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Full text of "New Warren's household physician, enlarged and revised [microform] : being a brief description in plain language of all the diseases of men, women and children, with the latest and most approved methods of treatment"

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NEW 

WAEEEN'S 



HOUSEHOLD PHYSICIAN, 



ENLAKGED AND KEVISED, 

BGIirO A 

BBIEF DESCEIPTION, IN PLAIN LANGUAGE, 



or AUiTHX 



Diseases of Men, Women and Children, 

WITH THB 

LATEST AND MOST APPROVED METHODS OF TREATMENT. 



ALLOPATHIC DEPARTMENT 
/ 

IRA WARREN, A.M., M.D., 

Pellow of the Maiiachuietts Meilical 
Society, etc. 

BEVIgBD BT 

WILLIAM THORNDIKE, M.D., 

fellow of Mansachusetts Medical Society, and 

Member of Boston Society for the Improve- 

ment of Medicine, etc., and others. 



HOM(EOPATHIC DEPARTMENT 

A. E. SMALL, A.M., M.D., 

President of the Hahnemann Medical 
College, Chicago, 111. 

BEVI8ED BT 

J. HEBER SMITH, M.D., 

Professor of Materia Medica. Boston University 

School of Medicine, and laie President of Ma»- 

lachusetts Homaopathio Society, 



And insny others on special subjects. 



FULLY ILLUSTRATED. 



By 86 Figures on i6 Splendid Colored Lithograph Plates, 262 ENk^KAviNGs, and 

Two Full-Page Manikins. 

TAit ieok is published strictly as a Suhtcription Book, and to he sold only as such, A ny person or 
persons infringing upon these rights will be held liable. 

THB RIOHT OF TRANSLATION IS RESERVED. 



BOSTON : 
A. I. BRADLEY & COMPANY, 

234 AND 236 COMORBM STBBBT, 

1898. 



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Entered occonling to Act of Congreu, in the year 1859, by 

IRA WARREN, 

In the Clerk's Office of the District Court of the DIf trict of Man. 



Entered according to Act of Congreis, in the year 1(63, by 

IRA WARREN, 

In the Clerk's Office of theDistrlctCourt of the District of Mass. 



Entered according to Act of Congress, In the year 1870, by 

CHARLES ROBINSON, JB., 
In the Office of the Librarian of Congrers, at Washington. 

Entered according to Act of Congress, in the year 1885, by 

CHARLES ROBINSON, JR., 
In the Office of the Librarian of Congress, at Washington. 

Entered according to Act of Congress, in the year 1880, by 

CHARLES ROBINSON, Jr.. 
In the Office of the Librarian of Congress, at Washington. 

Entered according to Act of Congress, ir the yaar 1807, by 

GEO. A. BLANEY, Admstr. Estate of Ira Warren, 
In the Office of the Librarian of Congress, at Washington. 



KIOBT OP TRANSLATION IB RESERVED. 



This work Is published strictly as a Subscription Book, 
and to be sold only as such.' Any person or persons in- 
fringing upon these rights will be held liable. 



H. M. PLIMPTON A CO., PRIN-.ER8 A BINDERS, 
NORWOOD, MASS., U.S.A. 



PEEPACE. 



This book is written for the people. It is based on the assump- 
tion that every man — the mechanic, the farmeiMind the day laborer, 
as well as the professional man — has a right to all the knowledge 
he 18 capable of acquiring, on all subjects, — medicine not excepted. 
1 he book aims, therefore, to popularize and adapt to the many what 
Has been claimed as belonging only to the few. 

I do not hesitate to avow that my sympathies, as a man, are with 
the great masses, who maybe called the bone and muscle of the race. 
Ihey are, in the main, more shrewd, more endowed with common 
sense, more simple and true in their natural instincts, and conse- 
quently less perverted, than those who claim more refinement and a 
nigher place m the social scale. 

" ^n men," says Hippocrates, one of the great fathere of medicine, 
"ought to be acquainted with the medical art. I believe that knowl- 
edge ot medicine is the sister and companion of wisdom." Such 
knowledge would shield the many from the impositions of quackery. 
No one, I venture to say, who reads this book thoroughly, will be 
often imposed upon thereafter by quack nostrums, or quack doctora. 
Jivery man s physical organization is his own ; and he is charged with 
the responsibility of taking care of it. To do this properly, he needs 
knowledge of it; and to withhold this from him is another form of 
the old oppression, which decreed knowledge and power to the few, 
and Ignorance and obedience to the many. 

In accordance with the design of the work, it has been written in 
plain simple English, and brought within the comprehension of all 
who have medium powers of mind. 

In preparing this book, a great number of authors have been care- 
tully consulted, to whom I acknowledge large indebtedness; yet the 
work is not a mere compUation. In dealing with each disease, I 
have aimed to sketch a brief pen-and-ink portrait, so like it that 
every reader shall know the original whenever he sees it; and then 
V give, in the fewest words, the best treatment. 
• No work of the sort has ever explained the reasons, or given the 
whys and wherefores of medicine to anything like the extent of this : 
nor has any one been so extensively illustrated. The engravings 
have ^en, with fp- exceptions, done expressly for this work. The 
colored lithographs and manikins are inserted at great expense, and 
add much to the value of the book. 

I. W. 




SECOND PREFACE. 



The Household Physician was written in the belief that the people were 
ready and waiting for a popular medical work based on liberal principles ; 
and that one hundred and forty thousand copies have already been sold 
is a sufflciont evidence that the belief was well-founded — many persons 
assuring the publishers that fifty or one hundred dollars would be no temptar 
tion for them to part with the copy they have if they could not obtain 
another. Such an extensive sale of so large a book, with the demand 
constantly increasing, shows its value. 

For these evidences of public favor the Publishers are not ungrateful or 
unmindful of corresponding duties on their part. A chapter is now added, 
therefore, on "Old Age and its Diseases," — a subject never before intro- 
duced into any popular treatise on medicine, and very rarely, indeed, into 
any medical book. Great pains have been taken in preparing it, and we 
sincerely hope that many fathers and mothers will, in future years, be 
kindly remembered in consequence of the suggestions it contains. Also a 
chapter oa new popular Gymnastics, illustrated with many cuts. 

The Publishers. 



THIRD PREFACE. 



The Household Physician, now so well known throughout the English 
and German-speaking world, again appears before the public, printed from 
entirely new plates, revised and improved in accordance with the progress 
of medical science of the present day. 

Old, obsolete matter has been discarded, and only those methods and 
remedies of olden times have been preserved to which, though numerous, 
recent discoveries have found nothing superior. 

Much new information has been added, including articles on Russian 
and Turkish baths at home. Drowning, and on Diseases of the Nervous 
System peculiar to modern times. The illustrations have been supple- 
mented by fine colored plates and manikins showing the arrangement of the 
various organs of the body, the muscles, arteries, veins, and nerves. New 
colored plates of medicinal herbs have also been added, thus giving a dis- 
tinct idea, not only of the pathological seat of many maladies, but of many 
of the sources from whence are derived their specific remedies. 

The prescription list has been most carefully revised, and the old heroic 
doses of opium in its various forms have been superseded by milder nar- 
cotics and sedatives. Mercury no longer shows its hideous features on 
these pages, except as it is to be given in syphilitic affections. The work 
now airly competes in rich information with any newer system of popular 
medicine, and may be relied on, as ever before, for accuracy, best advice, 

aud the most modern medical customs. 

The Publishbbs. 



i 



TABLE OF CONTENTS. 



Preface ^ • 

General Introductory Remarks 

Anatomy 

Physiological Laws of Life and Health — Hygiene 
Temperaments, Constitution and Symptoms 

Skin Diseases 

Diseases of the Brain and Nerves 

Diseases of the Throat 

Diseases of the Chest .... 

Heart Diseases 

Diseases of the Abdominal Cavity 

Venereal or Sexual Diseases 

Female Diseases .... 

Married Ladies' Perpetual Calendar . 

Care of Children and their Diseases . 

Diseases of the General System and MisceHaueous Di 

Diseases Peculiar to Modem Times 

Old Age and its Diseases 

Accidents ...... 

Surgical Diseases .... 

Homoeopathic Treatment of Diseases . 

A Treatise by A. E. Small, M.D. 

Diseases of the Head . 

Diseases of the Brain and Nerves 

Diseases of the Eye and Lids 

Diseases of the Ear 

Disorders of the Nose . 

Diseases of the Respiratory Organs 

Diseases of the Urinary Organs . 

Diseases of the Organs of Generation 

Diseases of the Skin 

Diseases of the, Organs of Circulation 

Diseases involving the Various Organs 

Diseases of Various Organs and Regions 

Dropsies, Hydropsies .... 

Insidious Diseases .... 



seases 



L 



Paob 

3 

S 

14 

64 
122 
134 
164 
208 
229 
274 

'jm 

360 
379 
443 
445 
469 
493 
496 
509 
317 
608 
608 
613 
615 
622 
625 
62" 
628 
634 
638 
642 
651 
653 
665 
684 
686 



i 



TABLE OF CONTENTS. 

Homoeopathic Treatment (continued). VAa* 

MiscellaneouH Diueases 600 

Affections of the Mind 692 

Surgical Diseases 700 

Diseases of Infants 706 

, DiBe<\8eH of Women 713 

Labor, Parturition 716 

Speciflc Indicr aons for Remedies in Fevers .... 720 

Poisons and their Antidotes 726 

Processes of the Hydropathic Treatment ..,,.*. 732 

Domestic Management of the Sick-Room 766 

Cookery for the Sick-Room 789 

Dieting in regard to Health . . ' 798 

Dieting in Disease 801 

Bathing 803 

Proofs of Death 807 

Medicines and their Preparation^ — Materia Medica .... 808 

Prescriptions — Recipes 920 

Proprietary and Patent Medicines 944 

Physical Culture — Gymnastics 960 

Pronouncing Dictionary 961 

General Index 965 

Index to Homoeopathic Department . . . . . . . 982 



LIST OF COLORED AND FULL-PAGE PLATES. 



Portrait of Dr 

Plate I. 

II. 

" III. 

IV. 

" V. 

" VI. 

VII. 

" VIII. 

" IX. 

»' X. 

«' XI. 

" XII. 

XIII. 

" XIV. 

XV. 

" XVI. 

" XVII. 

" XVIII. 

" XIX. 



. Ira WaiTen 

Sectional Manikin of Human Head 
The Human Skeleton . . . . 
Muscles of the Human Body 
Arteries and Veins of the Human Body 
Fig. 1, Measles ; Fig. 2, Scarlet Fever 

Small-Pox 

Erysipelas 

Sectional Manikin of Human Trunk 
Internal Organs of Human Body . 
Syphilitic Eruptions 
Syphilitic Affections of Throat 
Medicinal Plants (Aloes, etc.) 

" " (Bittersweet, etc.) 

" " (Dandelion, etc.) 

" " (Ground Ivy, etc.) 

" " (Hemlock, etc.) 

" " (Mullein, ete.) 

" " (Plantain, etc.) 

" " (Thoroughwort, etc.) 



Frontispiece. 

Facing Preface. 

. p. 19 

Facing p. 27 

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GENERAL INTRODUCTORY REMARKS. 



Progress of Medicine. 

Medicine may be divided into a science and an art. It is a science 
as it presents facts and evolves principles ; an art as it consists of 
rules for practice. For its present attainments, it is indebted partly 
to researches scientifically conducted, and partly to empirical and 
haphazard discovery. 

As a science, medicine is chiefly indebted, and must ever be, to the 
members of what is called the " regular profession." This body of 
men, while it contains numerous persons whose talents and attain- 
ments do not raise them above the mei'est quacks, does yet embrace 
large numbers of men who are alike ornaments of the race, and lights 
of their profession. It is to the writings of this class that every stu- 
dent must go who would qualify himself for the proper discharge of 
the duties of a physician ; and he who attempts the practice of medi- 
cine without a knowledge of standard medical writings is either a 
fool or a knave — either without the brains to understand science, or 
destitute of the honesty to deal fairly with men. 

While this is said, however, it must be granted that a respectable 
portion of the facts which make up the science of medicine have been 
contributed by the industry of men who have not had what is called 
a regular standing in the profession. I am sorry to be obliged to add 
that the great body of this class have been quacks and charlatans, 
while only a few of them have had talents and acquirements. 

Nevertheless, they have been too indiscriminately condemned. 
Their labois have been useful in various ways, and have contributed 
to the advancement of medical knowledge. A regard for truth, not 
less than justice to these persons, requires this statement. 

One-Idea Men. — The " irregulars," as they have been called, have 
generally had their hobbies, which they have ridden with singular 
diligence, and often in little better than John Gilpin plight. Yet they 
have di-awn attention to great truths, which the regular profession 
either did not see, or would not commend ; and they have done this 
by dwelling incessantly upon some single idea. 

The one-idea men, of every class, have been ridiculed in all ages ; 
and indeed have always exhibited some singular obliquities. Yet 
when they have been men of learning and talents, they have accom- 
plished great things, either for good or evil. 



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- OENKKAI, INTRODUCTOKY KKMAUKS. 

Martin Luther was strictly fv one-idea man. The wliolo forro of 
liis extraordinary eharactor was jriventothe ()r()|)ajfation of the sinjirlo 
doctrine of justification by faith; and by the incessant efTortH he made 
for this purpose, ho sank the doctrine deeper into the heart of Europe 
than a hundred ecpially powerful men could have done by giving it 
only an ordinary share of attention. 

William Ellery ('banning was a one-ideaist. Matu the noblest 
work of creation, to be developed, educated, adorned, loved, made 
like unto (iod,wa8 the thought of his life, — a thought which ho em- 
bellished and moulded into all the forms of beauty which our flexible 
language is capable of producing. Under the mild promptings of 
his genius, and the workings of this thought, philanthropy, quick- 
ened into a new life, spread out her aims, and embraced the world. 

Sir Isaac Newton was a one-ideaist. So entirely did he devote his 
great powers to astronomy and the liigher mathematics, that he be- 
came unfitted for the duties of social and domestic life — so unfitted, 
that when induced by his friends to give a little attention to courtship, 
he fell into one of his abstractions, and detected himself in using his 
lady-love's fore-finger to poke down the ashes in his pipe I But Sir 
Isaac advanced mathematical science to a point far beyond its previ- 
ous attainments, and laid it under such obligations as no general 
scholar could have done. 

It is in this way, though in a vastly less degree, and without tlie 
scientific method, that one-ideaists in medicine benefit the world. 
They seize upon some single remedy, — generally one which has been 
overlooked — and using it themselves to the exclusion of all others, 
they press it upon the world as the panocba for all its ills. With 
them disease is a unit, and they have found its one all-important 
remedy. Thus convinced, they jn-ess it upon others with the enthu- 
siasm of fanatics. Testing it in all cases, they develop all its virtues. 
Those who have the good sense to turn their attention to it have 
only to use it in those cases for which its adaptation is proved. 

It is in this way that these men become, incidentally, medical dis- 
coverers ; and not being burdened with modesty, they never with- 
hold their importunities till the world acknowledges whatever value 
there is in their discovery. And although they may do some mis- 
chief with the single-edged tool which they handle so industriously, I 
doubt if they do much more than many better workmen who use too 
many. At all events, wise and generous men thank them for their 
gift to the profession, small though it may be, and use it in the light 
of a clearer knowledge. 

Hydropathy. — As an illustration of what I have just been saying, 

1 may refer to hydropathy, or the plan of treating all diseases by water. 

The singularly careful avoidance, by the whole medical faculty, for 
many ages, of the article of pure water as a medicinal, or, rather, 
health-imparting agent, was anything but creditable to the profession. 

It is now admitted by all sensible men that water, cold and warm, 



ORNKRAF, INTRODUCrORY RKMARK8. 



force of 

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1 faculty, for 
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used at jH-oper times and to a reasonable extent, huH great power over 
several diseases, and is a powerful promoter of li'eiilth. No physiinaiis, 
except those who arc; too ii lolciit to know what is going on in the 
world, or too fast lu(;k(!d in old pnijudicos to touch new things, now 
oniit ita use in tmujf cases, I low warm anctsincere my own approval 
of water iw a r nedy is, almost every page of this volume will attest. 

Indeed, it may honestly be allowed that the hydropathists have 
fairly droicni'd the almost criminal professional prejudice against 
water. They are in all tlio more need of this (concession, since in 
their absurd zeal to cure all diseases l)y water, and make aquatic; an- 
imals of men, they have also drowned their own common-sense. 

Homoeopathy — This mode of practice is of comparatively recent 
origin ; but it has already sunk itself deep into the popular heart, 
and has drawn to its support many of the wealthy, the cultivated, 
and the intelligent, in our most refined communities. I do not pro- 
fess to comprehend and appreciate its principles, nor would it bo 
honest in me to pretend to see how its infinitesimal doses can pro- 
duce the results which it often shows, and which it is fair to confess 
look like singular success ; and saying this, I can neither adopt nor 
approve the violent denunciations and censures which so many are 
induced (by fashion, I fear) to employ towards this generally well- 
cultivated class of practitioners. I hold them as useful members of 
the profession, and mean ever to cultivate towards them fraternal 
feelings. They give great attention to exercise, diet, the use of 
water, etc., — things which contribute very powerfully to preserve 
health, and to restore it when lost. In this thing, the oUUchooI 
practitioners ought to learn a most important lesson from them. In 
truth, they are learning it, but very slowly and reluctant! i/, I am 
sorry to say. 

The centml idea of the homoeopathist, that " like cures like," the 
" great law of cure," as he styles it, I do not feel called upon to dis- 
cuss — theories being of much less consequence than rules of prac- 
tice. The old-school men have certainly much to learn from him 
respecting the augmented power of medicine from the greatest possi- 
ble division by trituration. We have learned from him, too,— 
though many are too ungenerous to confess the source of the infor- 
mation, — that we may gain our purposes with much less medicine 
than we were once in the habit of giving. 

Eclectics. — There is a large and growing class of physicians, called, 
at first, after the founder of the school, Thomsonians. Subsequently, 
they were generally known as Botanic Physicians. Now they pass 
under the title of Eclectics. 

These men, directing their attention, at first, chiefly to cayenne 
and lobelia, have gradually extended their zealous researches over 
the vegetable kingdom, and have gathered much information worthy 
to be preserved. These researches have revealed a sadly neglected 
duty on the part of old-school practitioners. 



TS^ 






WT^^^^S?*?***" 



I 



8 OKNERAL INTUODUCTORY RRMAKKS. 

Tho iHlncatioi) niid tiiltMitM of tliiH cIohh of pnictitioiuM'H have grad- 
ually risen, year by ^ear, until tliey liavo Heveral medical hcIiooIh, 
where HliidenU an; well inHtrueted in the principles of ni(;(li(Mne, hy 
men of real ahility. They have also a liUiraturr of no mean si^ni- 
ticance, espceially in the department of materia niedieu. The liut 
of renjcdies they liavo ffivnn to the w(»rld, drawn from our home 
plantH, are a l>oon of no small value. I regard them an equal in 
value to all we were previounly in possession of from the vegetable 
kingdom. The sulwtitution of 'ngetiible remedies, in most ciiHes, 
for mercurials, can hardly be too highly prized. 

Physiologists. — Besides these various direct privctitionera of medi- 
cine, there is the large and (}uite intelligent :;laH8 of physiologists, 
including the phrenologista, who nearly discard medicine, and ai>- 
pealing to the laws of life established by the (Creator, urgt temper- 
ance in eating and drinking ; exercise in the oj)en air ; securing of 
pure air by ventilating dwellings, school-houses, and (ihurches ; lath- 
ing in cold and wa'-m water; cheerfulness of mind ; and the cultiva- 
tion of tlie Christian virtues, as the only mtional modes of securing 
health and life. 

I confess myself inclined to forgive this class their error in Ikvu- 
ishing medicine, in view of their zeal and success in disseminating 
hygienic information of the utmost value and importaiice to man- 
kind. Put man into harmony with nature, and establish over him 
the empire of reason, and their theory would be excellent; but as 
tilings are, medicines, like prisons, and alms-houses, and large cities, 
are " necessary evils." 

Other Practitioners. — Finally, we have Mesmerists, Pathetists, 
Electro-biologists, Spiritualists, Nutritivists, and what not, all pre- 
tending to cure disease by processes peculiar to themselves. They 
are all experimenters in different departments of nature, — now 
spreading over oiir eyes a large plaster of humbuggery, and now 
drawing a small curtain and giving -us a peep into the large and 
well-furnished rooms which nature has fitted up for our reception, b}' 
and by, when we are better instructed. 

All Useful in a Degree. — On the whole. I am disposed to regard 
all the operators in the different departments of medicine a* useful 
in their degree ; excepting always those mercenary quacks, who lie 
about their remedies to make money. Each of all these (I mean all 
sincere and true men who believe what they teach) is aiding in some 
measure the general advancement. And though the truths, as they 
gather and present them, are but fragmentary, they are useful in the 
hands of those true Eclectics, who have the wisdom and independence 
to select the best things out of all systems. 

General Conclusion. — This brings me to remark that there is but 
one truly libera' and piulosoTjlvical school oi medicine. It is the Ec- 
lectic, — composed of those who have liberality enov gh to reject 






rM 



niNKKAI, r».TKOI)trCTOUY KKMARKS. 



9 



prnvd- 
iooIh. 
e, 1>.V 

i \\ni 

home 
ml ill 
i table 
caseH, 

medi- 
ogiste, 
lul a\y- 
iMuper- 
ring of 

; bath- 
•ultiva- 
3curing 

in l)an- 
linating 
to man- 
VQV him 
but as 
e cities, 

.thetists, 
till inv- 
They 
now 
nd now 
r^e and 
)tion, by 

lo regard 
|ih useful 
who lie 
Imean all 
in some 
L as they 
lul in the 
pendence 

tre is but 
Is the Ec- 
Ito reject 



(•very frcliifiiu' iii/iiti'm, and to Hulect out of all HyHteins thone thingH 
vvliicli iiH' a|i|iroved by t'xpcrionce and reason. 

I liave alrrady Hpokcn (if the school of practitionei's callt'd KchHttic. 
To a certain extent tliey an* (entitled to tlu* name, but I tliink not 
entirely. They have formed a separate and exclusiv»t Hcbool. They 
have turned some articles out of the materia medica /loioti/ili/ for no 
letter reasoji than iM'cause their jiarty is conunitted to th.ar rejec- 
tion ; whereas tliey should have no party, but allow each man to act 
as if he were a citizen of the world only, and not a member of any 
restricttnl association. But I will not ([uarrel with them on this 
point. I think they are hefoinin</ . .dectic. 

Progress of Medicine. — There :;. ra been long periods when the 
science and the art of mcdiciiu' made scarcely any i)rogress. They 
are now advancing, — in sonu! departments quite rapidly. 

The Chemistry of Man, commonly called Animal (.'hemistry, is 
opening new sources of light. 

The writer was in the habit of asserting, many yeai-s ago, that 
most of the true progress in mediiune must come through Animal 
('hemistry; and the developments of the last few yeare Imve made 
good the assertion. Liebig, a diligent student in chemistiy, has done 
much to open the way for inquirei-s in this department. Simon has, 
per'iaps, done nmre. Mialhe is a yet later explorer, and has made 
valuable discoveries. 

The result is that students have now before i. ^ir minds, and are 
endeavoring to solve and act upon as fast as possible, inquiries and 
propositions like these : — 

What is the chemical composition of the solids and fluids of the 
healthy human body ? 

What is the nature of the changes which occur in the composition 
of the solids and fluids during disease? 

What alterations in the chemical composition of the solids and 
fluids take place during the operation of , medicines ? 

Before it can exert any remote action on the animal economy, a 
remedy must be absorbed. 

Before it can be absorbed, it must be soluble in the fluids of the 
living body. 

Medicines are subject to chemical changes during their passage 
through the system. 

These changes are regulated by ordinary chemical laws, and may 
therefore, to some extent, be foretold and made available in the cure 
of disease. 

These chemical laws are disturbed and varied, to some extent, by 
the law of vitaliuy, — just as the magnetic needle is made to vary by 
disturbing forces. 

What are those disturbances, and to what extent, and under what 
circumstances, dc ';hey occur? 

With these and similar inquiries and propositions before his mind. 







10 



fihNERAL INTRODUCTORY REMARKS. 



diligently studied, a iniui will in time learn tt> picsciil)u with sonic 
intelligent aim. Me will not know 'everything, to be sure, but what 
he does know, he will have a reason for knowing. If he give a 
medieine, he will have in view the el emieal (dianges of the solids 
and llnids of the body, known to be produced by the disease he is 
combating. He will also kee]> in mind the solution of the medicine 
in the fluids of the body, and the chemical reaction between its com- 
ponents and the acids, alkalies, etc., found in the alimentary tube 
and elsewhere. 

As the science of medicine advances, and becomes liberal and ec- 
lectic in its character, gathering from all systems the best attested 
facts, and using them to the exclusion of all mere theories, these 
facts must not themselves degenerate into mere pettsd theories, but 
must be held in subordination to future experience. Medical prac- 
titioners, who would meet the wants of the age, must be men of 
progress. The light of to-morrow, with them, must nKwlify and im- 
prove the light of to-day. They rv iit knock CN'ery hour for admis- 
sion into sqme new apartment of nature. 

Need of Liberality. — That medical progress may be real, physi- 
cians mu3t be free from bigotry. They must have no narrow preju- 
dices against any man, or class of men ; but be ready to examine 
candidly any new thought or new remedy brought to their notice, 
from whatever source it may come. 

They should not hedge themselves about with such restrictive by- 
laws and Bocietiiry rules as are calculated to fetter their thoughts, 
and turn their investigations, by a sort of moral necessity, into the 
narrow channels of party conservatism ; remembering that he who is 
once enclosed by such restrictio'.is must hew a path for his feet 
through bigotry, and even malevolence itself, before he can escape 
them, or be a free man in any node sense. 

The members of medical societ'.es do themselves no credit, in the 
nineteenth century, by putting on airs, and telling others to stand at 
a distance. This Avould do better, had medicine become an exact 
science ; but while the primary effects of even opium are not settled 
— some physicians considerint^ it as ^irimarily stimulant, others as 
sedative, others as stimulant to tl^e nerves and sedative to the 
muscles, others as neither, and still c thers as alterative, — such ex- 
clusiveness seems neither wise nor modest. When the professors of 
the iiealing art can hoard medical knowiedgre as misers hor>rd gold, 
and can submit its purity to equally certain tests, it will appear in 
better taste for them to grow exclusive. Until then, the most be- 
coming badge they can wear is the Christian direction : " Let each 
esteem others better than himself." 

Medical societies, with liberal by-laws, are fitted to do good ; but 
it would be hard to show that those with stringently restrictive '"lies 
can operate otherwise than as checks upon progress. In truth, they 
are apt to become mere catacombs in which to embalm dead ideas . 



^Mm 



GKNKRAIi INTKOUUCTORY KEMARK8. 



11 



3od; but 

live ■^'iles 

ith, tliey 

id ideas. 



They are very liable to Im made the instruments for iwcoinplishiiig 
the ambitious purposes of a few leading men. They tenil to suppress 
all sympathy with everything outside their orgauization ; and they 
Ijeget a feeling like that which would forbid the lixed stars to drop 
their light into our atmosphere without first coming down and joining 
the solar system. 

Conservative Leaders. — There are no influences which hold so 
steady a check upon medical progress as the conservative leaders in 
many of our medical association , Not that they are oi)posed to im- 
provement in the medical art, t /ould object to any amount of dis- 
covery, if it could come to the profession through channels which they 
have the honor of opening. But against all light from outside, or 
from obscure sources, they will draw down the curtains, and close the 
doors ; and, if it chance by any means, in spite of them, to get within 
the sacred enclosure, they will call it darkness, and, as priests of the 
temple, will attempt to atone for the indignity offered to the god of 
medicine, and fill the whole sky with murky clouds from their altivrs. 

These men have strong faith in caste, and in the right of the few 
to govern the many. In the low places of society, they look for 
nothing but ignorance and poverty. Notwithstanding that the light 
of every natural day breaks in the horizon, and ascends, they so far 
despise analogies as to insist that all medical light breaks at what 
they call the zenith of the profession, and comes dovm. With them 
the temples of Esculapius are all rebuilt, and tLcy are the priests ; 
and to offer in sacrifice the smallest medicinal plant is a sacrilege, 
unless it be entrusted to their hands. 

Such persons measure and weigh a man by the amount of money 
he has. Property is their god, which gives laws to everything. 
With them, knowledge, like property, goes to posterity by will,- — 
they being the principal testators. Like their money, t' \ it goes 
chiefly to their sons, and to certain favored institutions, by .vhoni and 
in whicli it is to be hoarded, and whence it is to go out only ux certain 
appi'oved channels, weighed and stamped, like coin from the mint. 

These are the men who regard knowledge as a contraband article, 
unless regularly entered at the custom-house, with bills of lading 
properly certified by the conservative magnates at some other me- 
tropolis. With them, knowledge is not like the west wind, fanning 
the brow of the peasant as gently as that of the king — not like the 
light of heaven, entering the small, clean window of the hut, as 
readily as the larger one of the palace ; not a boon which comes alike 
freely to all, and which is to be everywhere amplified, changed sus 
circumstances and conditions require, and especially adapted to the 
present hour. It i,? rather, as they too often view it, like litho- 
jrraphed letters '-i advice, printed upon stamped paper, and carefully 
sealed up and addressed to posterity. And then, if they can be 
made the mail carriera, and be permitted to pass, unchallenged, with 
the precious bag, from post to post, and pass it over, carefully sealed, 




II! "Til 



■ '■. 






12 



(iENEKAL INTKOnUCTOllY RKMAKKS. 



to the next generation, they will think it has done its work, and that 
they have fulfilled their mission. 

I would not be unjust or severe, but I cannot but remark fui-ther, 
that these men present but one view of humanity. They are monot- 
onous objects of inspection. Look at them a thousand times, and 
you see only the same unaltered phase of life. To the mariner on 
life's ocean, they are not safe lights. If he approach them on the 
dark side they remain black as night to him, until he comes round to 
their shining front. Th^y are not revolving lights. They have 
light : it may be bright and genial ; but it gleams out upon the 
watei-s only in one direction. It does not sweep round, and throw its 
rays upon every mariner's path. 

Such men are useful, but only to a certain class. They have in 
them no true omnilogy — they are not all-teaching. Their lives are 
ins ructive to their friends, their clique, their party, their school ; 
but a stumbling-block, a hindrance, an oppression, an offence to evei-y- 
body else. They are like porcupines, with fronts smooth and easy 
of access ; but their backs bristle with quills to stick into those on 
the wrong side. They are not whole men. Humanity has infused 
into them only one or two of its elements. They have length, but no 
breadth. They are citizens of Boston, New York, Philadelphia, or 
Cincinnati, but not of the world. Within certain circles, they are 
genial friends, but cynics and haters outside of them From their high 
places they come down to their humble followeid with tokens of 
friendly recognition ; upon others they frown and lower like armed 
castles. 

The True Physician. — How different the character of the true man 
and physician ! He is genial in his disposition. He has no dislikes 
and antipathies, and hates no men except tyrants. He accepts knowl- 
edge, though it come from the humblest source ; believing th( ve is no 
experience but will repay a study of it, and no husbandman's plough- 
share but turns up a soil worth analyzing. He belongs exclusively 
to no party, and can be approached easily by respectable men of 
every stamp. Whether belonging to the same society with him or 
not, you may take hold of liis nature and draw it out, without hav- 
ing it slip from your fingers, and spring back from your presence into 
a thousand kinks, like an overtwisted thread. He is a whole man. 
God made him for the world, and not for a party. By some strong 
influence you may possibly, for a time, draw him from the world into 
some iiarrower sphere, but not only will his reluctant nature, like a 
retiring tide, run back continually to embrace the continent, but will 
soon break from its confinement, and, like a full sea, come back, boil- 
ing and running over. 

What is now Wanted. — The foregoing remarks indicate one great 
leading want, in order that medical knowledge may increase. It is 
liberality in the true and full sense. We want true men in high 
places, who will not only let their otmi light shine everywhere, but mil 
cease to hinder otfier meiCs light from shining. 



GENKHAL INTKOltUCTORY KEMAKKS. 



13 



man. 
Itrong 
into 
like a 
It will 
boil- 
great 
It is 
higli 
it mil 



Beyond this, find of nearly equal importance with it, we want med- 
ical knotvledge diffused among the people. We want — what the 
world has never seen — a popular medical literature. We want the 
temples of Esculapius pulled down, and the priests turned into the 
streets to bersome teachers of the multitude, rather than worshippers 
in the inner sanctuary. 

I know this want will be stoutly denied, but not, I think, on well- 
considered grounds. We do not think it necessary to confine a 



'•M, 



'lere is no 
.aymen to 
ol)8curest 
or push the 
Why should 
body? They 



knowledge of the soul to the ministers of religion. 

branch of theology which we do not deem it proper 

study; we even popularize it for our children, in 

towns of New England, laymen who follow the plough 

plane, become, in many cases, eminent theologians. 

they not study the lower science which relates to the 

liave not been able to heretofore, because its mysteries have been 

purposely hidden under technicalities. These coverings should be 

torn off. 

It is said that those who begin to read upon medicine are very apt 
to imagine themselves afflicted with the various symptoms they find 
described. To some small extent this is true ; but it is also true 
that the light they obtain relieves them from many apprehensions 
which their previous ignorance allowed to prey upon them ; as boys 
lose their feara when the light of the morning changes to some 
familiar object the ghost of the preceding night. 

Physicians oppose the popularizing of this kind of knowledge too 
often, I fear, upon the sordid ground of self-interest. They think 
their own services will be less sought. 

We do not dispense with the services of ministei-s because the 
people study theology, neither shall we cease to employ teachers and 
practitioners of medicine when each man and woman is wise enough 
to study the healing art. The principal change we shall witness will 
be much larger attainments in knowledge among practitioners, — 
just as the ministers of religion now know, and are obliged to know, 
ten times as much as in those darker periods when the people re- 
ceived all spiritual knowledge from their mouths. The teachers of 
any art or science are obliged to keep in advance of their pupils. 
Let medicine become a popular study, and we shall have very few 
io^norant physicians, and quackery will become one of the impossi- 
liilities. Homoeopathists, Eclectics, Hydropathists, and Physiolo- 
jifists, believe in scattering medical books, stripped of their techni- 
calites, among the multitude, and their people purchase very few 
secret, advertised medicines ; — these being cliiefly bought and con- 
sixmed by the followers of those who believe this kind of reading 
fosters quackery 1 



ANATOMY. 



Anatomy describes the structiu'e and organization of living be- 
ings. 

Special Anatomy treats of the weight, size, shape, color, etc., of 
each organ separately. 

General Anatomy investigates the tissues or structures from which 
organs are formed. 

Surgical Anatomy or Regional Anatomy (jonsiders the relations of 
organs to one another. 

Physiological Anatomy treats of the uses or functions of organs in 
health. 

Pathological Anatomy describes the alterations made upon dif- 
ferent organs by disease. 

We shall here introduce a very brief compendium only of Sj)ecial 
Anatomy. 

It is of great consequence that everj' person should have some 
knowledge of anatomy and physiology. Self-knowledge ought to 
extend to the Iwdy as well Jis the mind. To know one's self, physi- 
cally, is to gain a new insight into that wonderfully skilful adjust- 
ment of means to ends which is never absent from the works of God. 
Without this knowledge, one cannot know how to take care of the 
health ; and without health, life loses most of its value. 

Structure of the Body. 

The human body is composed of solids and fluids. 

The fluids are most abundant in cliildren and youth. It is this 
which gives softness and pliancy to their flesh. In old age tlie fluids 
are less abundant, and the flesh is more hard and wrinkled. 

The fluids contain the whole body, as it were, in a state of solu- 
tion ; or rather, they hold the materials out of which it is manufac- 
tured. 

Chemical Properties of the Body. 

The four elements, oxygen, hydrogen, carbon, and nitrogen, make 
up nearly the whole bulk of the fluids and soft solids of the human 
body. A numljer of other elements, cliiefly in a state of combina- 
tion, and in much smaller quantities, enter into several of the tissues. 

Binary Compounds. — Thus, we ha/e carbonic acid in blood, urine 
and sweat; and we have water univei-sally diffused through the sys- 
tem, — each of these substances l)eing a binary compound, that is, 
composed of two elements. 

Compounds of more than two Elements are widely distributed 
over the body ; as, 



eellu 

watei 

fi'oin 

iinoth 

of hid 

silk, 



Fat 

"id con 
lias 110 
'''« oIei( 
^'it is us 



ANATOMY. 



15 



this 
uids 



, urine 

le sys- 
hat is^ 

ibuted 



Carbonate of Soda in serum, saliva, bile, mucus, sweat, and tears. 
Carbonate of Lime in cartilage, bone, and teeth. 
Phosphate of Lime in Iwnes, teeth, and cartilage. 
Phosphate of Iron in blood, gastric juice, and urine. 
Chloride of Sodium in blood, brain, muscle, bone, cartilage and 
pigment. 

Chloride of Potassium in blood, gastric juice, milk, and saliva. 

Chloride of Calcium in gaatric juice. 

Sulphate of Potassa in urine, gastric juice, and cartilage. 

Sulphate of Soda in sweat, bile, and cartilage. 

Sulphate of Lime in bile, hair, and scarf-skin. , 

Oxide of Iron in blood, black pigment, and hair. 

Organized Compounds. — Besides the above inorganic elements 
and compounds, several organized substances, or proximate elements, as 
they are called, exist largely in the body. The chief of these are 
albumen, fibrin, gelatin, mucus, fat, and casein. Others need not be 
named. 

Albumen is found in great abundance in the'human body. It is 
the mw material out of which the flesh and other tissues are made. 
The white of an egg, which is nearly pure albumen, is a good speci- 
men of it. 

Fibrin, when removed from the human body, changes from a solu- 
ble to an insoluble state. In other words, it coagulates in a kind of 
net- work. Nearly the same thing takes place constantly in the living 
body, when the liquid fibrin leaves its soluble state, and is deposited 
as solid flesh. Fibrin bears the same relation to albumen that wool- 
len yarn does to wool ; it is spun from it in the busy wheel of or- 
ganic life. And the flesh or muscle is related to fibrin as the cloth 
is to yarn ; it is woven from it in the vital loom. Fibrin has been 
called liquid flesh. 

Qelatin exists largely in the ligaments, cartilages, bones, skin, and 
cellular tissue. When dissolved, five parts in one hundred of hot 
water, it forms a thick jelly. Isinglass is a form of gelatin obtained 
from the air-bladder of the sturgeon and the codfish. Glue is still 
another form of gelatin. It is extracted from the bones, and parings 
of hides, and the hoofs and ears of cattle, by boiling in water. Black 
silk, varnished over with a solution of gelatin, forms court-plaster: 

Mucus is a sticky fluid secreted by the gland-cells. It is spread 
over the surface of the mucous membranes, and serves to moisten and 
•Iffcnd them from injury. 

Fat consists of cells held together by cellular tissue and vessels, 
iinil contains glycerin, stearic acid, margaric acid, and oleic acid. It 
liiis no nitrogen. If the stearic acid be in excess, the fat is hard ; if 
till! oleic acid preponderate, it is soft. The stearine extracted from 
tat is used for making very hard candles. 



16 



ANATOMY. 



t I 



CaAeIn is abundant in milk and constitutes its curd. It is held 
in solution in milk by a little soda. When dried, it is cheese. It is 
found in blood, saliva, b and the lens of the eye. It forms the 
chief nourishment of thos ig animals which live on milk. It is 

found in peas, beans, and i^ s. Vegetable and animal casein are 
precisely alike in all their properties. Fibrin and albumen contain 
almost exactly the same amount of oxygen, hydrogen, cail)on, nitro- 
gen, and sulphur, whicli i» found in casein. This Litter, wlien taken 
into the stomach, therefore, goes, without much change, to the forma- 
tion of the albumen and fibrin of the body. 

Physical Properties of tlie Body. 

The Tissues. — The solid organized substances of which the human 
body is composed, are called tissues. There are various kinds of tissues. 

The Cellular Tissue, commonly called areolar, is made up of small 
fibres and bands woven together into a sort of ne^work, with numer- 
ous little spaces opening into each other. These spaces are filled with 
a watery fluid ; and When this is greatly increased by disease, so as 
to cause the parts to swell, and the skin to shine, the person has ana- 
sarca, or cell-dropsy. The uses of this tissue are to give parts and 
organs a kind of elastic cushion to rest upon, so that they may not be 
bruised and injured by the shocks of life ; to make a kind of safe 
highway for delicate vessels to pass from one part of the body to 
another ; and to furnish a beautifully arranged lodgment for the wa- 
tery fluid which gives such roundness, smoothness, and grace to the 
human form. The opening of the cells into each other exjjlains the 
reason why feeble persons have swelled feet and ankles in the even- 
ing, and not in the morning — the fluid settling down from cell to cell, 
into the lowest parts, while they are up during the day, and running 
back to its proper place while they are Ij'ing down during the night. 

The Mucous Tissue, or nviicous membrane, lines all the cavities 
which communicate with the air, as the month, stomach, bowels, liuigs, 
etc. It is supplied with numerous small glands which secrete a 
sticky kind of fluid called mucus, to protect the surface from any 
injury which might be inflicted by air, or by instating substances 
suspended in it. 

