caused Fig. 275. 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- 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 fere nee. 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 strong narcotic to the lids CATARACT. Fig. 277 CAPSULAR CATARACT PARTICULAR OPERATIONS. 427 and bulls 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 the 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, ttfld 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 is 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 hyoloidea , and then the lens pushed down by placing the flat surface of the needle on top of it, fig. 278, below the pu- Fi „ 278. oil, and slightly backward into he vitreous humor ; or it may tie 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. Extraction. — This is the operation for removing the opaque lensL The upper eyelid is supported by the retractor, or by an assistant 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 transparent 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 fin the purpose. In a short time the eye is again opened, fthe 128 SURGERY corneal 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 strong 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. Absorption, or Solution. — 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 couching, 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 fragments. 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 wdl 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 operation, can be readily checked by washing the mouth with the coldest water, and exposing it freely to the cool, open air. When forceps 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 stead}^ force, slight lateral motions are to be made to loosen the ftmgs in the socket. In the extraction of incisoi teeth, circular motior Fig 279 EXTRACTION OF CATARACT. PARTICULAR OPERATIONS 429 should be made. The cuspids may be extracted with the incisor, and the bicuspids with the molar forceps. In extracting fangs or snags/* Fig. 280. MOLAR FORCEPS OF DR. HILL. Fig. 281. COMMON INCISOR FORCEPS. 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, when 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 cases 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 straight or curved tube can be inserted by any one familiar frith the anatomy of the parts 430 SURGERY. To introduce the male catheter most conveniently, the patient lies on the back with the shoulders somewhat elevated ; the catheter is held at a 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. Common 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. (Esophagotomy. — 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 ©ration may prolong, but seldom saves life. PARTICULAR OPERATIONS. m 'Shaking 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 fast in the pharynx, where it may produce suffocation by pressing upon the larynx and ex- citing spasm of the glottis. By opening wide the mouth, the article can generally be loosened with the finger, a fork, teaspoon, spoon-ban die, or curved forceps. If it has passed below reach in this way, it may be pushed into the stomach with a probang, a piece of whalebone, hav- ing a rounded end, and covered with silk ; or withdrawn by means of an air-pump. jARYngotomy. — 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 membra no, when the point of the scalpel v? passed sud- denly through this membrane. Tracheotomy. — The trachea or windpipe is sometimes opened in 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 held by two assistants, who are to tighten it as the fluid es- capes. The surgeon then makes an incision in the tinea alba, two 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 off 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 rosume habits of exercise very gradually. 482 SURGERY Paracentesis Ves c.e.— The bladder may e “tapped” above the front of the pubes, or punctured through the rectum in males, or vagh na in femeles, in obstructions which admit of no other method of relief. Imperforate Anus. — Children are sometimes born with the in- tegument 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- taching 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 closely united with those of the first. Imperforate Urethra. — When this is a congenital malformation, a round trochar is to be inserted, followed by a canula, and then by a catheter, and this is retained until the orifice heals. Lititontripsy and Lithotomy. — Each of these modes are resort- ed to for stone in the bladder. The former operation consists in crushing it in the bladder with an instrument called the lithontrijptor , and is only applicable 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 applTcable to the fe- male, by reason of the larger diameter of the urethra ; and for ths same reason, even this is very rarely necessary Fig. 283. PARACENTESIS ABDOMINIS. PARTICULAR OPERATIONS. 433 For the operation of lithontripsy , the urethra must be dilated by nougies until the lithontriptor will pass. This instrument, fig. 284, ifl Fig. 284. LITHONTRIPTOR 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 way 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 crushing process is completed, the lithontriptor is withdrawn, the patient turned face 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 cutting 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 oe detailed here. Amputation. — The Water-Cure method of treating injuries, tu- mors, ulcers. and inflamt rations is destined to diminish very greatly the 434 SURGERY. demand for this operation, which, however, is much more simple than 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 the Jlap 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 preferred in all cases requiring amputation, but emergencies do sometimes exist in which 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. Jn the circular operation upon the arm, one assistant supports the forearm, and another grasps the arm above with both hands, and pulls back the integument as much as possible. The surgeon passes his hand under the arm, bringing the knife cc m« Fig. 285. uietely over it on his own side, with the point downward, fig. 285, and makes the first incision by drawing the b’ade backward from hilt Ea PARTICULAR OPERATIONS 435 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 ot 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, the 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 off, the splints, if any, remain, being smoothed off 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 Jidvisable. The stump is then cov- ered with lint, retained by a light, easy bandage ; and the dressings are to be kept constantly wet 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 usually 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 urtery should be compressed where it passes over the first rib, by the thumb of an assistant. SURGERY. m In the jlap operation, for the forearm , fig. 286 shows the proper posh Fig. age. 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 correspond 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, Fig. 287. is most frequently per- - formed at the base — the phalan geo-metacarpal ar- ticulation, fig. 287. An incision is made upon tho knuckle in an ell.'ptical form around the finger, extending down upon the palmar surface of the fin- FLAP OPERATION. 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 joint dislo- cated by carryii g the knife through it. Ligating and Compressing Arteries. — These 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 tumors 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 observed are, to make an oblique incision 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 direct the exact point for the pressure to be made, which is to be increased until the pulsation ceases. The subclavian artery 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 lies near the surface. The circulation of the lower limb may be effectually 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 the 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 made to order, should it prove necessary or more convenient. Fig. 288 represents the double hook employed in Lie operation for strabis- mus. Fig. 289 is the curette or director used in the same operation. Fig 290 is a pair of fine took forceps. 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 lisease. Fig. 294 is the ordinary curved couching - needle , and fig. 295 is called Huy's couching-needle. The former nee- dle is sometimes called Scarpa’s, and is generally preferred. 295 . PART VIII MIDWIFERY. CHAPTER I. HISTORY OF MIDWIFERY A jjctent 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 that female midwifery was an honorable calling among the ancient Hebrews. “Since the beginning of history,” says Mrs. C. M. Dali, “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 great 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 practice 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 most eminent professional men-midwives com pares rather unfavorably 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 Slates, 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 MIDWIFER 7. countries on earth, civilized and uncivilized, woman officiates in all or- dinary cases. Throughout Russia, at this day, educated females at- tend all classes of society, from the royal family to the meanest serf. The Chinese employ midwives in all ordinary cases, obstetrical sur- geons Deing called upon only when instrumental assistance is necessary. The American Indians, the Otalieitians, the New Zealanders, and many other nations and tribes, who employ female mid wives or none, are celebrated for easy births and exemption from accidents. In F ranee, the sage femme* wise woman, is the principal accoucher. In Germa- ny, the vroedvrouw , skillful woman, officiates. In Denmark her title is iordermoder , earth-mother. In Sweden and Norway she is called lord- gumma. In Spain and Portugal, the co-madre — literally, with mother — attends. All of these terms are equivalent to midwife in our language. Female Authors and Practitioners. — Soon after the institution of tire first medical school in Greece, the exclusive spirit of the faculty obtained the enactment of a statute prohibiting the practice of this ait by 44 women and slaves.” The tyrannical act spread dismay among the women of Athens ; and so tumultuously did they rebel against the out- rage upon “woman rights,” that a new act was soon after passed al- lowing free-born women to learn midwifery. 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 their peculiar de- partment of the healing art, the following names may be mentioned in this place: Agnodike, the daughter of Hierophilus ; she practiced suc- cessfully at Athens in defiance of the medical clique. Artemesia, the queen who assisted Xerxes at the battle of Salamis. Elpindike, of Greece, daughter of Cimon, and sister of Miltiades. Yroutata, of Sa- lerrno, who practiced in the latter part of the thirteenth century, and wrote several books. Mad. Perrette, who was sworn into the office of midwife, in Paris, in 1408, and became famous throughout France Mad. Gancourt, later in the fifteenth century, became equally cele- brated. Mad. Francoise, the midwife of Catherine de Medicis, was an approved lecturer on obstetrics near the middle of the sixteenth century. Olympia Morata, born in Ferrara in 1G2G, wrote the lec tures which her husband, a young physician, delivered at Heidelberg. Mad. Pernnne had the reputation of contributing all the obstetrica. matter which was published in the works of the eminent French sur- geon, James Guillerneau. Louise Boursin Bourgeois, born in 1580 . married » surgeon, was appointed tc attend the Queen of France, am 1 HISTORY OF MIDWIFERY". 441 published many valuable works. Mad. La Marche, born 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 century, 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. Sarah Stone, of England, was the authoress 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. Reffatin, 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 the 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.Lesebours was the authoress of a work published in 1770. An Irish midwife, named Dunally, performed the Caesarean 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. Wittembaok 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 ninety- four years, assisted as midw fe in more than eleven liundre l 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, w r ho 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 successful!}’ bringing into the world above three thou- sand children. Mrs. Jane, Alexander, whc lied at Boston in 1845, aged sixty-one years, studied midwifery witu Dr. James Hamilton, of Edinburgh, and practiced in this country 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 had been settled more than a century. In 1723, Dr. John Maubray, the first male lecturer in 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 every 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 — 1762. Dr. Atw r ood, 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 published and circulated a pamphlet advocating the exclusion of females from the practice, and the substitu REPRODUCTION 443 tion of males. At the present time, nearly every allopathic medical journal in the world is vehemently 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 f midwifery to educated fe- males ; but I am very far from desiring tc 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 engrossed 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-three modifications of those ■theories have been proposed. Without wasting any time up n these 444 MIDWIFERY. fanciful speculations, it is enough for all practical purposes, to under* stand that sexual association is necessary to the propagation of oui race; and that the female furnishes the ovum or germ nf 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 than 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 already 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 anti mental character of their offspring. It should be universally known, too, that the passion which impels to procreation, 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 abu'se 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 whcse ab* dominal organs are contracted and rigid, and whose brain is coi^tantly irritated by indolence, novel reading, constipating food, strong coffee, green tea, or the Sequent indulgence of the passionate or fretful moot}, R E P II ODUC 'Ll O N. an do justico to the rising generation. If in any of these ways they u 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 evidences equally among the wretched millions who toil incessantly for less than a suffi- 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 exercised, will nat- urally degenerate, and they will propagate a race comparatively idiot- ic. Those who exert the brain intemperately, and suffer 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 thi3 duty than by making the following quotation from a recent work (Or- ganic Laws), by J. Bradford Sax : “ The various organs and faculties 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 nt 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 practije can possibly be so debilitating, depraving, and de* m MIDWIFERY Btructive to all tlie 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 health or happiness.” In a recent and very excellent work ( Popular Education ) bv Ti p 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 agreed 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 them that hate Him or violate His laws. Strictly 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 majority 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 marriages. The sound- est physiologists and phrenologists regard twenty-two to twenty-five for the female, and twenty-five to thirty for the male, as the most appro- priate ages for assuming the serious duties as well as participating in the pleasures of matrimonial life. Physiological Law of Marriage. — Physiologists are divided on the question, whether organizations similar or unlike are most condu- cive to vigorous offspring. 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 lower animals, and even from the cross-marriages of the people of different nations, sc fa 1 * as observations have been recorded. 1 np PHYSIOLOGY OF THE F (E T U S. 44 / prebend, 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 functions 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 IIL PHYSIOLOGY OF THE FCETUS. Fcetal Development. — About two weeks after impregnation, the new organization becomes about as large as a pea, and its two envelopes, or membranous coverings, called choricn 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 are well defined, the weight being two 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 3 r the bony structure is ossified, the rudiment* 448 MID WIFE Rl. of the second set of teeth are seen under the first, and the substance 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 motions 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 Fig. 296. weight is about one pound, and the length about nine inches. In the sixth month the head be- comes downy, and the nails mark- ed ; the weight increases to one and a half or two pounds, and the length to twelve inches. During the seventh month 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 three 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 morv.< active. Fgtal Circulation. — Untii quite recently the opinion pre- vailed that the blood of the mother circulated direcJy through the vessels of the foetus ; but it is now known that the foetus has a sort of independent existence, although PHYSIOLOGY OF THE FCETUS. 449 its nutrient materials are of course derived from the mother. The mother secretes the substances of nutrition, which, by coining in con- tact with the foetus, are absorbed ; and, after being modified in their passage through the placenta, are digested and assimilated. Fig. 296 is a representation of the foetal 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 (4, 4), to be distributed to the livei ; and one (5), the ductus venosus, whicn 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 bio^d is denoted by the arrow, proceeding from 8 to 9, the left auricle. 10. Left ventricle; the blood follow- ing the arrow to the arch of the aorta (11), to be distributed through the branches given off 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 (15), 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 left pulmonary artery cut off; these are of extremely small size as compared with the ductus arteriosus. The ductus arteriosus joins the descend- ing aorta (18, 18), which divides into the common iliacs, and these into tne internal iliacs, which become the hypogastric arteries (19), and return the blood along the umbilical cord to the placenta ; while the other divisions, the external iliacs (20), are continue^ 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 the left auricle it passes into the left ventricle, thence into the aorta, 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 extremities by the superior vena cava to the right auricle ; from this it 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 greater portion passes through 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 through th 3 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* 450 MIDWIFERY”. veyed by the internal iliac, hypogastric, and umbilical arteries to tho placenta ; the hypogastric arteries proceeding from the internal iliacs, and passing by the side of the fundus of the bladder, and upward along the anterior wall of the abdomen to the umbilicus, where they become the umbilical arteries. “From a careful consideration of this circulation,” says Dr. Wilson {Human Anatomy ), “ we perceive, 1st. That the pure blood from the placenta is distributed in considerable quantities to the liver before en taring 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. u 3dly. That the blood which circulates through the arch of the aorta comes directly from the placenta; and, although mixed with 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 very impure, being obtained principally from the returning current in the superior cava, a small quantity only being derived from the left ventri- cle* v ,et it is from this impure blood that the nutrition of the lower . ities is provided. Hence we are not surprised at their insig- nificant development at birth; while we admire the providence of na ture that directs the nutrient 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.” The foramen ovale becomes gradually closed by a membranous layer which separates the two auiicles. As soon as the lungs are inflated by inspiration, the blood of the pulmonary artery rushes through its right and left branches into the lungs, to be returned by the pulmonary veins to the left auricle. PHYSIOLOGY OF THE FCETUS. 151 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- 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. Physiologists do not agree whether the vessels of the placenta term- inate in or communicate with those on the uterus ; or whether, in its utenne portions, there are intermediate, cells in which the arteries terminate, 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 foetus 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 the action between water and bloc I, in the bronchial vessels of aquatic 452 MIDWIFERY. animals, some portion of the blood of the foetus does actually go the round of the mother’s circulation. The Umbilical Cord. — The funis, cord , or navel-string forms the connection between the placenta and child. It is composed of two ar- teries and a vein, and, like the placenta, is insensible. The arteries wind spirally around the vein from right to left, forming in their course a number of loops or knots. The length of the cord varies greatly: 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 Amnii. — This term 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 from one to two pounds. It serves as nutriment to the foetus ; 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 ossa innominata form the pelvis lat- erally and in front, each of which is divided into the ischium, or sit- ting-bone ; ilium, or hip or haunch-bone ; and pubis , or share-bone, as heretofore explained ; and the sacrum and coccyx behind. The brim of the pelvis is defined by the ilio-pectineal line. All below this line is called the true or lower pelvis ; while the false or upper pelvis, which is really the lower part of the abdominal 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, n&easuring five to six inches posteriorly, three inches and three fourths from the brim to the tuber ischii, and from tw ; inches to two and a OBSTETRICAL ANATOMY. 453 half anteriorly at the symphisis pubis. The bones of the pelvic cavity nre smooth on their inner surface, and present a series of inclined Planes, tending at first downward and slightly backward, then down- ward and forward. The brim or upper margin of the cavity, which is •is narrowest part, is called the superior strait ; and the lower or outlet, *he inferior strait. This outlet is of an oval shape, but irregular; its lateral boundaries are immovable, but its antero-posterior diameter can ie extended on account of the mobility of the coccyx. Diameters of the Pelvis. — The three principal diameters arc Fig. 298. represented by the lines in fig. 298. They are the antero-posterior (1 j, from the prominence of the sacrum to the inner and upper edge ot the symphisis pubis ; the transverse (2), across the widest part of the brim, at right angles to the 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 airi three fourths. Half an inch either way 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 mal-presentations. In ordinary cases nature will accomplish her worn just as well without our knowledge of ob- stetrical anatomy as with it. Deformities of the Pelvis. — The bones of the pelvis may be 154 MIDWIFERY (distorted in a variety of ways, and to an extent which renders labor tedious and protracted, or entirely impossible. These cases, however, are extremely 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 mollities ossium , or softening of the bony struc- 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. antero-posterior distortion. PftEGNANUY. 