The Serous Tissue, or membram, lines all the cavities which do not 
communicate with the air, that is, all those which are shut, and have 
no outward opening. The skull, the chest, and the belly are lined by 
this kind of membrane. The membrane itself forms a closed sac. 
— one layer of it being attached to the cavity it lines, while the other 
is folded back upon and around the contents of the cavity, which are 
left outside of the sac. A watery fluid oozes from the inner surfati- 
of the sac, to make its sides glide easily upon eacjli other. When 
some disease causes this water to Ije poured out too freely, so as to 
fill or partly fill the cavity, we have dropsy of the brain, or chest, or 
abdomen, as the case may be. 



ANATOMY. 



17 



lo not 

have 

led by 

Id sac. 

1 other 

[oh are 

lurfai'i' 

IWhPii 

b aH to 

liest, or 



The Dermoid Tissue covei-s the whole outside of the body. We 
call it the akin, or eutia. It is Himiliar in Htnicture to the mucous 
lueinlmines, which are a mere continuation of it. It is harder than 
the mucous membrane, liecause more exposed to injury. In health, 
it never ceases to secrete and throw off a fluid which we call insen- 
sible pei-spiration while it is in the form of an invisible vapor, and 
pei'spiration, or sweat, when it is so increased as to be seen. So 
^reat is the sympathy between this dermoid covering of the Iwdy 
and the mucous membranes, that when it is eJulled so as to stop the 
invisible perspimtion, the internal membrane becomes affected, and 
we have a sore throat, or diarrhoea, or running at -the nose ; that is 
to say, when the skin cannot sweat, the mucous membrane begins to 
sweat. 

The Fibrous Tissue consists of closely united fibres, and for what- 
ever purpose used, forms a fine, dense, and enduring body. In some 
cases it takes the form of a membrane, as the dura mater, which lines 
tlie interior of the skull and spinal coluimi. The li(/ament8 which 
liold the lx)nes together, and the tendons or cords, which fasten the 
lunscles to the Ixmes, are fibrous Inidies. It is this firm substance of 
which rheumatism frequently takes hold, and this is the reason why 
it lingers so much about the joints. It sometimes tiikes hold of the 
ligament which fivstens the deltoid muscle to the bone of the upper 
arm, about two-thirds of the way from the ellwjw to tlie shoulder. 
This muscle lifts up the arm. In this form of rheumatism, therefore, 
the arm hangs helpless at the side. 

The Cartilaginous Tissue covers the ends of the bone^ where they 
come together to make a joini. It is well fitted to make the joint 
work easy, being smooth, hard, and elastic. 

The Osseous or Bony Tissue varies in its composition, density, 
and strength, according to the age of the person, and the uses of the 

lM)ue. 

The Muscular Tissue, or muscle, he'mg made for a great deal of 
pulling and lifting, is formed something like a rope, except that 
there ia no twisting. Many small 
fil)ies or filaments unite to form 
fasciculi. A fasciculus is a bundle 
of fibres surrounded by a delicate 
layer of cell-tissue called sarcolemma, 
— just as a cord is a number of 
smaller threads of cotton or hemp 
bound together. A number of these 
fiusciculi united together make a 
muscle, — just as several cords, called 
strands, twisted together, inake a 
i()l)e. Figure 1 gives us a good view of the fibres and bundles, 
liighly magnified. 




FlO. 1. 



18 



ANATOMY. 



& 



The Adipose Tissue is the material which the human Iwdy works 
up into pots and cells contivining/n^ It is found chiefly under the 
skin and muscles of the belly, and around the heart and kidneys, 
liy the increase of this tissue, persons may Iwcome enormously en- 
larged without having their muscles at all increased in size. Such a 
condition is to he deplored, — the body having become merely the 
storehouse or depot of myriads of pots of fat. 

Tlie Nervou.» Tissue i» composed of two distinct kinds of matter, 
— the one gray and pulpy, called eineritious, the other white and 
fibrous, called medullary. The external part of tlie brain and the in- 
ternal portion of the spinal cord are composed of the gray or ash- 
colored tissue ; the nerves are made only of the white or flbrous 
matter, and are inclosed in a delicate sheath called neurilemma. 

Vital Properties of the Body. 

Bodies begin their growth with a simple cell, which is a delicate 
little bladder or shut sac. Cells take their rise in that portion of 
the blood which is capable of being organized, and which is called 
blastema. 

In animal Iwdies each cell generally begins as a minute point in 
the blastema, and grows until a transparent bladder or vesicle spjings 
out from one side uf it, and soon appears to enclose it. The bladder 
is then called the cell, and the point or dot is its nucleus. Within 
this nucleus appears another dot, which is called the nucleolus. 
When fully ripened, the cell bursts and sets the nucleus free, and 
this, in its turn, matures and yields up its contents. Thus all cells 
have their origin in germs produced by previously existing parent- 
cells. They are multiplied with great rapidity. Having grown to 
a certain extent, they lose their fluid contents, and their walls col- 
lapsing or coming together, they form simple membraneous discs. 
In this way, with some variations, the simple tissues of the body be- 
gin to be, and the foundation is laid for the noble structure of man. 

Anatomy of the Bones. 

The human skeleton is composed of two hundred .and eight bones, 
the teeth not included. 

When fastened together by natural ligaments, the bones are said 
to form a natural skeleton; when attached by wires, an artificial skele- 
ton. 

In Figure 2, — 1, 1, represent the spinal column; 2, the skull; 3. 
the lower jaw ; 4, the breast-bone (sternum) ; 6, the ribs ; 7, the col- 
lar-bone ; 8, the bone of the upper arm (humerus) ; 9, the shoulder- 
joint ; 10, the radius; 11, the ulna; 12, the elbow-joint; 13, the 
wrist; 14, the hand; 15, the haunch-lxme ; 16, the sacrum; 17, the 
hip-joint; 18, the thigh-bone; 19, the knee-cap (patella); 20, tlie 
knee-jt)int; 21, the fibula; 22, the tibia; 23, ankle-joint; 24, the 
foot; 27, 28, 29, the ligaments of the shoulder, elbow, and wrist; 



A 

18 

1» 
80 ■ 

21 ._..J 

22 ■ 

23 . 
M 



20 



ANATOMY. 



5J0, tlie liir^e iirtiTv ot" tlu! iirin ; J^l, the ligiimentB of the lup-joint; 
•\2, tlie liiij^e hl(i(i(l-V('S8('lH of the thigh; ."{;{, tlie artery of the It-g ; 
•i4, .iij, 80, the ligiiiiieiitH of tlio knee-cap, knee, and ankle. 

'rh(! piotnherances itr swellingH in certuin parts of the hones are 
called proeeHtu-s, and are the puinUt to whii-h ninHcieH and li^iamentH 
are ftwtened. 

The iMineH are Hnjtplied with nntritive vesm-ls, and, like other parts 
of tlie JKid'. , are formed from the hlood. At liist they are compurH- 
tively Hoft and eartilaginonH. After a time, in the y(»nng animal, 
they hegin to change to lM)ne at certain places, called pointti of onniji- 
nation. They are covered with a strong, fihroUs membrane (tailed the 
perionteum. A sonufwhat similar covering upon tlie cartilages has 
the name of /n-rii'/iondrium, and that which covers the skull is the 
pfrioranium. 

The hones are compounded of earthy and animal matter. From 
the former — phosphate and carbonate of lime — they receive their 
strength; from Llu' latter — cartilage — they derive their life. 

''ut a bone for a few days into diluted nnuiatic acid, — one part 
of acid to six of water, — and the i)ho8i)hate and carlK)nate of lime 

will all l)e removed, while 
the bone will remain the 
same in shape. It will now 
l)e comparatively soft, and 
may l)e bent, or even tied 
into a knot without break- 
ing. Place a similar lK)iie 
in the tire for a few houix, 
and it will also retain its 
shape, but the cartilaginous 
portion will Ite gone. It is 
now brittle, and may Ih; 
picked in pieces with the fingers. 

The bones are divided into those of the head, thirty ; of the body, 
fifty-four; of the upper limbs, «ixiy;foMr ; and of the lower limtjs, 

xixty. 

i 

I 

Bones of the Head. 

The bones of th head are divided 'into those of the »kull, the ear, 
and the/fflrv. 

The skull has eight bones. They are composed of two plates, one 
above the other, with a porous partition between. These two plates 
are capable of giving the brain very powerful protection against in- 
jury, the outer one being fibrous and tough, — the inner one, hard 
and glass-like, and hence called vitreous. 

The middle layer has the name of diploe. Its spongy nature 
deadens the jar from a blow inflicted upon the outer table. In euily 
life, when the bones are tender and yielding, tlxis porous layer is not 
needed, and is not found. 




Fio s. 



In the 
backbon( 
Ijieast-bo 
ealled 
cavities, 

TJie 
»> front, 



ANATOMY. 



91 



1)6 



in, one 
pliites 
i8t iii- 
j, hiivd 

I nature 

eiivly 
is not 




Fio. 4. 



That the bonps of the skull may not eiwily Hlip by eiioh otlier, and 

^'t't out of place, tlicy arc ilovftailiil tojrcther in curiouH lineH called 

HiUium. In advanced yeui'H, tlieHe gen- 
erally cloHc .ip, the ItoiieH uniting (irmly 

together. In early life they are <|nito 

open, the Hrin iKtncH nut covering the 

whole hniiii. The ojM'iiinj,' of the 

coronal suture in childhood in called a 

fontanelle. It present* a soft place 

upon tlie top of the head, where the 

tinker could l)e jjreHsed down into the 

liniin. In Figure 4, — 1, 1, hIiow the 

coronal HUture on the front and upper 

part of the skull ; 2, the Hagittid Huturo 

on the top of the skull ; and 8, 3, the 

liiM»hdoi(hvl suture, nuining down on 

each side of tiie l«vck part of the skull. 

Figure 5 shows the skull-bones sepamted from each other at the 

sutures : 1, the frontid bone ; 2, the parietivl ; 2, the occipitjil : 4, the 

toiupond ; 5, the niwal ; 6, the malar ; 7, the superior maxillary ; 8, 

the unguis ; 9, the in- 
ferior maxillary. Ar- 
nott has demonstrated 
that the form of the 
skull is the best possible 
for sustaining weights, 
and resisting blows. The 
oummit of the head is a 
complete arch, like that 
of a bridge. 

The ear has .our 
small l)one8, whi^^h aid 
the sense of hearing. 

The bones of the face 

are fourteen in number. 

They hold the soft part« 

in place, and aid in 

F.O. B. grinding the food. 

Bones of the Trunk. 

In the trunk there are twenty-four ribs ; twenty-four pieces in the 
backbone or spinal colunui ; four bones in the pelvis and hips ; one 
breast-bone, called sternum ; and a bone at the base of the tongue, 
called 08 hyoides. They are so put together as to form two great 
cavities, namely, the thorax or chest, and the abdomen or belly. 

The n'6«, connecting with the backbone behind and the breast-bone 
in front, form the thorax, wliich contains the lungs and heart. Fig. 




W. 



' 



"m 




Fl<l. 6. 



B ANATOMY. 

<i hIiowm tho natural form of the lunilthy f l>08t : 1, is the flpino ; 2, 2, 
tliH cnllai'-ltoiiuH ; 8, !l, the hcvcii upjK!!. or tnut lilw; 4, 4, th« five 
lower or fiilw rWm; f), tho lirciiHt-lMJiic, i.» which tho tnio lilw arc 

united ; (), the sword-Hhaped 
«artilapo whir.li conHtitutos tin- 
lowor (Mill of tiic hroaut-liono. 
called enxifonii rartilage. ; 7, 7, 
the upper part (»f two lungs ; 8, 
H, the right luug, scon hotwoen 
tho ril»H ; 9, 1>, tho left lung ; 10. 
10, the heart; 11, 11, the dia- 
phragm, or midriff; 12, 12, the 
liver; IH, 18, the stomach, 14, 
14, the second stomach, or 
duodenum ; li), the transverse 
colon; IH, tho upper part of the 
colon on right side ; 1 7, upper 
part of colon on left side. 

Fdch piece of the spinal col- 
umn is called a vertebra. Upon 
every one of these are seven 
projections, called processes — a part of which are for linking the 
bones together, and the rest to furnish 
attachments for tho muscles of the back. 

The projections are linked together in 
such a way, that a continuous channel or 
opening runs down through the whole, 
in which is lodged the spinal cord, or 
medulla spinalis. This nervous cord is 
'jonnected with the base of the brain, and 
is u kind of continuation of it. 

Between all the vertebrae are certain 
cartilaginous cuBhions, which, when com- 
pressed, spring back, like India rubber, 
and thus protect the brain from being injuriously jarred by running, 

leaping, or walking. 

The pelvis has four bones : 
the two nameless bones — iih 
nominata, the sacrum, and the 
coccyx. In the side of each of 
the nameless bones is a deep, 
smooth cavity, called the aite- 
tabulum. Into this the round 
head of the thigh-bone is nicely 
fitted. When the bone is 
thrown out of this cavity, the 
hip is said to be out of joint. 
*'"'• *• The sacrum took its name 




FlO. 7. 




froi'i 
llieiu, 
• if (ho 
ilie in 
", a, t 
PdIh'n 
culunii 



FlO. 9, 

ened in tl 
nieut, form 
•iieubs. A 
fore-arm. 
%9: 1, 
head which 
which unit< 
Of the t\ 
"»ites with 
"fher bone 
— o'l the sf 
^[« ««}, witi 
"'e ulna ; 2 
wJ'ich the ll 
!'f the ulna 
J"'"t; 6, tlu 



MHi 



AK ATOMY. 



98 



lies : 
ill'- 
1 the 
of 
leep, 
1 ace- 
luiul 
cely 
is 
the 
bint, 
line 



froi'i the (net tliiit tlio hciithuim iiHcd to offer it in siicriflcu'. With 
iht'iii, it wiiM the hiujimi hoiii;. Thu iMxicyx is tlic h)wur teiiniMiitioti 
(if tlio iMukfK)!!!!. Tlit'Ht) Imhuih iiiM! lepreHoutJMl ill Vi^r. H: 1, 1, lM'illJ» 
I hit iiinniiiiiiat^i, 2, thi* Hiutruni ; 8, the coccyx ; 4, 4, the iicotuhuluni : 
II, II, i\w (tiihic portion of the niiineUm.s iKUieH ; d, the arcli of tlie 
|)iih(>H ; (\ thu union of thu mierum and the lower end of the upinul 
cohiinn. 

Bones of the Upper Extremities. 

Thk should fr-hlaile (seapuhi), the collar-hone, (clavicle), the h<yne of 
the upper arm (humerus), tho two hones of the forearm (ulna and ra- 
dius), the hones of the wrist (carpal Ixmes), the hones of the 
\pnlms of the hand (inetivcarpal Iwnes), the hones of the 
thuinh and Jini/ers (phalanges), — these are the bones of 
the upper limbs. 

The eollar-hone is fastened at one end to the breast-bone, 
at the other end to the shoulder-blade. It keeps the shoul- 
ders from dropping forward. Many persons allow it to fail 
of this end by getting very much bent in early life. This 
happens at school, when children are allowed to sit in a 
stooping posture. In the French, a race re- 
markable for a straight, upright figure, this 
bone is said to be longer than in any other 
people. 

The shoulder-hlade lies upon the upper part 
of the back, forming the shoulder. It has a 
shallow cavity (glenoid cavity), into which is 
inserted the head of the upper arm-lK)ne. Sev- 
eral strong muscles are attached to the eleva- 
tions of this bone, which keep it in its place, 
and move it about as circumstances require. 
The upper arm-hone has its round head fast- 
ened in the glenoid cavity, by the strong capsular liga- 
ment, forming a joint capable of a preat number of move- 
ments. At the elbow it is united with the ulna of the 
fore-arm. It is a long, cylindrical bone, represented by 
l^'ig. 9: 1, is the shaft of the bone ; 2, the large, round/ 
head which fits into the glenoid cavity; 8, the surface! 
whieh unites with the ulna. 

Of the two bones of the fore-arm, the ulna is on the inner side, and 
unites with the humerus, making an excellent liinge-joint. The 
otlier bone of the fore-arm, the radius, lies on the outaide of the arm, 
— on the same side with the thumb, — and unites, or articulates, as 
we sa), with the bones of the wrist. In Fig. 10: 1, is the body of 
the nlna ; 2, the shaft of the radius ; 4, the articulating surface, with 
whieli the lower end of the humerus unites ; 5, the upper extremity 
of the ulna, called the olecranon process, which forms the elbow- 
j'>int ; 6, the point where the ulna articulates with the wrist. 



Fio. 9. 




FlO. 10. 




ANATOMY. 

The eight bones of the wrist or carpus are ranged in two rows, and 
being bound close together, do not admit of 
very free motion. In Fig. 11 : 8, is the scaphoid 
bone ; L, the semilunar bone ; c, the cuneiform 
bone ; P, the pisiform bone ; T, T, tlie trapezium 
and trapezoid bones ; M, the os magnum ; u, the 
cuneiform l)one. The last four form the sec- 
ond row of carpal bones. 11, 11, are the meUi- 
carpal bones of the hand ; 2, 2, the first mnge 
of the finger-bones ; 3, 3, the second mnge of 
finger-bones ; 4, 4, the third range of finger- 
bones ; 5, 6, the bones of the thumb. 

Of the five metacarpal bones, four are atr 
tsiched below to the first range of the finger- 
bones, and the other to the firat bone of the 
thumb, while the whole are united to the second 
range of the carpal bones above. 

Bones of the Lower Extremities. 

These are the thigh-hone (femur), the knee-pan (patella), the shin- 
bone (tibia), the Hviall hone of the leg (fibula), the bones of the instep 
(tarsal bones), the hones of the middle of the foot (metji- 
tarsal bones), and the hones of the toes (phalanges). 

The thigh-bone is the longest bone in the system. Its 
head, wliich is large and round, fits admirably into the 
cavity in the innominatum, called acetabulum, and forms 
what is called a ball-and-socket j int. In Fig. 12 : 1, is 
the shaft of the thigh-bone (femur) ; 2, is a projection 
called the trochanter minor, to which some strong mus- 
cles are attached; 3, is the head of the femur, which fits 
into the acetabulum ; 5, is the external projection of the 
femur, called the external condyle ; 6, the internal con- 
dyle ; 7, the surface which articulates with the tibia, 
and on which the patella slides. 

The knee-pan or knee-cap (patella) is placed on the 
front of the knee, and being attached to the tendon of 
the extensor muscles above, and tf) the tibia by a strong 
ligament below, it acts as a pulley in lifting up the leg. 

The shin-hone (tibia) is the largest of the two in the 
lower leg, and is considerably enlarged at each end. 

The email bone Oi the leg (fibula) lies on the out- 
side, and is bound to the larger bone at both ends. Fig., 
13 shows the two bones of the leg: 1, being the tibia ;| 
5, ihe fibulo ; 8, the space between the two ; 6, the 
junction of the tibia and fibula at the upper extrem- '"■ 
ity ; 8, the internal ankle ; 4, the lower end of the tibia that unites 



That he 
Joints are 
«o coustrucl 
«ach other, 
tilings, a 



ANATOMY. 



25 



with one of the tarsal lx)ne8 to form the ankle-joint; 7, the upper 
end of the til)ia, which unites with the femnr. 

The instep (tiiraus) has seven Iwnes, which, like those of the 
wrist, are so firmly l)oun(l together as to allow but a limited motion. 

The metatarsal houi's, corresponding with the palm of the hand, are 
five in number, and unite at one end with the tarsal l)ones, and at 
the other witli the first range of the toe-bones. 

The tarsal and mebitjirsal bones are put together in the form of 
an arch, the spring of which, when the weight of the body descends 
upon it in walking, prevent** injury to the organs above. (Fig. 14.) 

The phalanges have fourteen bones. The great toe has two miiges 




FlO. 14. 




FiO. 16. 



Fia. 18. 



v.f bones ; the other toes have three. Fig. 15 gives a view of the 
upper surface of the bones of the foot : 1, is the surface of the as- 
tragalus where it unites with the tibia ; 2, the body of the astragalus ; 
3, the heel-bone (os calcis) ; 4, the scaphoid bone ; 5, 6, 7, the cune- 
iform bones ; 8, the cuboid ; 9, 9, 9, the metatarsal bones ; 10, the 
first bone of the great toe ; 11, the second bone ; 12, 13, 14, three 
ranges of bones forming the small toes. 



liki* 



The Joints. 

That bones may be of any use, they must be jointed together. 
Joints are of the greatest importance. It is necessary they should be 
80 constructed that then^ shall be no harsh grating of the bones upon 
each other, and no injurious jars in walking, etc. To prevent these 
things, a hard, smooth, and yet yielding, cushion-like substance is 



*«^l 



■MMM 



a 



i? 



i 



• ■ 




W ANATOMY. 

required between them in joints. Such are tlie cartilages. Fig. 16 
ifivcH a specimen oi these intervening cartilaj,'('8. I), is the body of 

a lM)ne, at the end of 

wliich is u socket ; C, 

the cartilage lining the 

socket, tiiin at the sides 

and thick in the centre ; 

B, the body of a bone, at 

^o. 16. the end of which is a 

round head ; C, the investing cartilage, thin at the sides and thick 

in the centre. 

Cartilage grows thinner, harder, and less elastic in old age. Hence 
old people are not quite as tall as in middle life, and a little stiffer 
in their joints. 

The synovial membrane is a thin layer covering the cartilage, and 
being bent back upon the inner surface of the ligaments, it forms a 
closed sac. From its inner surface a sticky fluid oozes out, which 
helps the joints to play easily. 

There are other smaller sacs connected with the joints, called 
bursa mucosae. They secrete a fluid similar to that from the syno- 
vial membrane. 




Fig. 17. 



FlO. 18. 



Fta. 19. 



The ligaments. To retain the bones in their places at the joints, 
some strong, flexible straps are required to stretch across from one 
to the other, and to firmly unite them. Such are the ligaments. 

They are the pearl-colored, lustrous, shining parts about the joints, 
in the form of straps and cords. There are a number of them so 
woven together as to form a complete covering of the joint, called a 
capsular ligament. In Fig. 17 : 1, 2, are ligaments extending from 
the hip-bone, 6, to the femur, 4. In Fig. 18: 1, is the socket of the 
hip-joint; 2, head of the femur, lodged in the socket; 3, the ligament 
within the socket. In Fig. 19: 1, is the tendon of the muscle whicli 
extends the leg ; 2, the knee-cap (patella) ; 3, the anterior ligament 



ANATOMY. 



27 



of the ])atella; 6, the long external lateral ligament; 4, 4, the syno- 
vial membrane ; 5, the internal lateral ligament ; 7, the anterior and 
superior ligament that unites the tibia with the tibula. 

Uses of the Bones. . 

The bones are to the body what the frame is to the house. They 
hold up and retain the other parts in their proper places. They fur- 
nish points of attachment for the muscles, to hold the body together 
and to give it motion. They also furnish strong, bony cavities for 
the lodgment and protection of such delicate organs as the eye, the 
brain, and the heart. 

A single bone, examined by itself, might not seem to have much 
beauty or design about it; it might even look clumsy and misshapen. 
But when all the bones are inspected with reference to each other, 
we immediately discover a general plan upon which they are made, 
and are compelled to admire their beautiful harmony, and the sym- 
metrical grace with which they act. They show us that God can 
command our wonder, even in the bony frame of our bodies. 









^ts, 
l)ne- 

its, 
so 
a 
lorn 
Ithe 
lent 
tch 
lent 



The Huscles. . 

That part of the animal's body which we call lean meat is com- 
posed of muscles. We have already explained that muscles are com- 
posed of threads, etc., put together in great numbei-s, forming bundles. 
So numerous are these threads and bundles in some cases, that the 
muscles which are composed of them have a strength truly wonderful. 

Toward the end of the muscle, the fibres cease, and the structure 
is so modified as to become a white cord of great density and strength. 
This cordy substance is fastened to the bone so strongly, that it is 
impossible, except in some rare cases, to detach it. Generally the 
bone will sooner break than this attachment will give way. Some- 
times this cord spreads out like a membrane. It is then called fascia 
or aponeurosis. 

The fibres of a muscle have the peculiar property of contractiriff 
under a nervous stimulus sent to them by the will. These contrac- 
tions cause them to act as pulleys, and to move the bones, and conse- 
quently tlie limbs and body, in such direction as the will commands. 
This is the special use of the muscles. All our movements are caused 
by them. They pull us about, not . blindly and at a nmdom, but 
under the direction of an intelligent will. 

The manner in which a muscle aista, with the cord attached, may 
l)eseen by examining the leg or " drum-stick " of a fowl. If the cord 
on one side be pulled, the claws are shut ; if that upon the other 
side he drawn, they will open. If both be pulled, they are held fast 
in one position, neither opening nor shutting. 

An examination of a piece of boiled lean meat will show the 



i 



! 



! 



n 



28 



ANATOMY. 



FlO. 20. 




threads of which it is composed, With proper instruments, these may 
be unravelled, as it were, until fibres will be found not larger than a 
spider's web. These, covered with sheaths of great delicacy, extend 
beyond the fleshy fibre, and with the cell-sutetance connecting the 
fibres, are condensed into t' don. 

Millions of these sheathed fibres are gathered into a bundle, and 
covered with a sheath, and thus form what is called & fasciculus. A 
muscle is a number of these fascicula made into a bundle, and cov- 
ered with a sheath called n fascia (Fig. 1). 

The arm is a number of muscles bundled together, and covered, 
likewise, by a fascia. 

The fibres in a fasciculus being parallel, act together. But the 
fasciculous bundles which make up a muscle act in various ways. 

Shape of the Muscles. — Some muscles are fusiform or spindle- 
shaped, so that the attachment occupies but a 
small space (Fig. 20). 

Other muscles are radiate or fannshaped (Fip, 
21). Such is the temioral muscle, the thin 
edge of which is attache I to the side of the head, 
without producing an elevation or deformity. 

In some cases the fasciculi are arranged upon 
one or both sides of a tendon. In this way a 
great number may concentrate their action upon 

a single point. Such muscles are called penni- 
form, — hieing shaped like a feather (Fig. 29). 

In other instances, the fasciculi form circular 
muscles, — orhiculares, or sphincters, as 
These surroiuid certain openings iijto the 
body, which thry are designed to close, either in whole or 
in part. They surround the eyelids, the anus, the mouth 
of the womb, etc. (Fig. 23). 

In still other instances the fasciculi are ranged side by side in 

rings, forming muscular 
tubes. By the successive 
contraction of these rings, 
^^° 24. any substance is drivt'ii 

through the tube, — as food or drink through the gullet of a cow. 
Fig. 24 is a section of the gullet : a, b, show the circular fibres : 
«?, the longitudinal. 

Sometimes the fasciculi curve around in paiuUel layers or intei- 
lace with each other, forming a bag or pouch. By the contraction 
of these fasciculi, the contents of the bag will be turned from side 
to side as in the case of the stomach, or driven out, as in that of tlic 
heart. Fig. 25 sluiws the muscles of the stomach : L, represent*! the 
fibres running in one direction ; c, in another ; E, lower end of gullet : 
( >, pylorus ; i), beginning of duodenum, or second stomach. 



FlO 21 



FlO. 32. 



they are called. 




FlO. 23. 




r'Z^r — rr:K^- 



m- 



I 



PI. 8. 




Numbe 

as tlic rojK 
iinatoinists 
They ar 
trunk, tlios 
tien. 

They ar« 
this brief a 
iiiider tlie 
while auotl 
tai y, movin 
the will, 
latter kind, 
it to keep r 
and mind a 

On the 

layers of ini 

other. Sucl 

**''«ry to pel 

movements 

arms, etc. ] 

liatc. hope, f 

made expres 

The diapl 

cavity of the 

penetrated b 

blood-vessels 

• over of a di: 

the breath is 

the chest at 1 

out, the revei 

Mode of Ai 

spoken, is sin 




"loved : 1, is , 
'•"lies below tl 
attachments o 



*>.^(irtjii 



MUSCLES OF THE HUMAN BODY 



m 



ANATOMY. 



29^ 



Number of Muscles. — The muscles of the iKidy arc nn numerous 
lis the ropes of a ship, — there being five hundred or more. Some 
iiiiiitoiniste reckon more, some less. 

'llii'Y are divided into those of the head and ttenk, those of the 
Inni/c, those of the upper extretnitiea, and those of the lower extremi- 
tie». 

They are too numerous to be named and indivithially described in 
tliis brief account of them. A part of them are voluntary, tliat is, 
under the control of the will ; 
while another part are involun- 
tary, moving without reference to 
tlie will, 'rhe heart is of the 
hitter kind, it being necessary for 
it to keep moving when the will 
and mind are asleep. 

On the back there are six 
layers of muscles, one above an- 
other. Such a number are neces- 
sary to perform the numerous 
movements of the back, neck. 
anus, etc. Every expression of the human face, as joy, sorrow, love, 
liatc. liope, fear, etc., is produced by the gentle pulling of muscles, 
made expressly to indicate these emotions. 

The diaphragm is a large flat muscle, reaching across the great 
cavity of the body, and dividing the chest from the abdomen. It is 
l)i'iietrated by the gullet going to the stomach, and by the great 
blood-vessels leading to and from the heart. It is shaped like the 
cover of a dinner-dish, the convex surface being turned up. When 
the l)reath is drawn in, it sinks down towards a level, thus enlarging 
tlie chest at the expense of the belly. When the breath is thrown 
out, the reverse takes place. 




Fio. 25. 



Mode of Action. — The cordractibility of a muscle, of which I have 
spoken, is simply its power of shortening itself. The hand is raised 

g by the shortening of a mus- 
cle in front, attached to the 
bone above the elbow, and 
to a bone below the elbow. 
The contraction of an an- 
tagonistic muscle behind, 
also attached alwve and be- 
low the elbow, brings the 
iK''ud back to its place. Fig. 
26 shows how all joints are 
"lovfd : 1, is the bone of the arm above the elbow ; 2, one of the 
'xjiies l)elow the elbow ; 3, the muscle wliich Iwnds the elbow ; 4, 5, 
iittaeliinents of muscles to bones ; 6, the muscle that extends the 




Fio. 2G. 




i. : 






I 



30 



ANATOMY. 



eU)ow ; 7, attachment to elbow; 8, weiglit in hand. The nuiHcle, 3, 
contiacts at the central part, and hringn the hand up to 9, 10. 

The complication, variety, and Hwiftness of motion, executed by 
muscles, are past conception. Every movement which a human be- 
ing makes, from the heavier motions of the farmer in cultivating his 
fields, up to the magic touches of the painter's brush, and the metliod- 
ical frenzy with which the great master's fingers sweep the piano, are 
all made by muscles obeying an intelligent will. 

The Teeth. 

The teeth are not like other bones, either in composition, method 
of nutrition, or growth. When broken they do not unite, not being 
furnished with the necessary power of reproduction of lost parts. 

Both the upper and lower teeth are set into l)ony sockets, called 
alveolar processes. These, with the fibrous gums, give the teeth a 
very firm setting. 

Origin. — The teeth have their origin in little membranous 
pouches within the bone of the jaw, which, in their interior, have a 
fleshy bud. From the surface of this the bone or ivory exudes. Tiie 
tooth and the Iwny socket are developed and rise up together, — the 
former, when sufficiently long, pushing itself through the gum. 

Number. — The first set of teeth are only temporary, and are called 
milk-teeth. There are but twenty of them. lietween the age of six 
and fourteen, these become loose, ard drop out, and the permanent 
teeth appear in their places. Of these there are thirty-two, sixteen 
in each jaw. 

Names. — The four front teeth in each jaw, a, h, Fig. 27, are the 
cutting teeth (incisors) ; the next one, c, is an eye-tooth (cuspid) ; the 




Fig. 27. 



next two, d, Cs are dmall grinders (bicuspids) ; the last three, /, g, h, 
are grinders (molars). One appears late on each side, from the age 
of twenty to twenty-four, and is called wisdom tooth. 




Compo 

• int-ernal p 
the surfac 
which rise 
which is c 
root or far 
vessels pat 
into the tc 
in tooth-a( 



The inc 

solid parts, 

In niii8ti( 

aiuklown r 

motion. J 

muscles. ] 

vegetable-ea 

while man 

a pretty clei 

The teeth 

and symmet 

kept in goot 

their decay i 

are spoken o 



The alimei 
the pharynx, 
chyle vessels 
oreas). 

The prepai 
takes place in 
cretion of the 
on each side. 

The Parotli 

"peniug into tl 

i^^y- This is 

Hence the dise 

TlieSubma 

ot Its angle. ; 
of the tongue ( 
On each side 
'''^ne of the ; 
P«««» its saliva 



W 



ANATOMY. 



SI 



Composition.— A tooth is composed of ivory and enamel. The 

int^.>rnai part is ivory, which is harder than bone. The coating upon 
the surface is enamel, which is still harder than ivory. That part 
which rises above the jaw-bone is called the crotvn ; it is this only 
which is covered with enamel. The part within the jaw is called the 
root or fang; this is composed of bony matter, through which small 
vessels pass in to nourish the tooth. Small white nerves also pass 
into the tooth. — of the presence of which we have terrible eviilenoe 
in tooth-ache. 

Use of the Teeth. 

The incisors cut the food asunder; the molars break down its 
solid parts, and grind it to a fineness which fits it for the stomach. 

In niivsticating the food, the lower jaw has two movements, the up- 
lUuWown motion, like a pair of sheai-s, and the lateral or grinding 
motion. These two movements are performed by different sets of 
iiuuscles. P'lesh-eating animals have only the up-and-down motion ; 
vegetable-eating animals have only the lateral or grinding motion ; 
while man has both the up-and-down and the lateral. This seems 
a pretty clear intimation that he is to eat both flesh and vegetables. 

The teeth aid us in articulating words, and they give a roundness 
and symmetry to the lower part of the face. When well formed, and 
kept in good condition, they add much to the beauty of the face, and 
their decay is an irreparable loss. Their proper care and treatment 
are spoken of in another place. 



i'] 



The Digestive Organs. 

The alimentary organs are the mouth, the teeth, the salivary glands, 
the pharynx, the gullet (oesophagus), stomach, bowels (intestines), 
chyle vessels (lacteals), thoracic duct, liver and sweetbread (pan- 
creas). 

The preparatory process of digestion, the mastication of food, 
takes place in the mouth, where the food is mixed with sallAa, a se- 
cretion of the salivary glands. Of these glands there are six, three 
on each side. 

The Parotid Qiand lies in front of the external ear. It has a duct 
opening into the mouth opposite the second molar tooth of the upper 
jaw. This is the gland that swells in the disease called mumps. 
Hence the disease is also called parotitis. 

The Submaxillary Qiand is inclosed withinthe lower jaw, in front 
of its angle. Its duct opens into the mouth by the side of the bridle 
of the tongue (fraenum linguse). 

On each side of this string or bridle, and under the mucous mem- 
brane of the floor of the mouth, lies the mhlingual gland, which 
poun its saliva into the mouth, through seven or eight small ducts. 



I,: , 



■■■ > 



l! 



. I 



I 



n. 



32 



ANATOMY. 



A disease called the frog consists 
Fig. 28: 1, the parotid gland; 2, 



in 

its 




Fia. as. 



the swelling of this gland, 
duct ; 3, the submaxiTlary ; 
^^vv>K\\wm\^w[i^^^HM^^ *4» its duct ; 6, the sublin- 

<^^^HM^ gual. 

f/^r^ ^iifiH^^^^I^^ ^^^ Pharynx con- 

y 4BP^^'^><i^l^EI^^^^^^^^ tiiiuation the mouth, iind 

lis tlie cavity just below the 
[soft palate. The two piw- 
Hiige.H going to the nose 
(posterior nares), the one 
going to the Htomach 
(oesophagus), and the one 
going to the lungs (larynx 
and trachea ; all meet in 
this cavity. In Fig. 29: 
1, is the trachea ; 2, the 
larynx ; 8, the oesof .lagus ; 
4, 4, 5, moaflles of pharynx ; 5, muscles of the cheek ; 6, the muscle 
which sui'-ounuB the mouth ; 7, the mus- 
cle forming the floor of tlie mouth. 

The Quilet or oeaophagus is a long tube, 
dcHcending behind the windpipe, the 
lungs, and the heart, thiough the dia- 
phragm into the stomach. It is composed 
of two membranes laid together, like two 
pieces of cloth. The inner one is mucous, 
the outer muscular. The two sets of 
fibres composing the muscular coat are 
arranged circularly and longitudinally 
(Fig. 25).. 

The Stomach lies in the upper part of 
the belly, to the left, and directly under 
the diaphragm. It has an upper opening, 
where the stomach-pipe enters it, called 
the cardiac orifice. This is the larger end of the stomach, and lies 
on the left side ; the smaller end connecta with the upper bowel, at 
which point it has an opening called the pyloric orifice. In addition 
to mucous and muscular coats, similar to those which compose the 
oesophagus, the stomach has still another over both, a serous coat, 
very strong and tough, to give this working organ additional en- 
durance. Within, it has many glands to secrete l5ie gastric juice. 

The Intestines, or alimentary tube, or bowels, are divided into the 
smaU and large intestines. 

The small intestine has a length of about twenty-five feet, and is 
divided into three parts, — the duodenum, the jejunum, and the ileum. 

Of these three divisions, the duodenum is the largest, and is about 




Fia. 20. 



a foot in 
passes l>a 
down pel 
the belly 

The Je 

The lie 

angle, nea 

to prevent 

the ileum. 

At this 

caecum, a 1 

dix vermifo 

from one U. 

The Colo 

transverse c 

The Ascc 

surface of ti 
part of the 1 
portion whi< 
on the left s 
of the descei 
which is call 

The Recti! 

ingattheani 

The Lacte 

mucous mem 
tween membn 
glands, from 
another coUe 
Passing, for a 
glands to anc 
progress increi 
ja number, the 
"ito the thoraci 
»P through tl 
J»lly, makes a 
forward, and ( 
^.rge vein whic 
% 30 : 1, is 
nie-flenteric glar 
teals pass; 6, 
fuaphragnj. 

% the help , 
small vessels mi 
«»tofthebowe 



1'. 



AMATOMT. 



83 



a foot in length. It begins at the pyloric oriiice of the stomach, and 
passes backward io the under surface of the liver, whence it drops 
down perpendicularly in front of the right kidney, and i)a8se8 across 
the belly behind the colon, and ends in the jejunum. 

The Jejunum continues the above, and terminates in the ileum. 

The Ileum is a continuation of the jejunum^ and opens, at an obtuse 
angle, near the haunch l)one, into the colon. A valve is located here, 
to prevent the backward passage of aubstances from the colon into 
the ileum. 

At this point the large intestines begin, and here is situated the 
mcum^ a blind pouch, or cul-de-sac, attached to which is the appen- 
dix vermiformi$, a worm-shaped tube, of the size of a goose-quill, and 
from one to six inches long. 

The Colon, or large intestine, is divided into the ascendinff colon, the 
trantvene colon, and the descending colon. 

The Ascending Colon rises from the right haunch-bone to the under 
8urfac« of the liver, whence it bends inward, and crosses the upper 
part of the belly, below the liver and stomach, to the left side. This 
portion which crosses over is the transverse colon. From this point, 
on the left side, it turns down to the left haunch, and has the name 
of the descending colon. Here it makes a curve like the letter S, 
which is called the sigmoid flexure. 

The Rectum is the lower portion of the large intestine, terminat- 
ing at the anus. 

The Lacteals are small vessels which begin in the villi, upon tlie 
mucous membrane of the small bowels. From here they pass be> 
tween membranes of the mesentery to small 
glands, from which larger vessels run to 
another collection ol glands; and after 
passing, for a space, from one collection of 
glands to another, at each stage of their 
progress increased in size and diminished 
in number, the lacteals pour their contents j 
into the thoracic duct. This having passed 
up through the diaphragm, out of the 
belly, makes a sudden turn downward and 
forward, and empties its burden into a 
large vein which ends in the right heart. 
Fig. 30 : 1, is the bowel ; 2, 8, 4, the 
mesenteric glands through which the lac- 
teak pass ; 6, the thoracic duct ; 7, the spinal column ; 8, the 
diaphragm. 

By the help of a magnifying ^lass, an infinite number of these 
smaU vessels may be seen starting from the rough, shaggy internal 
coat of the bowel. 




Fia. ao. 



i 



l^ 



84 



ANATOMY. 



The metentery ih a thick sheet of membrane, formed of several 
folds of the peritoneum, and spread out from the vertebras like a fan. 
The bowels are attached to ite edge, »ud are held by it in their place, 
and at the same time have free motion. Between its layers are a 
great number of glands, which Hometimes l)ecome diseased and swol- 
len in childhood, and prevent the chyle from pasHing along to the 
thoracic duct. Thus affect<Hl, children are not nourished, and waste 
away with a disease sometimes called mesenteric consumption. 

The Liver is a large gland, lying under the short ribs on the right 
side, below the diaphragm. It is convex on the upper surface and 

concave on the under, and is 
composed of several lolies. Its 
office is to secrete bile. It 
weighs about four pouiiik 
Ixjing the largest organ in the 
lM)dy. Fig. !U represents the 
liver: 1, being the right lol)e; 
2, leftlolte; 3,4,smailer lobeH; 
10, gall-bladder ; 17, the notch 
into which the spinal column 
is fitted. 

'^'*' "• The Qall-Bladder lies on 

the under side of the liver, and receives, it is supposed, the surplus 
bile, which is reserved for special occasions. It opens into the gall- 
duct, which carries the bile along, and pours it into the duodenum. 

The Pancreas, Fig. 32, is a long, flat gland, something like the 
salivary glands. It lies tiansversely across the back wall of the 
domen, behind the stomach. 
It secretes a colorless, al- 
kaline fluid called the pan- 
creatic juife, the office of 
wliich is to emulsify the 
different classes 6f food, 
so that the lac teals can ab- 
sorb it. This fluid is car- 
ried by a duct, and poure(' 
duct enters. 




al> 




FlO. 32. 



. duodenum just where the bile- 



The Spleen has an oblong, flattened form. It lies on the left 
side, just under the diapliragm, and close to the stomach and 
pancreas. It is supposed to be a reservoir for holding the surplus 
blood of the liver. It was thought by the ancients to be the seat of 
melancholy. The blood in passing through it loses a portion of its 
red globules. 

The Omentum or catd is a doubling and «3Xtension of the perito- 
neum. It is a kind of fatty body, whicii upon the surface of the 



bowels 
(iate tl 
Hence 



The 
thi! hlo( 
kidneys. 

The* 

region, I 

imd two 

and weij 

called tl 

ureter w 

kidney is 

01' cortict 

tlie bloot 

'i^i^y the 

TheUi 

and eight 
men, behi 
they empt 

The Bli 

composed 

and the in 

the interna 

it secretes 

rosiveness 

means of a 

"f the orga 

iw to give s 

relaxes and 

The blad 

peritoneum, 

the bladder 

This orga 

'"thout it, A 

dribbling aw 

The Uretl 

of the bladd( 
tic fibrous, 
urine passes 






mt^ 



ANATOMY. 



36 



lus 
lot 



Ihe 



bowels and is iit.taclu'd to tlie stomivch. Its use Heems to l)e to lubri- 
cate thu l)owel8, and uspecially to protect and keep them warm. 
Hence it is often called the apron. 

The Urinary System. 

The organs of this system are devoted to separating the urine from 
the l)loo<i, and carrying it out of the lM)dy. These organs are the 
kidneys, the ureters, the bladder, and the urethra. 

The Kidneys lie one on each side of the Imckbone, in the lumbar 
region, l)ehind thu peritoneum. They are four or five inches long, 
and two and a half broad. They are in shape like the kidney-bean, 
and weigh about half a pound each. In tlie centre there is a bag 
called the pelvis, -which tapers like a funnel, and unites with the 
ureter which convevs the urine to the bladder. The texture of the 
kidney is dense, presenting in its interior two structures, an external 
or (;ortical, and an internal or medullary. The cortical portion has 
the blood-vessels, the medullary is composed of tubes which carry 
away the urine. 

The Ureters are membranous tubes of the size of a goose-quill, 
and eighteen inches long, which run down the back wall of the abdo- 
men, behind the peritoneum, to the bladder, into each side of which 
they empty their contents. * 

The Bladder is located in the pelvis, in front of the rectum. It is 
composed of three coats; the external is serous, the middle muscular, 
and the internal mucous. The external coat is strong and fibrous ; 
the internal is drawn into wrinkles, which makes it thick and shaggy; 
it secretes a mucus whirh prevents it from being injured by the cor- 
rosiveness of the urine. I'he urine is retained in the bladder by 
means of a circular muscle, called a sphincter, which draws the mouth 
of the organ together. When the quantity of urine is so increased 
as to give some uneasiness or pain, this miiscle, by a sort of instinct, 
relaxes and lets it out. 

The bladder is attached to the rectum, to the hip-bones, to ihe 
peritoneum, and to the navel, by several ligaments. In the female 
the bladder has the womb between it and the rectum. 

Tliis organ is wisely provided as a receptacle for the urine ; v/nich, 
mthout it, would produce a great inconvenience by being constantly 
dribbling away. 

The Urethra is a membranous canal which leads from the neck 
of the bladder. It is composed of two layers, a mucous and an elas- 
tic fibrous. Through this channel, which is curved in its course, the 
urine passes out of the body. 



■^: 



ANATOMY. 



The Respiratory Organs. 

These organs consist of the windpipe (trachea) ; divinont and 
mbdiviaiona of the windpipe (bronchia) ; air-cells ; and the lungs or 
lights. 

The Windpipe (trachea) extends from the larynx — the seat of the 
voice — to the third dorsal vertebra, where it divides into two tubes, 
called bronchia. It runs down the ' <nt part of the throat, with the 
oesophagus behind and between it s.",d .he spinal column. It is com- 
posed mainly of rings of cartilage, i>.ie ubove another. 

The Bronchial Tul>es are, at the div' n of the windpipe, two in 
number, but they divide and subdivide until they become very nu- 
merous. 

The Air-Celis or Vesicles are small, bladder-like expansions at the 
ends oi the tubes. They are elastic and swell out when the air 
passes in. 

The Lungs All the greater part of the chest, the heart being the 
only other organ which occupies much space in the cavity. The 
size of these organs is larg^ or small, according to the capacity of the 
chest. Ea ch lung — for there are two — is a kind of cone, with its 
base resting upon the diaphragm, and its apex behind the collar-bone. 
They are concave on the bottom, to fit «he diaphragm, which is con- 
vex on its upper side. 

The right and left lungs are separated from each other by a parti- 
tion called the mediastinum, formed by two portions of the pleura, a 
smooth serous membrane coming off from the spine and closely en- 
veloping each lung ; the heart, covered by the pericardium, lies 
in the centre, between them. The right lung is divided into three 
lobes ; the left into two. 

Each lobe of the lungs is divided into a great many lobules, which 
are connected by cellular tissue. These lobules are again divided 
into very fine air-cells. Besides these, the substance of the lungs is 
compof t= i likewise of blood-vessels and lymphatics, and is well su^)- 
plied with nerves. 

In the foetal state, before the lungs have been filled with air, tLay 
are solid and heavy, something like other flesh, but after all their 
cells have been filled with air, and breathing has been established, 
they are exceedingly light and spongy, and float upon water. 

In cases where infanticide is suspected, and where it is desirable 
to know whether the child was still-bom, or bom alive and killed 
afterwards, the specific gravity of the lungs, compared with water, 
will often settle ^e question. 



The foe 

lacteals, ca 
tlie lungs, i 
if not distr 
fecting thif 
capillaries. 

The Hea 

side, and is 
form is som 
ward in the 
the left, occ 
three inches 
case or sac. 
The heart 
it is endowe( 
sides, a right 
cular partitic 
the lungs ; t 
side is divide 

The Auric 

i^servoirs to 1 
parts. 

The Ventri 

carnece. The 
I'ight, beirg r 
cavities will c 

The Tricus 

on the right 
'uembrane. ' 
side. Small ^ 
pass from th 
columnae earn 
«re of the bl< 
the auricles. 

'^if pvlmot 
"ght ventricle 
"f the left ver 
arteries are nn 
valves. Fig. 3 
^ is tlie right j 
Jght ventricle 
'll 10, the vesse 
the heart. 




BMi^ 



ANATOMY. 



87 



The Organs of Circulation. 

The food having been digested, changed to chyle, absorbed by the 
lacteals, carried to the veins, poured into the right heart, sent up to 
the lungs, and prepared for nourishing the body, will still be useless, 
if not distributed to every part of the system. The organs for ef- 
fecting this distribution are the Jieart, the arteries, the vein*, and the 
eapillariea. 

The Heart is placed obliquely in the chest, with one lung on each 
side, and is enclosed between the two folds of the mediastinum Its 
form is something like a cone. Its baae is turned upward and back- 
ward in the direction of the right shoulder; the apex forward and to 
the left, occupying the space between the fifth and sixth ribs, about 
three inches from the breast-bone. It is surrounded by a membranous 
case or sac, called the pericardium. 

The heart is a muscular body, and has its fibres so interwoven that 
it is endowed with great strength. It is a double organ, having two 
sides, a right and a left, which are divided from each other by a mus- 
cular partition, called a septum. The right heart sends the blood to 
the lungs ; the left heart distributes it to the general system. Each 
side is divided into two compartments, an auricle and a ventricle. 

The Auricles have thinner walls than the ventricles, being only 
reservoirs to hold the blood until the ventricles force it along to other 

parts. 

The Ventricles have within them fleshy columns, called columnce 
earnece. The walls of the left ventricle are thicker than those of the 
right, beirg required to contract with more force. Each of the four 
cavities will contain from one and a half to two ounces of blood. 

The Tricuspid valves are situated between the auricle and ventricle 
on the right side, and consist of three folds of a thin, triangular 
membrane. The mitral valves occupy the same position on the left 
side. Small white cords, called chordce tendince, 8^ Lio 

pass from the floating edge of these to the 
columnas earner, to prevent the backward press- 
ure of the blood from carrying the valves into 
the auricles. 



The pvlmonary artery is the outlet of the 
right ventricle ; the larger artery, called aorta, 
of the left ventricle. At the opening of these 
arteries are membranous folds, called semilunar 
valves. Fig. 33 gives a fine view of the heart : 
1. is the right auricle ; ti, the left auricle ; 8, the 
right ventricle ; 4, the left ventricle; 5, 6, 7, 8, 
9, 10, the vessels which bring the blood to and carry it away from 
the heart. 




Fia. 8S. 




ANATOMY. 



The Arteries are the round tubes which carry the red blood from 
the left side of the heart to every part of the body. 

The sides of arteries are stiff and hard, and do not fall together 
when empty. They may often be seen open in a piece of boiled beef. 

The arteries have tlu-ee coats, — an external, which is cellular, firm 
and strong ; a middle, which is fibrous and elastic ; and an internal, 
which is serous and smooth, being a continuation of the lining of 
the heart. They are surrounded by a cell vestment called a sheath, 
which separates them from surrounding organs. 

The Pulmonary Artery starts from the right ventricle in front of 
the opening of the aorta, and ascends to the under surface of the 
aortic arch, where it parts into two branches, sending one to the right, 
the other to the left lung. Having divided and subdivided to a great 
extent, they end in the capillary vessels, uniting, joining their mouths, 
and becoming continuous with the pulmonary veins just where they 
pass around the air-cells. 

The Aorta is the largest artery in the body. It takes a slight turn 
in the chest, called the arch of the aorta, from which are given off the 
arteries which carry the blood to the head, etc. ; thence it descends 
into the belly along the side of the backbone, and at the bottom of 
the abdomen it divides into two arteries, called the iliacs — one going 
to each of the lower limbs. The branches the aorta gives off a supply 
of red blood to every part of the body. 



The Veins carry the dark or purple blood. Being made red and 
vital by meeting atmospheric air in the lungs, and then conveyed to 
every part of the body in the arteries, the blood loses its redness in 
the capillaries, and comes back to the heart in the veins, dark and 
purple, and unfit to support life. The veins are more numerous and 
nearer the surface than the arteries. They have, likewise, thinner 
walls, and when empty, they collapse or fall together. They begin 
in the small capillaries, and running together, they grow larger and 
larger, and finally form the great trunks which pour the dark blood 
into the right auricle. The veins are composed of three coats, simi- 
lar to those of the arteries, with the exception of being thinner and 
more delicate. These vessels have valves all along their inner sur- 
face, to aid in circulating the blood. 

The large vein which receives all the dark blood from above, and 
pours it into the right auricle, is called the vena cava descendens ; the 
one which takes it from below, tvnd disposes of it in the same manner, 
is the vena cava ascendens. 

The pulmonary veins bring the red blood from the lungs to the left 
auricle, and thus are exceptional in their use, — being the only veins 
which carry red blood. 

The Capillaries are the extremely fine network of vessels between 
the ends of the arteries on the one side, and of the veins on the other. 



THE 



W 



mat 




PI. 4. 



THE ARTERIES AND VEINS OF THE HUMAN BODY 




Tli(>y inos( 

one end, a 

industrioui 

red, and i\ 

tliey take t 

and vitaliz 

beginnings 

for another 

in the lun^ 

In Fig. 

lation. Fi 

thrown int 

tery, 3, ar 

<!arry it to 

capilhiry v( 

conies in ( 

and l)ecom 

Thence it i 

auricle of 

veins, 7, 8. 

into the le: 

forcible C( 

sends it foi 

11. Its b 

distribute i 

Iwdy. The 

in the capil] 

the blood 1( 

goes back t 

1, by the ve 

15, and tht 

ens, 16. T 

17, prevent 

blood from 

to the right 

lunar valve 

blood from 

ventricle. 

the left ven 

vent the bai 

Ky a care 
the reader n 

The passa 
and back t'> 
its passii- f: 
to the right 



ANATOMY. 



89 



Tlicy inosculate, or join their nioutlis to tlic very small arteries at 
one end, and to the equally small veins at the other. They are the 
industrious little builders of the human frame. Receiving the blood, 
red, and full of life, from the terminal extremities of the arteries, 
they take the living particles out of it, and apply them to the renewing 
and vitalizing of the body, and then pass it along into the hair-like 
beginnings of the veins, dark and Iwreft of vitality, to he carried up 
for another freight of chyle, and to be again vitalized by being touched 
in the lungs by the breath of heaven. 

in Fig. 34 we have a good ideal illustration of the whole circu- 
lation. From the right ventricle of the heart, 2, the dark blood is 
thrown into the pulmonary ar- 
tery, !J, and its branches, 4, 4, 
carry it to lx)th lungs. In the 
capillary vessels, 6, 6, the blood 
conies in contact with the air, 
and becomes red and vitalized. 
Thence it is returned to the left 
auricle of the heart, 9, by the 
veins, 7, 8. Thence it passes 
into the left ventricle, 10. A 
forcible contraction of this 
sends it forward into the aorta, 
11. Its branches, 12, 13, 18, 
distribute it to all parts of the 
l)ody. The arteries terminate 
in the capillaries, 14, 14. Here 
the blood loses its redness, and 
goes back to the right auricle, 
1, by the vena cava descendens, 
15, and the vena cava aacend- 
ens, 16. The tricuspid valves, 
17, prevent the reflow of the 
blood from the right ventricle 
to the right auricle. The semi- 
lunar valves, 18, prevent the 
blood from passing back from the pulmonary artery to the right 
vcntricrle. The mitral valves, 1 9, prevent its being forced back from 
the left ventricle to the left auricle. The semilunar valves, 20, pre- 
vent the backward flow from the aorta to the left ventricle. 

By a careful examination of this diagram, with these explanations, 
the reader may understand the circulation very well. 

The passage of the blood from the right heart, through the lungs, 
and back t'> the left heart, is called the lesser, or pulmonic circulation ; 
its passu:^3 from the left heart through all parts of the body, and back 
to the nght heart, is the greater or systematic circulation. 




FIO. 34. 



.J' 



y 



If 



Vi 



V 



f 









40 



ANATOMY. 



The Absorbent Vessels. 



The vessels which absorb the chyle from the small intestines, and 
convey it onward towards the blood, are the lacteaU. They have 
been described. The veins are also supposed to have the power of 

absorption, particularly the small 
commencements of the veins. 
These have likewise been de- 
'^°- «• scribed. 




The Lymphatic vessels resemble the lacteals 
skin, the mucous membranes, 
and the lungs. They are 
very small at their origin, 
and, like the veins, they in- • 
crease in size, as they dimin- 
ish in numbers. Like the 
veins, too, they travel to- • 

wai-ds the heart, and their 



They abound in the 




Fio. 36, 



FlO. 37. 



contents are poured into it. 
Their walls are composed of 
two coats ; -S.\e external is 
cellular, and distensible ; the 
internal is folded into valves, 
like that rf the veins. 

These vessels, on their 
way to the heart, pass 
through soft bodies, called 
lymphatic glands, which bear 
to them the relation that the 
mesenteric glands do to the 




lacteals. T 
lymphatic g 
arm-pits, an( 
parts of the 
magnified; '. 
trunks; Fig 
thi'ough it. 

Fig. 38 rej 
6, show thes( 
the commenc 
lymphatic ai 
of the stomac 
13, 14, 15, th 
19, 20, the la 
the heart. 

A cold will 
ings aie calle( 
from cold, an( 
larly in scrofi 
and break, for 



The exhalar, 

Hon. 

The Exhala 

nations upon tl 
terminations uj 
posure. 

The Follicle 

membranes. 1 
little bags. Ve 

QIands are s 
ing many kinds 
united in one mi 
lias a small d 
main duct whic 
shows a gland : 
through its bo 
1, the large duct 
substance is car 

The mesente 
werely modify tl 
tnem ; others se 
fluids to be used 



m^ 



% 



ANATOMY. 4J 

lacteals. These glands are a ooUection ,.f small vessels. The 
lymphatic glands are most numerous in the neck, chest, abdomen 
arm-p,te and groins. They are also found, to some extant, in othei^ 
parts of the body Fig 3o shows a single lymphatic vessel, much 
maguihed; Fig 36 exhibits the valves along one of the lymphatic 

though it^" '' ' ^^"'P'^'^^' ^^'"^ ^''^ '^' vessels pLing 

Fig. 38 represents the lymphatic vessels and glands. 1, 2, 3 4 5 
b, show these vessels of the lower limbs ; 7, the inguinal gknds ;' 8,' 

he commencement of the thoracic duct, into which the contents of 
lymphatic are poured ; 9, the lymphatics of the kidneys ; 10, those 
?q ir^.T ' ^M^"«««f i»'« liver; 12, 12, those of the lungs ; 
1Q Jn' i ' t '^ °^-*^^ ^n'"' ' ^^' ^^' 1^' *h°«« of the face and neck ; 
the hit ""^"^ ' *^^ *^°''''''*' '^"'*' ^^' *^^ ly'^Phatics of 

A cold will' often cause lymphatic glands to swell. These swell- 
mgs are called kernels. They often swell, also, without the irritation 

cm cold, and become very much and permanently enlarged, particu- 
arlyiu scrofula. In scrofulous subjects they sometimes suppurate 
and break, forming bad sores upon the neck. 



The Organs of Secretion. 



^_JHE exhalants, the follicles, and the glands are the organs of seere- 

The Exhalants are the sweat-glands. These have external termi- 
nations upon the skin, thus communicating with the air, and internal 
t.™mations upon the surfaces of organs n^ot having an' outwTrd^x- 

membi-anpl,"'''T. "'" ''"^" T' i^^^^d V" ^^e true skin and mucous ^ 

iS iZ V ^T °^ *^' '^''^ *"" *^« ^"°"*1^« "'• o'^tlete of these 
little bags. Veins and organic nerves are sent to these vessels. 

aiands are soft organs, having a variety of structure, and perform • 
ig many kinds of secretion. A gland is made up of severallobS 
united in one mass, and each of these lobules ' 

has a small duct, communicating with a jSl^^. C? 

main duct which forms the outlet. Fig 39 
shows a gland : 2, the small ducts spread 
hrough Its body, and running together; 
i, the large duct, through which the secreted 
substance is carried away. 

The mesenteric and lymphatic glands 
merely modify the fluids which pass through 
tnem; others secrete from the blood either 
nuids to be used in the body, or such as are to be cast away 




■1^ 



42 



ANATOMY. 



if 



The Vocal Organs. 

No sounds touch the heart like those of the human voice, for no 
mechanic, however scientific and skilful, has ever been able to make 
an instrument which could produce sounds as beautiful, tones its 
varied, a timbre as melodious, and inflexions as manifold and agree- 
able. It has been compared to wind, reed and stringed instruments. 
In touching expression, it is most resembled by the concert-horn, tlie 
bassoon, and the hautboy. 

Vocal sounds, paat all question, are produced in the larnyx, but 
these sounds are grouped, or formed into articulate speech, by the 
pharynx, the nasal cavities, the tongue, the teeth, etc. 

The Larynx is a kind of cavity or tube at the top of the windpipe, 
formed by the union of five cartilages, namely, the thyroid, the cricoid, 
the two arytenoid, and the epiglottis. Ligaments bind these together, 
and muscles move them. 

The Thyroid Cartilage is composed of two parts, and has a con- 
nection with the bone of the tongue above, and with the cricoid car- 
tilage below. 

The Cricoid Cartilage is .shaped like a ring, and hence its Greek 
name. It is narrowest in front, and broadest behind. It connectfi 
with the thyroid cartilage 
above, and with the first ring ; 
of the trachea below. Fig. 40 
gives a side view of the car- 
tilages of the larynx : 1, bone 
at the base of the tongue (os 
hyoides) : 2, the ligament con- 
necting hyoid bone and the 
thyroid cartilage ; .3, the front 
of the thyroid cartilage ; 4, the 
thyroid cartilage ; 6, the cri- 
coid cartilage; 7, the wind- 
pipe. 
'^*'' **■ Fig. 41 is a back view of 

the cartilages and ligaments of the larynx : 1, is the back surface 
of the epiglottis ; 3, 3, the os hyoides ; 4, 4, the lateral ligaments 
connecting the os hyoides and the thyroid cartilage ; 5, 6, the back 
face of the thyroid cartilage; 6, 6, the arytenoid cartilages; 7, the 
cricoid cartilage ; 8, the first ring of the windpipe. 

The Arytenoid Cartilages are upon the back part of the cricoid, 
and are connected with the thyroid cartilage by the vocal cords. 

The Epiglottis is a fibro-cartilaginous lid, shaped like a leaf, which 
covers the upper opening of the larynx. It is connected by a carti- 





lage to the 1 
iage. Breai 
down upon i 
passing dow 

The Vocal 

fibres, enclos 
lines in widtl 
antt'iior pro; 
tilages, and 
the anterior 
are four ligi 
two superior 
ter being call 
k'tween ther 
ineiits thems 
the lips of the 
tween the suj 
is the ventrich 
Fig. 42 rep 
from above: . 
cricoid ; h, h, 
verse ar_ytenoi( 
ligaments. 

The muscles 
of pulling then 
the laryngeal c 
and to relax or 
others, the soui 
Tightening the 



The skin is 
entire person. 
is the true skin 
ture f,nd uses. 

TheScarf-SI 

"rane. partially 

blood-vessels or 
a simple coverii 
"gents. It is tl 
The scarf-skii 
'rom it in the si 
and dries up int 
of these scales, 
new layen, are £ 



ANATOMY. 



48 




uge to the bone of the tongue (os hyoides) and to the thyroid carti- 
age. Breathing opens and shuts it; and in swallowing, it closes 

down upon the top of the larynx, to prevent food and drink from 

piissing down the windpipe. 

The Vocal Cords are two ligaments, formed of elaatic and parallel 
hbres, enclosed in a fold of mucous membrane. They are about two 
lines in width, and inserted behind into the 
aiitt'iior projection of the arytenoid car- 
tilages, and passing forward, are fixed <o 
the anterior angle of the thyroid. There 
are four ligaments crossing the larynx, 
two superior and two inferior, — tlie lat- 2 
ter being called vocal cords. The interval 
tetween them is the glottis. The ligar 
ineiits themselveis are sometimes called 
tiie lips of the glottu. The depression be- 
tween the superior and inferior liganiciits 

is the ventricle of the larynx. r 

Fig. 42 represents a view of the larynx ''™' *^- 

from above .• a, 6, c the thyroid cartilage, enclosing the ring of the 
cricoid; A, A, e, c, the arytenoid cartilages connected by the trans- 

Z^T ' '"' '' *^' ^"'"* '"'^ ' "' ''' '^' crico-aiytenoid 

The muscles which are attached to the cartilages have the power 
of pulling them about so a« to change in various ways the shape of 
the laryngeal cavity; to enlarge or diminish the size of the riottis 
and to relax or tighten the vocal cords. By these means, and some 
othei., the sounds of fhe voice receive theirwious moScations 
lightemng the cords, for example, raises the pitch. 

The Skin. 

The skin is a membrane composed of two layers, coverimr the 
en .re pei.om The outer layer is the scarf-skin or^^.l-I J the fnner 

luiL r,ud"ust" '' '"'" '' ""■ ^^''' ^'^"'^ ^^'' ^" '^'^ «*^««-. 

The Scarf-Skin, called also cuticle and epidermis, is a thin mem- 
mne- P'^rtially transparent, like a thin shaving of horn. HavinTS, 
lood-vessels or nerves, and consequently no 4ling, it appear. I be 
a simple covering to protect the true skin from injury by external 
agents. It is thickest on those part« most exposed to friction 
froi- itrl ? '' *^! production of the true skin, -an exudation 
Z"^J ■ IT °^ * f""'^ ^^^^^ ^« «P"ad out aa a thin layer, 
TiiT "P/"^ ^f^""^^ '''*^"«- ^^^ «^<^i«l« ^ composed chiefl; ' 

tl\ZT \ ^''^' '' «T**"*^y ^^"^ "'^^•^^ off ^ «curf, while 
new layers are forming underneath. 




f 






44 



ANATOMY. 



The lower, softer layer of the scarf-skin, called the malpighian 
layer, or rete mucosum, is the seat of ,-:rior. In this part the cells 
contain a pigment incorporated with the elementary granules, which 
gives to the various races their sevenil shades of color. The depth 
of hue is dependent entirely on the amount of tliis coloring matter. 

The True Skin, which is called vuiia^derma or coriiim, is a kind of 
wel), woven of small fil)res collected into strands. In the upper por- 
tion, the web is line and tirm, but grows coarser below. Connected 





Fio. 43. 



with its under surface is a fibrous web in which the fat is deposited. 
Upon its upper surface is the sensitive or papillary layer, composed 
of blood-vessels and nerves, doubled into loops, which give little 
prominences called papillae. Fig. 43 gives an ideal view of these 
elevations, composed as they are, of a nerve, an 
artery, and a vein, lying side by side ; 1, 1, 
represent the true skin ; 2, 2, the papillary 
layer; 3, 3, the arteries; 4, 4, the veins; and 
6, 5, the nerves of the papillse. 

The arteries, veins, and nerves are spread 
over the true skin in great numbers, — so pro- 
fusely, that it is impossible to push the point of 
the finest needle into it, without piercing a 
blood-vessel and a nerve. 

Fig. 44 gives a view of the skin : a, a, the 
cuticle ; b, 6, the colored layer of the cuticle ; 
tf, c, d, c?, the true skin ; e, e, e, fatKiells ; /,/,/ 
sweat-tubes. 

The lymphatics are very numerous in the skin, besides which there 
are oil-glands and tubes, and sweat-glands and tubes. 

The Oil-Qiands are imbedded in the skin, and communicate with 
the surface by small tubes. They are most abundant on the face, 




FlO. 45. 



nose and ears 
the tube, and 
1 




The Sweat-i 

through tlie tri 
where it coils t 
tory gland. Fi 
nified forty diai 
two excretory d 
tul)e, which ope 
fat-cells. 
The hair and 



The Nervous 

nected with each 
nerves; the spini 

The Brain is t 

wnes. It is mac 

cipal parts, — the 
^*'««w, and the 
These are nicely 
tected by three m 
"wfer, the arach^ 
mater. 

^. % 47 shows a 
t'on of the brain, ■ 
»''d membranes 
^ne scalp turned 
rented by a, a ; e, 
^''ge of the bonea 
mater, drawn up 
">" convolutions c 

The Cerebrum i 

'■"Kt-'i' portion of i 



MH^ 



ANATOMY. 

noBP and eare. Fig. 4.5 hI.ows an oil-glan.l, 
the tube, and c, ita mouth. 



46 



— a, being the gknd, b. 





W^. 




th4.f rf;ui,T]^r:nVri n" *""i ^^^^'^ p- ^'-» 

where it coils upon itself inSTlTn^ »" the -neshes at the bottom, 

mfied forty dialtersTT^L h« -n ? f i ''''^' *''^' ^^'"»d, mag- 
two excretory duct« f;om the fland it *"''"• *?'" ^''""^ ' - 2, the 
tul., which opens at 4 wh ch fs th^nS'"' Tf''^ ^''"" «"« ^P'^*^! 
fat*ells. ' " '^ **'' ^'^^"ce ot the cuticle; 3, are the 

The hair and the nails are appendages of the skin. 



The Nervous System. 



--; the spinal ner^e. aidlJfe'.X^Srr;:' '^^ ^ ''' --'«^ 

^n^^ 'ftt iVdf upTfVh^er;^ '"^^^^ '^'^'' -'"^^ *^e ^^^^H- 
cipal parts -the cer.irwm, the cere- 
allium, and the w^rfw/Za oblor^ata. 
Ihese are nicely covered and pro- 

te ted y three membranes, the Zr« 
»'«J^r, the aracAno^rf, and the pia 

tilff ^1 ^t""^^ * considerable por- 

ThP^?^"*"^' being removed. 
The scalp turned down is repre- 

"later, drawn up with a hook • f 
"'« convolutions'^ of the braTn ' 

J^^^*';*'"•"™ « the upper and 

'"5>^^ portion of the brain, and is f.o. 47. 




IK 



46 



AM4T0MY. 



(livi(le<l into two hemiflphereB by a fisBure. A portion of the dura 
mater dipu into tJuH (;left, and from its re8enil>lanc(! to a Hicklu, in 
called the falx cerebri. The dimign of tbiH seems to Iw to support 
each half of the brain, and to prevent it from preHsingupon the other 
half when the head reclineH to one side. 

The undulating surface of the cerebrum is produced by what are 
called convolutioHH. The lower surface of this organ is divided into 
three lol)e8, — the anterior, the middle, and the posterior. 

The Burface of the (iereljruni w of a gray color, culled cortical, or 
oinerifioug ; the central portion is white and fibrous, and is called 
medullary. 

The Cerebellum is about one-sixth the size of the cerebnim. It 
lies just under the posterior lobe of the cerebrum, and is separated 
from it by an extension of the dura mater, called the tentorium. It 
is composed of white and gray matter; when the former is cut into, 
there is presented the appeamnce of the trunk and branches of a tree^ 
called arbor vita:. 

The MeduiJa Oblongata is the top of the spinal cord; but being 
within the enclosure of the skull, it passes for a portion of the brain. 
It consists of three pairs of bodies, united so as to form a bulb. 

The Dura Mater is a strong, fibrous membrane which lines the 
skull and spinal column, and sends processes inward to support the 
brain, and forward, as sheaths for the nerves which go out from the 
brain and spinal cord. 

The Arachnoid is a serous membrane, and like all other serous 
membranes, is a closed sac. It is leilected upon the inner surface of 
the dura mater. 

The Pla Mater is a vascular membrane, and lies next to and in- 
vests the whole surface of the 
brain, — dipping into its con- 
volutions. It furnishes nu- 
triment to the brain. 

The Cranial Nerves which 
go out from the brain are in 
twelve pairs. In reading a 
description of them, let the 
reader keep his eye on Fig. 48. 

The First Pair, olfactory 
(6), passes through several 
small openings in the ethmoid 
bone, and is distributed to 
the mucous membrane which 
lines the nose. Destroy this, 
and the sense of smell is gone. 




FlO. 48. 



The Secoi 

skull, and en 
retina. It ii 
of sight, call 

The Third 

iitiid bone to 

The Fourt 

iniiNcle of the 

The Fifth 

loots, iuid divi 
iiiid noNo, call 
the teeth of tl 
the third goin 
jiiw, and callei 
the hranches o 
affection callet 

The Sixth P 

•arotid artery < 
Ntmight muscle 

The Seventf 

teniiil ear. 

The Eighth I 

Jt sends nervou 

The Ninth Pi 

■'^"iiie opening w 
lous membrane 
The Tenth P« 

the pharynx, lui 
»"a iKJwels. 

The Eleventh 

"'"th and tenth j 

The Twelfth F 

i"'fl is its motion- 
those who talk m 

The Spinal Cor 

'n connection wit) 
Ihe upper fend of 
"ft. Another s 
^''hich go to the ui 
toi^, where the ne 

f^'ssures dip int. 
'^™ -^teral parts, w 

^hese lateral col 



ANATOMY. 



47 



The Second Pair, optic nerve (7), paaflea tliroiigh the iweof the 
skull, and enters the cavity of the eye where i h oxpiinded upon the 
retina- It iH a disease of this nerve which occtisions a gradual loss 
of HJpht, called amauroHtit. 

The Third Pair, niotoros oculorum (9), passes through the sphe- 
noid lx)ne to the muscles of the eye. 

The Fourth Pair, patheticus (10), passes to the superior oblique 
immclo of the eye. 

The Fifth Pair, trifacial nerve (11), like the spinal nerves, has two 
mots, and divides into three brandies, one going to the eye, forehead, 
iiiitl noHe, called the ophthalmio branch ; another going to the eye, 
the tf t'th of the upper jaw, etc., called the miperior maxillary ; and 
the third going to the ear, the tongue, and the teeth of the lower 
jaw, and called the inferior maxillary. It is a painful condition of 
the branoheHof the fifth pair which constitutes the ^'••.libie neuralgic 
affection called tie-douloureux. 

The Sixth Pair, abducentes (12), passes the opening by which the 
carotid artery enters the cavity of the skull, and goes to the external 
stniiglit muscle of the eye. 

The Seventh Pair, portio n<olIiH (13), is distributed upon the in- 
ternal ear. 

The Eighth Pair, facial nerve (14), is distributed over the face. 
It sends nervous filaments to the muscles. 

The Ninth Pair, glosso-pharyngeal nerve (14), passes through the 
same opening with the jugular vein, and is distributed upon the mu- 
cous membrane of the tongue and throat. 

The Tenth Pair, pneumogastric nerve (16), sends its branches to 
the pharynx, larynx, gullet, lungs, spleen, pancreas, liver, stomach, 
and Iiowels. 

The Eleventh Pair, spinal accessory nerve (16), connects with the 
ninth and tenth pairs, and is distributed to the muscles of the neck. 

The Twelfth Pair, hypo-glossal nerve (17), goes to the tongue, 
and is its motion-producing nerve. It 's a nerve of great energy in 
those who tivlk much. 

The Spinal Cord extends f'om the medulla oblongata, where it is 
in connection with the brain, down to the second lumbar vertebra. 
The upper fend of the cord presents a bulbous swelling, or enlarge- 
ment. Another swelling is found where the nerves are given off 
which go to the upper extremities ; and a third near the end of the 
cord, where the nerves l)egin which go to the lower extremities. 

Fissures dip into the cord before and behind, and divide it into 
two lateral parts, which are united by a thin layer of white substance. 

These lateral colunuis are divided by furrows into anterior^ lateral., 



; .^K. 



I 



^g.^yjiyi! 



48 



anat6my. 




FIO. 49. 



and posterior columns; — the anterior being supposed to be the motor 
column, the posterior that of sensation, and the lateral divided iu 
function between motion and sensation. 

The 5pinal Nerves, connecting with the cord, are in pairs, of 
which there are thirty-one. Each pair has two roots, — a motor root, 

C, Fig. 49, arising 
from the anterior 
columns of the 
cord, and a send- 
tivH root, D, spring- 
ing from the pos- 
terior columns. A, 
is a section of the 
cord, surrounded 
by its sheath. B, 
is the spinal nerve, 
formed by the 
union of the motor and sensitive roots. After the union, the nerve, 
with its motor and its sensitive filaments, divides and subdivides 
as it passes on, and is distributed to the tissues of the several 
organs. 

The thirty-one pairs of spinal nerves are divided into eight pairs of 
cervical, twelve pairs of dorsal, five pairs of lumbar, and six pairs of 
sacral nerves. 

Fig. 50 gives a view of the brain and spinal cord, with the nerves 
given off by the latter: 1, 1, being the two hemispheres of the brain; 
3, 3, the cerebellum ; 4, the olfactory nerve ; 6, the optic ; 7, the 
third pair ; 8, the pons varolii, so called ; 9, the fourth pair ; 10, the 
lower portion of the medulla oblongata ; 11, 11, the spinal cord ; 12, 
12, the spinal nerves ; 13, 13, the brachial plexus ; 14, 14, the lum- 
bar and sacral plexus. 

The Brachial Plexus is formed by the interlacing of the four lower 
cervical and upper dorsal pairs of nerves. It gives off six nerves, 
which are distributed to the muscles and skin of the upper extremi- 
ties. 

The Lumbar and 5acral Plexus is formed by the last aorsal and 
five lumbar nerves, from which nerves go to the muscles and skin of 
the lower extremities, and the last lumbar and four sacral, from 
which nerves are sent to the muscles and skin of the hips and lower 
extremities. 

The Sympathetic Nerve consists of a series of knots (ganglia), 
lying along on each side of the spinal column, and forming a knotted 
chain. There is a knot for each intervertebral space, the neck ex- 
cepted. These knots are composed of both cineritious and raeduUarv 
matter. 



Each knot ] 
downward, ext 



119. 



PlO. 60. 



•supplied with bran 
nerve of organic 
preside over nutril 
nerves of the brai 
motion and sensati 
% 51 is a fin 
great sympathetic, 
nections with oth« 
Jne semilunar ganj 
'J'"'g just under t 
^fce in this regioi 
Jomach sometimes 
«"t, the external 
''?'; and left coror 
'"'fl'Ile, and superio 



Tl 



ANATOMY. 



49 



Each knot is a distinct centre, and gives off branches upward, 
downward, externally, and internally. All the internal organs are 





\'¥^' 



FlO. SO. 



,•/' 






FlO. 61. 

supplied with branches from the sjrmpathetic nerve. It is called the 
nerve of organic life, and is supposed to , 
preside over nutrition, secretion, etc., as the 
nerves of the brain and cord preside over 1 
motion and sensation. 

Fig. 51 is a fine representation of the 
great sympatiietic, witli its knots, and con- 1 
nections with other nerves. A, A, A, is ' 
the semilunar ganglion and solar plexus, ^^ " 

b'ing just under the diaphragm and behind the stomach. Its pres- 
ence in this region is the reason why a blow upon the pit of the 
stomach sometimes destroys life. D, D, D, are the thoracic ganglia ; 
E. E, tlie external and internal branches of the same ; G. F, the 
light and left coronary plexus upon the heart; I, N, Q, the infei.. , 
middle, and superior cervical ganglia; 1, the renal plexus around the 




if 




ANAl'OMY. 



kidneys ; 2, the lumbar ganglion ; 3, the internal branches ; 4, the 
external branches ; 5, the aortic plexus. 

Fig. 52 represents a plexus, showing how the filaments of one 
nerve paas to be enclosed in the sheath of another. In this way they 
change at once the direction of their journey, and their companions 
upon the way. 

The Organs of Sight. 

The organs of vision are the optio nerve, the globe of the eye, the 
muscles of the eye, and the organs of protection. 

The Optic Nerve begins by two roots at the base of the brain, the 
fibres from which meet, as they come forward, and some of them cross 

each other. The two nerves then sepa- 
.rate, and enter the back part of the 
'globe of the eyes, and then spread out 
into a kind of membrane. In Fig. 53 : 
1, 1, show the globe of the eye ; 2, the 
crossing of the optic nerve ; 8, the 
origin of two pairs of cranial nerves. 

The Qlobe of the Eye is a better 
constructed optical instrument than 
man ever made. Its interior is filled 
with what are called refracting human 
or mediums, which are surrounded and 
held in their place by membranes, called coats. 

The Coats are the sclerotic and cornea ; the choroid, iris, and ciliary 
processes ; and the retina. 

The Sclerotic Coat is a fibrous membrane, covering the largest 
portion of the globe. To this the muscles are attached. It is the 
part which is called the white of the eye. It has a beveled edge in 
front, into which the cornea is fitted. 

The Cornea is a transparent layer which projects in front, and forms 
about one-fifth of the globe. It is shaped like a watch-glass. Its 
blood-vessels are too small to receive the red particles of blood. 

The Choroid Cpat is a vascular membrane. Its color is brown ex- 
ternally, and black within. It is connected with the sclerotic coat 
externally, and internally with the retina. It is composed of three 
layers. 

The Iris is named from its having a variety of colors in different 
persons. It is the partition between the anterior and posterior cham- 
bers of the eye, and has a circular opening in the centre called the 
pupil. Of its two layers, the fibres of the anterior one are radiating, 
and dilate the pupil, while those of the other are circular, and cause 
its contraction. 




FlO. 63. 



u'ls ; 



"H 



It 



ANATOMY. 



51 



The Ciliary Processes are a number of folds formed from the in- 
ternal layer of the choroid coat. 

The Retina has three layers. The external is extremely thin ; the 
middle is nervous, being an expansion of the optic nerve ; the in- 
ternal is vascular, and consists of a ramification of minute blood 
vessels. 

The divided edge of their coats may be seen in Fig. 64, namely, 
tlie sclerotic, the choroid, and the retina : 2, is the pupil ; 8, the 
4, the ciliary process ; .5, the scolloped border of the retina. 



uus 




FlO. M. 



no. 6S. 



The Humors of the Eye are the aqueous, the cri/stalline, and the 

vitreous. 

Th - Aqueous or watery humor is situated in the chambers of the 
eye. it is an albuminous fluid, with an alkaline reaction, and a spe- 
cific gravity a little greater than distilled water. 

The Crystalline Humor is immediately behind the pupil. It is a 
lens, and '^ convex both on the posterior and the anterior surface. 

The Vitreous Humor is also an albuminous fluid something like the 
aqueous humor, but more dense. 

In Fig. 55 we have in E a good view of the cornea fitted into the 
sclerotic coat ; A, is the choroid ; B, the pigmentum nigrum , C, 
the retina ; K, the vitreous humor ; D, the optic nerve ; I, the lens ; 
C, the Iris, painted on the backside with pigment; F, the aqueous 
humor. 

The muscles of the eye, six in number, are attached to the bones 
of the orbit behind, and to the cornea in front, by their tendons. 
These tendons give the eye its pearly appearance. In Fig. 56, 
five of the muscles are indicated by o, 5, c, d, e; f, is the optic 
nerve. 

If the internal muscle be too short, the eye is drawn in towards 
the nose, and the squinting called " cross^ye " is produced. 




AHATOMY. 

The Orbits are bony sockets which encloue the eye. The optic 
nerve passes through a large hole at the bottom. 

The Eyebrows are the projecting arches above, covered with short 
hair. They prevent the sweat from running down into the eyes, and 
also shade them from strong light. 