455 of the pelvis, is seen in fig. 300. This is one of the conditions which render natural labor impossible, although slight deformities in this re- Bpec.t 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, thougn 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 from the 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, forty-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 MIDWIFERY. space in the walls of the uterus. In all these cases the general signs of pregnancy are more or less apparent, while 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 cyst which incloses the foetal 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 the part for an indefinite period, or make an effort to remove 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 soothing all local inflammation, always recollecting that nature best accomplishes what she undertakes in her own way. Superfcetation. — The occurrence of a second conception before the termination of the first, has been regarded as impossible by many authors ; yet there are some well-authenticated cases on record. Sometimes both foetuses 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. Pathology of the F ceils. — Nearly all the maladies to which the child is subject may affect the foetus ; and when we consider how un healthfully the majority of females live while in the pregnant state, anu how readily the 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 the 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 ; flaccid ity or filling 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 us^al, 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 particulars, as for or- dinary abortions. PREGNANCY 467 Hygienic Management during Pregnancy. — 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 healthy 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 stupefy and enfeeble the 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 disagreeable; 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 phrase 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 far from being naturally cf 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 consumption, are suspended during pregnancy., to re 11—39 MIDWIFERY. 458 appear with all their formidable and fatal array cf symptoms soon after the completion of the reproductive function, sufficiently attests the prin- ciple that nature is true to her own purposes, and that 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 are general or local debility — “ inward weakness” — violent men- tal perturbation, and bodily shocks or injuries. Leucorrhcea 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 aftei 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 ur labors at the full term. In some cases the ovum is expelled with but little pain, and sometimes the fmtus is expelled and the membranous she31 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 destructiv ^s 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, recumbent 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, great lassitude, shiverings, frequent and feeble pulse, and the patient becoming pale, exhausted, and faint, with a dark shade under the eyes, the tampion may 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 in- PREGNANCY.' 459 troduced again if necessary. Enemata of the coldest water are also valuable auxiliaries in severe cases. In 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 faintness 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 hemorrhage. It is not uncommon for patients to remain an hour or two in a state of deliquium 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 relieved by eating very sparingly for a day or two, and careful attention to the bowels. Cramps, for which the old-school practice is, bleeding and laudanum, 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 the early than the later months of pregnancy. It requires coarser l#od 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 tha same way ; if excessive, warm water is more soothing than cold. Heartburn, sick headache, sleeplessness, and 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 these cases ; and when the 6ick 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 keeps all un- healthy articles out of her stomach, the trouble from this source will be of little consequence. Pains in the breasts are sometimes severe. They may always and safely be relieved by cold wet cloths, covered with dry; except 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 on M ID W IF Ell r. At>0 danger abortion. Fasting, and cold water-drinking, are the specia. 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, cupping, and blistering have been perseveringly pre- scribed for it by “ old-school” doctors, but without the slightest benefit in the great majority of cases. The wet 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 accordingly. Diarrhea is among the unusual occurrences. The treatment is, hip- baths, the abdominal bandage, cold injections, and a strict dietary. Difficult urination sometimes proves very annoying. When 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 novel reading, exciting company or parties, stimulating drinks, irritating food, cathartic and opiate medicines, etc. The treatment is wdiolly negative — an avoidance of these causes. Convulsions are less frequent occurrences than hysterical parox- ysms, but are produced by the same general causes, and can be pre- vented or cured by their avoidance or removal. PARTURITION m CHAPTER VI. PARTURITION. Rationale of Labor. — Many ingenious, if not profuunr3 specula- tions, have been written by medical philosophers, to explain ivhy the foetus and its appendages are expelled from the womb at about the end of ten 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 why the earth performs its circuit around the sun in three hundred 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 it 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-show , 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 thighs, gradually becoming fixed and reg- ular, with intervals of perfect ease, denote the preparation going on in the uterine region. Each labor “pain” 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 renewed at certain intervals until the dilata- tion is sufficient to permit the passage of the child without injury to the soft parts. The pain experienced by the patient bears no very near relation to the force of the contraction 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- -some writers say the voluntary efforts of the patient; but this 462 MIDWIFERY. action takes place whether the patient wills it or not — when the pa- tient is obliged to co-operate with the expulsive effort, by holding her breath, and then the pains are called forcing , or bearing-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 d^al upon the temperament of the patient, and upon 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 which 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 rupture at all, and the child is expelled entirely inclosed — in 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 in her own person; and conversely, find me a mother who lives physio- logically, and I will show you one with whom the act af childbirth has leither agony nor terror. The philosophy of this matter is admirably expressed in a little work (The Curse Removed), by Dr. T. L. Nichols : “The women of nature have no such word as ‘ confinement* — a word so appropriate 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 shrub to produce flowers and fruit; and her organs are as naturally adapted for the purpose. In a state of PARTURITION. 4Gf 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 ia 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 important of all the functions of the most perfect of created beings, of W'hom 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 Plis 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 replenish the earth,’ with- out peril or pain. The very idea of the curse inflicted upon her car- ries with it the belief, that jhe w T as 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 performance of the great function of her life? It is because the forbidden fruit of ener- vating luxuries and excesses is cont! nually 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 wi the structure of ou»r bodies, bring with them the curse of deranged nervous systems, broken health, irregularity 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, faith in God, obedience to His laws, and living in harmony with His works, assure to woman health and safety, and joy. in fulfilling «aU her destiny. These ar$ 464 MIDWIFERY. truths pregnant with meaning, and incontrovertible as the principles of nature.” Mrs. Pendleton remarks (Parent's Guide): “It is a well-establish- ed fact, 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 unless it were fairly within the capabilities of the race.” Mrs. Gove — now Mrs. Dr. Kichols — testifies (Lectures to Ladies ) “ I know many mothers who, with their husbands, have adopted tlio ‘ Graham System,’ or, in other words, those correct habits recom- mended in these lectures (that is, attention to di.et, exercise, and bath- ing freely and constantly with pure, cold water), and those mothers have abridged their sufferings in parturition from forty hours to one hour , and have escaped altogether the ^athly sickness of the three first 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 answer that the objection applies only to one sex, and is therefore not to bo 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 natural laws, 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 own sakes and for the sake of the future in fant, than they now are, while ignorant 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, creteris paribus, always enjoy more tranquillity both of mind and body, and in cur much less risk of injury to herself and child than she who, giving a 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 [Thesis on Childbirth) that “ Pain is a moriid PARTURITION. 465 symptom, the consequence of artificial modes oflife and treatment, and can be avoided by appropriate habits and treatment.” In corroboration of this already conclusive weight of authority, I can add, that I have known females in the city of New York adopt a re- form 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 charge 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 show3 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 1 , 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, unquestionably, 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 ; itnd, 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 the 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 principle of a more plain, and simple, and less concentrated diet. Such a dietary will always keep the system open and unobstructed, anc[ the e^cro- m MIDWIFERY. tions free, so that the superfluous particles of earthy matter, if any ex- ist in the farinaceous articles, will be readily 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 important of any one of the hygienic consideration* 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 anaes- 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. Stearns, “ are peculiarly forcing .” 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 fatal 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 y 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 which 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 n* birth, and in several cases they Were ir recoverably dead.” “ Since hen,” says Dr. Beck, “ a large PARTURITION. 467 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 Dr. William Moore, 46 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 ol them were still- births. Dr. Holcombe, of New Jersey, Dr. Davies, of London, Mr. T. Chavasse, of Birmingham, Mr. Paterson, of Aberdeen — all expe- rienced obstetricians, 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 birth can be ac- complished by the efforts of nature ; in contradistinction to unnatural and complicated labors, which require manual 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 nubis, and the face turned toward the sacrum 468 MIDWIFERY. The reversed presentation — the face forward — is rarely attended with any other difficulty than a more tedious delivery. Foot presentations almost always terminate naturally, and the same is true of breech pre- sentations. y Diagnosis of Presentations. — The distinctive signs by which dif- erent parts of the body can be recognized at once, ought to be familiar not only to all midwives, 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 fontanelles ; 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 nearly 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. — Th e 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 tk the bag of the waters,” i3 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 somewhat 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 as the head is repeatedly pressed against them, until the dilatation is sufficient to permit the head to pass, con- stituting the third stage , and completing the birth. The duration of natural labor varies from a few hours to several days. The average Lime is about twelve hours. In the fourth and last stage, the placenta is detached and expelled. It may occur in a few minutes after the delivery of the child, or not till a lapse of several hours. Its expulsion is attended by comparatively slight lahrv pains. Position during Labor. — Since man- midwifery has been i trade. PARTURITIO N. m *.« 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 in 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 — die doctor conveniently disposed, and one or two extra attendants making themselves “ gen- erally useful” in preparing medicinal slops for the woman in travail, and tea for the party, as soon as the travail can be urged to a conclu- sion. 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 should then recline on a hard bed or mattras!?. 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. In 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 keeping the patient i»i 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- 40 170 MIDWIFERY. ©ring women” quickly ; but al. people ought to be taught that all these things pertain either to rash measures or false pretences. It is a common, and, I believe, universal dogma among professional men- midwives, that the 'perineum must he 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- fessor 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 when 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 own 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 rather firm, circumscribed swelling; and probably no occurrence so trifling has ever occasioned so many 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 cry, or appears apoplectic or feeble, the cord should not be cut until, the pulsation in it ceases. Some authors have recommended slapping 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 olf, and then cut through near the first, ligature with a pair of scissors. Dr. Burke (Accouchefs Vade-mecum) tells us with be- 471 V A R T U R 1 T 1 0 N 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 After-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 recurrence of bearing-down pains — the cord may bo gently pulled upon — never forcibly ; and if the after-birth does 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 soothing and strengthening. After-Management. — Professors of midwifery instruct their 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 very 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 a a soon as convenient, and the patient supplied with 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 be Is any prescribed length of time. But, on the other hand, there is nothing gained in being too heroic. I have known females i« 172 MIDWIFERY. fchis city take the entire charge of their infants from the moment oj oirth, and leave their rooms comfortably on the day after delivery ; hut if all should 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 leucorrhcea, 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 lying-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 Jochial 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 afterward 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 upon thousands of infants in their cradles, and lay the foundation for debility, imperfect development, and enumera- 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 system, 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 suffh PA II T U III A ION. riently watery for all needful purposes if the milk be deficient, while dry toast, crackers, good bread, potatoes, etc., are amply corrective when the breasts arp overburdened with this secretion. Accidents during the Lying-in Period. — The majority of acci- dents and diseases which follow ordinary labors, are artificially pro- duced, the result of meddlesome doctoring or bad nursing. The ma- jority of medical writers on midwifery give directions for managing the patient, which, if strictly followed, could hardly fail to induce ac- tual diseases. It is a common practice to stimulate with wine or bran- ly, or camphor 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, and take blood even if she is cold and shivering, if the practitioner suspects the shivering 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 Midwifery, says : “ I have seen more than one instance in which there was reason to believe the life of the patient was sacrificed from ignorance of the true character of the 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 from the arm or by leeches, is the instant resort, and a few short hours con- firm the worst anticipations, by the fatal tei ruination, 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 by these fata' mistakes ? Lancets and leeches have no business in the lying-in cham- ber ; and if they were always where they should be no woman would be killed hy them; the doctor might err in opinion without causing the death of his patient. And here I may pertinently state a rule of uni- versal application, which doctors, midwives, and nurses might often revert to advantageousk * Whenever there is serious doubt as tc MIJDWIFER Y. i 1 what ought to be done for the patient — do nothing — ten chances to one that while the doubts are being solved, nature will solve the dif- ficulty. % Floating sometimes, though rarely, occurs several hours after de- livery. it is to be treated precisely as when occurring at any other time. The Lochial discharge, or flowing , sometimes ceases suddenly, or is suppressed by taking cold, or by inflammatory excitement, followed by distress 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. Puerperal fever , or peritonitis, is one of the most frequent and fatal diseases under old school practice ; but I have never known nor heard 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 merely accidental modifications or different degrees of severity of the same disease, which consists essentially in an inflammation of the peritoneal membrane, sometimes, however, com- plicated with inflammation of the bowels or uterus, and attended al- ways with a violent Gut low r prostrating fever of the typhoid type. 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- ng 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 applying 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 turpentine treatment, not to speak advisedly on this point. Inflammation of the breast, resulting in abscess or “ broken breast,” is among the frequent results of the system of living and doctoring we oppose, and among the things unknown in hydropathic 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 he d’*awr. hi with the breast-pump, or by that ever- INFANT N JR SI N G. 47o convenient suction-pump, the human mouth. When the nipple is malformed or deficient, the breast- pump will often succeed in drawing 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 can never occur if the system is kept free from obstruction by proper diet and bathing, and is not drugged. Sore nipples require nothing more than 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, or 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 ns the general heat de- mands ; otherwise, tepid ablutions are to be very frequently employed. Puerperal swelled leg — phlegmasia dolens — 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 or Infanis. — The first provision to make for the new-born mfant 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. On no 476 MIDWIFERY. account should any thing be pinned or tied around the abdomen, o* any part of the body, like a belt or bandage, unless for some surgical purpose. Bathing Infants. — Every child should be washed over the whole surface daily ; always, too, immediately after waking from sleep, and never soon $fter eating. The water should be of a mild temperature at first — 85° to 80° — 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 had 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- ply 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 appearance of the teeth, about the seventh month, seems to indicate that as the nat- ural period for commencing the employment of solid food. It in a NFANf NURSING. 477 great mistake to suppose that all the food taken into the tender and delicate stomach of the infant should be fine, concentrated, divested of all innutritious matter, and very nutritious. It is, on the contrary, even more important for children than 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- onable materials for the infant dietary ; but a worse selection could hardly oe made. Graham flour, mush, cracked wheat, coarse Indian meal, hominy, boiled rice, 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 they are able to take any kind. This plan of dieting will secure the chiid against dysentery, cholera infantum, colics, gripes, spasms, con- vulsions, scrofulous swellings, skin diseases, painful teething, etc., etc., which annually sweep off so many thousands to their graves. Improper diet has a vast deal to do with making children cross, fret- ful, and ugly-tempered, as well as dull, sickly, and stupid. The most healthy children may be stuffed so outrageously as to suffer continu- al^ from cramps, colics, and all sorts of aches and pains ; and so feeling bad, will act bad, in spite of good counsel, parental authority, 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 effect upon its body or mind than this miserably foolish fr a h- ion. Two or three years is early enough, and several years later is still better, for any child to first taste of flesh. But many mothers, perhaps the majority, stuff fat, 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 bod 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 railroads or steamboats will, it they are of observing habits, notice that a large 178 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 exist, 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 great 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 wrong who try to keep them still and out of mischief. The true philosophy of babyism 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 B quiet child i? a sick one. INFANT NURSING. 472 Excretions of Infants. — Nothing can exceed the absurd it}’ 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 irritating 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 degree of irregularity. For a few days after birth the discharges will be dark and watery, consisting of the foecal matters, or meconium , which accumulate in the bowels during the latter part of the fcetal life, mixed with the ordinary foecal 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 we 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 constipation, no other medication is necessary than cool injections, with the wet abdominal bandage in the former case, and tepid injections, and perhaps a greater proportion of fruit, in the latter difficulty. 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 remedy 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 cl children. Serious evils ofte^ result 480 MIDWIFERY'. from it, and all the good it promises can be assured by the other means { have mentioned. Drugging Infants. — From a little book (Essays on Infant Thera - peutics ), by the late John B. Beck, M.D., Professor of Materia Med* 7ca and Medical Jurisprudence in the College of Physicians and Sur- geons 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 London; one of the Vice-presi- dents of the Academy of Medicine of New York, etc. — these titles "how that this book is one of authority — I copy the following state- ments : •“ With regard to the effects of opium on young subjects, there are f wo facts which seem to be well established. The first is, that it acts with much greater energy on the infant than it does on the adult ; the second is, that it is more uncertain in its action on the infant than the adult. 