The Eyelids are the curtains which rise and fall in front. The 
smooth membrane which lines them is called the conjunctiva. It 
secretes a fluid which makes the eyelids open and shut easily. 




FlO. 67. 

The Lachrymal Qland is at the upper and outer angle of the 
orbit. Several small ducts open from it upon the upper eyelid, 
through which the tears run down upon the conjunctiva. 

The Lachrymal Canals begin near the internal angle of the eye, 
by two small-tear points, which communicate with the sac at the 
upper part of the nasal duct. 

The Nasal Duct is a canal about three^uarters of an inch long, 
which runs down to the inferior channel of the nose. 

Fig. 67 shows these organ : 1, being the lachrymal gland ; 2, the 
ducts leading to the upper eyelid; 8, 8, the tear-points (punota 
lachrymalis) ; 4, the nasal sac ; 5, the termination of the nasal duct. 



u 



The Ors^ans of Hearing:. 

The External Ear is composed of the pavilion of the ear (the pinna), 
and the auditory canal (the meatus audltorius externus). 

The Pinna surrounds the entrance to the auditory canal. It stands 
ou' .'-om the head, and is in common language called the ear. 

The rieatus Auditorius in a canal about an inch long, partly bony 
and partly cartilaginous, which goes from the pavilion of the ear to 
the drum of the ear. 

The Drum of the Ear (membrana tympani) is an oval-shaped thin 
membrane, inserted into a groove around the auditory canal. 



wim 



2-lS?y-1rifa!-3£tii;^ 






'TSl 



ANATOMY. 

The Tympanum is a cavity within the temporal bone. 

The Eustachian Tube is a 

channel of communication be- 
tween the tympanum and tlie 
upper part of the pharynx. 
The object of this is to convey 
air to the drum of the ear, as 
without air no sound can be 
produced. 

The Labyrinth is a seiies of 
chambers through the petrous 
bone — embracing the vestibule, 
a three-cornered cavity within 
thv, tympanum ; the semi-circu- 
lar canals, communicating with 
the vestibule, and the cochlea, 
which makes two and a half 



53 





PIO. 68. 

the fenestra ovalis ; 4, 6, 10, the 



FlO. SB. 

turns around an axis, called the 
modiolus. 

In Fig. 68, a, is the pa- 
vilion of the ear; c,' the 
auditory canal ; g, the mem- 
brana tympani ; k, the t3Tn- 
panum ; e, the bones of the 
ear ; b, the semicircular ca- 
nals ; /, the cochlea; h, the 
vestibule ; i, the eustachian 
tube ; d, the auditory nerve. 
In Fig. 59, we have a 
view of the labyrinth laid 
open, and highly magnified : 
1, 1, being the cochlea; 2, 
8, the channels that wind 
around the central point 
(6) ; 7, 7, the vestibule ; 8, 
the foramen rotundum; 9, 

gemicircular canals, 



PHY8I0I0GICAL LAWS OF LIFE AND 
HEALTH.— HYGIENE. 



Life, the Infancy of Being. 

It may be stated as a general truth that man has but just learned 
to live when he is ready to die. We expend a large portion of our 
lives in searching out our mistakes, and in striving to undo the mis- 
chiefs they have occasioned. This is true in reference both to our 
moral and our physical life ; and I draw from it the conclusion that 
the present must be only the infancy of our being, and that our blun- 
ders and consequent sufferings here will cause us, in the great here- 
after, to place a higher value upon knowledge, and to struggle with 
new fortitude to rid oui-selves of eveiy bondage. 

A life which has just begun to take shape and symraetiy, cannot 
be permitted, I think, under the rule of a benevolent Creator, to be- 
come extinct. We shall certainly be permitted to take up the broken 
thread of life, and, in the clearer light of the future, with the warning 
experience of the past, and surrounded by better guards, to try again. 
In the meantime, while here, the sooner we become acquainted with 
the laws of life, and the better we obey them, the more we shall en- 
joy- 

Tlie Nervous System. 

Man is brought into connection with the outward world through 
the senses of feeling, seeing, hearing, etc. These communicate with 
the brain and mind through the nerves of sensation. 

The nervous system is divided into two great central portions, 
the brain and the spinal cord ; and these together are called, by the 
learned, the cerebrospinal centre. There are numerous pulpy white 
cords, called nerves, which at one end are connected with this great 
axis or centre, and from thence run to all parts of the system. A 
portion of these nerves start from the base of the brain and run to 
the eye, the ear, the tongue, etc. (Fig. 48) ; while another, and a 
larger part spring from the cord which runs through the backbone, 
and are distributed over the body and the lower extremities (Figs. 
50 and 60). One portion of these cords produce feeling ; another 
part, motion. The former we call sensitive ; the latter, motor. Both 
kinds are widely distributed over the body. Those which spring 
from the spinal cord have two roots, one uniting with the back, the 

54 




Copyright, by Bradley & Woodruff, 1892, 




I 




Copyright, by Braolkv & WoonRUKK. 1S02 



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other with 
part to wl 
mon lan^ 
comes nm 
may move 
before. C 
root, whic 
producing, 
to which il 
move. Il 
thougli it 
acutely. 1 
nerves tlial 
the spinal 
pretty well 
ill Fig. 60. 
If the ci 
of motion ' 
the face be 
tion or pas 
expressed, 
will all be 
like statuar;; 
to laugh, t 
give, expres 
feeling of 
guish, or lo 
impossible, 
breath of ai 
face will be 
ly as before, 
or palsy, as 
partial orge 
result of in ju 
or many of tl 
producing m 
ralgia, tic c 
etc., arise i 
disease, perh 
nuition, of th 
sensation. 

How the 

of the extern! 
communicate 
acted on by e: 
sensations." ' 
with the inte] 



HYGIBNE. 



55 



other with the /ron^ part of the cord. Cut off the back root, and the 

part to which It 18 distributed loses its feeling. As wo say in com' 

mon language, it be- ^ 

comes numb, though it 

may move as well as 

before. Cut the front 

root, which is motion- 
producing, and the part 

to which it goes cannot 

move. It is palsied, 

though it may still feel 

acutely. The numerous 

nerves that spring from 

the spinal column are 

pretty well represented 

ia Fig. 60. 

If the cranial nerves 
of motion which go to 
the face be cut, no emo- 
tion or passion can be 
expressed. The features 
will all be immovable, 
like statuary. To smile, 
to laugh, to frown, to 
give, expression to the 
feeliug of pity, or an- 
guish, or love, is alike 
impossible. And yet a 
breath of air upon the 
face wiWhe felt as readi- 
ly as before. Paralysis, 
or palsy, as it is called, 
partial or general, is the 
result of injury upon few 
or many of these motion- 
producing nerves. Neu- 
ralgia, tic douloureux, 
etc., arise from some 
disease, perhaps inflam- 
niation, of the nerves of 
sensation. 

How the Mind get* Knowledge. Everything the mind knows 
of the external world, it learns through the the orgLs of Teme wSd! 
communicate with it through these nerves. Thus, the nm^es ail 

ZtZ^'T^:\:'TT''i''''' ^r^^ "" the'bmin anTcaS 

ensatons. When the hand is burned the nerves of sensation run 

^N.th the intelligence to the brain, which, quick as thought, through 




FlO. 60. 



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• WiiTiTW 



HYCTENE. 



the nerves of motion, despatches orders to the muscles to repel the 
injury. 

Comparison. — The arrangement and operation of the nervous 
system are like thoje of the electric fire-alarm system of a city. 
The brain is the intelligent centre, like the central office. The 
nerves of sensation which carry to the brain, with electric speed, 
intelligence of what is going on outside, are like the wires which run 
to the central station from the several boxes. The quick carry- 
ing to the brain of any information of injury done to some part of 
the body, is like sending to the central station from an alarm-box 
the intelligence of fire in one of the districts. The rapid transmis- 
sion of orders from the mind to the muscles is like flashing the alarm 
over the wires to every part of the city. And, finally, the powerful 
action of the muscles in warding off danger is like the dashing of 
firemen over the pavements and the energetic playing of the 
engines. 

Sensations. 

An effect produced on the mind thi-ough a nerve is called a 
sensation. Hunger is a sensation. It is an effect produced upon the 
mind through ascertain nerve by the condition of the stomach. 
Thirst, pain, heat, cold, are sensations in a similar sense. Nausea 
is a sensation produced by some injurious substance acting upon the 
coats of the stomach. 

Strength of Sensation. — Some sensations are much stronger 
than othei-s ; some are very intense. A very strong sensation is 
called a feeling. It is common to say, " I feel cold," or, " I feel hot." 
We simply mean by this, that the temperature of the weather makes 
a very powerful impression upon us. 

Kinds of Sensation. — Sensations are either pleasurable or pain- 
ful. Pleasurable sensations arise from the proper exercise of some 
healthy part of the body ; and they are a suitable reward for any 
care the mind may take of the corporeal organs. 

The sensations arising from a proper amount of exercise are 
pleasurable. The muscles find a sort of enjoyment in action. He 
who leads a sedentary life, either from choice or necessity, loses much 
enjoyment. Hence, there is pleasure in labor ; and the working-man, 
though often pitied by the wealthy, is generally the happiest of men.* 
The eye and the ear, when directed to agreeable sights and sounds, 
derive the most agreeable sensations from exercise. The air of a 
beautiful spring-morning gives impressions which none can describe, 
but which all know to be delightful. These impressions are well 
fitted to reward us for taking at that season, in the open air, the ex- 
ercise we so much need. 

Moral Uses of Sensations. — How little we reflect upon the 
amount of happiness it is in our power to create by making agreeable 



impression 
impression 
(if families 
lies in the 1 
(hopping ii 
acts of ber 
agreeable a 
of life, — c 
and which 
us like spri 



In aiming 

be governed 

of happinesi 

stairs, — shi: 

refining infl 

or for recrea 

to wear a fn 

flowers of ht 

Every hui 

ism of whicl 

urable or pai 

life, it shouL 

Wives may j 

tion of their 

heart of the 

the liusband. 

pressions upc 

fully. Most 

the heads of 

saying, or do 

other. A w 

loved either I 

who desires t 

life, the whol 

sions upon ot 

Agreeable 

tions not onl^ 
to health. T 
Travelling pi 
variety of the 

Care of the 

portant that i 






HYGIENE. 



87 



impressions upon others. A civil and polite address makes a pleiisant 
iin|)re88ion. A kind word, fitly spoken, makes the heart glad. Heads 
of families might do much to increase the happiness of their domes- 
tics in the kitchen by meeting them with a pleasant countenance, and 
(hopping in their ear, now and then, a word of approval. Such, little 
nets of benevolence are easily performed, and they make the most 
agreeable and lasting impressions upon persons in the lower stations 
of life, — creating attachments, in fact, which end only with death, 
and which in hours of future sorrow, which come to all, may refresh 
us like springs of water in the desert. 

" Full iiiauy a shaft at random sent, ' 

FindH luai'ks the archer little meant; 
Full many a word at random spoken, 
May heal a wounded heart that's broken." 

Sir Walter Scott. 

In aiming to make agreeable impressions upon domestics, we should 
be governed by the simple desire to create happiness. Their sources 
of happiness are comparatively few. They spend their days below 
staira, — shut out from a portion of the light of day, and from the 
refining influences of the drawing-room, — having little time for rest 
or for recreation. How unfeeling to treat such persons with harshness, 
to wear a frowning face in their presence, and thus wither the few 
flowers of happiness which bloom around them! 

Every human being is endowed with the beautiful nervrsus organ- 
ism of which I have spoken, and is daily receiving impressions, pleas- 
urable or painful, from thousands of sources. In all the relations of 
hfe, it should be our aim to touch delicately this sensitive structure. 
Wives may add much to the happiness, and I may say, to the affec- 
tion of their husbands, by always wearing a pleasant face ; and the 
heart of the wife may be made light and glad by gentle words from 
the husband. We cannot but love those who make pleasurable im- 
pressions upon us, and we necessarily dislike such as impress us pain- 
fully. Most of the coldness and alienations which grow up between 
the heads of families, spring from the habit of one of the parties, of 
saying, or doing, or looking something which painfully impresses the 
other. A woman who habitually wears a "sour" face cannot be 
loved either by her husband or her children. The man or the woman 
who desires to be loved, must cultivate a manner, a look, a speech, a 
life, the whole scope of which is fitted to make pleasurable impres- 
sions upon others. It is against nature to love what gives us pain. 

Agreeable Sensations a Source of Health. — Pleasurable sensa- 
tions not only beget love, and increase happiness, but they add much 
to health. They exhilarate the spirits and drive away melancholy. 
Travelling promotes health and prolongs life, by the number and 
variety of the pleasing impressions it makes upon the mind. 

Care of the Sick. — Tf the above statements be correct, how im- 
portant that the sick should be so dealt with as to have none but 



I 





HYQIENE. 



aj'p'eeable sensations made upon them. Many a life has been mcri- 
ficed to the peevish temper of a nurse. When the nerves are weak 
from disease, even slight causes make powerful impressions ; and if 
these impressions are of a painful kind, the results are most deplora- 
ble. To treat harshly the sick, especially those whose nervous system 
is broken, implies either great thoughtlessness or extreme cruelty. A 
single harsh word, which would scarcely move one when well, may 
send the same person, when sick, almost to distraction. Every word 
spoken to persons in sickness should, therefore, l)e gentle and sooth- 
ing. Every feature of the face should express either cheerfulness, 
or tenderness and pity. 

As the painful impressions which disease is making tends to de- 
press the spirits and create melancholy, it is not expected that peraons 
when sick will exhibit as amiable tempers as when well ; and for 
this all due allowance must be made. 

Effect upon the Disposition. — This leads me to say that pleasur- 
able sensations improve the temper and disposition. This is a fact of 
very great importance, and parents should never lose sight of it in 
dealing with their children. There are few children but would grow 
up amiable and useful members of society, were they dealt with in 
the gentle and tender manner which their young and impressible 
natures require. From the moment the young mind wakes to intelli- 
gence, it will he occupied with something. Parents and guardians 
should aim, therefore, to turn it to all those things which will impress 
it pleasantly, and at the same time do it no hai-m. Exercise, songs, 
playthings, flowers, — to these and other entertainments it should be 
led by gentle hands. No thoughtful parent will ever pain a child 
by harsh threats and denunciations, or shock it by an oath. 

Bad Effect of Unpleasant Sensations.— If pleasurable sensations 
improve the health and temper, unpleasant ones do just the opposite. 
They break down the health and spoil the disposition. 

They are intended to give us a warning of impending injury. 
Thus, we have painful sensations when we have overworked the body 
or mind. The sensation of weariness tells us that the muscles have 
worked as long as their good requires, and that they need rest. Were 
this sensation unheeded, exhaustion and entire prostration would be 
the result. 

When fatigue begins to be felt, either of body or mind, the sensa- 
tion may be dissipated by strong tea, or intoxicating drink, or opium ; 
but to drive it away in this manner, for the purpose of working longer, 
is wrong, and leads, in the end, to disease or exhaustion. It was said 
that one of the most brilliant advocates of recent times was dependent 
upon opium for the stimulus to carry him through his extraordinary 
flights of eloquence ; but his restless motion and nervous face reminded 
one that he had bent his bow very nearly to the snapping point, and 
that a sudden collapse of his vital powers, at no distant day, might 
be feared as the result of such tension. 



Persons 

sorrow, sh( 
jects and c 
light, and 
sliould visi 
I)res8ions. 

When w 
to use it a 
our fault, 
feeble. T 
which says 
hungry for 

Need of 

ideas of the 
the organs 
mind, shou 
str laments i 
and will m 
portance, t 

imprope 

iidierit dis( 
eased brain 
the offsprii 
Among th( 
Europe, n( 
arises, in a j 
practice uni 
The wisdon 
certain deg] 
vation of p 
who will ti 
body, obser 
relations. 

Need of 

of its duties 
than any ot 
to this impi 
lessened or ( 
loss of bloc 
charged wit 
well, the bl 
brain, and t 
any way, or 
it is breathi 
brain, and tl 
headache, fa 



m 



IIYOIENK. 



60 



Persons in affliction, whoso spirits are depressed and broken by 
sorrow, should have their thoughts turned away from all sombre ob- 
jects and contemplations. They should be taken into the open sun- 
light, and be diverted by the beautiful things of nature. They 
sliould visit cheerfu; society, and open their hearts to pleasurable im- 
pressions. 

When we penmit any part of the body to remain idle, neglecting 
to use it as much an we ought, unpleasant sensations remind us of 
our fault. The muscles, when unused, waste away and become 
feeble. This is sure to produce an uneasy, nervous state of feeling, 
vvliich says to us as plainly as a sensation can, that the muscles are 
hungry for exercise, and that it is injurious to let them rest longer. 

Need of a Healthy Brain. — In order that we may get correct 
ideas of the external world, it is necessary that the brain, the nerves, and 
the organs of sense through wliich sensations are made upon the 
mind, should be in a healthy condition. It is evident that if the in- 
strumenbs of sensation be diseased, the sensation cannot be natural, 
and will make a false report to the mind. It is of the highest im- 
portance, therefore, that the brain should be sound. 

Improper Intermarriages. — This organ, like every other,'may 
inherit disease from parents. Insanity, which springs from a dis- 
eased brain, is often hereditary. When both' parents are diseased, 
the offspring are of course more liable to partake of their defects. 
Among the wealthy, and particularly among the royal families in 
Europe, nervous diseases and sterility are very common. This 
arises, in a great part, from intermarriages among blood relatioJiS, — a 
practice under which any people will degenerate, and finally perish. 
The wisdom of the Old Testament prohibition of marriage within 
certain degrees of consanguinity has been established by the obser- 
vation of philosophers and the experience of mankind. Let those 
who will transmit to their descendants a sound mind in a sound 
body, observe the laws of life, and avoid all marriages with blood 
relations. 

Need of a Qood Supply of Blood. — B'or a proper performance 
of its duties, the brain requires and receives a larger supply of blood 
than any other part of the system. One-tenth of all the blood goes 
to this important organ. If the quantity or quality be materially 
lessened or changed, great disturbance of the brain follows. A large 
loss of blood occasions dizziness and fainting. If an atmosphere 
charged with too much carbonic acid gas be breathed, as in a deep 
well, the blood is not vitalized in the lungs, so as to sustain the 
brain, and unconsciousness soon follows. If the air be vitiated in 
any way, or have its oxygen extracted, as in large assemblies, where 
it is breathed over several times, it becomes unfit to support the 
brain, and the result is languid feelings, inability to apply the mind, 
headache, fainting, hysterics, and other nervous manifestations. 



jr- 




HYOIEMK. 

Ventilation. — This hIiowh the great necessity of having dwellings, 
churcheH, and school-houMeH well ventilated. 

Were a good system of ventilation adopted in all our churches, 
ministers would seldom preach to sleeping audiences. A congregiw 
tion Hitting in one of our places of public worship, where the air in 
a single afternoon is as many times used over as the minister's ser- 
mons are in a lifetime, can neither hear with attention, nor compre- 
hend with clearness. 

In many of our school-houses, the ventilation is (juite as bad, and 
the consequences worse, Injcause they are occupied six houi-s of tlie 
day instead of three, and five days of the week in place of one. In 
the small s^hool-.'-ouses which our children filled to overflowing in 
former yeai-s, in wnich there was no ventilation, unless they happened 
to be blessed with an old-fashioned chimney and tire-pjac3, the effects 
upon the nervous system of the children was deploraWe. Many of 
the diseases which afflict i j present generation of men and women 
had their origin in the bad air of those crowded nuraeries of edu- 
cation. 

Our dwellings were partly ventilated in olden time, when the 
open fire-place received the " back -log," the " top-stick," the " fore- 
stick," and other sticks to match ; but since we have been warmed 
by the stove and the .furnace we have known little of the luxury of 
pure air at the domestic hearth. 

Need of Exercise for the Brain. — Health requires that the 
brain should be properly occupied with vigorous thought. The 
same reasons may be given for this as for the exercise of the muscles. 
It is governed by the same laws which apply to other parts of the 
system. Use improves its strength and vigor ; idleness causes it to 
grow feeble. Of course the labor it is put to should be only reason- 
able in amount, and should not be too long continued at any one 
time. With the weakening of the brain, the whole bodily forces, 
and indeed the whole mental and moral character, fall into feebleness 
and decay. It is a great mistake to suppose that the cultivation and 
even vigorous use of the mind impairs health and shortens life. 
Just the opposite is true. Many of the most eminently intellectual 
men, who have worked their brains hard all their lives, have been 
distinguished for long life. 

Bad Effect of Change in Circumstances. — No class of persons 
suffer more from nervous diseases and general ill-health than those 
who, having worked hard in early life, with little or no cultivation 
of the mind, are suddenly raised to wealth, and immediately drop all 
exercise, and fall into habits of indolence and luxury. The condition 
of such persons would be much less pitiable, did they take up books 
when they lay by the hoe or the broom. But they seldom do this. Many 
a woman, in early life, haa felt the glow of health in every limb, 
and a thrill of pleasure, too, while scrubbing -the floor on her hands 



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IMAGE S:VALUATION 
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Photographic 

Sciences 
Corporation 



33 WEST MAIN STREET 

WEBSTER, N.Y. I4S80 

(716) 873-4503 



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Collection de 
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Canadian Institute for Historical MIcroreproductlons / Instltut Canadian de microreproductlons historlques 





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HYGIENE. 



61 



and knees, who has, in subsequent years, reclined in misery upon 
her damask-covered lounge, and wondered that she could not have 
the health of other days. Let her cultivate her brain, live temper- 
ately, and exercise in the open air, and life may again have real 
pleasures for her. 

Discretion in Exercising the Brain. — In exercising the brain 
we must use discretion. We must not sit down in the morning, and 
ply it with work during the whole day, without rest. This would 
soon bring upon it disease, or premature decay. It should be worked 
only until it begins to show symptoms of fatigue. Then it should be 
permitted to rest ; or, what is better, be turned to some new subject, of 
a lighter, or a different character. This often rests the brain better 
than to entirely suspend its action. 

Overworking the Brain in Childhood. — Great care should be 
used not to exercise the brain too much in early life. Like other 
parts of the system, it is tender in childhood, and will not bear pro- 
longed exertion. As a general thing, children are put to school too 
early, and made to work their brains too hard. Great mischief arises 
from this source. Children are born with larger brains now than 
formerly ; and it is no uncommon thing to see upon a child of ten 
years, a head equal in size to that of an adult. Children run to 
brain. Precocity in development of brain and mind is common. 
The results of stimulating and hastening the unfolding of such minds 
are depiorable. In such children, the brain should be the last thing 
to be cultivated. We do not need to urge its growth. It will come 
forward fast enough in spite of us. Our chief aim should be to harden 
and fortify the general constitution, so that the brain which it is 
required to bear up and sustain may long be its crown and glory. 

Yet parents are proud of their precocious children, and often re- 
verse this rule. They do it thoughtlessly, and would be terribly 
startled could they suddenly look into the future and see the results 
of their folly. Could they do so, they would see inflammation and 
softening of the brain, epilepsy, insanity, paralysis, apoplexy, with all 
the horrors of uudescribed and indescribable nervous affections, which, 
though without a name, have a terrible reality. 

Old People's Brains. — Persons in advanced life should be par- 
ticularly careful not to overwork the brain. In middle life it re- 
covers easily from great fatigue. In the decline of life, its powers 
of recovery are feeble. A single exhaustion may cause its fatal col- 
lupse. Old age should be distinguished for gentleness and modera- 
tion. The journey of the down-hill of life should be made by sliort 
and easy stages, through regions of uiversified beauty. 

A Supply of Blood. — EA'iery part of the system, when hard at 
work, needs and must have a very large supply of pure blood. 
Witliout this, it is torpid and inactive. To cause the blood to flow 
to any particular part, it must be exercised. The lumberman, when 



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rm 



s 






62 



HYGIENE. 



in the forest in extreme cold weather, stamps his feet vinlpnfl, 

the ground, or beat« them against a log, anfwhU hi Wd«^ "^'"'J 

proportion that it dmws the vital current to 2Yw7«„;i ^"'^ '" 

bram and all otiier working organs. ^ ^' '^'^ "^ *^« 

worrer!:i:ei;lftrsat\im^^^ ^^^ ^' -^--an 

brain to hard work i.rTf^dLt^l ' 7. . 'n '"^P^^Per to put the 

stomach then wrt^ the bio. !.n^ iK^ ^."" "*""^' ^«^"«« th« 
the blood be ca ed off fo h K '^'^^^ '^-^^ ^^««* <^^^^' ^«od; and if 
the stomach be oaded with fo^'l ^'1?" ""? ^^P* ^^' ^^ould 

. thinking; for the i:^:^^%ITi;'7:to:'x i^oii^i '^•^•' 

own excitement has had time to subside ^^ ^^''' ^*" 

Sympathetic Nervous System 

need to go on wh leTe Z'ai^-« . i '' ^'1 ''^*^"''^^ P'""'^^^^^^ ^^^^^^ 
The nerfous sy^ e n of .vWch WtT "'^•^.^^^"»«t ^^^^^d to them, 
tions which areClednvotto/P^'^lf^^f^.^^^^^ -" those fuuc- 
will is needed for their performanol' ~s! '?'^ '^'^"'' "° ^^* '^^ the 
and the circulation o Tebinod Si ,^''"f «"' absorption, digestion, 
well as while we ll e. wt^ kn L'^^^^ fj^ M? "^'^ "^ «^^^P' ^ 
performance, as in walking Pntin^ "^'^ necessary to their 

have to ceas; thrm^meXe 2^ T'^r""/"^' '*"•' '^''^ ^^^^ ^«»W 
the result. ^^^ '''^'" ^^^^ ^^««P' ^^d death would be 

con^dmoStn; "TvU'E ''''\ n.'' ^^« «^^- ^^ «- 
flamed, the stomach seemstn^y, ^ l'- ^'^^'^ ^^^ ^«ng« ^re in- 

becaus; this wou d a^ivlte th^T' "^ '^ T^^"^ ''^^^^^^^"^ f««d' 
Well would it belf ifS, n t ^^:J ^^ *^^ neighboring organs. 

and abstain from bote ^cte ^/"ff "''^'^-f ''''''''' ^ ^^' forbeaifnce, 
injure their neighboii ««l%^tification which they know will 

r ^^ish to*add'l*frrwo'Ji??fi!!' r ^^/u '"^ ''^^'^^"8^ *h««« observations, 
diseases which chamc^rJ/'u'P'^'^*'"^ ^^'. ^'^'^^^^ effects of nervous 

Thai tuJ '^"aractenze the present time. 

That theya« far more „„i^ ,„„ ,„i„y,^ ^,^„ .„ ^^^^^ 



m.m 



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HYGIENE. 



63 



years, must be apparent to the most careless observer. They are 
nothing more nor less than the price we pay for a high civilization, 
and especially for our democracy. Among us, every man feels his 
individuality, and has a motive for thinking and doing his best. 
Thought and action are here unfettered ; and if the race is not to 
the swift, nor the battle to the strong, eveiy man acts as though he 
thought it was. The great excitement which the struggle for wealth 
kindles and inflames, deranges and shatters the nervous system to a 
shocking degree. 

And wealth, when obtained, does its full share to weaken the 
nerves. It brings with it high living, indolence, loss of energy, dis- 
sipation, and a weakening of the whole moral and physical powers. 
It need not do this ; but, in most cases, it does. 

Tlie result is, that, at least, every other person has some nervous 
disease, which makes life a misery rather than a blessing. The brain 
and nerves are too much developed in comparison with the develop- 
ment of the muscles. Half our boys and girls have heads as large 
as men and women. It is common to see a boy or a girl at ten talk- 
ing and acting like a man or woman. I do not mean by tliis, that 
they imperfectly imitate the actions of older persons. It seems to be 
natural to them. Their brains are prematurely developed, and their 
acts and thoughts have the maturity of adult life. 

What is Coining ? — What will be the result of this state of 
things, no man can predict. I sometimes think the race will break 
down ; that that which was intended to be its ornament and strength 
will be its destruction. I hope not. Yet there is danger of it. 
Nothing can save us but the wisdom to adopt such means as will 
develop all parts of the system alike. No race of men can stand for 
many generations such a strain upon the nervous system, unless bet- 
ter means are adopted to counterbalance its evil effects than are now 
used in the United States. We have got to pause in our swift 
career, and look after our health, or we shall become a nation of 
maniacs. No proof is needed of what is here said. 

Hopeful ConsiJe rations It is proper to say, the considerations 

here presented, terrible as they are, are mitigated in some measure by 
others of a more hopeful character. 

Physiology and the laws of life are now better understood than at 
any former period. These subjects are getting "nto our common 
schools, and are engaging the attention of our youth. Declining 
health has already made us think more of the means of preserving 
it, — such as diet, exercise, bathing, travelling, and amusement. To 
encourage and intensify this hopeful direction of the public mind, I 
propose to devote a few pages to these subjects. 




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64 



HYOIENK. 



Pood and Digestion. 

F..OM the earliest dawn of existence to the last moment of life our 
bodies are constantly changing. Old particles of matter, when tliev 
are worn out, leave their places and are thrown out of the systeni 
Were this the whole of the matter, our bodies would soon wuste 
away, and that would be the end of us. But as fast as the old mate- 
rials are thiown away, new ones take their places ; and it is solely 
out o.t our food that these new materials are formed. 

In order that the food maybe well digested, it must first be broken 
into small particles in the mouth. The act of chewing it Ls called 
mastication. During this act, if it be well performed, I large quan- 
tity of spittle, called saliva, flows out of a number of glands, called 
salivary giands, and mixes with the food, forming with it a soft mass 
m tlus conaition, it is thrown backward into the top of the throat 
called the pharynx. Here, a little cartilage, called the epiglottis 
drops down apon the opening into the top of the windpipe, and pre- 
vents its entrance into the breath-passage ; and it is pushed alonp 
into the gullet, a tube which runs down behind the windpipe and 
lungs, and which physicians call the oesophagus. Here a succession 
ot muscular bands, circular in shape, contract upon it, one after 
another, and force it down into the stomach. 

It is importc^nt that two things should be securfid while the food is 
m the mouth, namely, that it should be reduced to a good degree of 
fineness by chevying, and that a proper amount of saliva should be 
mixed with it. If the chewing were not necessary, teeth would not 
have been given us; and the salivary glands would certainly not liave 
been put in the mouth, if the mixing of water with our food would 
serve the purposes of digestion as well. 

Eating too Rapidly., —Americans have fallen into a pernicious 
error in eating their food too rapidly. Time is not given to chew it 
sufficiently to excite a full flow of saUva; and as it cannot be swal- 
lowed m a dry state, it is not uncommon to see persons taking a sip 
of water after every second mouthful, to enable them to force it into 
the stomach. It is a habit we Americans have of cheating ourselves 
both of the pleasures and the benefits of eating ; for the only real 
pleasure of eating arises from the flavor of food while retained in the 
mouth, and the only benefit we can derive comes in consequence of 
Its proper digestion. 

The food when received into the stomach is in the same condition 
as when taken into the mouth, except that it is, or should be, ground 
hne by the teeth, and well mixed with saliva. 

The Gastric Juice. — The stomach, like the mouth, the windpipe, 
and the gullet, is Uned by a mucous membrane. The chief office of 
this membrane is to secrete, or take out of the blood, a fluid which 
we caU gastnc juice, which means stomach juice, from the Greek 




-iPt^' 



HYGIENE. 



u 



name of stomach, yaorf'p (gaster). This fluid has not much smell 
or taste, and looks like spring water. It has a powerful effect upon 
food, which, when mixed with it, soon undergoes an important 
change, which is apparent to the taste, the smell, and the sight. The 
natvu-e of the gastric juice and how it produces Its effect upon food 
are not certainly known; but it contsiins two active elements, — a 
tree acid and pepsin, whose function is to dissolve the nitrogenous 
parts of the food and convert them into albuminose or peptone. The 
albnniinose is absorbed by the coats of the stomach and enters 
directly into the circulation ; while the sugar and fat pass on to the 
duodenum to -be acted upon by the bile, the i)ancreatic juice, and 
other secretions of the bowels. 

Too Much Cold Water at Meals. — There are some interesting 
facts connected with the formation of this fluid, of which it is im- 
portant that every person should be apprised. 

Its quantity and quality depend on the amount and healthfulness 
of the blood which flows to the stomach during the first stage of 
digestion. It is, therefore, injurious to drink large quantities of very 
cold water with, or immediately after, our meals ; as this will chill 
the stomach, and repel the blood from its vessels, so that but little 
of the juice can be formed. Digestion, in such case, must be im- 
perfect. 

This Fluid not Secreted Without Limit. — This fluid does not 
flow into the stomach continuously, but only when we swallow food, 
and then not as long as we please to eat, but merely till we have taken 
what the system requires. If, in the amount we take, we go beyond 
the wants of nature, there will not be fluid enough formed to dissolve 
it, and the whole will be imperfectly digested, and be a source of in- 
jury rather than benefit. This should teach us to be careful that our 
food be only reasonable in amount. 

Not Secreted in Sickness. — When we are sick, the gastric juice 
is either not formed at all, or only in small quantities. Whatever 
may be our feelings of lassitude, and however much we may appear 
to need food, at such times, it is usjless to take it, for it cannot be 
digested, and will only aggravate our disease. If the illness be only 
slight, the fluid will be formed to some extent, and food may be 
taken in proportion. 

Its Secretion Favored by Cheerfulness. — A cheerful disposition, 
and a happy, lively frame of mind, are highly favorable to the pro- 
duction of the gastric juice ; while melancholy and anger and grief 
^nd intense thought of business, at the hour of meals, greatly hinder 
its natural flow. 

This should teach us to go to our meals with light hearts, and to 
make the family board a place of cheerful conversation, and of a light 
and joyous play upon the mirthful feelings of all present. Should 
any of the family circle be in the habit of using vinegar as a condi- 








6(5 



HYGIBNE. 



ment, we should never be guilty of compelling them to extract it 
from our faces. A vinegar face is not easily excused anywhere ; at 
the table it is unpardonable. A single countenance of this description 
will throw a gloom over a tableful of naturally cheerful peraons ; and 
if habitually present at the board, may finally spoil the digestion of 
half a dozen, and entail dyspepsia upon them for life. 

The stomachs of the sick pour out but very little of this fluid, and 
they can tiake but a small amount of food. It is cruel to deprive 
them of the power of digesting that little by treating them harshly, 
and filling them with gloomy and desponding feelings. I therefore 
repeat the substance of the advice given on a previous page : Deal 
gently with the sick. 

How all this Is Known. — As the stomach is wholly concealed 
from view, the reader will very naturally ask how it is known that 
the gastiic juice is poured into it in certsiin states of the mind, etc., and 
withheld in others. It certainly could not have been so accurately 
known, had it not been for an accident which opened the living and 
working stomach to the inspection of Dr. Beaumont, a United States 
Surgeon. A young man by the name of Alexis St. Martin, a Cana- 
dian by birth, but then in the State of Michigan, had a large part of 
his side torn away, and a hole of considerable size made into his 
stomach, by the accidental discharge of a gun. To the surprise ot 
his surgeon, St. Martin recovered ; and the edges of the wound in the 
stomach refused to grow together, preferring rather to fasten them- 
selves to the borders of the breach in the side, thus leaving the pas- 
sage open. A kind of curtain grew down over this, which prevented 
tlie food from falling out. Dr. Beaumont, taking advantage of this 
state of things, instituted a series of valuable experiments, by lifting 
the curtain, and inserting various articles of food, and witnessing the 
process of digestion. 

Movement of the Stomach. — The presence of food in the stom- 
ach causes its muscular coat to contract and throw it about from side 
to side, mixing it thoroughly with the gastric juice, and reducing it 
to a pulpy mass, called chyme. This, as fast as it is properly pre- 
pared, passes through the pylorus into the upper bowel, or duodenum, 
called also the second stomach. 

Chyme. — A certain witty professor of anatomy and physiology 
was in the habit of asking his class if they ever saw any chyme ; and 
when they answered, no, as they often did, he called their attention 
to what is occasionally to be seen in the morning, upon the sidewalks, 
where drunken men have held themselves up by lamp-posts, and left 
the contents of their stomachs. 

The pylorus, or opening into the bowel, has a very singular and 
wise instinct, which is worthy of remark. When a piece of food, 
which has not been digested, attempts to pass into the bowel, the 
moment it touches the inner surface of this orifice, it is instantly 



thrown 



'j»»sBP*BBsas 




HYGIENE. 



67 




thrown back by an energetic contraction ; tliough a portion of well- 
prepared chyme, touching the same opening immediately after, is 
allowed to pasa unchallenged. 

Chyle. — The chyme, when it reaches the duodenum, seems to 
ciiuse the liver to S(M;rete bile, and 
the pancreas to produce pancreatic 
juice. These two Huids aie con- 
veyed into the upper portion of the 
second stomach, and there are mixed 
with the chyme, and cause it to 
separate into a delicate, white fluid, 
called chyle^ and a residuum, which, 
being worthless, is pushed onward, 
and thrown out of the body. 

Bile in the Stomach. — Most 
persons suppose that the bile is gen- 
erally found in the stomach ; but 
a Tani- H '^^^ '^ * mistake. It is thrown up 
by vomiting, because in that act, the 

action both of the tii-st and the second stomach is reversed, and the 

bile is forced up from the duodenum, 
— taking a direction the opposite of 
its usual course. 

Destination of the Chyle. — The 

chyle being separated from the dregs, 
is pushed onward in its course by the 
worm-like motion of the intestine ; 
and as it passes along, it is gradually 
sucked up by thousands of very small 
vessels, whose mouths open upon the 
inner surface of the bowel. These 
little vessels are called lacteals, froi/i 
the Latin word lac, which means milk, 
because they drink this white, milky 
fluid. Fig. 61 shows a section of the 
small bowel, turned inside out, and 
covered with the villi, or root-like fila- 
ments, closely set upon its surface, for 
absorbing the chyle, and at the bottom 
of which the lacteals take their rise. 

In these lacteals, and in the mesen- 
teric glands, the chyle is gradually 
changed, so as to approach nearer and 
nearer to the nature of the blood ; but 
precisely what the change is, or how 
it is effected, is not known. Several 




Fio. 02. 



68 



HYOIENE. 



learned men liave publifllied their tlieories upon these points, and the 
writer has opinions upon them; but it is not worth while to trouble 
the reader with them. It is B\il1ieient to say that the fluid is carried 
by the lacteals to the thoracic du(t,tiirough whi(!h it is conveyed into 
a large vein at the lower part of liie neck, wher(i it is jjotired into 
the blood, and becomes, after going through the linigs and experi- 
encing another and a vital change, the material out of which oui' 
bodies aie daily and hourly new-created. 

Fig. 62 gives a genei-al idea of the stomach, bowels, etc. : 9, being 
the stomach ; 10, 10, the liver; 1, the gall-bladder; 2, the duct which 
conveys the bile to 4, which is the duodenum ; 3, is the pancreas ; 5. 
the oesophagus ; A, the duodenum ; B, the bowels ; C, the junction of 
the small intestines with the colon ; D, the appendix vermiformis ; 
E, the coecum ; F, the ascending colon ; G, the transverse colon ; H. 
the descending colon ; I, the sigmoid flexure ; J, the rectum. 



Nature and Destination of Food. 

The food which man requires for his support and development is 
of two kinds, inorganic and organic. The firet of these embraces 
certain mineral substances, as common salt, sulphur, phosphoru.s, 
iron and lime, either in combination or separate. 

These are not generally reckoned as aliments, and yet no human 
being can live without them. In their absence, the body decays, dis- 
integrates, and perishes. Common salt is composed of muriatic acid 
and soda. The first is an important ingredient in the gastric juice, 
and the latter promotes the secretion of bile. Sulphur is found in 
several of the tissues, particularly in the muscles. Phosphorus, 
united to fatty matter, is highly honored in forming a portion of 
the brain and nerves, and is also combined with oxygen and lime to 
make the earthy or hard part of bones. 

Found in Food. — These articles it is not necessary often to intro- 
duce into the system in a separate state. They are contained, in 
larger or smaller proportions, in most articles of food ; and man al- 
ways suffers, as all animals do, from theit absence. Common salt is 
found in the flesh of animals, in milk, and in eggs. It is not very 
abundant in plants ; and we all know how eagerly domestic animab 
devour it when it is given to them, and how constantly wild cattle 
resort to the salt springs, which, in the grea't West, are called " buffalo 
licks." Lime exists in nearly all animal and vegetable substances. 
In wheat flour we get it in combination with phosphcric acid, that 
is, as phosphate of lime. Lime exists too, in the state of carbonate 
and sulphate, in all hard water. Iron is found in the yolk of eggs, 
in milk, in animal flesh, in potatoes, pears, cabbages, mustard and 
other articles. Sulphur we get in flesh, eggs and milk ; and, as 
sulphate of lime, in spring and river water. Phosphorus is derived 
from eggs and milk; and flesh, bread, .'ruits, and husks of grain, 



r-;: 



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HYGIENE. 



69 




coniiuonly called bran, contain even a larger proportion tlian we need 
in our diet. 

Organic Food, — The organic elements of man's food, which in 
bulk embrace almost the whole of it, remain to be considered. In the 
animal economy they serve two great purposes. A part of the arti- 
cles which compose them are blood-formers, out of which all the 
tissues are made, — the other part produces fat, which serves to warm 
the body by being burned with oxygen. These articles are derived 
partly from the vegetable and partly from the animal kingdom. 

Divided into Four Qroups. — For convenience, these articles may 

be divided into four groups. For the 

tir.st, sugar stands as a type. We there- 
fore call it tlie ttaccharine group. It em- 
braces starch, gum, and the fibre of wood. 
These articles may all be converted into 
sugar by a simple chemical process. 
Figure 63 gives a microscopic view of 
the granules of starch. 

The second group we call the oleayinous. 
It is composed of oily substances, from 
whatever source derived, whether the an- 
imal or tht vegetable world. 

The third group is the albuminous. A 
good type of it is the white of egg. 

The fourth is the gelatinous, or Jelly group. 

First and Second Groups, Supporters of Respiration. — The ar- 
ticles composing the first and second groups are analogous in com- 
position, all containing oxygen, hydrogen, and carbon. They are what 
Liebig calls supporters of respiration ; the meaning of which is, in 
more comprehensible terms, that they are supporters of combustion. 
They are the fuel which warms us. They keep the fires going, from 
which arises all the heat we have in our bodies. But they are desti- 
tute of nitrogen, and, on this account, they are not blood-formers, and 
cannot be worked into flesh. Hence, man cannot live on them. 

The food articles embraced in the third and fourth groups also 
contain oxygen, hydrogen, and carbon ; and to these they add nitro- 
gen. This fourth component part, which forms only a small portion 
of them, gives them, for some reason never explained, the peculiar 
quulity of producing blood and flesh. They are the raw materials, 
out of which our bodies are reconstructed from day to day. 

Feed a man ever so largely upon sugar, starch, gum, and oils, and 
lie will starve as certainly as if he were allowed nothing but water. 

Names of Two Great Divisions of Food. — The possession or non- 
possession of nitrogen, then, is what distinguishes from each other 
the two great classes of food-articles. Those which contain nitrogen 



»'lO. «8. 



mmd 



70 



HYOIKKE. 



have been called nitrogenized, and thoae which are destitute of ii, 
notirnitrogenized cuni]iound8. As nitrogen is often called azote, the 
former class are more frequently named azotized ; the latter, no7t- 
azotized. 

Let the reader now fix it in iiis mind that the azotized articles of 
food produce blood and flcph ; the non-azotized, heat ; and he will 
have the key to understand much of what is to be said, and likewise 
to unlock many ot the mysteries of diet. 

Nutrition Table. — Taking human milk as the standard, and ex- 
pressinp the amount of nitrogen it contains by 100, the following 
tiible saows the relative amount of nitrogen in the principal flesh- 
producing articles of food, and consequently their power of forming 
the tissues : — 



II 



VEGETABLE. 



Rice 81 

Bye l(» 

Com 120 

Buley 12S 

Oati 138 

WhMt 144 



Potatoes 84 

Turnips lOti 

Carrots ISO 

Peas 239 

Be.n8 320 



ANIMAL. 



Human Miik 100 

Cows' Milk 237 

Oyster SOB 

Yolk of Eggs 305 

Cheese 331-147 

Eel 428 

Pork-Ham 807 

Salmon 610 



White of Egg 845 

Herring 910 

Haddock 816 

Pigeon 78(i 

Lamb 8KI 

Mutton ... 882 

Veal 911 

Beef 912 



Other Standards of Value. — We must not infer that t^ose articles 
which have most nitrogen are necessarily best adapted for human 
diet because they are the most effective blood-producers. In deciding 
the value of an article for food, other things are to be looked at be- 
sides its nutritive qualities. Those which are poor in nitrogen, are 
rich in carbon and hydrogen, and are well fitted to serve the double 
purpose of nourishing and wanning the body at the same time. The 
fitness of n article for diet depends veiy much upon the ease or 
difficulty with which it is digested and assimilated. If an article 
having a great deal of nitrogen, and being very nutritive, is with 
great difficulty reduced in the stomach by the digestive process, it 
may be much less desirable for food than one which is digested and 
assimilated easily, but is much poorer in nutritive qualities. 

Heat-Keneratins; Food Articles.— The reader has before him the 
principal blood and tissue-forming food articles. Those which we 
reckon as fuel, or heat-generators, are chiefly oils, sugar, starch, farina, 
sago, arrowroot, tapioca, gums, etc. These are less essential than the 
others ; for the blood-forming articles have within them the ele- 
ments out of which fat is formed in the process of assimilation ; for 



V 



320 



84S 
910 
816 
7M 
838 
862 
911 
M2 



HYQIKNE. 



71 



inimv of them contiiin nU\\vh ; and this, in tlie Innnaii organiam, is 
(ihan^'od into fat. The amount of starch in some of these articles is 
ii8 follows : — 

Wboat Hour, good nunllty, 100, c.ontaiiiM lift to H<i partM in KJO tmre starch. 

Whent . 108 " Kl " Wt 

Karley iiioul 119 " M •' «6 

Hurley ....... 130 " .iT " 37 

Hyo Ill " 44 *• 47 

Buckwheat 108 " 43 " 44 

Indian Corn 138 " (10 " «6 

Rice 171 " 88 " 86 

Peas 69 " ;W " .'»9 " " " 

Wiiite BeanH 09 " 37 " .38 " " 

In the Nutritive Food Articles, there i.s a fixed relation existing 
between the elements of the tissue-formei-s and the heat-producers 
which they contain. Out of a few of them Baron Liebig has con- 
jtructed the following table : — 



For every ten parts of blood and tissue-formers ther'^' are, — 

In Wheat flour, 10 46 In Bwley, 

In liye meal, 10 67 In Rice, 

In Oatmeal, 10 SO In White potatoes, 

In Uuolcwheat, 10 130 In Blue potatoes, 



10 OT 

10 123 

10 86 

10 130 



Diet a Complex Subject. — From the facts and tables now pre- 
sented, it appears that the question of diet is one of complexity; and 
that the determination of its several points requires that a number of 
things should be taken into the account. First, in deciding the use- 
fulness of any article, we may i.uquire respecting — 

Its Digestibility. — If an article be not digestible, it is of little 
coiisequeiice how much or how little albumen, starch or nitrogen it 
may contain. The first and most important inquiry respecting it is, 
is it digestible P If not, it is to be rejected ; for, whatever ouier quali- 
ties it may have, it can only injure the stomach and embaixass Uie 
whole system. 

The following table will be useful to the reader, though I do not 
set it down as reliable in all cases. There is . ften a great difference 
in :lie ease with which different stomachs will digest the same food. 
Many stomachs are afflicted with what is called an idiosyncrasy, — a 
liabit, peculiar to itself, of rejecting or refusing to digest some one 
or more articles wliich are acceptable to all other stomachs. This 
tiible shows the length of time required for digesting the several ar- 
ticles in the stomach of St. Martin, as shown by the experiments of 
Dr. Beaumont; — 




■i- 1 





72 



HYGIENE. 



Article*. 


PreparatiODi. 


Time. 


Articles. 


Freparationi. 


Time. 


Rioe 


Boiled 


h.m. 
1 — 


Pork, recently salted 


Raw 


h.m. 
3- 


Pig's feet, soused 
Tripe, soused 


Boiled 


1 — 


Soup, chicken 


Boiled 


3- 


Boiled 


1 — 


Oysters, fresh 


Roasted 


3 in 


Trout, salmon, fresli 


Boiled 


1 ;io 


Pork, recently salted 


Broiled 


3 1,') 


«( 11 It 


Fried 


1 30 


Pork steak 


Broiled 


3 l.T 


Apples, sweet, mellow 


Raw 


1 30 


Corn bread 


Baked 


3 1,5 


Venison, steak 


Broiled 


1 30 


Mutton, fresh 


Roasted 


3 15 


Sago 


Boiled 


1 45 


Carrot, orange 


Boiled 


3 l,-) 


Apples, sour, mellow 


Raw 


2 - 


Sau8a.K0, fresh 
Beef, fresh, lean, dry 


Broiled 


3 20 


Cabbage, with vinegar 


Raw 


2 — 


Roasted 


330 


Codfish, cured, dry 


Boiled 


2 — 


Bread, wheat, fresh 


Baked 


3 30 


Eggs, fresh 
Liver, beef's fresh 


Raw 


2 — 


Butter 


Melted 


330 


Eroi'ed 


2 — 


Cheese, old, strong 


Raw 


330 


Milk 


Buiijd 


2 — 


Eggs, fresh 


Hard boiled 


330 


Tapioca 


Boiled 


2 — 


Fried 


330 


Milk 


Raw 


2 IB 


Flounder, fresh 


Fried 


330 


Turkey, wild 


Roasted 


2 18 


Oysters, fresh 


Stewed 


3 30 


<i •< 


Boiled 


2 26 


Potatoes, Irish 


Boiled 


3 ;«) 


" domesticated 


Roasted 


2 30 


Soup, mutton 


Boiled 


330 


Potatoes, Irish 


Baked 


2 30 


" oyster 


Boiled 


3 30 


Parsnips 


Boiled 


2 30 


Turnip, flat 


Boiled 


330 


Pig, sucking 


'Roasted 


2 30 


Beets 


Boiled 


3 45 


Meat hashed with ) 
vegetables j 
LamD, fresh 


Warmed 


230 


Com, green, and beans 
Beef, fresh, lean 


Boiled 
Fried 


3 45 
4- 


Broiled 


2 30 


Fowls, domestic 


Boiled 


4- 


Goose 


Roasted 


2 30 


If 11 


Roasted 


4 - 


Cake, sponge 


Baked 


2 30 


Veal, fresh 


Broiled 


4- 


Cabbage-head 


Raw 


2 30 


Soup, beef, vegeta^ 1 


Boiled 


A 


Beans, pod 
Custard 


Boiled 


2 30 


bles, and bread ) 


1 ^— 


Baked 


2 4B 


Salmon, salted 


Boiled 


4 — 


Chicken, full-grown 
Apples, sour, hard 


Fricasseed 


2 46 


Heart, animal 


Fried 


4- 


Raw 


2 60 


Beef, old, hard, salted 


Boiled 


4 15 


Oysters, fresh 


Raw 


2 56 


Pork, recently salted 


Fried 


4 15 


Bass, striped, fresh 
Beef, fresh, lean, rare 


Broiled 


3 — 


Cabbage, with vinegar 


Boiled 


4 ;« 


Roasted 


3 — 


Ducks, wild 


Roasted 


4;!0 


" steak 


Broiled 


3 - 


Pork, recently salted 


Boiled 


4 30 


Com cake 


Baked 


3 ~ 


Suet, mutton 


Boiled 


4 30 


Dumpling, apple 


Boiled 


3 — 


Veal, fresh 


Fried 


4 30 


Eggs, fresh 


Boiled soft 


3 - 


Pork, fat and lean 


Roasted 


6 15 


Mutton, fresh 


Broiled 


3 — 


Suet, beef, fresh 
Tendon 


Boiled 


630 


11 (t 


Boiled 


3 — 


Boiled 


6 30 



This table may be considered as giving a general idea of the rela- 
tive digestibility of the food-articles contained in it. If aot found 
exactly right in each individual case, it can be rectified by experience. 
The experience of no other individual's stomach will ever be found 
precisely lik j that of St. Martin's, — though in its general features, 
it may be sufficiently similar to make his valuable. The general 
principles of conduct may be learned from the experience of othei-s. 
The particular application must come from our own experience and 
reason. ' 

Digestibility Influenced by Amount.— The rapidity with which 
any article is digested will vary with the amount taken. A larger 
quantity than is called for by the wants of the system will be di- 
gested more slowly than the proper amount ; while, on the other 
hand, an insufficient supply begets an inability to reduce in the 
stomach even the small quantity taken. We may err in taking too 



. Mei ™ _ ' _ *w -- ' i.a.i ! J^-i^ 



rfa 



Time. 



HYGIENE. 



73 



little food as well as in taking too much ; though the former error is 
much less likely to occur than the latter. 

Choosing Food in HI Health. — But in deciding the kirid and 
amount of food we must be guided not only by its digestibility, but 
by the state of the health. 

If we find the stomach apparently in good working condition, capa- 
ble of dissolving properly whatever is submitted to its action, and 
yet we are for some cause losing flesh and stre: igth, we should resort 
not only to the most nutritious of the albuminous group of the azo- 
tized articles, but likewise to the oleaginous group of the non-azo- 
tized. We want a great amount of nutriment, and we need oils to 
make fat. This is the kind of food generally wanted in constitu- 
tional consumption. 

In fevers, but little food can be disposed of at l)est ; and that little 
must be chosen with reference to its mildness and its unstimulating 
qualities. Generally the ^arinaceous or starchy articles are most 
suitable, because they have no stimulating and irritating qualities, 
and especially because they furnish fuel to be burned with oxygen, 
and thus take the place of the animal tissues, which are being rapidly 
consumed with this devouring element. In fever, oxygen is literally 
burning up the body. In this state of the system, this element ac- 
quires, by some means, a singular affinity for the tissues ; and, unit- 
ing with them rapidly, forms a true combustion. The physician who 
throws to this devouring agent some of the mild, non-azotized articles 
which offer it stronger affinities than it finds in the tissues, is as wise 
as he who tosses his dog to a hungry lion to avoid being devoured 
himself. 

Exercise to be Considered. — In deciding the diet, the amount of 
exercise is not less important to be considered than the health. The 
farmer, who works in the open air, and uses his muscles a great deal, 
wants considerably more nutritive, as well as more combustive, food 
than one who leads a sedentary life. Of course there is a great deal 
more waste of the tissues, and he requires more of the flesh-forming 
articles ; and as he breathes deeper, and takes in more oxygen, he 
needs more of the supporters of respiration, — the sugars, oils, and 
starchy aliments. 

Beans. — By turning to the table which shows the amount of nitro- 
gen in the different food-articles, the reader will see that beans are 
rich in this element. They are, therefore, excellent food for working 
men, who are obliged to make great use of their muscles. Our 
fathers, who broke and subdued the rocky soil of New England, 
showed wisdom even in their instincts in taking so large a portion 
of their aliment from the bean, — especially as they oiled it with the 
fat of pork. But for the hard-working student, who daily makes 
heavy drafts upon his brain and nervous system, beans and peas are 
an improper diet. They contain no phosphorus, in the shape of 




74 



HYGIENE. 



pboHphate of lime ; and no brain can work hard without a due supply 
of phosphorus, which forms a part of its substance. 

Unbolted Wheat Flour. — For the man who uses his brain a great 
deal, there is no other one article of food equal to bread made from 
unbolted wheat flour. Fine wheat flour is little better for him than 
beans, because the miller has robbed it of much of the phosphorus, 
which is found chiefly in the hull or bran. 

I mention only two or three articles of food as specimens. By 
looking over the tables furnished, and reasoning upon the whole in 
the way I have done upon these few, the reader can give every arti- 
cle something like its proper value in most circumstances. 

Climate. — If health and exercise should influence us in choosing 
the kind and the amount of food, climate must do so quite as much. 

In the frigid climate of high latitudes, it is necessary that a great 
deal of heat be produced in the body, in order to avoid perishing 
with cold. There is no mystery now, as there once was, about the 
production of this heat. It comes from the burning of carbon and 
other substances in the body, where they unite with oxygen, and 
make just as real a flre an that which warms our houses. Oils, sugar, 
starch, gums, etc., are largely composed of carbon, and readily unite 
with oxygen in the body. This is the reason they are reckoned as 
fuel, and are called supporters of combustion. And for this reason, 
they require to be largely consumed in very cold climates. The in- 
stincts of men seem to lead to the same conclusion, for the dwellers 
in all high latitudes consume great quantities of oils and fats. The 
amountof train-oil, tallow, the fat of seals and other animals, devoured 
by the Laplanders, Kamtschatkans, and other northern people, is truly 
wonderful. 

In hot countries, the fundamental rule for preserving the health is 
to keep the body cool. Without observing this rule, the strongest 
will often fall victims to the climate in low latitudes. But to keep 
cool, of course all the heat-producing articles of food should l)e 
avoided. Particularly all alcoholic drinks, which are powerful sup- 
portera of combustion, should be rejected. Rice and the various fruits 
form the most suitable articles of diet. 

The great sacrifice of life witnessed among the early emigrants to 
California, was the result chiefly of using ardent spirits and heat- 
producing food while crossing the Isthmus, which, to a northern 
constitution, is much like a vast oven, heated to a temperature suit- 
able for baking bread. There are few persons, with tolerable health 
and strength, but could safely endure the hottest climate if they 
would avoid alcoholic liquors and confine themselves to an abstem- 
ious vegetable and fruit diet. 

Bayard Taylor's Opinion. — The distinguished traveller, Bayard 
Taylor, reports that while spending a few days in a heated part of 
Africa, he lived as the inhabitants did, pretty much e.itirely upon the 



HYGIENE. 



76 



supply 



flesh of well-fatted sheep ; and that he enjoyed, meantime, excellent 
health and strength. From this he concludes that animal food is as 
suitable in hot climates as in cold. 

It is a pity a man of such excellent parts as Mr. Taylor should 
have allowed himself to rear so tall a structure upon so narrow a 
foundation. That he could live on flesh in eo hot a region, and not 
be made sick, only proved that he had a fine constitution, and that 
liis health was not easily disturbed ; and when he attempted, from 
Iiis limited experience of a few days, to reason against the established 
facts of science, and against the well-attested laws of life, he did it 
evidently without reflecting that he was in a field of thought which 
he never had occasion to cultivate. 

The great Jewish Lawgiver doubtless had a reason for prohibiting 
pork to the Jews. Whatever that reason was, the prohibition had a 
wise bearing upon the health of the people. Palestine has a hot 
climate, in which pork-fat is an improper diet. 

More Fat in Winter, — It follows from what has been said, that a 
more fatty as well as stimulating diet is needed in winter than in 
summer. But the change should be made gradually. When cold 
weather approaches, the food should become more nutritious and 
warming by little and little. The exercise should likewise be in- 
creased. 

Even the lower animals act upon this plan. In the fall, squirrels 
eat nuts, which are full of oil, and grow fat upon them. 

The instincts of men move in the same direction. It is in the fall 
that the hog, the ox, and the poultry are killed ; and in the winter 
that they are largely feasted upon and enjoyed. Upon such food, 
combined with various sorts of starch, man fattens ; and a good sup- 
ply of fat, deposited in the cells, is equal, in keeping out cold, to a 
layer of cotton batting, — to say nothing of the fire kept up within 
the body by the burning of such fuel. As hot weather comes on, we 
gradually lay aside these fattening articles (or ought to), and return 
to the watery vegetables and fruits, such as squash, string-beans, 
strawberries, currants, etc. 

Few of us, I apprehend, would suffer from heat in summ'er, if we 
could persuade ourselves to abandon stimulating and firo-producing 
food, and confine ourselves pretty much to a cooling and succulent 
diet. Diarrhoeas in summer are not induced by eating wholesome 
vegetables, but by combining them with large quantities of animal 
food 

The State of the Mind. — This should by no means be over- 
looked in choosing the kind and the amount of food. If we have 
lost friends, or heard desponding news, or experienced calamities of 
itny kind, we must, during the first hours of the shock, or even during 
the first days, if the affliction be heavy, partake very sparingly of food. 
The stomach is in no condition to receive it. The brain lies pros- 



tmmm 



d 



76 



HYGIKNE. 



trate under the stroke, and the stomach, in sympathy with il, u«ks 
for a day of sorrow and fasting. Disturb it not. 

Heat-producing Food Incompatible with Excitement. — It is 

folly to take heat-producing aliment when laboring for days under 
high excitements. During political campaigns, when the blood of 
politicians is at the boiling point, the diet should be unstimulating, 
— containing very little animal flesh, and not much combustive food. 
Many a man has died of apoplexy, or of heart-disease, by putting on 
the steam when his blood was up. Whenever we have a day of un- 
common excitement to pass through, we should always begin and 
end it with an unusual degree of al»tinence as to the amount of food 
taken, and with special care that the articles be of the highest kind. 

Anger Demaad« Abstinence. — Anger is a passion which espe- 
cially unfitii the stomach for doing much work. If it occur often, or 
be protracted, but little food should be taken. Those who indulge it 
have a double cause for abstinence. Both their folly and their stom- 
achs call for a fast. 

Food Adapted to Different Periods of Life — Food must vary in 
different periods of life. The infant needs a fattening diet ; and this 
has been supplied in the milk of tlie mother, which contains more 
hitter (the fattening portion) than the milk of any other animal. 
But as the infant has much less exercise than the young of animals, 
its flesh is not wasted, and it does not require so much azotized food, 
that is, the reader will remember, foorl witli nitrogen in it. Accord- 
ingly, it will be seen by looking at tli table on page 70, that human 
milk has much less of this element 'an that of the cow. As the 
child grows up, and begins to take acti\ 'xercise, indoors and out, 
it wants more solid food, and teeth make their appearance to masti- 
cate or chew it. 

In Youth and Jlanhood, the great amount of exercise usually 
taken calls for larger supplies of azotized aliment, — beef, mutton, 
pork, fowl, fish, wheat-flour, corn-meal, rye-meal, potatoes, turnips, 
peas, betlns, etc. This is the working part of life, when the tissues 
are rapidly wasted by action, and the flesh-forming aliments are 
wanted to keep them good. 

In Old Age, the exercise is diminished, the blood circulates more 
slowly, and the body grows cold. Now is the time to resort to non- 
azotized food, — oils, fats, the various kinds of starch, sugar, and the 
like. These will furnish fuel to warm the sluggish blood, and will 
invest the body with fat, which will serve the purpose both of a cush- 
ion and a garment. Wine, beer, porter, and distilled spirits are never 
needed by young peraons in health ; but the aged are frequently bene- 
fited by them, if taken in small quantities. They are chiefly com- 
posed of oxygen, hydrogen and carbon, and are properly ranked with 



HYGIENE 



77 



the supportera of combustion. They are like^vi8e stirauiant, and add 
to the comfort of the old by quickening their circulation. Like tea 
and coffee, they diminish the waste of the body, and thereby lessen 
the demand for food. 

The smallest amount of aliment upon which a healthy adult person 
ever lived for any length of time, v.as twelve ounces a day. Upon 
this small daily allowance, Lewis Cornaro, a noble Venetian, sub- 
sisted in perfect health, during the protracted period of fifty-eight 
years. This he was able to do only by adding daily to his food 
about twelve ounces of light wines. I shall have occasion to refer 
to this case again. ' 

Cost of Pood. 

Onk other consideration must ever influence the great majority of 
• men in selecting their food. I mean its cost. It is a matter of great 
importance to the poor, to know what kinds of food they can subsist 
upon with least expense. Sometimes provisions are so high that 
persons in poor circumstances greatly need advice in this matter. 
Let me endeavor to furnish some information which shall be of ser- 
vice to the reader. 

Milk is supplied by nature to be our first food, and is a good type 
of all alimentary substances. It contains 
(turd, which has nitrogen, and is equivalent 
to albumen and fibrin, and represents the 
hlood-formers. It has butter and sugar. 
These represent the heat-formers. It has 
salts, which contain potash, soda, phospho-j 
rus, etc. Fig. 64 is a microscopic view of I 
good milk ; Fig. 65, of poor milk ; and Fig. 
66, of milk adulterated with calf's brains. 

Food will be valuable in proportion as 
it combines, in due proportion, the articles 
contained in the four groups, represented 
by albumen., fat., sugar., and salts. 

Albuminous Group. — Albumen, fibrin, casein, and gluten, all en- 
ter into the substance of animal and vegetable bodies, and are all 
composed of the same elements, namely, 48 parts carbon ; 36 of 
hydrogen ; 14 of oxygen ; and 6 of nitrogen. In containing nitrogen 
they all differ from the other three groups. Albumen being a good 
type of them, they are called albuminous compounds. Albumen 
forms a large portion of the serum, or colorless part of the blood. 
It is the leading principle in alimentation. It is worked up into the 
tissues of our bodies. It forms our muscles, our membranes, a por- 
tion of our nerves, etc. It is the bricks of which the house we live 
in is made. AH the articles, therefore, which are chemically consti- 
tuted like it, may well be termed albuminous. 




FlO. 64. 



V 



|r 



78 



HYGIENE. 



These bodies, consisting of the four organic elements named above, 
have been called quaternary compounds. Besides these elements, they 
have a minute portion of sulphur and phosphorus. They are also 
called protein or proteinaceous compounds. 

Albumen is a very unsUible compound, — tending strongly to de- 
composition. This is owing to the complexity of its cor'position. 





Fio. 65. 



FlO. 6G. 



and to its union with the fickle element, nitrogen, which forms chemi- 
cal compacts reluctantly, and breaks tliem without remorse. Sub- 
stances which coagulate or fix albumen in an insoluble compound, 
or preserve the tissues of the body, which are made from it, from 
decomposition or putrefaction, are called antiseptics. 

Fatty Oroup. — The next group, represented by fat, performs very 
important offices in the system, — the most injportant of which is a 
union with albumen in the formation of cells. All animal and vege- 
table life begins with the cell, — the tiny cup, with which nature dips 
all the streams of life out of the great fountain of inorganic matter. 
No cell is formed without a minute ]jarticle of oil. Tiie portion not 
used in forming cells, is either burned as fuel to keep us warm, by 
uniting with oxygen, or it is stored away in the cellular tissues, add- 
ing to the bulk of the person. If, then, the very beginnings of life 
are dependent upon fat, it is of great importance as an article of diet. 
So necessary is it in the economy of life, that when not taken in the 
food, it is formed out of albumen in the processes of assimilation. 

The Starch and Sugar Group, composed of several kinds of sugar, 
gum, etc., is never used in forming the tissues, but they perform im- 
portant offices in the changes going on within the human organism. 
Thus, sugar of milk is decomposed, and forms lactic acid, so called 
from being found in sour milk. This acid plays a veiy important 
part in the process of nutrition. 

Pure starch is a snow-white powder, having a glistening aspect. 
It is composed of grains from .gj^ to ^^^ of an inch in diameter in 
the different grains ; being largest in the potato and smallest in 
wheat. When examined with the microscope, they appear as in Fig. 
68. 



^ 



HYGIENE. 



79 



The Salts Qroup are sufficiently spoken of in another place. 

A wise philosopher in ancient time said, " I do not live to eat and 
drink; I eat and drink to live." If we intend to eat to live, we must 
combine, in our food, the four groups above explained; and if we 
would live at as small expense as possible, we must take those arti- 
cles which are low in price and rich in nutritive matter. The fol- 
lowing table will help the reader make his selections : — 

Tabk of the relative value of articles of food arranged according to their proportions of 
nutrimt matter in each of the four groups of elements concerned in vital changes. 



In 100 pound! of 



I 



Gbains : 

Wheat 

Barley 

Oats 

Rye 

Indian Com . . , . 

Buckwheat . . . . 

Rice 

Pod Plants: 

Beans 

Peas 

Roots : 

Potato 

Turnip 

Carrot 

Beet (manKold wurzel) 

Long red 

Sliort red 

Sugar beet .... 

Parsnip 

Leaf; 

Cabbage 

Mkal; 

Wheat flour . . . . 

Ryemeal 

Barleymeal 

Oatmeal 

Wheat bran .... 



I 



.-I 

r 



15 
16 
16 
12 
14 
15 
13 

14 
14 

76 
88 
86 
86 
86 
85 
86 
80 



16 
16 
16 
15 
l.S.l 



15 

16 

20 

10 to 20 


26 

:i 

8 to 11 
9 

4 

2 

3 

2 
3.03 
3.31 

2 
1.6 



4.63 

55 



la© 

E 3 "I 



10 to 19 
12 to 16 
14 to 19 
10 to 15 
11 

8 

7 

24 to 28 
24 

2.1 
1.6 
1.5 
• 2 
0.48 
0.26 

2.5 

30 to 36 

10.8 

8 

6.3 
12.6 
19.3 



So 

H 



2to4 
2 to 3 
6to7 
3to4 

8.1 

0.4 

0.7 

2to3 
2.1 

0.«l 
0.3 
0.4 



0.36 



9 



r£ 



'J 



it 



2 

2 

2.4 

6.6 

4.7 



6S 
60 
60 
60 
74 
60 
79 

40 

50 

18 
9 

10 

11 

10.36 
12.46 

13 

16 



70.6 
73 
74 
64 
.6 



2 
3 
4 

2 

Oi 

3 
3 

;toii 

Sto4^ 

lito2 

tol 

.s 

i 



2 

2 
3 
7.3 



The following tables have an admirably practical bearing upon 
economy in food : — 



100 lbs. 



Parley 

Beans 

Beets 

Buckwheat . . . 

Carrots 

Corn 

Oats 

Peas 

Potatoes 

Turnips (field) . . 
Do. (Swedish) . . 
Wheat Flour . . . 
Wheat Bran . . . 
Cheese (whole milk) 
Cheese (skim-milk) 



Muscle- 

forminc 

Elemenn, 

in lbs. 



14 
26 

2 

8 

li 

12 

17 

24 

2 

2i 
11 
18 
28.4 
49.8 



Fat-forminp; 

Blcmenta, 

Inlbt. 



64 
42 
12 
64 
10 
77 

62 
19 

9 
12 
79 

6 
51.1 

6.3 



Relatire Propor- 
tion of each, 
In lbs. 




ItoA 
Itofj 



Husky, or 

Woody fibre, 

in lbs. 



16 
10 

(?) 
26 
3 
6 
20 
8 
4 
2 
2 

56 



lAlil'iUi 






iHri 



80 



▲rtlelM. 



Barley . . . : 

Beans 

Corn 

Outs 

Peas 

PotaiiOeB. . . . 
Turalpg .... 
Flour ^flne) . . 
Flour (unbolted) 



HYGIENE. 






Cost, 


Mtuole-prodnolng 


Coatof Muacle-pro 


Eleuent*. 


ducing Klemanti. 


$1.00 per bu. 


M lbs. 


12c. per lb. 


1.80 " 


16.6 " 


lie. " 


0J50 " 


6.7 " 


7*0. " 


OM " 


8.2 " 


7a " 


1.00 " 


14.3 " 


7a " 


0.(15 " 


1.6 " 


Ks,. " 


OJ50 " 


1.2 " 


41a " 


n.OO per bbl. 


22.0 " 


23c. " 


4J0 " 


24.8 " 


18c. " 



These tables will well repay study, for their practical use will s.ave 
many dollars to the poor. Let it be remembered that producing 
muscle is the same thing as producing strength, or labor-power. 
Bearing this in mind, the following table will be very interesting: — 

One pound of labor-power from Potatoes costs 6Sc. per lb. 

" Fine Flour, 2;k;. 

" Unbolted do., 18c. " 



Turnips, 

Barley, 

Corn, 

Beans, 

Peas, 

Oats, 



41c. 
12c. 

7ic. 
lie. 

7c. 

7c. 



\ 



Meats are omitted in the table. So far as their nutritive qualities 
are concerned, it is of little consequence which are taken. Some are 
more digestible than others, and this consideration should influence 
those with weak stomachs in selecting. Every person, of coui-se, 
knows their relative cheapness. 

Among the vegetables given in the table, there is a wider range 
for choice. Let us consider them in course. 

Wheat. — In this, the four groups are represented in excellent 
proportion. When not deprived of the bran, it is perhaps the very 
best supporter of animal life. So high have been the regards of men 
for it, and so generously have they awarded to it their acknowledg- 
ments, that its product, bread, has been everywhere called " the staff 
of life." The settlement and cultivation of the immense prairies of 
the West have within recent years so increased the production of 
wheat, that its cost is now less than half what it was fifty years ago, 
and it is indeed within the means of all in America. 

Barley.— This has the four groups represented in nearly the same 
proportions as wheat. It is, therefore, nearly as valuable an alimen- 
tary grain. Unfortunately it is not so toothsome as wheat, ai)d can 
never be so popular an article of diet. The Scotch, however, feed 
upon it with apparent relish, and doubtless think it strange that for- 
eign palates are not better pleased with it. 

Oats.— This grain, strange to say, has more albuminous, or nutri- 
tive matter, more fat, more starch, and more salts than wheat. In 
uniting a large quantity of the four alimentary groups, it surpasses 



^ 



HYOIKNE. 



81 



liutri- 
In 
basses 



every other vegetable substance. In albumen, it is not quite as rich 
as peas and beans, and in starch it falls a trille below fine wiieat 
rtoiir ; but in fat it is exceeded only by Indian corn. This grain is 
likewise cousiuned largely by the Scotch, — a people whose claims to 
sliiMwd common sense are well supported by, iw their liardy coustitu- 
tioiis vindicate, tiie choice. This grain might well be permitted to 
tike tiie j)lace of rice. It affords several times as much nutriment, 
u liile it costs only about one-fifth as much. There is good reason 
why the hoi-se should thrive upon oats. Most stidjle-keepei-s think 
their horses will do more work upon corn-meal, but this must Ihj a 
mistake. In using oats for horse-feeding, a large portion of the nu- 
triment is lost by not (jrinding them. 

Rye. — This is also a grain of considerable nutritive value. It is 
much cheaper than wheat ; and r3-e meal has long been a standard 
article of diet in New England, — particularly in connection with 
Indian meal, as "brown bread." It is useful for relieving costive- 
ness, in th« form of " hasty-pudding," with molasses. 

Indian Corn. — This stiiple article of American produce needs no 
praise from me. It is comparatively cheap, nutritive, and wholesome. 
It abounds in fat and starch, and has a fair amount of albumen, 
though not as much as the oat, the barley, or the wheat. In salts, it 
is rather deficient. Indian corn is strictly an American plant, and is 
perhaps the most popular grain in the country. It has emphatically 
a national reputation, and is perhaps worked up into more savory 
dishes than any otlier. At the South it is an institution. It is there 
made into hoe-cake, corn-cake, batter-cakes, batter-bread, muffins, corn- 
pone, etc. At the North, we have johnny-cake, Indian and pumpkin- 
cake, baked Indian pudding, boiled Indian pudding, beside the well- 
known rye and Indian bread, and other preparations. Give an in- 
genious Southern or Northern housewife a few simple adjuncts, such 
as lard, milk, sugar, eggs, cream of tartar, and soda, and she will 
make a pretty respectable larder from this single grain. If molasses 
be substituted for sugar, and a little stewed pumpkin be thrown in 
by way of garniture, we may have several preparations which are 
very nourishing as well as cheap. 

Buckwheat. — Poor in nutritive matter, fat, starch, and sugar, but 
tolerably well supplied with salts. Jt will do very well for batter- 
cakes in winter. When brought smoking upon the table, and served 
with sugar or molasses and butter, these cakes are a luxury, in which 
the rich may indulge if they clioose ; but for the poor, the amount of 
nourishment they afford is too small for their cost. 

Rice. — Much like buckwheat, except that it has more fat, sugar, 
and starch, and less salts. As an article of diet, it has had too high 
a reputation. Those who would live on small means cannot afford 
it. Boiled in plain water, it is excellent for a relaxed state oi tlie 
bowels; and this about all the conunendation to which it is entitled. 



82 



HYOIKMB. 



Beans.— The rlclicHt in nutritive mutter of all vegetable substances, 
except cabbage and oats. They have more albumen than wiieat, or 
corn, or barley, or oats ; but in fat and starch they are lower in Ihe 
scale. Add to them salt pork, and the highoet of all nutrient com- 
pounds is obtiiined. During not less than four generations, pork 
and beans, as the principal diet, nourished an iron-sided race of men 
in New England. Hcan-porridge was like honey upon tlie tongue of 
the foundem of New England institutions. They ate it morning, 
noon, and night ; and thanked God for it every time. And well they 
might thank Him ; for, with Indian corn, it furnished them with a 
diet better adapted to their condition than any other. 

Peas. — Not quite as rich as Iwans in albumen, but more rich in 
starch, is of about the same value on the whole. The Canadian French, 
in Lower Canada, feed on pciis to about the same extent that the 
New Englanders did on l)eans. Pea-soup, as prepared by the best 
cooks among them, is a dish of great nutritive excellence ; and, in 
my judgment, more palatable than bean-soup. 

The Potato. — Three-quarters of this root is water, and it is poor 
in all the elements of nutrition. It is a palatable article, and most 
persons are much attached to it. As bulk is of some consequence in 
food, the potato is not without value. Men do not often live entirply 
upon potatoes, — not even in Ireland. Milk, butter-milk, and cop.> 
cially cabbage, are united with them. 

Turnips, Carrots, Beets, Parsnips. — These are much alike, — 
being all poor in nutritive qualities. They serve to please the pal- 
ate by furnishing a variety ; but in our city markets they are expen- 
sive, and do not furnish an economical diet. 

Cabbage. — It is interesting to observe how the instincts of men 
have in all tages led them to select those articles of diet which their 
circumstances have demanded. The poverty of the Irish has led 
them to subsist hugely upon the potato, — a root which the soil of 
their country yields profusely. But as this root has but little nutri- 
tive matter, necessity required that it should be united with some 
other vegetable. The natural instinct selected the cabbage ; and 
when chemical science came, at length, to pass judgment upon the 
correctness of this instinct, it turns out that the cabbage is the richest 
in albumen of any known vegetable. The cabbage, then, is the nat- 
ural complement of the potato ; and the Irish had the sagacity, with- 
out science, to bring the two together. It is said the Irish have a dish 
named " kohl-cannon," consisting of boiled and mashed potatoes and 
cabbage, seasoned with pork fat, pepper, and salt, and that it is a 
truly savory dish. It certainly is a nourishing and a cheap one. The 
ambassador who was sent to tamper with the patriotism of a Roman 
who liad dined on beans, wiis asked if he was silly enough to think 
gold anti silver could bribe a man who was satisfied with so plain a 



HYQISNE. 



9» 



expen- 

of men 
ch the li- 
as led 
le soil of 
iiutrl- 
th some 
^e ; and 
)on the 
richest 
the nut- 
ty, with- 
Ive a clisli 
toes and 
it is a 
ne. The 
Roman 
) think 
ph'in a 



fare, and dcsirod no other. We come to the fonrhision then, that 
l)ean-|i()rridgo, pcii-noin), «iU!t-piulding swecflened with nioliisHeH, tuit- 
iiieal, iiiid buioy-hreiid, with " kohl-ciiniion " for those who can digest 
it, will t'urniBh, for hard-workinjj men, tlm most Knhstiintial diet, at 
the smallest possible G"i)en8e. To ren(U'r these dishes savory, and 
to make the bible on which they are spread an inviting lx)ard, the 
deft housewife must emph)y her best skill in servinjj them. With 
the thouspud " fixings, with whi<h a New England matron knows 
how to garnish them (or would know how if they came within her 
culinary operations), they are well fitted to leave savory impressions 
upon tongues which would praise them to the end of life. I speak 
of these articles as furnishing a cheap diet for working men. The 
indolent, the sedentary, and the effeniimite from various causes, uould 
not digest them. 

The Amount of Food Taken. 

We have already exj)lained that this should be governed, in part, 
by the amount of exercise taken, by the condition of the health, by 
the state of the mind, by the climate, by the seiuson, etc. It remains 
to add a few words in a general way, respecting the rtl)eolute amount 
required by an adult man. 

It is plain enough that most men eat too much. We come veiy 
near, in this country, being a nation of gormands. A principal rea- 
son of our over-eating is, that we eat so fast. When the food is well 
and slowly masticated and swallowed, the gastric juice has time to 
mix with it ; and at the proper moment the appetite ceases. But 
when our food is bolted rapidly, nature, finding her laws disregarded, 
and all her purposes frustrated, stands back, and lets mh learn to stop, 
too late, alas ! from a sense of fullness in a stretched and abused 
stomach. 

It has already been stated that Lewis Cornaro lived fifty-eight 
yeai-s, namely, from the age of forty-two to one hundred, on twelve 
ounces of solid food a day, with about the same amount of light 
wines. At the age of eighty-four he wrote a book, in which he 
praises " divine temperance " in terms which are sometimes eloquent 
and often enthusiastic. Indeed it is very rare that a man at tliat 
age retains such clearness of intellect, and especially such freshness 
of feeling as he evinces in his book. Probably but few could live on 
tlie amount of food which he found sufficient. Yet it is said tlie 
distinguished John Wesley lived on sixteen ounces a day, which, as 
he took no wine, and had to derive the combustive materials for 
warming the body from the food, was quite as scanty a fare as that 
of Cornaro. Considering that he led a most extraordinarily active 
life, both of body and mind, being half his waking hours in the sad- 
dle and preaching almost daily, this is probably the most remarkable 
case of absteminousness on record. Jonathan Edwards did not, I 
think, exceed the same amount of food, but he was not so active a 
man. 



M 



HYfilKNE. 



Putting asido such oxcoptiotml civhpr ns (Ih'hc, w«' nmyHay in round 
iiun)bei*H, tliat ii ltilN)riii^ iiiiiii r(M]iiiri!H, ti> k(!(i() him in luniltli, aluiiii 
two or two and a half pnumlB of Holid food per day. For miniHtvi'x, 
lawyerH, doctoix, aiillioix, and niun-lianUi, ono pound and a lialf is 
amply Huniciunt. TUv amount hIiouUI Ik; inciraHod a littlu iiy a se- 
lection from Honut of tlu; fnul-fonnurM, if no ft>rmonte<l or alc()lit)li(' 
drinks Ixt taken, and Hlightly diminished if they are UHed. Tlii' ivii- 
Hon is that thuNi' drinkH furnish fuel to l>c lmrni>d in hreatliin^', 
which haw to l)e drawn from the food when they are not employi'il, 
This furnisheH no motive for usin// ardent spiritM ; for there is fuel 
enough tu be had in the oJs, starcheH, and sugani. 