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 drops. Dr. Christi- son states that three drops of laudanum in a chalk mixture for diar- rhea, killed a stout child, fourteen months old, in six hours. Dr. Ry- au 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 effort made, the child died in eleven houra after.” INFANT NURSING. 481 If so many children die from the effects of such small doses, how ruinous must be its common administration by the hands of nurses 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, soothing 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 flabby and shriveled ; the lips are bloated, and the countenance sallow and wrinkled. There is an absence of all intelligence, and the whole appear- ance is haggard and aged, presenting a sort of 4 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 Jifje 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 Infirmary, report several cases of children of one to four years of age, dying from taking the common antimonial wine for ordinary cough and cold. Dr. Arm- strong has many times seen delirium produced in young children by very small doses of antimonial preparations. Professor Schaepf Merei, of the Children’s Hospital in Pesth, Germany, certifies that he has known several children 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 the 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 th® 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- astrous. “ Sloughing of the gums and cheek,” says Dr. Beck “ II — 41 gen- 182 MID W I F E It r . eral prostration and death, are by no means uncommon occurrences.’* Dr. West ( Diseases of Infa r ncy and Childhood) has known fatal gan grene of the cheek, and necrosis of the jaw, to result. M. Beding- field states ( Commend of Practice ), that he has known the parotid glands Doth ulcerated and entirely destroyed bj mercurial action in young children. Dr. Beck expresses the opinion that the practice of giving calomel as an ordinary purge to children, because of the facility with which it can be taken and retained, has laid the foundation for the ruin of the constitutions of thousands. I could extend these quotations indefinitely; but my purpose is to exhibit a reason why the whole trade of drugs should be rejected from the nursery at once and forever ; and if the testimony already presented, which the reader will bear in mind is all taken from standard authori- ties of the school which advocates the practice I am opposing, is not conclusive, neither would people believe though all their children should die under their own eyes. The little good that these execrable poisons seem to do in some cases, is counterbalanced a thousand fold by the certain injury. Besides, and more than all, there is never — I say emphatically never — any necessity for their employment. There is no conceivable disease, state, condition, or ailment for which there is not a surer, safer, better way. Infantile Diseases. — A multitude of small books have been writ- ten on diseases of small children, in most of which the matter is treat- ed as though it was as natural for babies to be sick as it was to breathe. Gum rashes, gripings, spasms, fits, running at the ears, thrush, aptha or canker, inllamed gums, etc., are usually regarded by this class of writers as things to be expected, and provided for by keeping a due as- sortment of medicines on hand. I need not waste time in exposing the absurdity of all this, which is self-evident to all who will take the trouble to think for themselves. The mother who chooses to rear her children according to the principles advocated in this work, will have little to do with “ infantile diseases-” And if she chooses to throw the responsibility of the health and well-being cf her offspring upon the doctor, I can only pity them , and pray for her enlightenment COMPLICATED LABORS. 483 CHAPTER VIII. COMPLICATED LABORS. Tedious or Protracted Labors. — These result from a variety of causes, the principal of which are debility of the muscular fibers of the uterus ; obliquity of the uterus ; premature escape of the liquor amnii ; excess of the waters of the amnion ; unusual toughness of the membranes; and rigidity of the os uteri. In nearly all these cases, however, nature is competent to accomplish her work without our in- terference ; and our main duty is therefore to exercise patience, and encourage the patient to do the same. In some few instances manual and medical assistance may be rendered. When the membranes pro- trude externally during several pains, they may be ruptured with the finger,. and the waters discharged, after which the labor will be rapidly finished. Females who have suffered much from leucorrhcea or pro- lapsus, are liable to a thickening of the mouth of the womb, rendering it undilatable, or, rather, causing its dilatation to be unusually slow and painful. An occasional warm hip-bath will materially add to the com- fort of the patient. Preternatural Presentations. — The statistics of over 300,000 cases, collected by various European practitioners, show that breech presentations occur once in about 53 cases, and foot-lings once in about 90 cases. In 78,027 cases, 1,277 were breech presentations; 1,019 presentations of the inferior extremities; and in 293 cases the superior extremities presented. From these data we may see how rarely is there occasion for instrumental or manual interference, even under the present disease-producing habits of the civilized world. In the great majority of these preternatural presentations, the labor can be accomplished by the efforts of nature alone. Those which most frequently require assistance are presentations of the superior extremities. The general remedy in all these cases is version , or turning , except in cases of' badly-deformed pelvis, or enlargement, or some other deformity of the child, when evisceration may have to hf resorted to, or, as a preventive measure, premature labor induced. Operations in Midwife rt — The operations in complicated ease* M I D W I F £ K 1. 484 of midwifery which are considered as regular, are turning, the induc- tion of premature labor, the lever, the forceps, craniotomy, and hy- sterotomy. Turning, or version , consists, whatever may be the part } resenting, in bringing forward the feet, this converting the case into a footling. The statistics of English, French, and German practice together show that the operation has been performed once in about 120 cases. In English practice 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, atid in presentations of the placenta, which are attended with alarming flooding. In performing this operation, the hand is introduced very gradu- ally during the intervals of the pains, the fingers 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 present, it can then be pushed upward, and the head brought down to the oblique diameter of the brim of the pelvis, and the labor thus left to the efforts of nature. If the case is an arm presentation, the hand is to be passed along the arm until it reaches the body, then passed ovet 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 the front of the child, and as the feet are drawn 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 pains. 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 always be emptied. Madame Bouvin performed this operation 218 times, with a loss of 48 children. Premature labor may be justifiably induced in such knows 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 undertaken by regu- lar physicians in any country; and the results, as far as statistics have been gathered, show that about half the children survive, while the mortality of the mothers is about one death in ten cases. No less COMPLICATED LABORS. 4 83 than six different methods of exciting prematurely the uterine com tractions have been advocated, the most effective of which are punc- turing the membranes, or mechanical dilatation of the os uteri. Uter- ine action usually cc Ties on in one, two, three, or four days, and the patient requires the same management as in ordinary labois. The lever , or vectis , is not frequently employed in midwifery, yet, more frequently than it should be. Its first introduction into practice was “hailed as a discovery calculated to confer immense benefit upon the human race but, like many other pretentious affairs, 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 instrument is, that 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 com- 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 limited 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 jibor, 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- bility of the base of the skull. In Dublin, Dr. Clarke used the forceps once in 728 labors ; in Paris, Madame Lachapelle 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 the 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 MIDWIFERY 48' and the other a head presentation. The difficulty consisted in the heads, both of which were small, being locked in he pelvic cavity; the head of the footling remaining fastened back of ihe head of the other I did not see the patient until the labor was too far advanced to remedy the malpositions, and hence was obliged to eviscerate both heads before either could advance. From the statistics of over three hundred thousand 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 sacrifice of its life to save that of the mother; as, otherwise, both would inevitably perish A great variety of instruments have been invented for this operation Th e perforator is commonly employed to open the cranium, and then the crotchet, 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 craniotomy ; 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 superior 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 Crests' ean section — as it is called after Claudius Caesar, who has the reputation of being the first who came into the world in this way — consists in making an incision through the abdom- inal walls and the uterus, removing the foetus and placenta, and then dressing the external wound by sutures and adhesive plaster. It is the dernier resort, and only justifiable when distortion or obstructions ren- der all other methods unavailable. In British and American practice rather more than half the 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 Sigauit, who experimented in this way at Paris in 1777 ; and notwithstanding he 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 Presentations —The face may present in either of two po- COMPLICATED LABORS. 487 sitions, as the forehead is toward the right or left acetabulum. The presenting part is known by the general inequalities of the surface 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 dangerously 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 anteriorly or posteriorly toward the symphisis pubis or sacrum. They occur, on an average, a* 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 same effect : “ The most common and dangerous error committed by the medical attendant arises from officious and injudi cious attempts to hasten or assist during the early stages of labor, than 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 breech presentations, although 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 part is liable to be mistaken for the elbow ; it may be distinguished by its 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 Itself than in either of the preceding varieties of malposition. Presentation o? the Suferior Extremities. — In nearly ^» NlEX Page Abdomen, vol. i... 213 Abdomen, dropsy of, ii,. 256 Abdominal wrapper, i\. . 53 Ablution, i 378 Abortion, ii 458 Absence of mind, ii 278 Absorption, i 270 Abstemious diet, i 444 Abstraction, mental, ii. . 278 Abscesses, ii 365 Abyssinian baths, i 41 Accidents, lying-in, ii. .. 473 Acid poisons, ii 312 Acids, i 329 Acidulous drinks, i 314 Acrid poisons, ii 323 Acrotismus, ii 229 Adhesive plaster, ii 326 iEsculapius, i 11 Aetius, i 18 Alfusion-bath, ii 41 After-birth, ii 471 Ague and fever, ii 90 Ague-cake, ii 249, 251 Ague, dumb, ii 91 Air, atmospheric, i.. 267, 296 Air-bath, ii 49 Air-tight stoves, i 302 AlLino skin, ii 308 Albucasis, i 18 Albumen, i 332 Albuminous aliment, i. . 331 Alchemists, i 19 Alcoholic diathesis, ii. . . 