Dyspeptics. — U is said that dyHi>eptic8 eat more than {Mirsons in 
health ; and, in many caHes, the remark may he true. The appetite 
of a person suffering from this disease is almost always morbid, and 
the information it gives respecting the real want« of the systenj van 
seldom be trusted. If we allow a disetuied sk)math to dictate to us 
when and what and how much we shall eat and drink, our misery 
for life is a foregone (juestion. A sick stomach is like a spoiletl eliild, 
— it cries for what it should not have. If the dyspeptic will live, 
and enjoy any amount of peace and eonifort, lie must follow tiiis 
simple rule : I'o eat no more than can be diiiegted, even though the 
amount be only an ounce a day. 



Animal and Vegetable Food. 

It has generally been supposed that it was intended man should 
subsist on a mixed diet, consisting of both animal and vegetjii)le 
substances. Within the last fifty years, however, a school of physi- 
ologists have appeared, who affirm that a vegetable diet is alone 
consistent with the laws of health. They declare tiiat animal food is 
not adapted to man's organization, — that it unduly stimulates the 
blood, predisposes tf) fevers, consumptions, diarrhoeas, choleras, apo- 
plexy, and numerous other diseases, and of course shortens life. 
That such a school should have come into existence in this countiy, 
where animal food is more largely consumed than in any other part 
of the world, in proportion to the number of people, is not surprising. 
We do, undoubtedly, eat too much flesh. So enormous is the consunip 
tion, that notwithstanding the vast herds of cattle raised in all our 
agricultural states, and especially on the western plains, the deniund 
keeps up with the supply so well that beef brings, on an average, 
about twenty centa per pound, — at least twice its full value as a 
blood-former. 

Facts show that man may live upon flesh alone, upon vegetables 
alone, or upon flesh and vegetables combined. Is it be»t he should 
subsist upon vegetables only, or upon a mixed diet ? A mere affirm- 
ation upon these points is of little consequence. To cite facts avails 
nothing. Men have a way of making their own affirmations, and of 



HYaiENE. 



86 



lortkiiig lit factH with oyes which uometimcs see clearly enough on 
lK)th HidcH of them, hut totally ignore their existence. 

Man's Structure Settles the Question. — To settle thJH matter, we 
must a[)]>eal to man's organization. His structure will tell uh some- 
thiiiji; we need not mistake. All the works of God show design. 
Kvi'iything he has made has a use, and is so contrived as to he 
iidiipted to that use. Lions, tigers, and other animals, for example, 
whicli feed on flesh alone, have a tshort second stomach, — it heing 
(inly ahout three times tiie length of the animal's l)ody. Aninials 
witicli eat no flesh have a long second stomach, — that of the sheep 
lieiiijr from thirty to thirty-five times the length of its body. A very 
iviiiarkablo difference of anatomical structure I 

This is the meaning Oi .he difference : Vegetable foqd has a great 
(leal of waste matter in i Woody fibre makes quite an item in it« 
cDiiiposition. This wiuste portion must be carefully separated from 
the nutritive part, and tiiis must all be done in the second stomr. h. 
It takes time to do it. It must not l)e done in a hurry. The nutri- 
tive materials are destined to build a living structure, whose dura- 
tion, like that of all other fabrics, will depend on the care with 
which the materials are selected and put together. The second 
stomach of the sheep is long, that there may be ample time for the 
mixed mass of chyme, when it pisses out of the first stomach, to Xte 
(iiaiiged to chyle, and then to lie carerfully separated into the two 
parts, the useful and the useless. Animal food is in iXn composition 
just like our own flesh, — the « is little waste matter, and not much 
time is required for it« separation ; ^ ^nce, the second stomach of 
flesh-eating animals is short. Nearly the whole alimentary mass is 
([uiekly taken up by the lacteals, and there is no occasion fOr itf 
travelling through a long second stomach. 

Mans second stomach is in length midway between that of the 
fle8h-<^ating and the vegetable-eating animals. If there be design in 
the works of the Creator, and if that design in the structure* of the 
flesh and vegetable-consuming animals has now been correctly inter- 
preted, it is plain that man is best nourished when he eats both kinds 
of food. The structure of his teeth and the motions of his jaws 
(see p. 80), confirm the same conclusion. 

Americans Eat too Much Meat. — Yet, as I have said, there is no 
doubt the Americans eat too much meat. Sedentary persons require 
but very little. Less is wanted in summer than in winter, — in warm 
chiiiat€s than in cold. People of wealth, whose circumstances im- 
pose no bodily hardships, need less than the poor, who are much 
exposed, and work hard; whereas, they consume more. Those who 
<lo not labor with their hands, should never taste meat more than 
oncfc a day. 

It ife painfuUy-amusing (if such a compound word is admissible) 
to hear a nervous female, whose sole exercise consists in going from 



I 



m.. 



H 




86 



HYQIEME. 



the parlor to the kitchen once or twice a day, and in making a brief 
shopr'ug excursion once a week, complain that she cannot maintuin 
her strength unless she eats freely twice a day of moat, vnd takes her 
free potations of strong coffee and wine. 

A like opinion prevails generally among the feeble who are not 
obliged to labor. Tiie child in its nurse's arms must daily, it is 
thought, suck a piece of chicken or beefsteak in order to thrive. 
Children thus fed have their blood constantly inflamed, and stand a 
poor chance when attacked by scarlet fever. The little master or 
miss who attends school complains of headache, and grows pale, 
feeble, and nervous. The booki are blamed and thrown aside for 
what the dishes have done. The doctor is called in and assured 
that the dear child can eat nothing but a little fat broth, a custard, 
or cake ; and if he prescribe a diet of plain bread and milk, he is 
believed to be heartless, and his prescription is not followed. 

The Majority of Mankind Eat no Flesli. — All such misguided 
persons should be apprized that the great majority of mankind eat 
no flesh, because they cannot afford it. And they do not appear to 
suffer from its loss. Millions of 7rish do not taste of flesh or fish 
from one month's end to another. Potatoes, oatmeal, and cabbage 
constitute their chief diet. Rice, poor aa it is in nourishment, 
sustains, when combined with vegetable oil, millions of people in 
Asia. The Lazaroni of Naples, with active and finely moulded 
forms, live on bread and potatoes. These facts do not afford ground 
for altogether rejecting animal food, any more than Bayard Taylor's 
statement respecting whole tribes in Africa who live upon flesh 
furnishes a reason for excluding vegetable aliment. Man may live 
and enjoy health upon either, but his organization implies the use 
of both. 

Proportions of Animal and Vegetable Food. 

Upon this subject, it is impossible to fix any absolute rules. This 
is a point which must be determined by the temperament, the state 
of the health, the constitution, etc. Persons of a scrofulous habit 
should eat freelj'^ of animal food. But an inflamed stomach should 
never be tormented with flesh. Meat is stimulating, and will i)C 
almost sure to do nc'schief v hen there is heat and tenderness at the 
pit of the stomach. There are cases of inflammation of this organ, 
in which it may be necessary to live on bread and milk, with articles 
of the starch group, for months, and even for years. 

On the other hand, when the system has run low from some 
exhausting disease, which excites no feverish action, it may be 
necessary at times to take a diet almost exclusively animal. 

It is absurd to talk of the same diet as adaptea to all persons, even 
when in health. As well might we expect one shoe to fit every 
foot, or one coat every back, or one color every eye, or one doctrine 
every mind. 



nummm 



HYGIENE. 



87 



Temperance the Main Thing. — After all, the great thing to hv> 
aimed at is tempenince. It is not so necessary to reject one article 
and use another, as to partake of all with moderation, " I do not 
live to eat and drink ; I eat and drink to live," said a wise philoso- 
pher of the olden time. One would think the moderns have 
reversed this rule. A modern table has the appearance of being 
s[iread for the purpose of inducing men to eat all their stomachs will 
hold. A man who can dine daily, for half a dozen years, at one 
of our first-class hotels, and then find himself free of dyspepsia and 
all other diseases, must have a fine constitution, as well as most 
admirable control over his appetite. Mr. Addison said, " When I 
behold a full table ^et out in all its magnificence, I fanr^ . see 
gout, cholic, fevei-8, )d lethargies lying in ambuscade among the 
dishes " ; to which he adds, with much truth, in another place, 
" Abstinence starves a growing dist3mper." 

Qood Results of Temperance. — A temperate diet has always 
been attended with excellent results, and always will be. There are 
times of great anxiety, when abstinence should be pushed to the 
extreme verge of endurance. During the siege of Gilbraltar, Lord 
Heathfield, its gallant defender, lived eight days on four ounces 
of rice per day. Dr. Franklin, when a journeyman printer, lived 
two weeks on bread and water, at the rate of ten pounds of bread a 
week, and was stout and hearty. Dr. Jackson, an eminent physician 
in the British army, says, " I have wandered a good deal about the 
world, and never followed any prescribed rule in anything; my 
iiealth has been tried in all ways ; and, by the aid of temperance and 
liard work, I have worn out two armies, in two wars, and probably 
could wear out another before my period of old age arrives." 

Lord Bacon was right in tlie opinion that intemperance of some 
kind or othtjr destroys the bulk of mankind, and that life may be 
sustained by a very scanty portion of nourishment. Cornaro, whom 
I have before mentioned as having lived fifty-eight years on twelve 
ounces of solid food a day, wrote as follow respecting himself in 
his eighty-fifth year : " I now enjoy a vigorc"8 state of body and 
of mind. I mount my horse from the level ground ; I climp steep 
ascents with ease ; and have written a comedy full of innocent mirth 
and raillery. When I return home, either from private business or 
from the senate, I have eleven grand-children, with whose education, 
amusement and songs I am greatly delighted; and I frequently 
sing with them, for my voice is clearer and stronger now than ever 
it was in my youth. In short, I am in all respects happy, and quite 
a stranger to the doleful, morose, dying life of lame, deaf and 
blind old age, worn out with intempei-ance." Howard, the philan- 
thropist, fasted one day in the week ; and Napoleon, when he felt his 
system unstmng, suspended his meals, and took exercise on horse- 
l»ck. 

Nothing can be plainer than the duty of fasting, when the 
stomach, having been overworked, is disinclined to receive food. 



88 



HYGIENE. 



Brutes invanably follow this suggestion of nature ; they never eat 
when sick, — probably because they have no silly nurses to coax 
them to swallow stimulating aliments. The habit of putting high- 
seasoned food into the stomach when it is inflamed and feverish is 
about as wise as directing streams of blue, violet, or red light into 
the eye when it is red and swollen with inflammation. 



Tea and Coffee. 

It is proper, before closing this chapter upon diet, that something 
should be said respecting the beverages of tea and coffee. 

Some years ago, a meeting was held by the leading physicians 
of a city in the old world, in which the merits of tea and coffee were 
discussed. In this discussion each man first stated his experience 
in the use of these articles, and then consti acted his argument 
according to that experience. The amount of what the reader could 
learn from the discussion was that Dr. A. had used tea all his life, 
and been benefited by it, while coffee had uniformly injured him ; and 
that he thought tea should be used, while coffee should be rejected ; 
that Dr. B. had taken coffee at breakfast, and found it an excellent 
support to the stomach and nervous system, while tea had disturbed 
his digestion and his mind ; and that the former was a beverage 
of excellent qualities, wnlle the latter was detestable ; that Dr. C. 
had always drank both tea and coffee, and recommended them to 
everybody ; and that Dr. D. had hi^iself never been able to indulge 
either tea or coffee, and would have them both expelled from every 
household. 

The discussion was not creditable to the learned and really able 
men who participated in it. The arguments were all based upon the 
miserably narrow basis of single individual experiences. They were 
no more valid than that of the man who should hold up a shoe, de- 
claring it fitted his foot the best of any he ever had, and recommend- 
ing all men to have their shoes made upon the same last. 

The truth is, there is but one thing which can be afiirmed univer- 
sally of the effect of tea and coffee. They both, when taken, tend to 
prevent waste in the body, and, consequently, less food is required 
when they are used. This may be afiirmed of tLem in their applica- 
bility to all persons, but nothing further. The truth is, some can 
drink tea but not coffee, and some coffee but not tea ; some can use 
both, and some neither. Every man's susceptibility to the effects of 
these beverages is his own, as much as liis susceptibility to the effects 
of light, or heat, or atmospheric changes ; and these effects, each per- 
son must learn from experience. Coffee often produces, and gener- 
ally aggravates, a bilious habit, — an effect which cannot, I believe, 
be traced to the use of tea. I have no doubt but that many cases of 
confirmed dyspepsia are traceable to the use of coffee alone. 



HYGIENE. 



89 



Water. 

There is one universal beverage ; it is water. All men are fond 
of it. In sickness and in health, in joy and sorrow, in summer and 
winter, in cold climates and in hot, man loves and drinks water. The 
stomach, abused and made sick by stimulating food and drinks, and 
repelling everything else, still gratefully opens itself to water. Wher- 
ever man exists, therefore, or wherever he should exist, water is 
found, either in the form of springs, or running brooks, or rivers, or 
ponds, or lakes ; and even where it is not found in some of these 
forms, it is periodically dropped down from the clouds. As there is 
110 element in nature more necessary for ' j *s existence than water, 
80 there is none more universally diffuse' 

Pure Water Essential to Health But water varies very mate- 
rially, both in its pliysical qualities, and in its adaptation to its pur- 
poses. Pure water is as essential to health as pure air. When either 
of these fluids is rendered impure by mixture with foreign matters, 
disease will be a frequent result. The ancients must have been in- 
fluenced by this fact, or they would not have incurred such heavy 
expenses in procuring pure water from great distances. The strong 
aqueducts through which, for many miles, large streams of water are 
even at this day poured into Rome, attost the freeness of the expendi- 
tures she mad^ for this purpose in the day of her greatest renown. 
We may pity the ancient Romans for being governed in their military 
operations by the opinions of augurs and soothsayers, and certainly 
these things were silly enough ; but in other things, at first view 
equally superstitious, they showed practical wisdom. Vetruvius re- 
ports that in selecting the sites of theii: cities, they inspected the 
livers and spleens of animals to learn the salubrity of the waters and 
the alimentary productions of the region. The size and condition of 
these organs do in fact indicate the nature of the pasturage and the 
qualities of the water with which animals are supplied. No people 
can enjoy good health when subjected to the double influence of bad 
water and impure air. 

Division of Water. — The simplest division of water is into two 
kinds, soft and hard. Rain, river, pond, and snow water is soft: 
well and spring water is generally hard. Soft water contains but 
little impurities, and when used for washing, forms a good lather 
with soap. Hard water contains at least one of the salts of lime, 
often more ; mixed with soap, it curdles and turns white. Tte reason 
of this is, that the oily acids of the soap unite with the lime, and 
form a compound which the water will not dissolve. Such water is 
not suitable for domestic purposes. 

Chemical Nature of Water. — Water contains, reckoning the ele- 
ments of which it is composed in volumes, two volumes of hydrogen, 
and one volume of oxygen. These two gases, the unlearned reader 



90 



HYGIENB. 



will please remember, &.re highly subtle bodies, not visible to the eife ; 
and yet, when chemically united, they form a liquid which covei-s 
two-thirds the entire surface of the globe, — floating upon its lx)S(im 
the navies and merchant ships of all nations, and by its unmeasured 
depths and vast breadths and sublime movements, fills the thoughtful 
mind with conceptions of creative Power, which words never attempt 
to express. Should the two gases which compose this vast body of 
water cease to love each other, and fall asunder, the first lighted taper 
would set the world on fire, and not a living being upon its surface 
could escape destruction. 

Impurities in Water. — It is not surprising that a fluid with as 
great a solvent power as water, should often dissolve and hold in 
solution a great many impuritiss. In passing along through the 
earth, before it comes up in springs and wells, it is filtered through 
various mineral earths, and becomes contaminated accordingly. In 
running through beds of limestone, it takes up a little carbonate of 
lime. Salt-beds impart to it common salt (muriate of soda), while 
sulphur and other ores tinge it with salts of various kinds. 

Warer-Supply. — At the present time all large cities and most of 
the towns in this country are supplied with water for domestic pur- 
poses, either from ponds or lakes, or from artesian wells, of greater 
or less purity, but in almost all cases superior to the common well- 
water, so liable to contamination by cesspools and sewage. The re- 
sult is that the health of the people has been materially improved, 
and fevers, particularly those of a typhoid type, have diminished both 
in prevalence and fatality. The decaying vegetable and animal mat- 
ter, which formerly was washed into the soil, and percolated into and 
poisoned the wells, is now washed away by copious supplies of pure, 
fresh water. 

Lead Pipes. — In cities, water is usually conveyed through the 
dwellings in leaden pipes, — a practice fraught with a danger, to 
avoid which various expedients have been devised. That lead does 
often become oxidized and impart its poisonous properties to water 
when long in contact with it, is a well-known fact. Let a number of 
persons drink every morning from the the first water drawn from tiie 
pipes, and a portion of them will be attacked with some form of lead 
disease. The pipes should be emptied every morning before using 
the water for domestic purposes, and then there is little danger. Tin- 
lined pipes have been found to be almost entirely free from danger 
of lead-poisoning. 

Physical and Otlier Properties of Water.— Good water is with- 
out smeil, is perfectly clear, and in the mouth has a soft and lively 
feel. Whan poured from one vessel to another, it should give out 
aiivbubbljb. Boiled and distilled waters have a vapid, flat taste. 
This is ovdng to their containing no carbonic acid gas or atmospheric 



acid 



we 



MVJ 



Wff« 



HYGIENE. 



91 



air, — these being driven off in the act of boiling and distilling. A 
hundred cubic inches of good river water contain about 2^ of carbonic 
acid, and 1^ of common air. 

Carbonic acid is what gives to mineral, or soda water, its brisk, 
and even pungent taste. Without a portion of this acid and atmos- 
pheric air, water is perfectly insipid, and not fit to be used as a bev- 
erage. Hence, if it be boiled or distilled to clear it of earthy matters, 
we must expose a large surface of it to the air, and shake it, that it 
may re-absorb from the atmosphere what it has lost, and thus recover 
its taste. . . 

Rain Water is the Result of Distillation on a large scale, and 
would be insipid, like other distilled water, only that, after being 
distilled off from the waters upon the surface of the earth, it recovers, 
while ascending as vapor, the carbonic acid and atmospheric air. 

Fishes breathe air as well as land-animals, and hence, lakes upon 
the tops of high mountains, where but little oxygen can be absorbed 
into the water from the air, are not inhabited by the finny tribes. 

The Saltness of the Ocean is simply the accumulation of the saline 
substances washed out of the bowels of the earth. 

The water which for thousands of years has been distilling off as 
vapor from the surface of the ocean is nearly pure. Reing carried 
by the winds to the continents, it falls as rain, sinks iulci the earth, 
is filtered through mineral substances, comes to the surfaces in springs, 
is collected into rivers, and, with all its freight of mineral salts, is 
borne back to the ocean. Everything that water can dissolve, and 
carry down from the continents, finds a great depository in the ocean; 
and as this has no outlet, the accumulation must go on without limit. 
Rivers which flow into the ocean contain from ten to fifty grains of 
salts to the gallon, — composed chiefly of common salt, sulphate and 
carbonate of lime, magnesia, soda, potash and iron ; and these are 
the constituents of sea-water. 

Cleansing of Impure Water. — Impure waters should be cleansed 
before being used for domestic purposes. Distillation is the most 
perfect method of purification. Filtration through sand is a good 
method. It removes all suspended vegetable or animal matter, and 
all living animals. Boiling likewise kills all animals, and throws to 
the bottom carbonate of lime. It is this which constitutes the crust 
which lines tea-kettles in all regions where limestone exists. 

'Settlers in a new country should make it a prime object to find 
good water. This is of great moment. Their own health and the 
health of their posterity is dependent upon it. Any soil, good or 
bad, is not worth half price, if it yield impure water. 

Reasons for Prizing Water. — Finally, we ought all to prize water 
very highly, for it composes nearly eight-tenthn of our entire bodies, in- 
cluding our flesh, blood, and other fluids. Nay, we owe to it the very 



m 



mM 



92 



HYGIENE. 



softness, delicacy, and smoothness of our persons. Our musclfs. 
nerves, blood vessels, glands, cartilages, etc., all play smoothly upon 
each other in consequence of water. Take all the water out of us, 
and we should be dry sticks indeed. All our comeliness would W 
gone. Nobody would or could love us. We should be walking 
reeds, sh ' -n and sported with by every wind. Let us never forget 
how mu ire indebted to water. 



Exercise. 

Animal life is conditioned upon exercise. Without it health can- 
not exist, or life -itself be continued for any great length of time. 

Proper exercise communicates motion to every part susceptible of 
it. It expands the chest, contracts and relaxes the muscles, quickens 
the motion of the blood, moves afresh all the other fluids, and stirs to 
the centre of the whole frame. More easy and perfect digestion, the 
nutrition of every part, and the proper performance of all the secre- 
tions and excretions, are the results of such exercise. 

A distinguished physician said : " I know not which is most neces- 
sary to the support of the human frame, food or motion." Some of 
the finest talents in the world are probably lost for the want of 
exercise ; for without it the mind loses its keen perception and its 
bounding energy, ita power of application and its general scope. If 
men of great talents would give attention to exercise, the world 
would reap a larger harvest from their written thoughts. 

The arrangements of modern society have very much abridged the 
facilities for taking exercise ; but if Trenck in his damp prison, 
with fetters of seventy pounds weight upon him, could preserve his 
health by leaping about like a lion, most persons could do as much 
with the fetters of modern society upon their limbs. 

Must be Regular. — Exercise, to be of much service, must be regu- 
lar, — not taken by fits and starts, — a good deal to-day and none to- 
morrow ; but in reasonable measure every day. Occasional efforts, 
with intervening inactivity, only does mischief. 

Must be Pleasurable. — It should be connected, too, if possible, 
with some pleasing occupation or pursuit. The movement of the 
limbs should carry us towards some place or end in which the mind 
feels an interest ; exercise will then do us most good. Hence botan- 
ical pursuits, the cultivation of a garden, and the like, are often pre- 
ferable to a solitary and aimless walk. , 

Must not be Excessive Exercise should never be carried so far 

as to produce great fatigue. Extremes are injurious ; and too much 
exercise, especially by a sick or feeble person, may he as injurious as 
too little. 

No clothing should be thrown off after exercise, nor should one 
cool off by sitting in a draft of air. Very serious consequences often 
follow this practice. 



HYGIENE. 



w 



Not to be Taken After Meals. — It is not best to take exercise im- 
mediately after meals. The reasons for this caution have been ex- 
plained. It is true many laboring men go at once to their work after 
eating, without apparent injury. Yet they are strong, and can en- 
dure what those who use their brains chiefly could not. And even 
they do not labor as easily and cheerfully immediately after dinner. 

Active and Passive. — Exercise is properly divided into active and 
passive. Walking, running, leaping, dancing, gardening, various 
sports, etc., are active. While sailing, swinging, and riding in car- 
riages are passive. Riding on horse-back is of a mixed nature, — 
being both active and passive. 

A few remarks upon these several kinds of exercise will have a 
practical value to some of the readers of these pages. 

Walking is one of the most gentle, easy, and generally one of the 
most useful of the active exercises. It is within the reach of all who 
have the use of their limbs, and is indulged at the expense only of a 
little shoe-leather. To make it agreeable, the face is only to be 
turned to some favorite locality, and the mind put in communion 
with the voices of nature. 

To walk with the best advantage, the body should be kept upright, 
the shoulders thrown back, the breast projected a little forward, so as 
to give the lungs full play, and the air an opportunity to descend to 
the bottom of them. This attitude places all the organs of the body 
ill the most natural position, and relieves them from all restraint. 
Walking then becomes a source of pleasure. The artist who bends 
over his pallet, and gets into a cmmped position, is by this kind of 
walking relieved, and his body kept upright. Females, particularly 
of the wealthier class, are much more apt to neglect this species of 
exercise than males. 

It is not so in England. There it is no uncommon thing for ladies 
of high rank to walk ten miles a day ; and they do it in shoes of suf- 
ficient thickness to protect their feet from all dampness, and in 
clothes large enough to give their muscles full play. As a conse- 
quence, they enjoy excellent health, and in many cases even retain 
their freshness and beauty to old age. 

A master of one of the vessels of our navy who spent some time, 
lately, in the British Channel, was several times invited to spend the 
evening at Lord Hardwick's, where he made the acquaintance of two 
•laughters of his lordship, who, in the drawing-room, he thought the 
most accomplished ladies he ever saw. Yet those young women, on 
two occasions, in company with other friends, walked miles to visit 
his vessel, once on a rainy day, clad in thick, coarse cloth cloaks which 
no rain could penetrate, and caring as little for wet weather as a 
couple of ducks. 

Good for the Studious. — For the studious, walking is a most capi- 
tal exercise. It varies the scenes so constantly, and brings the mind 



■•BiiiiTirann/Tir' 



^■''■■■" ■ ■ I 



94 



HYGIKNE. 



in contact with so many objects, that the monotony of in-door Hfe is 
admirably broken. It was a maxim of Plato, that " he is truly a crip- 
ple, who, cultivating his mind alone, suffers his body to languish." 

Good in Cold Weather. — Walking is valuable in cold weather, 
because it exposes one to the cold atmosphere, and hardens the person 
against frosty weather, — a consideration of great consequence in 
countries which are subject to extremes of cold. 

Running and Leaping are forms of exercise which should be in- 
dulged with prudence even by the young and healthy. For the feeble 
and the aged, they are entirely inadmissible. Used cautiously, in a 
system of regular training, they may help raise the bodily powers to 
a high degree of agility and endurance. The North American Indian, 
who was bred to the chase, ran with surprising swiftness, and for en- 
durance was scarcely excelled by his faithful dog. What training 
has done for the Indian, it may do for the white man, who may 
chance to inherit as good a constitution. 

Tlie Qame of Base-Ball requires very active running, and for the 
young, it is an exceedingly healthful amusement. It fills the whole 
frame with a bounding spirit, and sets the currents of life running 
like swollen brooks after heavy rains. 

QymnasticA. — The more active species of exercise have generally 
been included under the term gymnastics. Among the (ireeks aiul 
Romans, feats of strength and endurance were supposed to confer 
honor. For this reason, and because war was a laborious calling, re- 
quiring bodily endurance and strength, their youth were trained in 
the most active exercises. Gymnastic games were with them at once 
the school of health, and the military academy. 

In England, during the middle ages, acts of Parliament and royal 
proclamations were 'employed to regulate and foster those manly 
sports and exercises, which fitted the people for the activity required 
on the field of battle. 

Those preparations for brutal wars would be unsuited to the pres- 
ent state of the world ; but the capacity for endurance which these 
trainings produced, could be most usefully employed in the laborious 
and scientific researches which modern advancement requires. Very 
few of our scientific men have sufficient hardness of fi-ame to sustain 
them in their laborious studies. 

The heart-diseases which prevail so extensively are the result, 
many of them, of violent exercise, taken, perhaps, from necessity, and 
proving injurious because not a matter of every-day practice. Violent 
exercise, more than any other kind, must be regular in order to be 
borne. 

Needed by Young Women. — Gymnastic exercises and calisthenics 
are particularly needed by our young women, to give them something 
of the robustness of our mothei-s, a few genemtions back. For the 



HYGIENE. 



M 



loor life is 
uly a crip- 
tiguish." 

I weatlier, 
the pei-soii 
qnence in 

uld be in- 

the feeble 

ously, in a 

powers to 

an Indian, 

Hid for en- 

it training 

who may 

nd for the 
the whole 
'e running 

! generally 
treeks and 
to confer 
calling, re- 
trained in 
3in at once 

; and royal 
)8e manly 
;y required 

the pres- 
hich these 
3 laborious 
res. Very 
to sustain 

the result, 
lessity, and 
5. Violent 
rder to be 

alisthenics 
something 
, For the 



want of them, they are dwindling away, and becoming almost worth- 
less for all the purposes for which they were made. 

In view of this want of exercise the introduction of the lucycle 
offers an excellent means of development for ladies, and it is very 
gratifying to note its increasing use. It brings into play many of 
the nniscles of the body, while affording an exhilarating enjoyment 
of fresh air and changing scenery. But caution must be used, not to 
overdo one's self. Short rides only should be taken at first, increas- 
ing the distance as the muscles l)ecome hardened. 

Moderns Physically Inferior to the Ancients. Reason for it. — 

It is evident that the moderns are inferior in bodily strength to the 
ancient Greeks and Romans. Before the introduction of Christianity, 
men knew very little about the future, and therefore strove to make 
the most of the present. Hence, they took measures to ensure health 
and long life. It is true that a due regard to the welfare of the fu- 
ture need not, and should not, prevent a care for the present ; but 
from various causes, to be referred to on a subsequent page, such has 
been the practice, to the manifest physical injury of the race. 

Dancing:, when hedged about with proper restrictions and limita- 
tions, has great advantages as a physical training for the young. 
There are very few forms of exercise which give so free a play to all 
the muscles, and at the same time so agreeably interest the mind. 
Begun in early life, and pursued systematicaHy, dancing imparts a 
grace and ease of motion which nothing else can give. For this rea- 
son alone, it should be cultivated as an art. 

Every man and woman is often placed in circumstances in life 
where the possession of an easy carriage of body, and an unembar- 
rassed manner, would be prized above gold. One's personal influence 
in tlie world is greatly increased by an easy, graceful manner. We 
all know how a polite manner wins, while a rough and vmcouth one 
rejjels us. 

Warning against Excess. — While dancing has many things to 
recommend it, there are also several considerations which should warn 
us against using it to excess, particularly in the ball-rooms of fashion- 
able life. So many muscles are called into play, the breathing is so 
much quickened, and the air breathed is often so impure, that the 
circulation of the blood is hastened almost to fever excitement. And 
when to this we add the use of wines and cordials, alternated with 
ices and iced drinks, and the exposure, on returning home from balls, 
to the chilly night air, under the insufficient protection of light cloth- 
ing, we have drawbacks enough to abridge, if not to annihilate the 
benefits derived from this otherwise healthful and elegant exercise. 

But then it will be said, and truly enough, that these are the abuses, 
not the uses of dancing. To these abuses, no parent should permit 
the health of a child to be exposed. In the parlor at home, with a few 
young friends gathered in to spend an evening ; or, in a well-venti- 



r 



XIIMI 



96 



IIYGIRNR. 



lated hall, under the instruction of a master of known character and 
refinement, dancing is of high utility, and much may be said in its 
favor. An amusement for which there is so general a fondnoss, one 
may say, passion, must be fitted to meet some want of the animal 
economy, and perhaps of man's higher nature. 

Grace of motion gratifies our sense of the beautiful, and in its na- 
ture is allied to poetry. Turning away from the abuses of dancing, 
let the reader thankfully use it as one of the very best physical, so- 
cial, and rosthetical educatora of youth. 

But if dancing is salutary, it is only when every limb and muscle 
is allowed to participate naturally and without restraint in the general 
motion. When performed in a dress so tight as to restrain all free- 
dom, not only is every grace destroyed, but injury of a serious char- 
acter may be the result. 

The Cultivation of a Qarden is also a species of exercise highly 
conducive to health. To the poor it should have a double attraction. 
It is not only a healthful exercise, but it yields, in its season, many 
wholesome vegetables, the price of which, when they have to be pur- 
chased, frequently puts them beyond their reach. It is pleasant to 
know that in many of our manufacturing towns the workmen own 
small pieces of ground which they cultivate as gardens, — deriving 
health both from the labor, and from the vegetables raised. This is 
one of the kinds of exercise which are more beneficial from having 
an end in view. The man who works in his garden derives pleasure 
from the improvement he is making upon his ground, and from the 
prospect of advantage to himself and family. 

Otiier Active Exercises. — To the exercises already spoken of may 
be added those which are mostly taken indoors, — the dumb-bells, 
jumping the rope, battledore, etc. They may be resorted to when 
the weather is stormy, or when any other cause may prevent one 
from going into the open air. Nevertheless, as promoters of health, 
they are inferior to those exercises which take one out under the 
open sky. They are too mechanical in their nature, and have too 
little aim, to be allowed to take the place of the preceding. 

Passive Exercises. 

Sailing. — This, to many persons, is among the most pleasurable 
and exciting of the passive exercises. But the excitement arising 
from the motions of a boat, sometimes, in case of timid persons, de- 
g lerates into /ear, which is injurious. Young gentlemen who man- 
age the boat upon sail:.ig excursions, should never put on too much 
sail in a brisk wind, and torment the ladies by exciting their fears, as 
their own amusement may be in this way purchased at the cost of 
others' health, — a result far enough from their thoughts or inten- 
tions, but not the less real. 



ja w5-iMwTOiifw i i i iH i nMrii< iBiiMwww».«. 



'"nrnfWlifMWii 



'-^A'^iiiiaAi 



■f<ritii ^ 



HYOIRNE. 



97 



ractcr and 
said in itn 
(liicHs, one 
;he animal 

1 in its na- 
f (lancing, 
lynical, so- 

nd muscle 
he general 
u all free- 
rious char- 



ise highly 
attraction, 
^on, many 
to be pur- 
tieasant to 
imen own 
— deriving 
I. This is 
)m having 
98 pleasure 
i from the 



ken of may 
lumb-bells, 
i to when 
revent one 
I of health, 
under the 
1 liave too 



pleasurable 
ent arising 
)er8ons, de- 
I who man- 
too much 
}ir fears, as 
;he cost of 
s or inten- 



Swinging. — The sick may sometimes indulge in this exercise, w^ion 
capable of enduring no other. To swing gently has a soothing eflfect, 
and often allays nervous irritability in a way which nothing else can. 
It is like the lullaby motion of the cradle. It calms and soothes. 

Nervous children and grown persons in feeble health are some- 
times, by roguish boys, swung too high, and very much excited and 
alarmed. This is wrong. It may do great injury. Very few boys 
would do it if they knew the evil consequences. Boys and girls are 
generally kind-hearted ; and though they may like to hector others, 
they will seldom knowingly iin'ure them for their own amusement. 

Carriage-Riding. — The advantages to l)e derived from this species 
of exercise are probably rated too high. For feeble persons, just re- 
covering from illness, who cannot endure walking or riding on horse- 
back, it is valuable, particularlj' if taken in an open carriage. But for 
those who have more strength, it is less desirable than many other 
exercises. True, it is generally an agreeable mode of locomotion, and 
for this reason, it is more serviceable than the small amount of exer- 
cise afforded by it would lead one to suppose. 

Carriages are luxuries, and like all other luxuries, they are apt to 
bring on debility, and perhaps shorten life. A man is apt to order 
his carriage to the door at the time when increasing wealth enables 
him to retire from the active pursuits of life, — the very moment when 
he is most in need of some exertion to take the place of that to which 
he has l)een accustomed. Yet so it is, luxury comes to enfeeble, at 
the time when we need something to harden us. 

Could rich men be persuaded to let their luxuries consist, in part, 
in doing good, and, like Howard, find pleasure in travelling on foot 
to visit those who are sick and in prison, they would be surprised to 
see how their happiness would be increased. 

Close carriages are generally used by the wealthy. They at best 
contain but little air, which is breathed over and over, and becomes 
unfit for respiration. The windows of such carriages should always 
be open, except in rainy weather, when the latticed windows only 
shou'd be used. 

Riding in Sleighs furnishes an agreer'ole excitement, and may be 
indulged in to some extent with advantage. Yet it can be had only 
in cold weather, and persons who partake of its pleasures should be 
careful to wear clothing enough to protect themselves against the 
frost. This is the more necessary, as very little motion is communi- 
cated to their bodies by the sleigh. 

Horseback Riding.— This form of exercise may fairly rank next 
to walking ; in some states of the system it is preferable. It justly 
holds a high rank as an exercise for consumptive persons. Many a 
man, and woman too, has been benefited by it when suffering from 
lung disease. For those who have hernia, or falling of the bowel, it 
is not proper, as the most serious consequences may result from its 
use. 



lilfi 



•i nvniKNE. 

The Horse should be Owned, — A feeble man \/ho rides on horse- 
back, should, if possible, own his hoi"se ; for, beconiinjr attached to 
him, as ho generally does, he will be able to ride farther than ii|)ou 
an animal in which he feels less interest. A honse is p. noble cmou- 
turo, and a man who loves him will sometimes acquire a passiciji, 
almost, for beingupou his back, and witnessing his splendid purfoiin- 
ances. 

Pleasurable Exercises most Beneficial. — Finally, those exorcises 
are most beneticial, and can l>e longest endured, in which we feel the 
greatest interest. Place before eveii a feeble man some desirable (»l>- 
ject, and he will endure a great deal to reach it; or engage the iiiiiid 
of a very tired peraon in something which greatly interests it, and 
considembly more exertion will be easily borne;. This is well illus- 
trated by the story told by Miss Edgeworth of a certain father, who 
had taken a long walk with his little son, and founil the boy appar- 
ently unable to walk further, some time before reaching home. 
" Here," said the shrewd-minded father, " ride on my gold-headed 
cane." Immediately the little fellow was astride the cane, which 
carried him as safely home as the freshest horse. 

Mentc' Co-operation is of the highest importance in all exercise. 
Men who are paid by the job, work with far more spirit than those 
who are paid by the day. One would dig in the earth with \ery 
little spirit, if he had no motive for doing it ; but if expected with 
every shovelful of earth to bring u[) gold-dust, he would not only 
work with a will, but would endure a great deal more labor. From 
these considerations we may infer that those farmers and manufac- 
turers who pay their men the highest wages, make the most money 
on their work. 

The best time for taking exercise is that in which it does us most 
good. For most pei-sons the morning hours may be considered most 
favorable. But there are many who cannot take exercise in the early 
morning, without suffering from it through the whole day. Some 
are able to walk miles in the afternoon, who would be made sick by 
similar exertions immediately after rising. 

Persons often injure friends who have this peculiarity of constitu- 
tion by urging them out in the morning. They do it from good mo- 
tives, but are, nevertheless, blameworthy for attempting to advise iu 
matters which they do not understand. 



Rest and Sleep. 

Oim bodies are like clocks ; they run down and are wound up once 
every twenty-four hours. Were they obliged to work on uninter- 
ruptedly, they would wear out in a few days. It is a merciful pro- 
vision that periods of repose are allotted to us. Eveiything has its 



-"®^;.?*flAi'.T;-VAt,~ i!K55rei3r«.i'a*a 



HYOIENE. 



M 



oil liorse- 
tiU'lmil to 
Imu iijioii 
• >l)lo creii- 
a passion, 
1 pt'ifoiiu- 



1 exorcis's 

feel ilic 

siraltlc dlh 

ttu! niiiid 

tH it, and 

veil illiiH- 

itlier, will) 

lK)y a|)[)ar- 

njj iioiiie. 

)l(l-ht>adcd 

me, which 



1 exercise. 

han those 

with \^ry 

ectcd witli 

not only 

or. From 

. manufac- 

ost money 



les us most 
lered most 
1 the early 
ly. Some 
de sick hy 

I constitu- 
: good mo- 
advise in 



id up once 
Q uninter- 
rciful pro- 
ing has its 



proper place. Rest is not less a luxury after oxercisc, than exercise 
is after rest. They botli confer happiness at the same time thai they 
promote our well-l/oing. 

Sleeping Rooms. — The largest part of our rest is taken in sleep. 
Of course the kind of room in which we sleep is worthy of considera- 
tion. Hufeland says: "It must not Ikj forgotten that wo spend a 
considerable portion of our lives in the l)ed-chamber, and consecpiently 
that its healthiness or iinhealthinuss cannot fail to have a very ini 
portant influence upon our physical well-being." It should at lea«t 
1)0 huge. That is of prime importance, Iwcause, during the several 
iiours tliat wo are in bed, we need to breathe a great deal of air, and 
our health is injured when we are obliged to breathe it several times 
over. We should at least pay as much attention to the size, situa- 
tion, temperature, and cleanliness of the room we occupy during the 
horn's of repose, as to the parlors, or drawing-room, or any other 
apartment. And yet how different from this is tho general practice 
of families. The smallest room in the hoi^ise is commonly set apart 
for the bed and ita nightly occupants. 

The sleeping-room should have a good location, so as to be dry. 
It should be kept clean, and neither be too hot nor too cold. And, 
more important still, it should be well ventilated. 

One bed, occupied by two persons, is as mucli as should ever be 
allowed in a single room ; though, of course, two beds in a large room 
are no more than one in a small one. Both are objectionable. 

Fire in Sleeping Rooms. — As to having fire in a sleeping room, 
that is a matter to be determine:' by the health of the occupant. 
Persons who have poor circulation, and are feeble, had better have a 
little fire in the bed-chamber in cold weather. For those in good 
health a cold room is preferable. 

Open Windows in Sleeping Rooms. — In the hot weather of sum- 
mer, it is better to keep the windows open to some extent, through 
the night, but not on opposite sides of the room so as to make a draft 
across the bed. 

There is a difference of opinion as to the safety of this practice, 
but the experience of those who have used it prudently and persever- 
ingly has generally sanctioned its employment. It is presumed that 
night-ail is made to be breathed; and if we breathe it habitually, 
there is no good reason why it should be considered hurtful. At all 
events we have got to do one of three things, — either breathe it, or 
be poisoned by air which is breathed several times over, or use very 
large sleeping-rooms, and thus lay in a stock to last over night. 

An Open Fireplace in a bed-chamber will do much towards its 
purification. It carries off foul air. But many persons board up this 
outlet as if bad air were a friend with whom they could not think of 
parting. At the same time they will carefully close all windows and 
doors, as if fresh air were an enemy not to be let in. 



100 



HYGIENE. 



Beds. — It is a pleasant thought that while so many things which 
injure health are coming into fashion, some which have a like effect 
are going out. Among the injurious things which are silently witli- 
drawing are feather-beds. 