180 Alcoholic poisons, i 310 Ale, i 316 Alexandrian baths, i. . . . 39 Alexandrian school, i. . . 14 AH abbas, i 18 Aliment, i 339 Alimentary canal, i 215 Alimentary principles, i. 325 Almond oil, i 330 Almonds, i 350 Allspice, i 363 Alum, poisonous, ii 321 Amaurosis, ii 183 Ambergris, ii. 145 Amenorrhcea, ii 286 American race, i 292 Amnion, ii 447 Amnion, liquor of, ii. ... 452 Amputation, ii 433 Amylaceous aliment, i. . 327 Anaisthesia, ii 331 Anasarca, ii 253 Anatomical argument, i. 402 Anatomical erythema, ii. 196 Anatomical physicians, i. 2£ Page Anatomy, general, vol. i. 53 Anatomy, obstetrical, ii. 452 Anchyloblepharon, ii 425 Ancient bathing, i 36 Ancient physicians, i 10 Andromachus, i. 17 Aneurism, ii 349 Ancurisnial varix, ii 250 Angeiology, i 131, 148, 155 Angina, ii 113 Angina pectoris, ii 224 Angina stridula, ii 218 Anglicanus, i. 20 Anhelation, ii 216 Anhaemia, ii 136 Animal food, i 339 343, 421, 444 Animal jelly, i 334 Animal heat, i 282, 364 Ankle, fractures, ii 42*2 Ankle-joint, i 90 Ankle luxations, ii 406 Anteversion, ii. 294 Anthrax, ii 348 Antimonial poisons, ii. . . 315 Antipathy, ii 268 Antiseptic property, i. . . 338 Antiscorbutic vegetables, i 362 Anus, imperforate, ii. . . 432 Anxiety, ii 268 Aphonia, ii 282 Aponeurology, i 127 Apoplexy, ii 244 Aposteme, ii 365 Apparent death, ii 239 Apples, i 360, 435, 439 Apple-tea, i 314 Apricots, i 350 Aptha, ii 201 Arabian physicians, i. . . 18 Araetius, i 16 Arcagathus, i 15 Archigenes, i 16 Areolar tissue, i 237 Arenation, i 43 Aristot .e, i 14 Arm- bath, ii 49 Armstrong on epilepsy, ii 207 Aromatic fomentations,!. 44 Arrow-root, i 327, 361,434 Arsenical poisons, ii 314 Arteries, i 131 Artichokes, i 350, 437 Arthritis, ii 122 Artificial drinks, i 310 Articulations, i 78 Artificial heat, i 354 Ascites, vol. ii Asiatic cholera, ii 139 Asparagus, i 362, 439 Asphyxia, ii 239 Assyrian priests, i 10 Asthenopia, ii 135 Asthma, ii 217 Astrology, medical, i 19 Atmospheres, factitious, i. 45 Atrimatrics, i 44 Atrophy, ii 166 Aura epileptica, ii 206 Auscultation, ii 161 Autumnal fever, ii 90 Avenzoar, i 18 Averroes, i 18 Avicenna, i 18 Axunge, i 330 Baby-jumpers, i 369 Back-rooms, i 305 Bagliva, i 26 Bakers’ bread, i 353 Baldness, ii 310 Bandages, medical, ii. .. 52 Bandages, surgical, ii. . . 327 Barbadoes leg, ii 260 Barbiers, ii 214 Barley, i 356, *30 Bartlioline, i 23 Barytes, poisons of, ii... 321 Bastard-pox, ii 9$ Bathing, ancient, i 36 Bathing, habits, i 39 Bathing, history of, i 36 Bathing, hygienic, i 317 Bathing, rules, ii 56 Bath, order of, i 39 Baths, hydropathic, ii... 2*2 Baths, medicated, i 43 Beans, i 359, 430, 433 Beatty, on ergot, ii 467 Beck, on infants, ii 480 Bed-curtains, i. 302 Beddoes’ gases, j 44 Beds and bedding, i 373 Beech-nuts, i. 441 Beef, cooking of, i 421 Bees' eggs bath, i 43 Beets, i 362, 437, 439 Bell, Dr., on diet, i 399 Bellini, i 25 Beribery, ii 214 Bezoffr, ii 145 Bible Christians, i 412 Bible, on diet, i 399 Bile-ducts, i 221 Bile, nature of, i 263 Bilious cholera, ii 138 £96 INDEX. Page Bilious diarrhea, vol. ii.. 144 Bilious fever, ii 73, 90 Bilious temperament, i.. 289 Biscuits, i . . . 437 Bismuth, poisons of, ii. . 3 17 Bitter almonds, i 359 Blackberries, i „. 440 Black cancer, ii 179 Black currants, i 360 Black pepper, i. 363 Black pudding, i 343, 354 Black vomit, ii 88 Blanc* mange, i 335 Bladder, inflamed, ii. ... 121 Bladder, structure of, i.. 229 Bladdery fever, ii 202 Blains, ii 305\ Bleeding, abnormal, ii.. . 169 Bleeding, surgical, ii. . . . 338 Blepharidoplastice, ii. . . 425 Blenorrhoea luodes, ii. . . 292 Bligh, Capt., on rum, i. . 283 Blood, as food, i 342 Blood, nature of, i 276 Blood pudding, i 354 Bloody flux, ii 152 Bloody urine, ii 170 Blubber oil, i 330 Blue disease, ii 309 Bodily positions, i 301 Body linen, i 377 Boerhaave, i 28 Boiling flesh, i 343 Boils, ii 357 Bone cancer, ii 348 Bones, i 55 Bones, diseases of, ii. . . . 262 Bottle noses, ii 342 Bottoms, i 354 Bowels, function of, i. . . 281 Bowels, inflamed, ii 119 Brain, i 164 Brain fever, ii 112 Brain, inflamed, ii 112 Bramin baths, i 41 Brandy sores, ii 357 Bread-making, rules, i. . 429 Breads, i 352, 423 Breast, inflamed, ii 474 Breathing, i 269 Bright’s beverage, i 361 Broccoli, i 350 Broiling flesh, i 343 Bromine, poisons of, ii . 321 Bronchitis, ii 220 Bronchlemmitis, ii 114 Bronchocele, ii 345 Brown stout, i 314 Brown study, ii 278 Bruises, ii 335 Brunonian system, i. . . . 30 Buboes, i 292 Buckwheat, i 356 Bucnemia tropica, ii. . . . 260 Bunion, ii 343 Buns, i 354 Burns and scalds, ii 335 Burst eye, ii 185 Butter, i 330, 345, 422 Butteurailk, i 344 Kage Butternut, vol. i 441 Cabbage, i 362, 439 Cachexies, ii 154 Cadaverous food, i 346 Caesarian section, ii 486 Caglivari paste, i 354 Cairo, baths in, i 40 Cakes, i 354, 436 Calcium, 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 Calorification, i 281 Camel, diet of, i 407 Camp fever, ii 89 Cancer, ii 175, 346 Candle 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 Caucasian 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 Cellular dropsy, ii 253 Cellular tissue, i 237 Celsus, i 17 Cephalaea, ii 265 Cephalagia, ii 265 Cereal grains, i 351 Cerebral epilepsy, 11. ... 206 Cerebellum, i 167 Cerebrum, i 164 Cerumen, i 278 Chancres, ii 292 Change of air, i 300 Charlemagne, bath of, i. . 39 Chatard, on labor pains, ii. 467 Cheese, i 333, 345 Cheilo-plastice, ii 426 Chemistry of diet, i 413 Chemical physicians, i. . 20 Cherries, i. 440 Chestnuts, i 431, 441 Chest-wrapper, vol. ii... 53 Chicken-pox, ii 99 Chickory, 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 Chlorosis, ii 287 Chocolate, i. 313 Choking, ii 431 Cholera, ii 139 Cholera infantum, ii. ... 140 Cholera morbus, ii 139 Cholera, seasons, i 412 Chord, in music, i 255 Chorion, ii 447 Chorea, ii 212 Chrome, poisons ofj ii.. . 321 Chrysippus, i 14 Churchill, on pains, ii... 462 Chyle, i 264 Chyle-ducts, i 264 Chylification, i 264 Chylous diarrhea, ii. ... 144 Chyme, i. 262 Chymifieation, i 262 Circulation, i 264 Cinnamon, i 363 Circocele, ii 352 Citric acid, i 329 Citrons, i 35C Clairvoyance, i 248 Clams, i 349 Clapp, ii 292 Clarke, Dr. Adam, i 340 Clavi, ii 343 Clavicle bandage, ii 388 Clavicle, fractured, ii. . . 410 Clavicle, luxated, ii 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 Coffee, 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. . . 326 Compressing arteries, ii. 437 Compression, ii 335 Conception, theory of, ii. 493 Concords, in music, i. . 255 Concretions, intestinal, ii. 145 Concussions ii 334 Condiments, i ‘‘ > >63,44J INDEX. 497 F-ige Congelation, vol. ii 330 Congestive fever, ii 73 Consonants, i 258 Constipated colic, ii 137 Constipation, ii... . . 128,459 Consumption, ii 154 Contracted sinews, ii. . . 284 Contractility, i 238 Convulsions, ii 204 Cookery, hydropathic, i. 417 Cooper, on fractures, ii. 418 Copland, on bronchitis, ii. 149 Copper, poisons of, ii. . . 316 Cords, vocal, i 259 Corn, i 430 Cornea, diseases of, ii... 182 Corns, ii 343 Corn starch, i 434 Corsets, i 297 Coryza, ii 280 Coughing, ii 426 Cough, ii 215 Cows’ heels jelly, i 335 Cow-pox, ii 98 Cowslips, i 350, 439 Coxalgia, ii 126 Coxarum morbus, ii 368 Crabs, i 349 Cracked wheat, i 431 Crackers, i 354 Cradle, i 369 Cramp, ii 231, 459 Cranberries, i, 43o 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 263 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, i 350 Cullen, i. 29 Curd, i 333, 315, 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 Dali’s, Mrs., testimony, ii. 439 Dandelion tops, : 350 Dandruff, ii 303 Darwin’s Zoonomia, i.. . 30 Davies, Dr., on ergot, ii. 46'* Day mare, ii 219 Deafness, ii 196 Death, apparent, ii 239 Death, natural, i 386 Page Decay of nature, vol. ii. 167 Decidua, ii 447 Decline, ii 167 Deformities, ii..* 377 Deglutition, i 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 Diaphragm, i 270 Diarrhea, ii 139 Dicks m, controverted, i. 404 Dietaries, i 441 Diet, divisions of, i 444 Dietetic rules, i 441 Dietetics, i 397 Difficult breathing, ii... . 216 Digby, Kenelin, 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 Dislocations, ii 385 Displacements, ii 293 Dissonant 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 310 Drinks, intoxicating, i. . 314 Drinks, warm, i 312 Dripping-sheet, ii 27 Drop-bath, ii 49 Drop serene, ii 183 Dropsical diseases, ii. . . 25J Drug fever, ii 73 Drug-treatment, ii. . . . 9, 15 Drunkard’s delirium, ii. 209 Dry-cupping, ii 327 Dry pack-bath, ii 35 Dry scall, ii 304 Dumbness, ii 282 Dumplings, i 355 Dung-baths, i 43 Dunglison, controverted, i. 300, 331, 333, 336, 342, 358, 372, 404 Duodenitis, ii 133 Duration of life, i . 383 Duration of pregnancy, i. 455 Dysmenorrhoea, ii. ..... 286 Dysentery, ii 152 Dyspepsia, ii 129 Dyspeptic phthisis, ii. . . 158 Dyspnoea, ii 21 6 Dysuria, ii 297 Earache, vol. ii 194 Ear, anatomy of, i 195 Ear-bath, ii 47 Ear, diseases of, ii 187 Ear, 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 Effervescing mixtures, i. 314 Egyptian baths, i 37, 40 Egyptian ophthalmia, ii. 184 Egyptian priests, i 10 Elasticity, 4 237 Elbow, fractured, ii 414 Elbow, 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 Elliotson, on palsy, ii. . . 2i2 Embryotomy, ii 418 Emetics, surgical, ii. ... 330 Emissions, nocturnal, ii. 291 Emollient herbs, i 44 Empirical physicians, i. 11 Emphysema, ii 259 Empyema, ii # 365 Encephalitis, ii 212 Endine, i 351 Endocarditis, ii 117 Endosmose, i. 286, 287 ; ii. 7 Eneuresis, ii 298 English baths, i 42 Enlargements, ii 24t Enteritis, ii 11' Entropium, ii 184, 425 Ephemeral fever, ii 86 Epicures, i 341 Epilepsy, ii 206 Epithems, i 43 Epistaxis, ii 170 Episynthetics, i 16 Epulis, ii 344 Erasistratus, i 14 Ergot, in labor, ii 466 Eruptive fevers, ii 93 Eruptions, heat, ii 305 Eruptions, scaly, ii 303 Erysipelas, ii 103 Erysipelatous rash, ii. . . 196 Erythemas, ii 195 Esquimaux voracity, i. . 351 Essenes, vegetarians, i. . 414 Ethiopie race, i 291 Etiolated vegetables, i. . 305 Eustachius, i 23 Evacuations, i 379 Examples of longevity, i. 384 Excitability, i 238 Excretions, i 373 INDEX. jDS Page Excrementitious secre- tions, vol. i. 277 Excretory organs, i. ... 279 Excrescence, genital, ii. . 294 Excrescent gums, ii 135 Exercise, i 367 Exfoliation, ii 358 Exhalation, i 277 Exosmose, i. 286 ; ii. . . . 7 Experience in diet, i 4M Exsanguinity, ii 166 External absorption, i.. . 271 External senses, i 189 Eye-bath, ii 47 Eye, diseases oi^ ii 180 Eye, excrescences of, ii. 184 Eye, structure of, i 190 Eye, substances in, ii 186 Fabriculi fever, ii 73 Factitious atmosj|heres, i. 45 Factitious gases, l 44 Faculties, i 245 Faeces, i 262 Fainting-fit, ii 270 Falling sickness, ii 206 Fallopian dropsy, ii 258 Fallopian tubes, i 231 Fanaticism, ii 276 Farina, i 354, 432 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 di’ess, i 298 Ferment, i 426 Fermentationists, i 24 Fermented breads, i. 353, 425 Fermentation, i 427 Fern- 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. 33 L 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 302 Fish aliment, i 348 Fishes, as food, i 33$ 348 Fishes, poisonous, ii. . . . 323 Fish skin, ii 304 Fissures, vol. ii Page 363 Fistula lachrymalis, ii. 185, 364, 424 Fistula in ano, ii 360 Fistula in perenio, ii. ... 362 Fistula, salivary, ii Fixed oils, i 364 330 Flatulence, ii. 129 Flatulent cholera, ii 139 Flatulent colic, ii 137 Flesh-meat, i 339, 343 Flooding — Flowing, ii... 474 Fluor albus, ii 289 Fluorine, in food, i 325 Fluxes, ii 151 Foetal anatomy, i 233 Foetal development, ii. . . 447 Foetal pathoiogv, ii 456 Follicles, gastric, i 278 Fomentations, ii 50 Fomentations, medical, i. 43 Fomentations, surgio., 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.. 485 Forsyth, Dr., on diet, i.. 460 Fountain-bath, ii 40 Fowl, i 422 Fractures, ii 407 Fragillitas ossium, ii 263 Framboesia, ii 203 Freckles, ii 308 French baths, i 41 Fret, ii 198 Friction, ii 54 Fritters, i 354 Frogs, as food, i 339 Fruit-cake, i 354 Fruits, i Frying food, i 439 330 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 . . . Gangrenous erythema, ii 186 . 196 Gaping, i 238 Garlics, i Garments, i 376 Gas-burners, i 302 Gases, factitious, i 44 Gastric fever, ii 107 Gastric-juice, i 262 Gastric remitt, fever, ii. 166 Gastritis, ii 118 Gastro-enteritis, ii 11.9/ Gauls, bathing habits^ 3s: Paga 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. 