In earlier times, a bed made of eider-down was thought to be a 
great luxury^ to be carefully preserved, and handed down from mother 
to daughter. Beds made of hen's feathers, and other coarser kinds, 
were thought to be only fit for children. With due deference to 
these earlier judgments, it must be said that feather beds, whether 
downy or coarae, are not even fit for children. They are composed 
of animal matter, and by a slow process of decay, are always, when 
stirred, sending up an exhalation which it is not healthful to breathe. 

By their softness, too, they increase the general tendency to effemi- 
nacy. In warm weather they are too heating. To sink down into 
thera, and lie nearly buried all night, is to insure a feeling of lassi- 
tude and debility in the morning. Only the strongest persons can 
endure it without being made conscious of the evil effects. 

Beds must not be too Hard. — On the other hand, it is almost 
equally unwise to choose a bed of absolutely unyielding hardness. 
When very tired, we may rest even upon a board ; but sleep will 
generally be moro sound as well as refreshing, if the bed be some- 
what yielding. The hair mattress is the very best bed yet used. It 
is healthful and easy. No person once accustomed to it will ever 
return to feathera In summer, it is a luxury ; in winter, it is suffi- 
ciently warm, though a little more covering is needed than with 
feathers. 

Bedding. — In hot weather, linen sheets are preferable to cotton, 
and of course will be used by those who have ample means. But 
cotton ones are good enough, and in winter are decidedly the more 
desirable of th<3 two. Cotton is best, too, for those who suffer with 
rheumatic affections. For external covering, comforts are objection- 
able, because they do not let the insensible pe spiration pass off as 
freely as it should. They are light, however, and so are rose blankets, 
which have the additional good quality of being porous. We should 
sleep under as few clothes as possible, consistently with con. fort. 

Night- Dress. — The flannel, cotton, linen, or silk, worn next the 
skin through the day, should always be replaced, on retiring, by a 
suitable night-dress. The undershirt should be cf the same ma- 
terial with that which is taken off, but thinner. If we wear flannel 
through the day, we need it quite as much at night. 

Do not Cover tlie Face. — The practice of sleeping with the face 
entirely covered with the bed-clothes is very injurious. It compels 
one to breathe the air over several times. 

Natural Position for Sleep. — The most natural position in which 
to sleep is upon the right side. This affords the easiest play to the 



"■T^aafe'iWa^^^reaBtiBy'gaaw iiiiia^ ^ ATg 



HTOIEKI. 



101 



internal organs. It is best, however, to learn to sleep in different 
positions, and to change occasionally from side to side. Upon the 
bacic is not so easy a position. To lie in this way obstructs the cir- 
culation of the blood, by the pressure of the stomach, bowels, etc., 
upon the large blood-vessels which pass down and up in front of the 
backbone. It u very tiresome and inJHrious to lie with the hands 
above the head. 

Amount of Sleep. — The average auiount of sleep required by 
persons in health is from seven to eight hours. Occasionally we find 
persons who get along very well with six, or even five hours ; while 
some, even in health, require nine. There is no ^vbsolute standard 
for all persons, in the amount of sleep, any more than in that of 
food. It depends on the temperament, the constitution, the amount 
of exercise, and the exhausting nature of the mental application. 

The object of sleep is to repair the energies, the extent to which 
they are wasted, and the recuperative power possessed, will measure 
the amount required. 

Late Suppers. — These are a bar to all sound and healthful sleep. 
The last meal should always be taken at least three hours before re- 
tiring and should be light. During sleep the stomach should have a 
chance to rest. It will work the better on the morrow. ^ Some per- 
,8ons boast that they can sleep perfectly well after a heavy supper. 
Perhaps they can, but, as Franklin lias wisely suggested, they may 
by and by " have a fit of apoplexy, and sleep till doomsday." This 
will be sleeping too well! 

Preparation for Sleep. — Dr. Franklin left behind the record of 
a wise life, as well as many excellent moral and philusophical direc- 
tions. A good conscience was his prescription for quiet sleep and 
pleasant dreams, — a most excellent direction. Sleep is promoted, 
too, by withdrawing the mind, a short time before retiring, from all 
hard study and exciting themes of conversation, and turning it to 
calmer subjects of reflection, such as the moral attributes of God, and 
particularly his love and paternal character 



Objects oii Clothing. 

The clothes we wear are intended, or should be intended, to secure 
three objects, — warmth in winter, coolness in summer, and health at all 
times. 

It has already been shown that our bodies are warmed by their 
own internal fires. In the lungs, in the skin, and indeed in all parts 
of the body, oxygen unites vath carbon , : d other combustible mat- 
ters, producing heat in the same way that it is produced in a grate 
where coal is burned ; and as our temperature always needs to be kept 
to about 98° Farenheit, it follows that this combustion must always 
be going on. 



102 



HYOIENE. 



Now, the atmosphere which surrounds us is alwajrs receiving into 
itself the heat which comes to the surface of our bodies, and thus 
robbing us of our warmth. In summer, the atmosphere, full of the 
rays of a burning sun, may impart heat, instead of taking it away ; 
while in winter it takes more than it gives, and would cause us to 
parish with the cold, were it not for the protection afforded by our 
clothing. 

Clothes, of course, have no power to manufacture or impart heat. 
They only retain, and keep in contact with our bodies, that which is 
generated within us. If we have on a single garment which is made 
tight at the bottom and top, so that no current can pass up or down, 
there will be a layer of air between it and the body, which, becoming 
immediately heated, and being retained there, helps keep us warm, or 
rather, prevents us from being cold. With every additional garment 
put over this, there is another layer of heated air, adding still more 
impenetrable guards against either the intrusion of cold, or the escape 
of internal heat. 

Bad Conductors of Heat. — But, that our clothes may thus retain 
our warmth, and prevent its dispersion, they must be had conductors 
of heat, — that is, they must not readily take up the heat and convey 
it away from the body. They must slowly absorb the caloric into 
their own substance, and then retain it tenaciously. 

Linen, which is so universally popular in temperate climates, as 
an article to be woi-n next the skin, is unfortunately a good conduc- 
tor of heat. It does not afford a warm garment. It conducts heat 
rapidly away from the body. Hence it always 
feels cool to the touch. It is really no colder in 
itself than other kinds of cloth, but it is solely 
the rapidity Avith which it conducts heat away 
from the body, that gives it the feeling of cold- 
ness. It has other qualities which compensate, 
in some measure, for this defect. The fibres of which it is composed 
are round and pliable, which makes linen cloth smooth and soft, and 
the sensations produced by it on the skin altogether agreeable. Fig. 
67 represents a fibre of linen, as it appears under a microscope which 
magnifies it 155 times. 

Cotton is warmer than linen, because it is a worse conductor of 
heat. The perfection to which its manufacture has been carried, 
makes it almost a rival of linen in softness and pliability. It does 
not al)sorb as much moisture as linen, and there- 
fore better retains its powers as a non-conductor. 
But then the fibres of cotton are not round and 
smooth, like those of linen, but flat and spiral, 
with sharp edges. Fig. 68 represents two of its 
fibres, magnified 155 times. This renders cotton 
irritable to some very delicate skins. This is the reason why linen 




Fio. er. 




FlO. 68. 



HYGIKNE. 



103 




Biving into 
i, and thus 
full of tlu. 
J it away; 
iiuse us to 
led by our 

npart heat, 
it which is 
ch is made 
p or down, 
, becoming 
8 warm, or 
\\ garment 
still more 
the escape 

hus retain 
conductors 
nd convey 
iloric into 



limates, as 
id conduc- 
iucts heat 

it always 
3 colder in 
it is solely 
heat away 
g of cold- 
jmpensate, 

composed 
I soft, and 
,ble. Fig. 
ope which 

nductor of 
sn carried, 
. It does 
and there- 
conductor, 
round and 
and spiral, 
two of its 
lers cotton 
why linen 




FlO. 69. 



is better than cotton for binding up wounds, where there is tender- 
ness of the surface. 

Silk has a round fibre, like linen, which is even softer and smaller. 
It absorbs less moisture than cotton, and in its power of retaining 
warmth, it is superior to both the preceding. It forniR the most de- 
sirable fabric for clothing that we have ; but its cost makes it inacces- 
sible to the great body of the people, except as a holiday dress for 
the ladies. Its culture in our country, if extensively established, 
would be a source of national wealth. 

The Fibre of Wool is quite rough, almost scaly, and highly irrita- 
tive to delicate skins. Fig. 69 shows fibres magnified 310 times. It 
is not possible for some persons to wear it next 
the skin. But where this cannot be done it may 
be worn outside the linen or cotton ; and being a 
good nortrconduetor, it will in this way preseive 
the warmth of the body, without either irritating 
the skin, or disturbing its electricity. 

Wool, in cold climates, is one of the very best 
materials of which clothes can be made. In New 
England, and, indeed, in all cold and temperate 
regions, it should be worn by delicate persons, in 
the form of thick or thin garments, all the year round. It does not 
readily absorb moisture, and is a dry, warm, and wholesome material 
for clothing. 

Hair. — Though not precisely in the line of these remarks, hair 
may as well be introduced here. Wool is in fact hair. Every part 
of the skin, with the exception of that upon the soles of the feet, and 
the palms of the hands, is intended to produce hairs. On most parts 
of the body, they are short and fine, hardly ri-'ing above the surface. 
Upon the head and the face, they grow to coii,.iderable length. 

Hair, like wool, is a bad conductor of heat ; and, as growing upon 
the head and face, is doubtless intended for some useful purpose. 
That it was designed as a warm covering, can hardly be doubted. 
The beard, when permitted to grow, is a natural respirator, guarding 
the lungs against cold and dust. It has been noticed that black- 
smiths who have allowed their beards to grow, had their mustache 
discolored by iron-dust, which lodged among the hairs, and very 
justly inferred that the dust must have found its way into the lungs, 
and done mischief, had it not been arrested by this natural respirator. 

That the beard, when long, does Avard off a grcsat many colds and 
throat troubles, is too well known to be denied. It has required moral 
courage on the part of those who have broken away 
from the universal practice of shaving, foe which they 
should be honored rather than ridiculed. For those 
who do not suffer from throat or lung complaints, espe- 1 
cially if they are getting advanced in life, it may not be 
thought worth while to abandon the razor. Yet the change would 




M 



*!! 



FlO. 70. 



■P&asvw" 



■^^smmmm^ii&m&^^^i<iiiM^> 



104 



.lYOIENE. 



not be regretted. Fig. 70 is a human hair, magnified 250 timts, 
showing its scaly surface. 

The Color of our Clothing is a matter of some moment. The dark 
colors absorb the light, the sun's rays, and heat, much more than the 
lighter ones ; and as those bodies which absorb heat well are likewise 
good radiators, the dark colors have the highest radiating power. White 
reflect heat and rays of light, and is a bad absorber and bad radiator. 
In su.amer it prevents the sun's rays from passing inward to heat the 
body, and in winter, intermpts the heat of the body in its passage 
out. In summer, it makes the coolest garment ; in winter the warmest 
one. These facts can be very simply illustrated, by laying, side bj 
side, upon the snow, when the sun shines, two pieces of cloth, the 
one black, the other white. Lifting them up, after a time, the snow 
will be found considerably melted under the black cloth, but not under 
the white. 

It is now seen that the object of' clothing is not to impart heat to 
the body, but to prevent its loss ; that it is not to create it, but to 
furnish the occasion for increasing its degree. It appears further, 
that clothing protects the body against the evil effects of changes of 
temperature, and that white garments, by reflecting, instead of ab- 
sorbing heat, guard it against the heat of summer. 

Clothing should be Porous. — All articles used for garments should 
be porous, and permit the free passage of insensible perspiration. The 
skin receives oxygen through its pores, and gives back carbonic acid. 
It performs a sort of subordinate respiration. India-rubber garments, 
worn next to it, interrupt this, and must do mischief. Shoes made 
of this material soon cause the feet to become damp and cold. The 
dampness is occasioned by the insensible perspimtion, which cannot 
escape through the rubber. Such shoes worn in the open air, should 
be immediately taken off on entering the house. 

Thin Shoes. — The defective way in which American females pro- 
tect their feet from cold and wet, is a sore evil; and he who persuades 
them to adopt a wiser fashion, and cover their feet with better guard? 
against colds and consumption, will deserve the gratitude of the na- 
tion. We are in many things too fond of copying foreign fashions: 
but if our ladies would, in this matter, follow the excellent example 
of English women, they would live longer, and leave a hardier pos- 
terity behind them. 

The shoes worn by our females, high and low, rich and poor, are 
not thick enough to walk with safety upon a painted floor, hardly 
upon a carpet in an unwarmed room ; and yet they walk with them 
upon cold brick sidewalks, upon damp and frozen ground, and even 
in mud. 

The result is, that they suffer from colds, sore throats, pleurisies, 
lung-fevers, suppressions, inflammations of the womb, and many other 
ailments, which in early life rob them of their freshness and beauty, 



'•i»^^\ 



;k«w«iesii;;;^«i^S£uu^^^ 



HYGIENE. 



106 



passage 



of tlioir health aftfl comfort, of their usefulness to their linusehold 
1111(1 the world, and leave them helpless in the arms of their friends, 
with a patrimony of suffering for themselves while they live and a 
legacy of disease to hand down to their children. Would that they 
were wise in season ' Some, to their honor be it said, have already 



adopted a safer coui-se. 
rected. 



It is hoped the evil will be gradually cor- 



Never attempt to mould the Form by Dress. — Parents commit a 
great error when they attempt to mould the forms of their children, 
particularly their daughters, by their dress. This cannot be done. 
It is the work of nature, and she wants no assistance in it. The 
great object of dress in childhood, as well as in adult life, is to pro- 
mote health. With this, there is not much difficulty in preserving 
the symmetry ; without it, deformity is almost a matter of course. 

The fact cannot be too often repeated, nor too seriously urged upon 
parents, that while the foundation of all graceful and just proportion 
of the different parts of the body must be laid in infancy, it cannot 
be done by tight bands, and ligatures upon the chest, and loins, and 
legs, and arms. Upon all these points, the garments of children 
should set easy, leaving the muscles at liberty to assume the fine 
swell and development which nothing short of unconstrained exercise 
can give. Could infants tell all the hon'ors they suffer from the re- 
straints put upon them by tight dresses, it would make many a 
mother's heart bleed. 

In these brief remarks, the principles are given which should guide 
us in the selection of our clothing. The intelligent reader will be 
able very easily to fill up the outline. 



Bathing and Cleanliness. 

Aristotle calls cleanliness one of the half virtues ; and Addison, 
ill the Spectator, recommends it as a mark of politeness, and as analo- 
gous to purity of mind. Both in the Jewish and Mohammedan law, 
it is enforced as a part of religious duty. Its requirement as a pre- 
requisite to cliristian communion would be wiser than the demands 
sometimes made. A dirty Christian may perhaps be found, but not 
among those who mean to be intelligent. 

The importance of keeping the skin clean is not generally appreci- 
ated. The motive for cleanliness is often a lower and meaner one 
than should be allowed to have place in the mind. Many persons 
would be mortified to have their hands, or face, or neck dirty, who 
ilo not wash their whole body once a year. That they may appear 
well in the eyes of others, is the only motive with such for keeping 
clean. 

Offices of the Skin. — If we look a little at the offices of the skin, 
we shall better understand the need of keeping it clean. 



■■■■ 



106 



HYGIENE. 




The skin is not merely a covering to protect us trom the weather. 
It is a living structure, curiously wrought, with a large extent of sur- 
face, and having important duties to perform in the animal economy. 
Its structure is more particularly explained under the liead of " Anat- 
omy " and " Skin Diseases." It has been aheady said, that it helps 
the lungs in breathing. It does many other things on Wi.ich the health 
is dependent. 

Number of Perspiratory Tubes. — The skin performs several 
kinds of secretion, — that is, it separates several things from tlie 
blood, — one of which is the persjnratfbn, or sweat. The sweat is 
formed in small glands, situated just under the skin, and is brought 
to the surface in small ducts, or tubes, like the hose tlirough which 
firemen throw water. These little tubes are spiral, as seen in cut 44. 
and run up through the two skins. 

These spiral canals are very numerous, covering every part of the 
human frame, - there being about 2800 of them upon every square 
inch throughout the body ; and as a man of ordinary size has about 
2500 square inches of surface, the number of tubes in the skin of one 
man is seven millions. 

The mouths of these tubes are called tlie pores of the skin. Each 
one of these tubes is extended just below the skin ; and there, among 
the cells where the fat is deposited it, or rather the two bi-anches into 
which it is divided, is wound into a coil, called the sudoriferous or 
sweat gland. These ducts are each about a quarter of an inch in 
length, which make an aggregate length of tubing in the human skin 
of about twenty-eight miles. 

Insensible Perspiration. — Through each of these seven million of 
quarter-inch hose, there is poxired out, day and night, as long as a 
man lives, a stream of sweat in the form of vapor. When this is 
thrown off very rapidly, as happens when active exercise is taken, it 
accumulates in drops, and is called sweat. Ordinarily it does not 
thus accumulate ; it is then called insensible perspiration, — not 
being recognized by the senses. 

This transpiration may be proved very beautifully by inserting the 
naked arm into a long glass jar, and closing up the space around it 
at the month so that no air can get in. The inside of the glass will 
soon be covered with a vapor, which will grow more and more den.se 
until it is converted into drops. Boerhaave says : " If the piercing 
chill of winter could be introduced into a summer assembly, the in- 
sensible perspiration being suddenly condensed, would give to each 
person the appearance of a heathen deity, wrapped in his own sepa- 
rate cloud." 

Now, this continual exudation of sweat through these millions of 
tubes is for a wise and necessary purpose. It is to take out of the 
blood and other fluids various salts, which would do mischief if 
allowed to remain longer, and particularly carbonic acid, which is 



ESfissBEKeanHH 



HTGIENB. 



107 



the weather, 
ffentof sur- 
iil economy. 
'1 of " Anat- 
that it helps 
h the health 

rms several 
fs from the 
he sweat is 
is brought 
ough which 
11 in cut 44. 

part of the 

very square 

;e has al)out 

skin of one 

skin. Each 
lere, among 
unches into 
oriferous or 
an inch in 
luman skin 

n million of 
s long as a 
/^hen this is 
is taken, it 
it does not 
tion, — not 

iserting the 
! around it 
B glass will 
more den.se 
16 piercing 
bly, the in- 
ve to each 
own sepa- 

millions of 
out of the 
nischief if 
, which is 



poisonous, — the same matters, in fact, which are thrown out by the 
lungs. The skin, in truth, is a kind of helper of the lungs ; and a 
lady, by covering herself with garments which have no pores, and 
will neither admit air nor let off insensible perspiration, may be 
strangled almost as certainly as by putting a cord around her neck, 
and closing her windpipe. Almost twice as much fluid passes off 
through the skin as through the lungs. 

Keep the Pores Open. — It is obvious from what has now been 
said, that the pores of the skin should be kept open to preserve 
health. When bathing is neglected, and the undergannents are not 
changed sufficiently often, the insensible perspiration accumulates 
and dries up upon the skin, mingling with the oily matter secreted 
by the oil-glands, and with tha slireds of the scarf-skin, and form- 
ing a tenacious gluey matter, which closes up the pores. By this 
misfortune, that large quantity of worn-out matter which usually 
goes off with the fluid througVi the pores is retained to poison and 
embarnvss the living current of blood, or seek an outlet through lungs 
or kidneys, which are already burdened with quite as much as they 
are able to do. How important, then, that these channels through 
which the body is purified should be kept open I that the skin shoiUd 
be kept healthy and in working order ! 

The Bath, the Great Purifier. — But this can only be done by . 
daily washing. The bath is the great purifier of the human skin. 

The antiquity of bathing is very great. The practice is supposed 
to reach back to the infancy of the race, or certainly to a very early 
period. The inhabitants of Middle Asia are said to have been the 
firet to use the bath for the specific purposes of purification and 
health. Domestic baths are represented as having been used by 
Dioraed and Ulysses. Andromache prepared warm water for Hector 
on his return from battle. Penelope banished sorrow by unguents 
and baths. 

The Baths of the Medes, the Persians, and the Assyrians were 
much celebrated. Alexander, though familiar with the voluptuous 
baths of Greece and Macedon, was astonished at the magnificence of 
those of Darius. 

Roman Baths. — As luxury and refinement advanced, the means 
of luxurious bathing were multiplied, until establishments were 
built by the Romans, the very remains of which excite wonder at 
this day. Among these are the Thermae of Agrippa, of Nero, of 
Vespasian, of Titus, etc. One of the halls of the building con- 
structed for baths by Diocletian, forms at this day the church of the 
Carthusians, one of the most magnificent temples in Rome. 

Number and Character. — According to Pliny, baths were intro- 
duced into Rcme about the time of Pompey ; their first erection 
Dion attributes to Maecenas. Agrippa increased their number to 



108 



HYGIENK. 



one hundred and seventy ; and within two hundred years they were 
multiplied to about eight hundred. These establishments were sn 
vast that one writer compares them to provinces. They were paved 
either with crystal, or mosaic, or plaster, and were adorned by Hcidj)- 
ture and painting to the very highest degree. They added not 
merely to the health and luxury of the people, but contributed to 
their culture in the highest departments of art and taste. 

Names of Baths. — To the apartment of their dwelling in wliich 
they washed their bodies in warm or hot water, the Romans gave 
the name of balneum, or bath ; to the public establishments, that of 
balnea, or baths. The apartment which held the vessels was called 
vasarium. In this were the three immense vessels which conttuned 
the cold, warm, and hot water. There were instruments of lx)ne, 
ivory, and metal, for scraping the skin, with a groove in the edge, 
through which the impurities of the skin might run oif. 

On the north front of the thermae was a reservoir of cold water 
large enough for swimming, called by Pliny the younger, baptuterinm. 
In the centre was a spacious vestibule, and on each side, warm, cold. 
and vapor biths, with apartments for cooling, dressing, and refresli- 
ments. There was the frigidarium, a vaulted room, a cooling room 
midway between the warmer and the open air ; the tepidarium, with 
a temperature midway between the above and the hot bath ; and the 
calidanum, or the vapor bath. 

Then there was the room where the body was rubbed over with a 
great number of ointments and essences of the most precious kinds ; 
and another in which it was sprinkled over with powder ; and also a 
room which held the clothes, in which the bathera undressed and 
dressed at pleasure. 

All these upartments were double, the two wings being appropri- 
ated to the sexes. 

Open to all. — These baths, thus numerous and magnificent, were 
open to all classes of the people, and contributed largely to the gen- 
eral health and physical endurance for which the Romans were con- 
spicuous. 

The Bath Neglected under the Christian System. —When Jesus 
of Nazareth came into the world, he found man's nature cultivated 
in a most defective way. The moral element had sunk down to the 
lowest place, while the physical had risen to the highest, — just the 
reverse of the true order of things. This Divine Teacher came, not 
to recomm i a neglect of the body, but a new cure for the imper- 
ishable pa. -. Mankind were for the first time systematically taught 
to forgive injuries. Prostrate liberty and degraded woman became 
the wards of Christianity. 

Unfortunately, under the new order of things, the lower element 
of man, which had been exalted and worshipped, was cast down and 
abused. What the Pagan had pampered, the Chiistian pei-secuted. 



*»- ---- ^ 



HYGIENK. 



109 



i they were 
nte were ho 
were jHivcd 
hI hy Hculj)- 
added not 
tribntcd (o 

ig in wliicli 
)mans gave 
intH, that of 
was calh'd 
1 contained 
t« of lx)ne, 
1 the edge, 

coUl water 
aptisterinm. 
warm, cold, 
nd refresh- 
loling room 
%rium, with 
h ; and the 

over with a 

iouu kinds ; 

and also a 

ressed and 



appropri- 



icent, were 
to the gen- 
were con- 

^hen Jesus 

cultivated 

own to the 

-just the 

came, not 

the imper- 

illy taught 

an became 

element 
down and 
teraecuted. 



The Imdy, which had been bathed, and scrubbed, and anointed, and 
perfumed, waa thenceforward, in consequence of the improper inter- 
pretation of certain texts, scourged, and fasted, and clothed in rags. 
Thousands believed, and thousands do to this day, that to torment 
the body is to please God. Under this feeling, the public and pri- 
vate baths were neglected ; and to this day no Christian nation has 
fully appreciated the necessity of cleanliness, and of sanitary meas- 
ures for the maintenance of the public health. To a considerable 
extent, the body is still under disabilities ; still the subject of perse- 
cution ; and where this is not the case, it is too often regarded only 
as a loose outside garment, to be thrown over the traveller to the 
celestial city, and is expected to be well soiled with mud and dust. 
The teachings of the Great Master will by and by cease to be per- 
verted, and will be applied to raise up man's body, as they have 
raised his mental and moral nature, and will make a well-developed 
and harmonious being. 

In the meantime, it is the duty and the privilege of the physician 
to urge a return, not to the magnificence of the ancient regimen for 
training the body, but to its real efficiency in a simpler form. 

Cold Bathing. — Water applied to the skin at a temperature below 
75° of Farenheit, is called a cold bath. If applied to a person with 
sufficient constitutional energy to bear it, it is a decided and very 
powerful tonic. By this is meant that it promotes the solidity, com- 
pactness, and strength of the body. 

The first effect of the application of cold water to the skin, is the 
sudden contraction of all its vessels, and the retreat of the blood 
towards the internal organs. The nervous system, feeling the shock, 
causes the heart to contract with more energy, and throw the blood 
back with new force to the surface. 

This rushing of the blood back to the skin, is called a reaction ; 
and when it occurs with some energy, it is an evidence that the sys- 
tem is in a condition to be much benefited by the cold bath. When 
this does not take place, but the skin looks shrunken, and covered 
with " goose flesh," and a chilliness is felt for a longer or shorter time 
after bathing, then the inference should be, either that the water has 
been used too profusely, or that the bather has too little reactionary 
power for this form of the bath. The latter conclusion must not be 
accepted until cold water has been tried with all possible guards, — 
such as beginning with tepid water, and gfradually lowering the tem- 
perature ; bathing for a time, at least, in a warm room ; beginning 
the practice in warm weather ; and applying the water at first with a 
sponge out of which most of it has been pressed by the hand. With 
some or all of these precautions, mosf persons may learn to use the 
cold bath. It is always to be followed by brisk rubbing with a coarse 
towel or flesh-brush. 

The Sponge Bath. — \. wet sponge is the simplest, as well as the 
best mode of applying water to the surface of the body. With per- 



fiU 



tli> 



Jl 



no 



HYGIENE. 



sons who are feeble, a [nirl only of the hody should bo exposed at a 
time, — which part, having been quickly sponged and wiped dry, 
should Ihj covered, and another part exposed, and treated in a likt; 
manner. In this way, all parts of the body may successively be kiiI)- 
jected to the bnvcing influence of water and friction, with little risk, 
even to the most delicate, of an injurious shock. The only furniture 
required for carrying out this simple plan of bathing, is a sponge, a 
basin, anrl a towel. There is no form of iNithing so universally appli- 
cable as this, or so generally conducive to health. 

The Shower Bath requires a brief notice. The shock to the ner- 
vous system produced by itKs much greater than that from sponging. 
Beside the sudden application of coldness, there is a concussion of 
the skin by the fall of the water. This form of the bath is excellent 
for those who are strong and full of vitality, but is fraught with some 
danger for the feeble and delicate. This, however, depends on the 
judgment with which it is used. In the form of a delicate shower, 
and with tepid water, the frailest body might bear its shock. 

The Warm Bath. — A temperate bath ranges from 75° to 85° ; a 
tepid bath, from 86° to 95° ; a warm bath, from 95° to 98° ; a hot 
bath from 98° to 105°. A warm bath is of the same temperature 
with the surface of the body. Of course it produces no shock. To 
those who are past the meridian of life, and have dry skins, and l)egin 
to be emaciated, the warm bath, for half an hour, twice a week, is 
eminently serviceable in retarding the advances of age. 

It is a mistake to suppose the wann bath is enfeebling. It has a 
soothing and tranquillizing effect. It renders the pulse a little 
slower, and the breathing more even. If the bath be above 98°, it 
becomes a hot one, and the pulse is quickened. 

The temperature of the warm bath, as of the cold, should be made 
to range up and down according to the vigor of the frame, and the 
circulation of the individual. The aged and the infirm, whose hands 
and feet are habitually cold, require it to be well up towards the 
point of blood heat. The pulse should not be made to beat faster by 
it, nor should sensations of heat or fullness be induced about the 
temples and face. 

The Vapor Bath. — This differs from the warm bath in being ap- 
plied to the interior as well as to the exterior of the body. The 
warmth is inhaled into the air-tubes at the same time that it envelops 
the external person. The first sensation of the vapor bath is oppres- 
sion, and causes some difficulty of breathing ; but this passes off as 
soon as the perspiration begins to flow. From' the steam-chamber, 
the bather should step into a tepid bath, and after remaining a short 
time in this, wipe himself thoroughly with diy towels. 

Cold Affusion immediately after either the warm or the vapor bath, 
i(i excellent. In Russia it is common, after the vapor bath, to pour 



m^ 




posed at a 

npud dry, 

in a like 

ily IX! Hlll)- 

Uttli' risk, 

' furniture 

sponge, a 

ally appli- 



to tlio ner- 
Hpoiiging. 
cu88ion of 
) excellent 
with some 
ids on tlie 
te shower, 
k. 

to 85° ; a 
'8°; a hot 
mperature 
bock. To 
and l)egin 
■I week, is 

It has a 
se a little 
»ve 98°, it 

d be made 
, and the 

1086 hands 

wards the 
fiister by 

about the 

being aj*- 
dy. The 
envelops 
IS oppres- 
ses off as 
-chamber, 
y a short 

ipor bath, 
1, to pour 



HYUIENK. 



lU 



upon the head of the bather a bucket of warm water, then one of 
tepid, and hwtly one of cold ; and to finish with giving hira a good 
towelling. It is even said that the natives leave the uteaiu and the 
hot bath, and roll themselves in the snow. 

No danger need Ik; feared from cold affuwion when the skin is red 
and excited by tlie warm bath, provided the nervous frame is not in 
a depressed condition. If the body is chilled, and the nerves pros- 
trated by disease or fatigue, the appli(!ation of cold water to the skin 
may do great mischief, and should in no case bo hazarded. Cold 
water applied to a hot skin cannot do harm ; to a cold skin, it can do 
nothing but harm. Hence, the cold bath may In; used with advan- 
tage on rising in the morning, while the lK)dy is warn>. Another good 
time is at ten or eleven o'clock in the forenoon, when the nervous 
power is advancing towards its height for the day. 

Reaction Necessary. — iVs a means for promoting cleanliness, the 
importance of the bath can liardly be overstated. For the support 
and improvement of health, it is equally important. But for the pro- 
motion of the latter, one prerequisite is essential, — the reaction of 
the skin. 

Various means are resorted to, to secure this. The Hindoos secure 
it by a kind of shampooing, thus described by a writer: " One of the 
attendants on the bath extends you upon a bench, sprinkles you with 
warm water, and presses the whole body in an admirable nianner.- 
He cracks the joints of the fingers, and of all the extremities. He 
then places you upon the stomach, pinches you over the kidneys, 
seizes you by the shoulders, and cracks the spine by agitating all the 
vertebrae, strikes some powerful blows over the fleshy and muscular 
parts, then rubs the body with a hair-glove until he perspires," etc. 
" This process," siiys the wiiter, " continues for three-quartera of an 
hour, after which a man scarcely knows himself; he feels like a new 
l)ei.ig." Sir John Sinclair speaks thus of the luxury of the process : 
" Tf life be nothing but a brief succession of our ideas, the rapidity 
with which they now pass over the mind would induce one to believe 
that in the few short minutes he has spent in the bath, he has lived a 
number of years." 

The Coarse Towel, the horsehair glove, and the flesh-brush are the 
appliances commonly used for stimulating the skin, and causing re- 
action. For tender skins, the towel is sufficiently rough. With this 
the bather should rub himself, unless he is weak and the exertion 
produces palpitation. The muscular exertion necessary for this will 
help the reaction. 

Restoration oi the. Bath deslrabie. — It is greatly to be wished 
that the bath miglit be restored to .something like the importance it 
held among ancient nations. It is a luxury, a means of health, and 
iv source of purity both of body and of mind ; for the morals of any 
people will rise when"} the use of the bath is regular and habitual. 



h 



112 



HYUIENR. 



The attempt to cure all diseases by what in called the " water-cure," 
h:tH a hit of fanaticlHm about it, which will cure ituelf in time. But 
that water, used judiciously in the form of baths, is a potent moral 
and physical renovator of the nice, is not to be doubted ; and this 
should commend it to all sensible peo[)le, even though it should some- 
times be abused by excess, at* all good things art>. 

A people with clean hands, anU clean bodies, and clean health, will 
very natunilly come to like clean streets and clean cities, and finally, 
dean consciences. A fondness for cleanliness in one form, almost ne- 
cessarily runs into a like fondness for it in other forms, until the pu- 
rifying desire pei-vades the whole nature, moral as well as physical. 



Air and Ventilation. 

Water and air are fluids. Water covers two-thirds the surface of 
the globe, having a depth, in some places, of five miles or more. Air 
covers not merely the remaining third of the earth, but the water as 
well. It embraces the entire globe, pressing alike upon land and 
water, and having a depth of about forty-five miles. This is a sea of 
such magnitude, tliat the Atlantic or Pacific shrinks to a very small 
lake in the comparison. 

Man has his residence, and walks about fo the bottom of this ocean. 
He has no means of navigating it, and, therefore, never rises to its 
surface ; but, with his natural eyes, and with telescopes, he discovei's 
objects which lie millions and billions of miles beyond it, and even 
acquires much exact and useful information respecting them. 

This vast ocean of air we call an atmosphere, from two Greek words 
signifying vapor, and a sphere, — it being an immense fiuid-sphere, or 
globe. 

Pressure of the Atmosphere. — This atmosphere presses upon man 
and upon every object on the surface of the earth, with a force equal 
to fifteen pounds to every square inch ; and as a man of average size 
has a surface of about 2500 square inches, the air in which he lives, 
presses upon him with a weight of eighteen tons. This would of 
course crush every bone in his body, but for the fluids within him 
which establish an equilibrium, and leave him unoppressed. 

The Phllc^ophy of Breathing cannot be fully explained in the 
brief space p 'to this subject; it is enough to say, that, upon 

the attem' made to draw in the breath, the muscles of the 

breast ne ribs, the diaphragm or midriff at the same time 

conti — the whole movement being such as to create a vacuum 

in tht xgs. The air, pressing upon every part of the surface, as 
mentioned above, rushes in and fills the vacuum. The limgs being 
filled, the contraction of the muscles of the belly causes the dia- 
phragm, which has sunk down towards a plane, to rise up into the 
form of an umbrella, aud squeeze the aii- out of the lungs. 



HYGIENE. 



113 



This is about all that need to Ix) said of the method of getting the 
air into and out of the lungs. The whole process is under the con- 
trol of that part of the nervous system called the medulla oblongata, 
or the top of the sjjinal cord. 

Objects of Breathing. — There are at least three objects to be ac- 
complished by breathing ; the renewal of the blood and the taking of 
impurities out of it ; the warming of the body ; and the finishing uj) 
of the process of digestion, and the change of chyle into nutritive 
blood. 

There is no good reason for attempting here to explain the last of 
these objects. To give any idea of the first two, it is necessary to 
funiish a very brief explanation of the circulation of the blood. 

The heart is double. There are in fact two hearts, a right and a 
left, joined together. The right heart receives the blood from the 
veins, and forces it up into the lungs, whence it is brought back to 
the left heart, and by this is driven through the arteries into e v^ery 
part of the body. When received into the lungs, the blood is cf a 
dark purple color, and is loaded with carl)onic acid and some other 
impurities. It has also l)een deprived, during its circulation through 
the l)ody, of most of its oxygen. The small, delicate vessels which 
convey this dark and impure blood through the lungs, pass directly 
over the air-cells ; and at this moment the carbonic acid and water 
pass through the blood-vessels and air-cells, and are borne from the 

body on the outgoing breath ; while the oxy- 
gen enters the blood through the walls of the 
same vessels ; and this exchange, which takes 
place with every breath, alters the blood from 
a dark purple to a scarlet red. Fig. 71 
shows at 1, a bronchial tube divided into three 
branches ; 2, 2, 2, are air-cells ; 3, branches of 
the pulmonary artery winding around the air- 
cells with the dark blood to be reddened. 

That carbonic acid and water are borne out of the lungs with every 
breath, may be esisily proved. If we breathe into limo-water, it will 
become white. This is owing to the carbonic acid in the breath unit- 
ing with the lime, and producing carbonate of lime. Then, if we 
breathe upon a piece of glass, it becomes wet, showing that there is 
watery vapor in the breath. That the blood receives oxygen from 
the air we breathe is proved by the fact that the ingoing breath has 
one-fourth more oxygen in it than the outgoing. 

The lungs, then, take out of all the air we breathe, one-fourth of 
its oxygen. If we breathe it over a second, a third, and a fourth 
time, it not only has less oxygen each time, and is less useful for the 
purposes of respiration, but it becomes positively hurtful by rea- 
son of the poisonous carbonic acid which, at every outgoing breath, 
it carries with it from the lungs. 

Effect of Sleeping in a Small Room. — Now, consider the effect of 




Fro. 71. 



114 



HTOIBNE. 



sleeping in a small room, seven feet by nine, not furnished with the 
means of ventilation. A pair of lungs, of ordinary size, take in, at 
each breath, about a pint of air. Out of this air one-fourth of its 
oxygen is extracted ; and when it is returned from the lungs, there 
comes along with it about eight or nine per cent of carbonic acid. 
As it is not safe to breathe air containing more than three or four 
per cent of this gas, the pint which the lungs take in and throw out 
at each breath is not only spoiled, but it spoils something more than 
another pint with which it mingles ; and as the breatli is drawn in 
and thrown out about eighteen times per minute, not less than four 
culjic feet of air is spoiled in that time by one pair of Ivmgs. This is 
two hundred '••■id forty feet an hour ; and in eight hours, the usual 
time spent iU L .e sleeping room, it amounts to one thousand nine 
hundred and twenty cubic feet. During the hours of sleep, therefore, 
one pair of luags «o %poil one thousand nine hundred and twenty 
cubic feet of air ; it is positively dangerous to breathe it. 

In a room seven feet by ten, and eight feet liigh, there are five 
hundred and sixty cubic feet of air, a little more than one-quarter 
the amount spoiled by one pair of lungs during sleeping hours. In 
a room of this size, there is not air enough to last one person three 
yhours ; and yet two persons often remain in such rooms eight or nine 
hours. 

Why then do they not perish ? Simply because no room is entirely 
air-tight. Fortunately, all our rooms are ;^o made that some foul air 
will get out, and a little that is pure will find its way in. Were it 
not 80, no man who closed the door behind hir.i, for the night, in a small 
bed-^oom, would ever see a return of day 

Suppose fifty children are confined in an urventilated school-room, 
twenty feet by thirty, and ten feet high. These children will spoil 
about one hundred and fifty feet of air in one minute, or nine thou- 
sand feet per hour, or ttventy-seven thousand feet in three hours, — a 
usual half -day's session. But the room holds only six thousand o-uhic 
feet of air, — the whole of which these children would spoil in forty 
minutes. 

These simple facts show the absolute necessity of ventUation. Yet 
ho\v poorly it is provided for in our sleeping rooms, our sitting rooms, 
our school houses, our churches, our court houses, our halls of legis- 
lation, and even in our anatomical and medical lecture-rooms ! 

In sick-rooms, ventilation sfiould receive special attention.— 

Every disease is aggravated by the breathing of bad air. Yet it is 
common to close all the doors and windows of rooms where sick per- 
sons are confined, lest the patients should take cold. This is a bad 
practice. The sick should have plenty of fresh air. Their comfort 
is promoted by it, and their recovery hastened. 

It is strange that human beings sliould be afraid of pure air. It 
is their friend and not their enemy. Impure air only should be 
shunned. 



.:X' 



■- aUai.T-*-- 



HYGIENE. 



115 



The supply of good air ample. — There is no necessity for breath- 
ing air which has lost a part of its oxygen, and acquired a portion of 
carbonic acid. The supply of good air is ample. An ocean of it 
forty-five miles deep, covering the whole glote, seems a pretty plain 
intimation that it is not to Ix) sparingly used. When men retire 
within their dwellings, and attempt to shut out this great sea of air, 
they show about as much wisdom as would be exhibited by fishes 
which should build water-tight huts around themselves at the bottom 
of the ocean, and swim about continually in the unchanged water 
within. Fishes can ordy live in glass globes when the water is 
changed every day ; and if the water be changed half a dozen times 
a day, they cannot be as healthy as when swimming in the great 
ocean. 

Cultivating; Trees. — In most of our cities there is almost a crimi- 
nal neglect of the cultivation of trees ; yet they add greatly to the 
health, and prolong the lives of the citizens. 

The leaves of a tree are the lungs with which it breathes ; but in- 
stead of extracting oxygen from the air, and giving back carbonic 
acid, like man, it takes only the poisonous carboni-j acid, and gives 
back oxygen. 

Were there no animals on the globe, the vegetables would con- 
sume all the carbonic acid, and die for v ant of breathing material ; 
on the other hand, were there no trees or other vegetables, the ani- 
mals would in time so far exhaust the oxygen as to perish for lack 
of it. The two together keep the air healthy for each. 