352 Granular 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 2L6 Gums, excrescent, ii 135 Gutta rosea, ii 341 Guy, Dr., on hysteria, ii. 208 Haemastasis, ii 331 Heematamesis, ii 170 Haematuria, ii. 170 Hasmoptosis, ii 170 Hair, morbid, ii 310 Half-bath, ii 29 Half pack-bath, ii 25 Haller, i 28 Hallucination, ii 27C 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 35# INDEX. 4U9 Page Headache, vol. ii 265 Head-bath, ii 32 Head, dropsy of, 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 Heat, animal, i 281 Heat eruption, ii 305 Heated rooms, i 365 Hematocele, ii 353 Hemeralopia, ii 185 Hemiplegia, 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 Hernias, ii 369 Hernial anatomy, i.. 128, 131 Heroic physician, i 15 Herophilus, i 14 Herpes, ii 305 Hiccough — hiccup, ii. .. 236 Hill, Dr., on herniae, 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 Hoffman, 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 426 Horse, diet of, i 408 Horse-radishes, i. ... 363 Hosack, on ergot, ii 469 Hose-bath, ii 26 Hospital fever, ii 89 Hot- bath, ii 41 Hot rolls, i. 354 Human diet, i 409 Humerus, fractured, ii. . 412 Humid scalls, ii 306 Humoral pathology, ii. . 6 Humors of the eye, i. .. 193 Hunger, i 264 Huston, on bleeding, ii.. 473 Ilydfarthrus, ii 351 Hydrocele, ii 258 Hydrocephalus, ii 255 Hydrophobia, ii 225 Hydrometra, ii 258 Hydrops articular, ii 352 Hydrops capitis, ii 254 Hydrops thoracis, ii. ... 256 Hydro-rachitis ii 38', ' Page Hydrothorax, vol. ii. ... 253 Hygiene, i 295 Hygiene, mental, i 381 Hygienic agencies, i 295 Hypochondriacism, i 276 Hysteria, ii 207 Hysterics, ii 207 Hysteritis, ii 121 Hysterotomy, ii 486 Iced-water, i 309 Iceland moss, i 351 Ichthyophagists, i 348 Icterus, ii 132 Icthyiasis, ii 304 Idiotism, ii 279 Ignis sacer, ii 196 llvvi passion, ii 136 Illusion, mental, ii 276 Ulutation-bath, i 43 Imbecility, ii 279 Imbibition, i 287 immelodious voice, ii... 283 Imperforate anus, ii. ... 432 Imperforate urethra, ii.. 432 Impetigo, ii 306 Imposthume, ii 365 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 Inflammation, ii 108 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 430 insalivation, i 261 Insanity, ii 273 Insects, as food, i 350 Insects, poisonous, ii 23-1 Insects, wounding, ii 198 Insolation- bath, i. 43 Insufflation, i 44 Intermittent fever, ii. .. 90 Internal absorption, i. . . 271 Intertrigo, ii 198 Intestinal concretions, ii. 145 Intestinal enlargem’t, ii. 251 Intestines, i 217 Intoxicating beverages, i. 314 Invalids, rules for, i 441 Invermination, ii 145 Inversion, uterine, ii. 294, 492 Page Involuntary evacuations. vol. i 37S Iodine fumigation, i 4? Iodine, poisons of, ii. . . . 320 Irish moss, i 351 Iritis, ii 181 Iron, in food, i 324 Iron, poisons of, ii 318 Irrationality, ii 279 Irritability, i 238 Ischuria, ii 297 Isinglass, i 335 Italian baths, i 39 Itch, bakers, etc., ii 304 Itch, common, ii 307 Jail fever, ii 89 Jams, i 329 J arrold, on curvatures, ii. 235 Jaundice, ii. 132 Jaw, dislocated, ii 387 Jaw, fractured, ii 408 Jelly, i 328 Jelly, animal, i 334 Jelly, preparations of, i. 335 Jewish priests, i 10 Johnson, Dr. E., opposed, ii 103, 105, 211 Johnson, Dr. J , contro- verted, i. Johnny-cake, i.. Joints, structurp -f, i. .. 396 358 79 Joints, dropsy c_, ii 352 Iveratoplastice, ii 425 Kernels, i 359 Kidneys, structure of, i. 223 Kidneys, function of, i. . 280 Kidneys, inflamed, ii 120 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... 433 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 468 Lacerations, ii 491 Lachrymal flstula, ii. . . . 185 361, 424 Lacteal absorption, i 272 Lactic acid, i 329 Lactometer, i 344 Lagophthalmus, ii 425 Lambe, on diet, i. .. 403, 413 Lamps, i 302 Langhaus, criticised, ii.. 185 Lard, i 330 Laryngismus stridulus, ii 218 Laryngitis, ii 113 Laryngotomy, i: 431 Larynx, i 207 iLarynx, inflamed, ii. 113 lLaveinents, ii. 58 500 INDEX. Page Lawrence, on diet, vol. i. 403 Laziness, i 367 Lead colic, ii 136 Lead, poisons of, ii 316 Lee, Dr., controverted, i. 313 Leeching, ii . . 338 Leeks, i 350 Leg- bath, ii 49 Legumen, i 333 Lemons, i 350 Lemon-juice, i 439 Lentils, i 359 Leprosy — lepriasis, ii. . . 303 l ethargy, ii 244 Lettuce, i 362, 439 Leuchorrhoea, ii 289 Lever, obstetrical, ii. — 485 Lichenin, i 327 Lichenous rash, ii 302 Liebig, controverted, i. . 280 282, 321, 324, 336 Lientery, ii 144 Lieutaud, i 31 Life, duration of, i 383 Ligaments, i 78 Ligating arteries, ii 437 Ligature, surgical, ii. . . . 326 Light, i 304 Lignin, i 327 Limes, i 350 Lime-water, i 317 Linen, body, i 377 Linneus, on diet, i 403 Lion, diet of, i 406 Lips, i 215 Liquor amnii, ii 452 Liston, on fractures, ii. . 418 Lithontripsy, ii 432 Lithotomy, ii 432 Liver, alcoholized, ii 249 Liver complaint, ii 132 Liver, enlarged, ii 248 Liver, function of, i 280 Liver, inflamed, ii 118 Liver, structure of, i 219 Lobsters, as food, i 349 Lochia, ii 474 Locked-jaw, ii 231 Longevity, i 383 Longings, pregnancy, ii. 459 Lousiness, ii 308 Low diet, i 444 Low spirits, ii 276 Lumbago, ii 126 Lumbar abscess, ii 367 Lung fever, ii 116 Lungs, inflamed, ii 116 Lungs, structure of, i.- 211 Lupus, ii 349 Lust, inordinate, ii 293 Lying-in, ii . 472 Lymph, i 273 Lymphatic absorption, i. 272 Lymphatic system, i 155 Macaroni, i 333, 354, 454 Mace, i 363 Macular skin ii 308 Magical arts, i 19 Magnesium, in f jtjdy i. . . 325 Maize, vol. i 358 Mahometan baths, i 41 Malay race, i 292 Mai de la rosa, ii 169 Malic acid, i 329 Malignant cholera, ii. . . . 139 Malignant sore throat, ii. 113 Malt liquors, i 314 Mammals, as food, i. ... 339 Mammary abscess, ii 366 Mammary glands, i 232 Man, drink of, i 307 Man, diet of, i 399 Manganese, poisons of, ii. 320 Mangel, i 31 Manhattan water i 316 Mania — madness d 274 Mania, puerperai, ii 491 Marasmus, ii 166 Marriage, age for, ii 446 Marriage, law of, ii 446 Marrow, i 330 Marsh water, i 317 Mathemat. physicians, i. 25 Maxillary abscess, ii. . . . 336 Mayhew, transmission, ii. 446 Meadow sorrel, i 436 Mean temperature, i. . . . 367 Measles, ii 99 Meconium, ii 448 Medicated baths, i 43 Medicating labor pains, ii. 466 Medical testimony, i. 46, 412 Medicinal waters, i. .... 317 Medicine, history of, i.. . 10 Medulla oblongata, i. . . . 168 Medullary sarcoma, ii.. . 347 Melancholy, ii 273 Melanosis, ii 179 Meningitis, ii 112 Men, races of, i 290 Menorrhagia, ii 170 Menses, irregular, ii. ... 285 Mental abstraction, ii. . . 273 Mental diseases, ii 278 Mental hygiene, i 381 Mental nervous system, i. 243 Mercurial erythema, ii. . 196 Mercurialized tongue, ii. 380 Mercurial rheumatism, ii. 126 Mercury, poisons of, ii.. 313 Mesenteric fever, ii 166 Mesentery, enlarged, ii . 251 Mesentery, struct, of, i.. 215 Mesmeric phenomena, i. 247 Metacarpal disiocat’ns, ii. 396 Metallic oxides, ii 231 Metallic salts, ii 321 Metaphysical pbysici., i. 27 Metatarsus, i 91 Metasyncrisis, i 15 Metcalfe, on diet, i 417 Methodic theory, i. 15 Metritis, ii 121 Mexican baths, i.. . 41 Midwifery, ii 439 Miliaria, ii 105 Milary fever, ii 105 Milk, affected, i. 279/ M ]1 k diet, i 144 Milk ferez*, vol. ii 275 Milk, as food, i 344, 422 Milkweed, i „ 350 Milk-yeast, i 427 Millar, on fevers, ii. 81 Millet, i 35d Millet-rash, ii. 302 Mind, philosophy of, i. . . 244 Mineral system, i 19 Mineral waters, i 317 Mink, diet of, i 406 Mii’thfulness, i 367 Misanthropy, ii 276 Misdentition, ii 135 Misenunciation, ii 284 Mismenstruation, ii 286 Mismicturition, ii 296 Misossittcation, ii 262 Modus operandi of drugs, ii 15 Modus operandi of wa- ter, ii 4 Mole, ii 308 Mollities ossium, ii 263 Mollusks, as food, i 349 Monboddo, on diet, i. . . . 403 Mongolian race, i 291 Monks, medic, among, i. 19 Monomania on diet, i. . . 443 Monsters, ii 489 Monthly dietary list, i. . . 458 Moore, Mr., on ergot, ii.. 467 Moors, science of, i 19 Morbilli, ii 99 Morgagni, i 31 Moniing-sickness, ii. ... 459 Motory nervous syst’m,i. 241 Moses, on flesh-eating, i. 342 Mouth, i :... 215 Mouth-bath, ii 48 Mucilaginous aliment, i. 326 Mucin, i 331 Mucous diarrhea, ii 144 Mucous fever, ii 107 Mucus, i 277 Mud-bath, i 43 MulbeiTies, i 350 Mulder, conti*overted, i.. 361 Mumps, ii 115 Mutton, i 421 Muscular sense, i 251 Muscular tissue, i 238 Mushes, i 431 Mushrooms, as food, i... 351 Mushrooms, poison’s, ii. 323 Musical sounds, i 255 Musk-melons, i 440 Mussels, i 349 Mustard, i 363, 439 Myology, i 92 Myopia, ii 185 Nam matenii, ii 341 Narcotic poisons, ii 322 Nasal-bath, ii 47 Natural beverages, i. . . . 307 Natural death, i 386 Natural life, i 383 Natural labor, ii 467 Natural waters, i 315 Nebulae, ii. — .. . 133 INDEX. 501 Page Neck-joint, vol. i 80 Necrosis, ii 358 Nectarines, i 350 Nephritis, ii 120 Nerve-ache, ii — 266 Nerve*, i 161 Nervous fever, ii 88 Nervous influnnce, i. — 246 Nervous systems, i 240 Nervous temperament, i. 288 Nervous tissue, i 329 Nettle-rash, ii 201 Neuralgia, ii 266 Neurology, i - 161 Neutral salts, poisons, ii. 313 New York nuisances, i. . 299 N. York temperature, i. . 362 Nichols, Dr., on labor, ii. 462 Nichols, Mrs., on labor, ii. 464 Nictitation, ii 238 Nightmare, ii 219 Nipples, deficient, ii 474 Nipples, sore, ii 475 Nitrogenized food, i 322 Nodes, ii 355 Noli-me-tangere, ii 349 Non-nitrogenized food, i. 322 Nose, i 189 Nose-bleeding, ii 170 Nose, fracture of, ii 408 Nutmegs, i 363 Nutrition, i 274 Nutritive nerv’s syst’m, i. 241 Nuts, i 359, 441 Nyctalopia, ii 185 Oatmeal — 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 (Esophagotomy, ii 430 (Esophagus, i 217 Oil, as food, i 285 Oils, fixed, i.. 330 Oleaginous aliments, i. . 330 Olive oil, i 330, 437 Omelettes, i 422 Omentum, i 2L5 Omentum, enlarged, ii. . 252 Onions, i 439 Onychogrypliosis, ii. ... 343 Onyx, ii 367 Onyxis, ii 343 Opacity of cprnea, ii 182 Ophthalmia, ii 181 Oranges, i 350 Orange skin, ii 308 Oral-bath, ii 48 Orbits of the eye, i 66 Orang-outang, diet of, i. 411 Orchitis, ii 122 Order of development, i. 249 Order of the Bath, i. . . . 39 Organic elements, i 53 Organic transmission, • 444 Oriental 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 348 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 Ozaena, ii 281 Packing-sheet, ii 22, 35 Pain, nature of, i 11 Pains of labor, ii 462 Painter’s colic, ii 136 Palate, i 215, 216 Palpitation, ii 237 Palsy — paresis, ii 246 Panary lermentation, i.. 427 Pancakes, i 354 Pancreas, i 263 Pancreatic juice, i 263 Pandiculation, ii 239 Panther, diet of, i 406 Papulous seall, ii 306 Paracelsus, i 21 Paracentesis, ii..424, 431, 432 Paralysis agitans, ii 215 Paraplegia, ii 247 Parched corn, i 431 Parisian fashions, i 297 Parker, controverted, ii. 275 Parkinson, criticised, ii. 212 Paronchia, ii 345 Parotid glands, i 216 Parotitis, ii 115 Parsnep, i 362, 437, 438 Parturition, ii 461 Parulis, ii 357 Passions, hygiene of, i. . 381 Passions, ungovernab., ii. 275 Pastry, i 434 Patella, fractured, ii. ... 420 Pathology, ii 72 Pathol of the foetus, ii. . 456 Peaches, i. 435, 439 Peach-leather, i 440 Peanuts, i 441 Pearl barley Pearl wheat, i 354 Pears, i 359, 435 Peas, i 359, 430, 432, 433 Pectin — pectid acid, i. . . 328 Pectinaceous aliment, i. . 326 Pelvis, cavity of, ii 452 Pelvis, fracture of, ii. . . . 412 Pelvis, viscera of, i 224 Pemphigus, ii 202 Pendleton, on pains, ii. . 464 Pepper, i 363 Pepsin, i 262 Percussion, ii 161 Pereira controverted, i. 283 285, 313, 314, 321, 324, 336 Perforator, obstetrical, ii. 486 Pag« Pericarditis, vol. ii. 117 Peripneumony, ii 116 Peritoneum, i 213 Peritonitis, ii 120, 474 Perkins, on ergot, ii 46 Pernicious fever, ii 73 Pernio, ii 198 Persian baths, i 40 Perspiration, i 278 Pertussis, ii 215 Peruvian baths, i 41 Pessaries, ii 295 Petechial fever, ii 89 Pettit-toes’ jelly, i 335 Pharynx, i 2l6 Phenomena, mesmeric, i. 249 Phenomena of sleep, i. . 371 Philosophy of mind, i... 244 Philos, of water-cure, ii. 3 Phlebitis, ii 338 Phlebotomy, ii 338 Phlegmasia dolens, ii. 260, 475 Phonographic reform, i. 259 Phosphorus, in food, i.. . 323 Phosphorus, poisons, ii.. 320 Phrensy — phrenitis, ii.. . 112 Phthisis, pulmonalis, ii.. 152 Physiology, i 235 Physiology of diet, i. . . . 410 Piebald skin, ii 308 Pies, i 434 Piles, ii 148, 459 Pine-apple, i 350 Placenta, ii 451, 49C Plague — pestis, ii 107 Plantain, i 350 Platina, poisons of, ii. .. 321 Plato, i 14 Pledgets, surgical, ii. ... 327 Plethora, ii 17? Pleura, i 21i Pleuralgia, ii 126, 224 Pleurisy, ii 116 Pleurodyne, ii 126, 224 Plica polonica, ii 310 Plum-cake, i 354 Plum pudding, i 354 Plums, i 440 Plunge-bath, ii 30 Plural births, ii 489 Pneumatic physicians, i. 16 Pneumatoiogy, i 16 Pneumonia, ii 116 Podagra, ii 122 Poisons, ii 311 Polypus, ii 281, 354 Pompholyx, ii 305 Population, i 294 Pork, i 339 Porrigo, ii 306 Portable shower-bath, ii. 41 Portal. M., criticised, ii.. 243 Portal system, i 154 Positions aftect’g break- ing, i 300 Positions, bodily, i 301 Positions during sleep, i. 372 Positions in labor, ii 468 Potassium, in food, i. . . . 325 Potatoes, i 361, 436, 431 602 X X D E X. Potato-tops, vol. i Potato-starch, i Pot-cheese, i Pot-herbs, i Poultices, i Poultry, benighted, i Poultry, fattened, i Pox, venereal, ii Prawns, i Pregnancy, ii Pregnancy, accidents, ii. Pregnancy, diseases, ii. . Preparing food, i 421. Presbyopia, ii Presentations in labor, ii, Presentations, unnat., ii. Prickly heat, ii Prince of empirics, i. . . . Priests, ancient, i Prolapsed cord, ii Prolapsed uterus, ii. Propensities, i Prostatic abscess, ii Prostatic enlargement, ii. Protein, i Proteinaceous aliment, i. Prout, controverted, i... Proximate elements, i. . Prunes, i Pruriginous rash, ii Pruritis, ii Pseudarthrosis, ii Psoas abscess, ii Psoriasis, ii Psorophthalmia, ii Pterygium, ii Ptosis, ii 185, Puddings, i Puerperal convulsions, ii. Puerperal fever, ii Puerperal mania, ii Puerperal swelled leg, ii. 260, Pulmonary consump., ii. Pulse, nature of, ii Pulselessness, ii Pumping the stomach, ii. Pumpkins, i 361, Pupil, closed, ii Purification of air, i Purification of water, i.. Pythagoras, i 12, Quadrupeds as food, i. . . Quicksilver, poison of, ii. Quicksilver quack, i. . . . Quinces, i Quinsy, ii Rabies, ii Races of men, i Radishes, i Rain-bath, ii Rainbow-worm, ii Rain water, i Raised bread, i Raisins, i Ramolissement, ii Ramsbotham on labor, ii. Ranula, ii Raphania, ii Raspberries, i . Page 439 361 442 362 43 305 347 292 349 455 457 459 423 186 468 483 302 21 10 489 293 245 368 355 331 331 327 54 440 302 459 382 367 304 184 183 425 433 491 474 491 475 152 67 229 429 440 183 302 319 414 339 313 22 350 113 225 290 439 40 305 316 428 360 234 465 344 213 440 Page Rationale of crisis, vol. ii. 61 Rationale of drugs, ii. . . 15 Rationale of fever, ii. . . . 77 Rationale of inflamma. ii. 108 Rationale of parturi. ii. . 461 Rationale of water-cu., ii. 4 Rattling in the throat, ii. 282 Rayer, criticised, ii 305 Rausse, Dr., on crisis, ii. 63 Rear buildings, i 305 Recrementitious secre- tions, i 277 Reflex nervous system, i. 242 Regulars banished, i. . . . 14 Relapsing fever, ii 73 Remittent fever, ii 90 Reproduction, ii 443 Reptiles as food, i 339 Respiration, i 267 Respiration, habit3 affect- ing, i 301 Respiratory food, i 322 Restlessness, ii..- 268 Retinitis, ii 181 Retroverted uterus, ii. . . 293 Revery, ii 278 Rhazes, i 18 Rheumatism, ii 126 Rhinoplastice, ii 425 Rhinorrhape, ii 425 Rhubarb plant, i 436 Rhypia — rhupia, ii. 305 Ribs, fracture of, ii 411 Rice, i 356, 430 Rickets — rachitis, ii 262 Ringworm, ii 305 River-bath, ii 39 River water, i 316 Roasting flesh, i 345 Roller, surgical, ii 328 Roman baths, i 38 Ronchus, ii 282 Root-beer, i 314 Roots, edible, i 361, 437 Rose-rash — roseola, ii.. 301 Ross, Sir J., on rum, i.. 284 Rubbing wet-sheet, ii. . . 261 Rubeola, ii 99 Rubula, ii 203 Rum- blossoms, ii 342 Running scall, ii 306 Ruptures, ii 369 Rush on alcohol, i 284 Rusks, i 354 Russian vapor-bath, i. . . 30 Rye — rye meal, i 430, 432 Sacchar.ne urine, ii 297 Sago, i 327. 434 Salads, i 362, 439 Saline aliment, i 335 Saliva, i 261 Salivary fistula, ii 364 Salivary glands, i 216 Salt, antiseptic, i 338 Salt, common, i 336 Samp, i 358 Sand-bath, i 13 Sanguine temp’ment, i. - 288 Sarcocele, ii 353 Satyriasis, ii 293 Png* Salvages, vol. i 29 Sax, on organic laws, ii. 445 ocabies, common, ii 307 Scabies, rough, ii 306 Scalds, ii 335 Scall, dry, ii 304 Scalled head, ii 306 Scall, humid, ii 306 Scallops, i 349 Scaly eruptions, ii 303 Scapula, fractured, ii. . . 410 Scarifying, ii. 338 Scarlet fever, ii 100 Scarlatina, ii 100 Schirrus, ii 346 Schlesekotomy, ii 425 Schuylkill water, i 316 Sciatica, ii 126 Sclerotitis, ii 181 Scoresby. on alcohol, i.. 284 Scorbutus, ii 173 Scrofula, ii 173 Scurvy, ii 172 Scybalum, ii 145 Sea-biscuit, i 354 Seasonings, i 322, 382, 441 Sea water, i 317 Sebaceous glands, i 278 Secretion, i 277 Sedative baths, ii 28 Seeds, cooked, i 430 Semi-animist physici. i.. 28 Semolina, i 354 Sensation, i 25C Sensation, diseases of, ii. 284 Senses, external, i...!89, 25C Sensibility, i 239 Sensitive hair, ii 309 Sentient nerv’s syst’m, i. 242 Sentimen'alism, ii 276 Sequestrum, ii 359 Serous diarrhea, ii 144 Serpents, bites of, ii. 197, 200 Serpents, poisonous, ii. . 324 Serum, i 277 Sesamoid bones, i 77 Sexual diseases, ii 285 Shaddocks, i 350 Shaking palsy, ii.. 211 Shallots, i 350 Shallow-bath, ii 29 Shell fish as food, i 33S Sheeps’ trotters jelly, i. 335 Shew, Dr., on crisis, ii.. 63 Shingles, ii 305 Ship-bread, i. 354 Ship fever, ii. ^ 89 Shrimps, i - . 349 Shoulder-joint, i 84 Shoulder, dislocated, ii.. 389 Shower-bath, ii 33 Sight, organ of, i 196 Sight, morbid, ii 270 Sight, sense of, i 256 Silliness, ii 279 Silver, poisons of, ii 21? Sinews, contracted, ii.. . 384 Singultus, ii. 230 Sinuses, i 150, 15] Sitz-bath, ii 37 INDEX. sstf Pa-o .Skeleton, vol i 57 Skey, on dislocations, ii. 386 Skin, diseases of, ii 301 Skin, functions of, i 279 Skin, structure of, i 20i Sleep, i 370 Sleep-disturbance, ii. - . . 278 Sleeplessness, ii 268 Sleeping apartme., i. 302, 373 Sleep talking, ii., 278 Sleep-walking, ii 278 Small-beer, i 314 Small-pox, ii 93 Smee, on hysterics, ii. . . 209 Smell, morbid, ii 272 Smell, organ of, i 189 Smell, sense of, i 253 Snail-food — snail-parks, i 349 Sneezing, i 253 ; ii. 236 Snoring, ii 282 Soda water, i 314 Sod.ium, 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 ner^s, i 176 Spine, fractures of, ii... 412 Spitting of blood, ii 170 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 surgery, ii.. . 326 Spontaneous combus , ii. 179 Spotted fever, ii 89 Spring water, i 315 Spray-bath, ii 40 Squashes, i 361, 440 Squinting, i.i 184, 379 Stahl, i 26 Stammering — stutter., ii. 284 St. Anthony’s fire, ii 103 Staphyloma, ii 183 Starch, i 327 Stearns, on ergot, ii 466 Sternum, dislocated, ii. . 388 Tage Sternaigia, vol. ii 224 Sternum, fractured, ii... 411 Stethescope, ii 161 Stevens, controverted, ii. 243 Stiff-joint, ii. 235 Stitch in the side, ii 224 St-omach i 217 Stomach, 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 Strophulpus, 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 Submersion, death by, ii. 241 Subsultus, ii 238 Succotash, i 431 Sudoriferous glands, i.. . 278 Suet, i 330 Suffocation, ii 240 Sugar, i 336 Sulphur, in food, i 323 Sulphur, poisons of, ii.. 320 Summer rash, ii 302 Sunburn, ii 308 Superannuation, ii 279 Superfoetation, 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 Surg cal appliances, ii.. . 325 Suspended animation, ii. 239 Sutures, i. 65 ; ii. 329 Swathing 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 SyndesmoloL r y, i 78 Syncope, ii 270 Synocus fever, ii 87 Synovitis, i 376; ii. 339 Syphilis, ii 292 Tabes, ii 167 Table beer, vol. i 3*4 Talipes, ii 382 Tallow, i 330 1’amarinds, i 356 Tapioca, i 327, 434 Tarsal-joint, i 91 Tartaric acid, i 3-9 Tartarous teeth, ii 135 Taste, morbid, ii 272 Taste, organ of, i 20G Taste, sense of, i 252 Tea — tea-drinking, i. 310, 312 Tears, i 279 Teeth, i 67 Teeth-drawmg, ii 428 Teething, ii 135 Temperaments, i. 287 Temperature, i 363 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. . 316 Theobroma cacao, i 313 Theory and practice, ii. . 3 Theory of conception, ii. 493 Theory of fever, ii 75 Theory of inflamm’n, ii. 108 Theory of population, i. 294 Therapeutics, ii 72 Thigh, fractured, ii 416 Thirst, i 264 Thoracic duct, i 15S Thoracic viscera, i 204 Throat, inflamed, ii 113 Thrush, ii 201 Thymus gland, ii 451 Thyroid gland, i 311 Tibia, fracture of, ii 421 Tic Doloreaux, ii >». . 266 Tiger, diet of, i 405 Tight dresses, i 297 Tinea capitis, ii 306 Tin, poisons of, ii 317 Tissues, i 54, 235 Tobacco inhalations, i.. . 45 Tobacco smoke, i 299 Todd, on rabies, ii 227 Toe-joints, i 92 Toe-nail, incurvnted. ii.. 343 Toes, superfluous, ii. . . . 379 Tomatoes, i 440 Tones 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 113 Tonsils, i 216 Tonsils, enlarged, ii 378 Tonsils, excised, ii 378 Toothache, ii 138 Toothache in pregnan. ii. 459 Toothedge, ii 135 Toothlessness, ii 135 Toeth rash, ii 302 INDEX. rage Tcp«, bakers’, vol. i 354 Torpitude, diseases of, ii. 239 Torsion, surgical, ii 329 Touch, morbid, ii 272 Touch, organ of, i 201 Touch, sense of, i 252 Tourniquet, ii 329 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 Transudation, i 287 Tremor — trembling, ii. . . 209 Trephining, ii 423 Trichiasis — trichosis, ii. Triphthongs, i 258 Trismus, ii 231 Tubular diarrhea, ii.. . . . 144 Tumors, ii 340 Turnips, i 362, 437 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 Typhoid fever, ii 73 Typhomania, ii 244 Typhus fever, ii 88, 89 Typhus syncopalis, ii.. . 89 Ulcerated sore throat, ii. 113 Ulcers, ii 356 Ulna, fracture of, ii 415 Umbilical cord, ii. . .449, 452 Underground tenem’ts,i. 305 fJnfermented bread, i. . . 355 Ungovernable passion, ii. 275 United States, baths in, i. 42 Unleavened bread, i. . . . 423 Urethra, i 229 Urethra, imperforate, ii. 432 Urethra, stricture of, ii.. 362 Urinary calculus, ii 299 Urinary diseases, ii 296 Urinary secretion, i 280 Urticaria, ii 201 Uterine hemorrhage, ii.. 170 Uterus, anatomy of, i. . . 230 Uterus, displaced, ii 292 Uterus, dropsy of, ii. ... 258 Uterus, inflamed, ii 121 Uterus, inverted, -ii.. 294, 492 iTOiA, enlarged, ii 378 Page Vaccination, vol. ii. . .96, 430 Vaccine disease — vacci- nia, ii 98 Vagina, i 230 Vapor-bath, ii 37 Vapors, ii 276 Vai'icella, ii 99 Varicocele, ii 353 Varicose aneurism, ii... 350 Variola, Vari x— varices— varicose veins, ii 351 Vaults, i 305 Veal skin, ii 308 Vectis, in parturition, ii. 485 Vegetable diet, i 444 Vegetable food, i 350, 423 Vegetables, green, i 439 Vegetarian dietaries, i.. . 455 Vegetarian societies, i. 412, 414, 416 Veins, anatomy oij 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 Vesiculas seminales, ii.. 266 Vesicular erythema, ii.. 196 Vesicular fever, ii 202 Vicarious menstruati., ii. 287 Vicarious urination, ii. . . 298 Vicissitudes of weath. i. 363 Vinegar, i 329 Vipers, dried flesh of, i.. 25 Viscera, anatomy of, i. . . 204 Visceral inflamm’tion, ii. 108 Visceral turgescence, ii. 248 Vis medicat. natunp, i. 25, 30 Vitalist physicians, i 25 Vocal cords, i 259 Voice, i 257 Voice, irnmelodious, i. . . 283 Voice, tones of, ii. 259 Voice, whispering, ii 283 Volunt’y evacuations, i. 379 Voluntary muscles, i 94 Vomiting, action of, i 264 Vomiting of blood, ii 170 Vowel sounds, i 258 Waists, female, i 298 Walnu; oil, i 330 Walnuts, vol. i 441 Ward, on ergot, ii 467 Warm-bath, ii 41 Warts, ii 342 Washington’s death, ii.. 114 Water, acts on lead, i. . . 329 Water, adulterat’ns of, i. 319 Water-blebs, ii 305 Water-cress, i 439 Water-cure dietaries, i.. 453 Water-cure processes, ii. 22 Water-drinking, i. 308 ; ii. 57 Water in foods, i. 308 Water-melons, i 440 Water, purification of, i. 319 Waters, medicinal, i. ... 317 Waters, mineral, i 317 Waters, natural, i 315 Waters, tests of, i 318 Watery diet, i 446 Wave-bath, ii 39 Weariness of life, ii 276 Weather, vicissitudes, i. 363 Web finger 8, ii 379 Wedding-cake, i 354 Well-water, i 316 Wet dress-bath, ii 41 Wet wrappers, ii 53 Wheat — wheaten grits, i. Wheezing, ii 282 Whelk, in 341 Whispering voice, ii.... 283 White diarrhea, ii 144 White fish, i 421 Whites, ii ,. 289 White-sv'plling, ii 351 Whitlow, ii 345 Whortleberries, i. ..436, 440 Wiess, on crisis, ii 62 Wind cholera, ii 139 Wind colic, ii 137 Wind dropsy, ii 253 Windows, ventilated, i.. 302 Worms, ii 145 Wounds, ii.. 332, 338 Wrist, anatomy of, i. . . . 86 Wrist, fractures of, ii. . . 416 Wrist, dislocation of, ii. . 395 Wry neck, ii 235, 380 Yakut’s voracity, i 352 Yawning, i 329 Yaws, ii 203 Yeast, i 425 Yeast-bread, i 353, 425 Yellow fever, ii 88 Z* .ic poison*, ii "SENT PREPAID BY FIRST POST? AT PRICES ANNEXED. A LIST OF WORKS BY BOWLER & WELLS, 308 BROADWAY, NEW YORK, Thb following List, embraces all our Works, save those contained in onr “Special List,” and those on PHONOGRAPHY, which are given in separate Catalogues. Copies of these Works will be sent by Return Post, on receipt of price. Enclose the amount, and address as above. WORKS ON PHRENOLOGY. 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