The relation of plants and animals, in all that relates to their 
peculiar actions and effects, is a complete antagonism. Their move- 
ments are in contrary directions, and by hostile forces. Their oppos- 
ing actions may be illustrated thus : — 

The ATTiMAii ooNSTmBS the non-nl- 
trogenized substances, sugar, starch, 
and gum. 

The animal peoditcbs carbonic acid. 



The vegetable produces the non- 
nitrogenized substances, sugar, starch, 
and gum. 

The vegetable decomposes carbonic 
acid, water, and ammoniacal saits. 

The yeqbtable disengages oxygen. 

The vegetable absorbs heat and 
electricity. 

The vegetable is a de-oxidizer. 

The vegetable is stationary. 



water, and ammoniacal salts. 

The animal absorbs oxygen. 

The animal produces heat 
electricity. 

The animal is an oxidizer. 

The animal is locomotive. 



and 



We learn from the facts of Geology that the time was in the his- 
tory of our globe, when lunged animals could not breathe its atmos- 
phere ; it was too much loaded with carbonic acid. The trees then 
grew with a rapidity almost incoTiceivable, decomposing the poison- 
ous gas, taking to themselves the carbon and setting the oxygen 
free, and lifting up their brawny ar* s to heaven in acts of thankful- 
ness for the great feast. 

At length the noxious gas was exhausted \ and then, pale and 
sickly, they feebly held up their hands for help , and God sent num- 
berless tribes of warm-blooded uaimals, full of life and energy, that 



116 



HYGIENE. 



tl 



1 



I 



and carefully 
Ever}'^ narrow 
absence, thou- 



sported in the exhilarating air, anu destroyed vast forests, thereby 
reproducing carbonic acid. 

These simple facts should teach man the sanitary importance of 
trees and bushes ; and wherever he has a rod, I had almost said a 
foot of ground to spare, a tree should be planted 
nursed. This is particularly necessary in large cities, 
street in a city should be lined with trees. For their 
sands of men, women, and children have died sooner than they 
otherwise would. We want them stretching up their arms to all 
our windows to give us oxygen, and to take to themselves the car- 
bonic acid we exhale. 

Tight Dresses. — The health may be injured by not breathing air 
enough, as well as by inhaling that which is impure. It is therefore 
improper to compress the lungs by wearing tight dresses. If the 
ribs are held down by the dress, but little air can get into the lungs, 
and only a small amount of carbonic acid can be carried out. In 
this event, the health is injured in two ways : the blood is not vital- 
ized by oxygen received, and it is poisoned by carbonic acid retained. 

Tight lacing has in a measure gone out of fashion ; yet too much 
of it for the best development of female health is yet retained. As 
a knowledge of physiology and the laws of life, and a better judg- 
ment of the true symmetry of the female form prevail, this barbar- 
ous custom will pass out of use, and the substantial health and 
real beauty of the American woman will together rise to a higher 
standard. 

Fill the Lungs well. — Persons who take but little exercise are 
apt to acquire the habit of drawing the air very little into the lower 
part of the lungs. This' should be counteracted by taking long and 
full inspirations for a short time, every day, while in the open air. 
This practice would get the lungs in the habit of opening to the air 
quite down to their base, and would make the breathing much more 
natural as well as effectual at all times. In the case of young per- 
sons, it would enlarge the capacity of the chest, and add to the brief 
years of life. Parents should see to it that their children spend 
from ten to twenty-five minutes every morning inflating their lungs 
with pure air. 

Travelling. 

It is true that many persons who dwell in one spot, and hardly 
move from it all their lives, live to old age. Yet change of location 
for a short time, or permanently, does promote health, and protract 
life. The mind tires of contemplating one set of objects for a great 
length of time ; and in the absence of all stimulation, it sinks into 
apathy, and imparts no energy to the body. The physical frame, 
partaking of the ennui of the mind, droops. This is doubly true 
when one is suffering from illness. 



HYGIENE. 



117 



Travelling is eminently fitted to chaw the thoughts of the nervous 
and feeble from themselves, and to turn them with interest to out- 
ward objects. This is of great importance. It is better than stimu- 
lants and tonics. 

The nervous system has great power over the health; and the 
pleasurable sensations, excited by visiting new places and scenes, 
and conveyed to the mind through the nerves, often awaken in the 
constitution energies which are essential to recovery. 

Travelling places a man in entirely new circumstances. It sur- 
rounds him with novelties, every one of which makes a demand upon 
his attention. It breaks up his old trains of thought, which have 
been monotonous so long that they have grown oppressive. It 
3au8e8 the world to touch him at a thousand new points, and sur- 
prises him every day, perhaps every hour, with a view of the false 
relations he has sustained to it. It opens to him new depths in his 
own nature, and causes him to wonder that they never attracted his 
attepoion before. It opens to him one door after another, leading 
him into new apartments of knowledge ; and as the world grows, he 
finds himself growing with it, until his whole nature dilates and 
beats with new life. 

Means of Travelling Increased. — The last twenty-five years 
have greatly increased the facilities for travelling. Many of the 
sick may now seek health in distant lands, who, had their circum- 
stances been similar twedty years ago, would have been compelled 
to pine at home. The railroads give an easy journey to thousands 
with the comforts of the parlor cars. 

One thing more wanted. — But one thing is wanted to bring the 
means of travelling, for the sick, very nearly to perfection ; it is a 
method of propelling carriages upon common roads, by some cheap 
power, which can never be exhausted, and which shall be easily man- 
aged by the traveller or his companion. This is a prominent want 
of the present hour ; a giant discovery, which, at a single stride, 
would cany the world forward a hundred years, and which, we may 
hope, is in the womb of the near future. The power, it is believed, 
will be electro-magnetism. The mode of applying it, when discovered, 
will be simple, yet wonderful ; and the results to the sick, beneficent 
beyond expression. The human mind cannot conceive the advan- 
tages which invalids would derive from such a mode of conveyance. 
Journeys might be long or short ; might be made with any rate of 
speed which the strength permitted. The morning or afternoon 
stages might be discontinued when fatigue demanded, and resumed 
at pleasure. Over uninviting regions the traveller might gli'de 
swiftly, and linger where Nature spreads her feasts for the mind. 

The best Seasonsfor Travelling are spring and autumn. Win- 
ter is too cold. A pleasurable excursion may sometimes be made in 
summer, but in general the season is too hot for comfort. In chang- 



iHri 



118 



HYGIRNE. 






ing climate, food, water, etc., in the stiltry seaHon, there is danger of 
contracting very troublesome bowel complaints. 

Means of Travelling for the Poor. — There is one painful thought 
connected with travelling as a means of health, — it cannot be en- 
j'»yed by the poor. When sick they generally have the careful 
attention of humane physicians ; they receive from kind neighbors 
little delicacies of food and drink ; they are watched witli by night, 
and visited by day ; but though suffering from the hard routine of 
a laborious life, and needing diversion and recreation more than all 
else, they cannot travel. They have not the means, and nobody 
thinks of supplying them for such a purpose. 

This is a channel into which charity ought to pour some of its 
benevolent streams. In large cities there is a class of poor females 
who sit in their small rooms and ply the needle diligently through 
the whole year, and who run down every summer very near to con- 
finement in bed. Two or tlu-ee weeks, in the hot season, spent in 
travelling in the mountains and elsewhere, would bring back the 
color to the pale cheeks of such persons, and save them many years 
both from the grave and from the almshouse. No millionaire could 
make a better use of property than to set it apart, at his death, for 
the specific purpose of enabling the poor to travel. And if this 
suggestion should induce one rich man to consecrate his wealth to 
the Godlike work of bestowing health, happiness, and intelligence 
upon the poor, the great labor of preparing' this book will not have 
been endured in vain. 

Amusements. 

That which engages the mind, and at the same time impresses it 
with pleasurable sensations, is a sufficiently accurate definition of 
amusement. Whatever occupies the thoughts and senses in an 
agreeable way, and employs them with some degree of intensity, 
comes under the same head. 

This broad and general definition allovra us to disregard our daily 
employments as amusements when they engage our deep attention 
and at the same time give us pleasure. 

The term " amusements," however, in the more popular sense, is 
restricted to those sports, games, plays, exhibitions, entertaimaents, 
etc., which involve a mspension of our daily labors, and are properly 
called diversions. 

When nature is tired and worn with those severe and exhausting 
toils by which we earn our bread, amusements turn us aside, divert 
us, engage other powers, and allow our tired faculties to rest. They 
are, therefore, of very great importance. Even the most trifling 
amusements may have the highest value. Their very nature and 
object imply that they will be valuable just in proportion as they 
divert and rest us. And just in proportion as they do these thinori^, 
they give us health. 



HYCIENR. 



119 



One other thing amusements do for us, which must not be forgot- 
ten ; they preserve in us, in middle life, and even in old age, the 
warm simplicity of childhood. They keep us young in our disposi- 
tions and feelings. They keep us in harmony with nature, and con- 
sequently artless and truthful. They prevent the formalities of con- 
ventional life from stiffening us into cold and repulsive hypocrites. 

Selection of Amusements. — Of course the same amusements are 
not adapted to all persons. The farmer who has worked his muscles 
all day, would not be benefited by a game of ball in the evening ; 
yet there are few games more suitable for the student who has bent 
for many hours over his books. Care should always be taken, there- 
fore, that amusements or sports do not bear upon those limbs or 
faculties which are wearied by work. 

Amusements improve various faculties. — To one who haa a 

taste for art, who is fond of works of genius and poetry, theatrical 
entertainments will always be agreeable, and a source of gratification 
and health. I know these exhibitions are objected to by many as 
immoral and hurtful, but more, I think, from habit and fashion, than 
upon any solid grounds of reason or religion. They certainly appeal 
to a high order of faculties in the human mind ; and to those who 
are fitted to receive them, teach lessons of great moment. Even the 
lower exhibitions of comedy, though not particularly improving to 
the mind, are yet, from their power to provoke laughter^ among the 
most powerful up-builders of health. 

Tlie Games of Wtiist, Euchre, etc., engage the minds of the play- 
ers in a sort of mental contest, which is exciting, agreeable, and 
health-imparting. These games make us skilful in calculating 
chances, and judging how men ought to act under certain contin- 
gencies. They make us sharp to detect and turn aside the unseen 
forces, which tend to oppose and destroy our success in life. 

I hardly need to say that money or rather property should never 
be staked upon a game of cards, or upon any other game. Gambling 
is one of the meanest as well as most destructive things in which men 
can engage. It raises the healthful excitement of these innocent 
amusements, — innocent when prope 'v pursued, — into raging pas- 
sions, which, when defeat comes, as curae it will, sink into remorse 
and bitterness as terrible as the mind can conceive. I warn young 
men, as they would escape the pangs of a hell on earth, and the loss 
of character, happiness, and probably health for life, to avoid any 
such abuse of cards. 

Chess, Chequers, etc., appeal likewise to the fondness of competi- 
tion, which is common to all men. But they cultivate in us a little 
more of the mathematical element. As they require very close appli- 
cation of the mind, they are not suitable for persons of sedentary em- 
ployments, or whose daily avocations require a constant use of the 






120 



Hy«)IKNK. 



II 

ij 



mind. Such persniiH hIioiiM cliooHe lighter and more active amuse- 
raente. 

Lighter Amusements. — Beside these higher amusements, there 
are a great number of lighter and more childish ones, which should 
not be overlooked. 

Some of these are merely physical, involving a trial of strength, 
fleetness, action, etc., as the games of ball, cricket, etc. Othera are 
domestic in their nature, involving mirth, and various other of the 
lighter excitements, as blind-man's buff, puss in the corner, hole in the 
wall, fox and geese, hunt the slipper, hurly-burly, roll the platter, etc. 

In fashionable American households, these simple domestic plays 
have in a great measure gone out of use, — being deemed vulgar, and 
below the dignity of ladies and gentlemen. I am sorry to say this; 
for the vulgarity, in my judgment, is in those \. ho reject them, and 
not in the play. 

The oflBcer of our navy, whose visit to the mansion of Lord Hard- 
wick I have spoken of on page 93, reports that on the evening of one 
of his visits, the ])lay of blind-man's buff was engaged in by the whole 
party ; and that his Lordship in attempting to make a short, tfrn dur- 
ing the play fell upon his back, when one of his daughters, who was 
blinded, caught him by the heels, and being assisted by others, drew 
him feet-foremost half the length of the hall, amid the shouts of the 
whole party. This would have been deemed very vulgar by fashion- 
able people in this country. But to me, who am no believer in any 
nobility which Lord Hardwick can receive from kingp or queens, this 
simple naiTative raised him at once to a peerage in nature's realm. 
Without doubt, he is one of nature's noblemen. A man in his sta- 
tion, and with his wealth and temptations to snobbery, who can pre- 
serve such simplicity of character, must have a warm as well as a 
noble heart in his breast. 

Value of Domestic Amusements. — I remark here that, in all our 
amusements, we should, as far as possible, seek those of a domestic 
character. They are more simple and childlike in their nature, and 
preserve in us, even to old age, the freshness of feeling, and truthful 
simplicity, which spread so beautiful a greenness over the autumn of 
life. 

Simple domestic amusements, too, are always gotten up on a cheap 
scale; they do not encourage costly extravagance, and can be in- 
dulged in by the poor as well as the rich. 

But more, and better than all, they keep young men and old men, 
and young women and old women, at home, by making the domestic 
circle the centre of attraction. They draw the seekers of pleasure 
around the hearth-stone, instead of outward in the world. They in- 
cline young and old to look to the family circle as the centre of the 
most pure, because the most simple and natural, enjoyments. They 
teach us to look to home as the centre of life, and to all outside as 
onlj its appendages. 






-'Hif-i'-:-vMujjeiri, 



mmmsi^^^i^^ 



HYGIKNK. 



121 



It. has been said that homeg are found only in England; that in 
(itlier countries, life wanders, houseless and shelterless, abroad, seek- 
ing happiness, it knows not where, while in England it nestles warmly 
in the bosom of home. To whatever extent this is true, — and I be- 
lieve there is truth in it, — it is owing to the simple household amuse- 
ments of England. 

An American Want. — One of the great wants of this country is a 
more liberal provision for amusements. We attach here too much 
value to wealth ; and we pursue it with an intensity altogether in- 
compatible with health. We cannot take time for recreation because 
we are in so great a hurry to be rich. 

If we would save ourselves from a total wreck of health, we must 
tako broader and better views of life. We must value it for its solid 
comforts, rather than for its glitter and show. 

Contrary to the general belief, insanity is very prevalent among 
seamen and farmers. The former lead a life of dreary solitude upon 
the ocean ; the latter, one, if not of equal, certainly of very objection- 
able solitude upon the land. The sailor who does business upon the 
great sea should provide himself with great numbers of games to 
amuse hira in his wanderings. The farmers of our land should cul- 
tivate more of the sociabilities of life. Let them meet together in 
the fine summer evenings, like the peasants of France, and dance 
upon the green lawns before their cottages. They will till their lands 
more cheerfully for it ; enjoy better- spirita and health ; and live to 
greater age. 

Completeness of Life. — Amusements are necessary in order to 
give a completeness to life. The faculties of the human mind are 
numerous. It is only when they are all exercised, in their due pro- 
portion, that there is a harmonious beauty in our lives. The cus- 
toms of society twist us all out of shape, — perverting us mentally, 
morally, and physically, and robbing us of every maidy and health- 
ful quality. Getting out of the ruts of fashionable life, we must 
come back to the simple paths of nature. 

I would strongly impress upon parents, teachers, and guardians, 
the importance of studying well the various temperaments, physical 
and mental peculiarities of their children, in order to judge wisely 
of the kind and amount of recreation required by them. 

Instance : a pale, delicate child of ten to twelve or fourteen years, 
with clear complexion, flaxen hair, blue eyes, slender frame, and' a 
nervous, sensitive organization, with strong mental cast, requires 
much more recreation and out-door exercise than a full-blooded, 
robust child of that age ; a fact not at present duly considered, as a 
general thing. 



fl3E7tSS?^SS^?? 



>U^.'>*^i«»^KiS^*l»*«'*' 



TEMPEBAMENT8, CONSTITUTION, AND 

SYMPTOMS. 



Man has thinking^ wanning, nourishing^ and moving powers. For 
the performance of each of these great functions, he has organs of 
the best possible construction. 

For Thinking, he has a brain. If this be large in proportion to his 
other organs, it gives a character, a cast, a peculiarity to his whole 
organization. Everything about him is subordinate to his brain. 
We recognize him, at once, as a thinking and feeling being. He 
has an intellectual look. There is a delicacy, a refinement, a sensi- 
tiveness, a studious habit, an air of thoughtfulness about him, which 
determine his traits, his tone, his temper, his whole character. Hence 
it is proper to say he has a cephalic or thinking temperament. 

The Lungs and Heart, devoted to renewing and circulating the 
blood, are placed in the chest or thorax. If these be large in man in 
proportion to other organs, he is characterized by great activity of cir- 
culation, by a large supply of red blood, and by the general indica- 
tions of a full, warm, and bounding life. This activity gives him 
his tone and temper, and shows that his is the thoracic or calorific 
temperament. 

In the Great Cavity of the Abdomen is done the work of receiv- 
ing, digesting, and disposing of the materials which nourish the body. 
If the organs which do this work be large in proportion to others, the 
body is fed to repletion, and the whole organization speaks of the 
table. The habit, the look, the temper, are ell sluggish. This is the 
abdominal or alimentary temperament. 

The Bones and Muscles are instruments by which the movements 
of the body are performed. If these be the largest, in proportion, of 
any in the body, then the locomotive powers are in higher perfection 
than any others. There is largeness 'of person, energy of movement, 
and greatness of endurance. The whole cast of the person partakes 
of the strength and coarseness of bone and muscle. This is the 
muscular or locomotive temperament. 

This gives us four temperaments, as follows : — 

I. The Cephalic Temperament, denoted by large brain, activity of 
mind, and general delicacy of organization. 

122 



-T 



TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 



123 



, AND 



•wers. For 
1 organs of 

jrtion to his 
) his whole 
his brain, 
being. He 
snt, a sensi- 
him, which 
iT. Hence 
It. 

ilating the 
in man in 
vity of cir- 
iral indica- 
gives him 
or calorific 

of receiv- 
L the body. 
others, the 
iks of the 
Fhi^ is the 



movements 
portion, of 
perfection 
novenient, 
n partakes 
his is the 



ictivity of 



II. The Thoracic Temperament, indicated by a large chest, force 
of circulation, redness of skin, great activity, warmth of temper, 
and fulness of life. 

III. The Abdominal Temperament, denoted by a large develop- 
ment of the stomach, liver, bowels, and lymphatics; by a fulness of 
l)elly, fondness of high living, and a disposition to float sluggishly 
upon the current of the world, rather than to struggle against it. 

IV. The Muscular Temperament, indicated by largeness of frame 
and limbs, coarseness of structure, and great power of locomotion 
and endurance. 

There are some reasons for reckoning but three temperaments in- 
stead of four, by reducing the thoracic and abdox mal to one, after 
the manner of the phrenological Fowlers, — especially as the organs 
in the chest, and their appendages, take an important part in the 
process of nutrition. But as the heart and lungs are placed in one 
cavity, and the stomach, liver, etc., in another, and as one set of 
these organs may be largely developed, and the other defectively, I 
have thought it most convenient, on the whole, and quite as philo- 
sophical, to letain the four temperaments. 

These temperaments seldo.a or never appear single and pure. 
They mix and cross with each other in all possible ways. 

Medication and Temperaments. 

The object of speaking of temperaments in this work is to make 
the reader acquainted wit£ the principles upon which remedies are 
to be adapted to their development. The philosophical-minded phy- 
sician will, in prescribing, always keep the temperament in view. 

Persons of a Cephalic Temperament cannot bear powerful medi- 
cines, — particularly drastic purges. Their fine, delicate and sensi- 
tive organizations would be torn all to pieces by doses which would 
hardly be sufficient in a fully-developed muscular temperament. 
This should always be borne in mind in prescribing for persons of a 
large brain and delicate organization. 

In this temperament, too, fevers, instead of running a high and 
fiery course, take the low typhoid type, the patient becoming pale, 
and showing a constant tendency to sink. Such patients would be 
killed by purging, leeching, cupping, sweating, and starving. They 
want tonics, stimulants, and every kind of support ich the case 
will possibly permit. 

Persons of a Thoracic Temperament, having a rapid circulation, 
and a fulnesp of blood, are most liable to inflammatory diseases. 
When fever attacks them, they have what is called a " high fever." 
If rheumatism comes, it is acute rheumatism. Disease takes hold of 
them smaHly. As they do everything with emphasis and energy 



124 



TEM'iiRAMENTS, CONSTITUTION, AND SYMPTOMS. 



1.1' 



when well, ao, when ill, they make a businefls of it, and are sick with 
all their might. 

Stimulants and tonics generally make such persons worse. They 
want sedatives, and diaphoretics, and Hweato, and purgatives, and 
leeches, and cups, and low diet, and cold bathing, and whatever else 
will slacken the ferocious swiftness of their circulation. 

Those of the Abdominal Temperament are not particularly sub- 
ject either to veiy high fevers, or to those typhoid forms which 
produce sinking. As in the two temperaments noticed above, their 
complaints chiefly attack the organs most largely developed. Their 
diseases affect the stomach, the liver, the spleen, and the Ixiwels. 
These are the largest organs in their bodies, and are most used ; and, 
being overworked, they fall into disease. 

As these persons are slothful in all their habits, so their diseases 
run a sluggish course. They are not so liable to sudden death as 
persons of either of the preceding temperaments. They have all 
sorts of chronic diseases which linger a great while, and are cured 
with much difficulty. 

These persons will bear larger doses of medicine than either of 
the preceding. Neither do their constitutions respond as readily to 
medicine. A physician will be disappointed if he expects to see 
them recovering as fast under its use. 

Those of a Muscular Temperament, having little fondness for 
any wiing but a hardy, active life, are much exposed to the elements. 
Though strong and long-enduring, the hardship of their lives often 
breaks them down, and when felled by disease, they are oftentimes 
shockingly racked and torn by it. 

These persons bear large doses of medicine, and when sick, need 
to be treated with an energy proportioned to the strength of their 
constitution. Rheumatism, which affects the joints, the ligaments, 
and the tendons, is an affection from which they suffer severely. 



The Constitution. 

In prescribing for disease, it is of very great importance to take 
notice of the constitution. This is a different matter from the tem- 
peraments. Persons of the same temperament are often quite unlike 
in the strength of their constitution. And those having good natural 
constitutions, frequently abuse them by improper habits and indul- 
gences, and at length come to have broken and very feeble consti- 
tuiidns. 

Some persons' muscles and other tissues are put together as if 
they were never intended to come apart. Like some of the woods 
of the forest, — the lignum vitse for example, — they are fine-grained 
and tough. A real smart boy will wear out an iron rocking-horse 
sooner than one of these persons can exliaust their constitution by 



TIMPKBAMBNT8, CONSTITUTION, AND SYMPTOMi 



125 



e sick with 

rae. They 
atives, and 
utever else 

iilarly sulh 
rnis which 
bove, their 
3d. Their 
!ie lx)wel8. 
wed; and, 

ir diseases 
» death as 
f have all 
are cuied 

either of 
readily to 
:ts to see 



dness for 
elements, 
ves often 
iftentimes 

jick, need 
I of their 
igaments, 
3rely. 



e to take 
the tem- 
te unlike 
d natural 
id indul- 
e consti- 

her as if 
le woods 
3-grained 
ng-horse 
ution by 



hard work. Otliera, to outward appearance equally well made, have 
very little endurance, break dov/n easily under hard work, and lose 
their flesh from trifling causes. 

The state of the constitution, therefore, should always be learned 
before much medicine is given ; for what a person of a strong con- 
stitution will need, may greatly injure a feeble person, even of the 
same temperament. 

Habits.— These must likewise be attended to. Persons using 
stimulants require larger doses of medicine to affect them than other 
persons. 

Climate.— Medicines act differently on the same persons in sum- 
mer and winter. Narcotics act more powerfully in hot weather and 
climates than in cold, and must be given in smaller doses. 

IdioAyncraAy.— Medicines of only ordinary activity, act very pow- 
erfully, and even violen My on some persons. This is owing to a pecu- 
liarity of stomach, or constitution, called idiosyncrasy. It makes the 
person, in this particular, an exception to the general rule. And no 
physician can knv)w beforehand in what imrticulars this exceptional 
disposition will show itself. Persons, however, learn their own idio- 
syncrasies, and should make them known to those who prescribe for 
them for the first time. 

Thi Sex.— The peculiarities of each sex should never be forgotten 
in prescribing for the sick. 

Males are not so sensitive as females. They will bear more medi- 
cine, and their nervous system is not so readily excited by it. 

Influence of Age.— Human life is divided into infancy, childhood, 
youth, manhood, and old age. Each of these periods has peculiarities 
which modify disease. 

The First Period, extending from birth to the age of seven years, 
is marked by tenderness and excitability, and is alive to every "irrita- 
tion. Teething and other disturbances occur at this period, and need 
careful management. 

The Second Period extends from seven to fourteen, and is quite 
subject to disease, including the second dentition. During these two 
periods there is no great difference between the sexes ; both are ten- 
der, and need careful watching. 

During the Third Period, the changes occur which mark and sepa- 
rate the sexes. This is a developing period, when the functions be- 
come established, and the frame acquires form, proportion, and 
strength. 

At this time, hereditary tendencies to disease, latent till now, begin 
to show themselves, and call for every possible endeavor to break 
them up, and fortify the constitution. 



. -.rr^aicSBTpcfWy .31 



126 



TKMPKRAMENTS, CONSTITUTION, AND HYMPTOMH. 



The Fourth Period vinbroces tliu vigorouH maturity nf life, wlion 
the powera of body and mind, in both sexes, are at the Hutninit of 
their excuUunce. The functions are now well established. It Ih dur- 
ing this periwl that the female is siibjeut to most of the ImniNNin^ 
ailments peculiar to her sex. So numerous are these complaints, luiil 
so large and valued the class of persons uff;icted by them, that ho who 
treats thenj with the greatest skill, and with the delicacy which their 
nature demanils, may be said to be ut the head of his profession. 

The Fifth Period is that of old iige, wlien the functions are detain- 
ing, and the frame is bending u .der the weight of yeara. ()ld age 
l)egin8 earlie'" with females than with males. Many ailmelits are com- 
mon to this period, which require peculiar management, both medi- 
cinal and hygienic. 

Proper Frequency of Dose. — Kach suciceeding dose should Ixi 
given before the effect of the preceding is gone. If this rule is not 
attended to, the cure does not advance. What is gained by each 
dose is lost by the rallying of the disease in the interval. Care must 
he taken, however, not to apply this rule too strictly with very active 

medicines. 

« 

How to Examine a Patient. 

When a patient is presented for examination, having observed the 
tempemment, constitution, sex, and age, 

1. Learn the causes of the disease, whether local, specific, or gen- 
eral, and also its history. 

2. Search out its nature and character, whether febrile or other- 
wise. 

8. Take notice of the whole train of symptoms, -^ embracing the 
pulse, the condition of the mouth, tongue, and digestive organs, the 
breathing, the urine, the fecal discharges, the condition of the brain 
and nervous system, the state of the skin, etc. 



Brief Table Explanatory of Symptoms. 

GENERAL APPEARANCE OF PATIENT. 



1. Tonic spaHtn of the trunk 

2. Distorted features, altered pooltion, 

and impaired motion of limbs 
'■\. Irregular and perpetual motion 
4. Entire and absolute immobility 
.'). Qreat and unnatural Iroldneas 
(i. Great and unusual languor 

7. Ability to lie only upon the back 



8. Lying upon the face 

9. Lying upon one side 



indicates Locked jaws. 

" Paralysis of one side. * 

" St. Vitus's dance. 

" Catalepsy. 

" Insanity or delirium. 

" The beginning of an acute disease, or 

the progress of a chronic one. 

" Apoplexy. Organic disease of the brain 

or spinal marrow. Acute inflamma- 
tion of the lining of the abdomen. 
Rheumatism of the joints. 

" Several kinds of colics. 

" Pleurisy, or inflammation of the lungs. 

When one lung only is affected in 
consumption, the pai'.ont generally 
lies on the diseased side. 



t^aifkoA 



TEMPERAMENTS, C0N8TITUTI0N, AND HYMPT0M8. 



127 



in. MnlnUlninK tli« NittlnR poaturn indioaton 

only 
11. The lieail tlirown bock " 

Vi. KflNtlflmnnm Hiid totMinipt •• 

13. Uen«nl «nlargem ( of the body " 



DUnafin of tlio lionrt or InnRM, wlilrh 

interfnroH with br«athln|{. 
Hevere diiieaiieMof the larynx and wlnd- 

pljMS. 

Th« beKlnnlnp of acute Indammatlon. 

Fevers. Dellniini, uiid acute inanlu. 
CelUlroimy. Eui|ihy»enia from a 

wound of the clinNt. 



Head, Face, and Neck. 



1. TToad bent to one Hide 



2. Head increasetl in ilze 

3. Hwollon Hcali) 

4. Dull exprexNion of face 

5. Full, red face, with blood-veaaeU 

of eyed injected 

6. Pinched, contracted countenance 

7. I'iiiched nose, Hunken even, hollow 

tonipleH, Hkin of forehead tense 
and dry, complexion livid 
H, Wrinklefi hvtdm tho forehead 
0. Wrinkles from forehead, vertically 
to root of nose 

10. A white line from inner angle of 

the eye to just below the cheek- 
liono 

11. White line from the upper border 

of the wing of the nose (ala nasi ) , 
curved to the outer margin of the 
orb of the oye 



12. The white line In children from 

angle of mouth to lower part of 
face 

13. A white line external to the last 

two, in a semicircular direction 
towards the chin 

14. Swelling of tlie face and eyelids 

15. Transient redness or flushing of 

face 

16. Hectic flush 

17. Paleness of face 



18. Dingy, white, or greenish face 

19. Yellow tint 

20. A citron tint 

21. A bluish tint 

22. Pc-petual motion of eyelids 

23. Forcible closure of eyelids 

24. Byelidti remaining open 

25. PMsy of the upper lid 

20. Plowing of tears over the cheek 

27. Nostrils, dilating forcibly and rap- 

idly 

28. ItohiQg of nostrils in oldldren 



Indicates ConvuLiions. Paralysis of oiie-half the 

bo*ly. Dislocation of hones of neck. 

Swelling of glands of neck. 
" Chronic hydropholus. Knlarged brain. 

" Erysipolas. Hmall-pox. 

" Typhoid fever. 

Hwolling of heart. Congestion of 

brain. 
" Acute Inflammation of peritoneum. 

Exposure to severe cold. 
" Chronic disease just before death. 

" ExcesfllTe pain arising externally. 

" Distress, anxiety, and severe internal 

pain. 
In children, a brain or nervous affec- 
tion ; in adults, abuse of the genera- 
tive organs. 

" In consumption and wasting -f flesh. 

The lower part of the line indicates 
disease of stomach ; the upper part, 
some afTection of upper part of bowel. 
When united with the white line 
named above, and with a drawing in 
of the cheek, fixed eyes, and a wan 
complexion. It implies worms. 

' An afrection of the chest, with diffl- 

culty of breathing. 

" Chronic and obstinate disease in the 

chest or belly. 

" Albumen in the urine. 

" Suffering from the monthly irregular- 

" Consumption. Chronic aflfections. 

Cold stage of fever. Acute inflamma- 
tion. Chronic diseases, especially 
Bright's disease, during recovery. 
A low and deficient state of blood. 
Jaundice. 
" Cancerous disease. 

" Poor circulation in the veins. Cholera. 

Typhus fever. Blue disease. 
Mania and idiocy. 
" Intolerance or dread of light. 

" Orbicularis palpebrarum. Paralysis of 

the muscle which closes the eye. 
Injury of the tliird pair of nerves. 
' Obstruction of the lachrymal duct. 

Difficulty of breathing. 



Worms in the bowels. 



The Tongue. 



Surface of tongne covered with a 
layer of whitish, soft, mucous 
substance, which may partially 
be taken off with a scraper, — 
also, clammy mouth 



indicates Derangement of stomach , or bowels, or 
both. 



128 



TBMPEBAMSNTS, CONSTITUTION, AND SYMPTOMS. 

icdloates Acute dyspepsia. Asthma. 
" Severe oases of acute dyspepsia. 



3. State of tongue as above, with 

clammy mouth, bitter taste, and 
fetid breath. 
8. Oreat load on tongue as above, 
which pwU off, leaving the 
tongue smooth, red and tender 

4. TonKue slightly white from small 

white pomts, and sometimes cov- 
ered with for, like the fibres of 
coarae velvet 
6. Tongue pale, tumid, cloan and very 
smooth 

6. Tongue /urred and dry 

7. Tongue white and loaded, with 

much thirst 

8. As above at first, — afterwards 

c/ean, red, and dry 

9. Tongue white and loaded, with dry- 

ness 

10. Tongue dry, parched, tender, and 

dark brown or black. Pushed out 
with great difficulty and tremb- 
ling 

11. Tongue loaded with white, through 

which numerous elongated, very 
, red papillae protrude their points 



Chronic djrspepsia. Some affection of 
the liver, if the fur be yellow. 



Chlorosis or green sickness. 

Violent local inflammation. Irritation 

in bowels. 
Inflammatory fever. 

Protracted inflammatory fever. 

Mild tjrphus fever. 

Severer forau of typhus fever. 



Scarlet fever. 



The Throat. 



1. Throat enlarged 

2. Violent pulsation of carotid arteries 



8. Pulsation of the nameless artery 
(arteria innominata) above the 
breast b me, and to the right of 
the windpipe. 

4. Circumscribed swelling about throat 



indicates The approach of puberty in females. 
" Acute mania. Inflammation of brain. 

Enlargement of heart, and dilation 
of right ventricle. Anemia. 
" Regur^tation from aorta. 



Enlivgement of glands. 



The Chest 

1. General enlargement of one side of indicates Large effusion of water from pleurisy, 
chest 

" Water from pleurisy settling to the 

bottom. 
" Emphysema. 

" Enlargement of liver. 

" Water in heart-case. Enlargement of 

heart. 
" Aneurism of the ascending aorta. 



2. Bulging at the base of a lung 

3. Bulging at front upper part of chest 

4. BuIgingrighthypochondrium(See 

5. Bul^iig m region of heart 

6. Tumor where the third rib joins the 

breast-bone 

7. Tumor between the base of the 

shoulder blade and the spine 

8. Depression or retraction of one tide 

of chest 

9. Breathins increased in rapidity. 

Oenerally, in health, about 
twenty breaths aro taken in a 
minute 
10. Breathing diminished in rapidity 



11. Jerking respiration 

12. Breathing with muscles of ribs only 



Aneurism of the descending aorta. 

Constmiption. Absorption of fluid, 

effusea by pleurisy. 
Spasmodic asthma. 



Pleurisy. Paralysis of respiratory mus- 
cles, inflammation of lungs. Emphy- 
sema. Pneumothorax. Consumption. 

Spasmodic asthma. Obstruc)Jon in 
larynx and windpipe. 

Abdominal inflammation. Inflamma- 
tion of diaphragm. 



1. Increased size of belly 



The Belly. 

indicates Dropsv. Wind in bowels. Inflam- 
mation of peritoneum. Obstruction 
in bowels. Hysteria. 



TEMPERAMINTS, CONSTITUTION, AND SYMPTOMS. 



129 



2. Enlargement In epigastrium (FUr. 93) indicates Hysteria. Cancer of stomach. 

3. Enlargement In hypogastrium (Pig. 96) " Distension of bladder. Ovarian tu- 

mors. Accumulation of feces in 
bowels 

4. Belly diminished In dze " Chronic dysentery. Lead ooUc. Also 

in most chronic diseases, 



1. Enlarged penis in children 

2. Drawing up of testicles 

3. Enlargement of scrotum 



1. The limbs immovable 

2. Limbs contracted and rigid 

3. General swelling of limbs 

4. Swelling of joints 

5. Limbs diminished in size 



Private Organs. 

indicates Stone In bladder. Masturbation. 
" Stone In kidneys. 

" Hydrocele. Hematocele. Sarocele. 

The Limbs. 

Indicates Paralysis. 

" Softening of the brain. 

" Defective circulation of blood. 

" Bhenmatism. Water In the joints. 

White swelling. 
" Faralysiii. * 



The Nervous System. 



/' 



1. Morbidly increased sensation 

2. Tensive pain 

3. Dull, heavy pain 



4. Smarting pain 

5. Shooting, tearing pains 

6. Boring pains 

7. Contualve pains. 

8. Itching. Sensation as of ants creep- 

ing over the skin 

9. Exaltation of vision 

10. Black flecks floating before the 

eyes 

11. Painfully acute hearing 

12. Dull hearing 

13. Increase of strength 

14. Debility 
16. TrembUng 

16. Rigidity of upper extremities 

17. Cramp 

18. Temporary spasm 

19. Pain at extremity of penis 

20. Pain in right shoulder 

21. Pain in left shoulder 

22. Exaltation of affections 

23. Loss of moral sensibility 

24. Ezaltat m of Intellect 



Indicates Acute Inflammation of brain and 
spinal marrow. Fevers. Hysteria. 

" Phlegmonous inflammation. 

Enlarged internal organs. Internal 
tumor. Effusion of water into cavi- 
ties lined with serous membranes. 
Felt In the loins previous to dis- 
charge from menstruation, and from 
piles. 

" Scarf -ekln removed. 

' " Neuralgia. Cancer. 

" Constitutional syphilis. Rheumatism. 

Oout. Inflammation of periosteum. 

" Bruises. Acute diseases. 

" Several diseases of the skin. 

" Ophthalmia. Inflammation of brain. 

Some nervous diseases. 
" Affections of the brain and optic 

nerve. Dyspepsia. 
" Inflammation of brain. Hysteria. 

" Typhus fever. 

" Delirium. Inflammation of brain. 

Mania. 
" Most diseases. 

" Cold stage of fever. Nervous affec- 

tions. Old age. Action on the sys- 
, tern of lead, mercury, strong coffee, 

alcoholic drink, tobacco, opium. 
" Softening of the brain. Infiltration 

of blood into the brain. Hysteria. 
" Pregnancy. Hysteria. Painters' colic. 

In convulsions of children. Some 

affections of the brain. 
" Stone in bladder. 

" Congestion of liver. 

" Disordered stomach. 

" Hypochondriasis. 

" Mania. Typhus fever. Masturbation. 

Melancholy. Sometimes indicates 

close of Ufe. 



1. Stiffness of chest 

2. Pressure upon parta 



The Breathing. 

indicates Cartilages turned to bone. Pleura 
hardened. Distortion from rickets. 
Tumors. Dropsy of belly. 



180 



TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 



3. Obstruction of air-tubes 



4. Compression of lungs 

5. Pain in parts moved in breathing 

6! Paralysis of muscles of chest 

7. Spasm of muscles of chest 

8. Deficiency of red blood 



indicates Spasm of glottis. Spasm near the 
small ends of bronchial tubus. 
Mucus, etc., thrown out upon the 
inner surface. 

" Effusions in pleurisy. Water in 

chest. Air in substance of lungs. 
Aneurism and other tumors. 

" Pleurisy. InflAmmation ol perito- 

neum. 

" Injury of spinal marrow. 

" Locked jaw. Spasmodic asthma. 

" Angemia. Chlorosis or green sickness. 




1 . Hollow and barking cough 

2. Sharp, ringing cough 

3. Hoarse cough 



4. Wheezing cough 

5. Belching cough 
H. Cough in paroxysms 

7. Cough sounding harsh and concen- 

trated when listening with the 
stethoscope. 

8. Cough sounding hollow, when lis- 

tening with the stethpscope, as 
thougli it came from a cavern. 

9. Cough having a metallic or ringing 

sound when listening with the 
stethoscope. 



The Cough. 

indicates Last 8i.age of consumption. Clironic 
bronchitis. Some nervous affections. 

" Croup. 

" Beginning of cold. Chronic laryn- 

gitis. 

" Asthma. 

" Some diseases of larynx. 

" Hooping cough. Hysteria. 

" Consumption. Inflamination of thn 

lungs. Pleurisy. Enlargement of 
bronchial tubes. 

" Tuberculous cavity. Enlarged bron- 

chial tubes. 



Large tuberculous cavity. 



1. Scanty expectoration 

2. Copious expectoration 

3. Watery expectoration 

4. Mucous expectoration 
6. Expectoration of pus 



6. Expectorated matter shaped like 

coin (nummular) 

7. Muco-purulent, iloculent expecto- 

ration 

8. Tubular expectoration 

9. Whitish or greenish expectoration, 

that clings to the vessel 

10. Yellow expectoration 

11. Rusty expectoration 

12. Putrid smell of expectoration 

13. Faint and sweetish smell of expec- 

toration. 

14. Expectoration smelling like garlic 



The Expectoration. 



indicates First stage of acnte diseases of the 
lungs. 

" Decline of acute diseases of air-passages 

and lungs. 

" Beginning of bronchitis. Congestion 

of lungs. Vesicular emphysema. 

" Bronchitis. Inliammation of lungs. 

" Consumption. Third stage of inflam- 

mation of lungs. 

" Tubercular consumption. Bronchitis 

of measles. 

" Consumption far advanced. 



Plastic bronchitis. Pneumonia. 

Acute affections of lungs, particularly 
bronchitis 

Chronic bronchitis. Other chronic af- 
fections of the lungs and throat. 

Inflammation of tL ' lungs. 

Gangrene of the lungs. 

Bronchitis. First sta^o of consumpti jn. 

Broncho-pleuial fistria. 



1. Dull, heavy, aching pain at the 

base of the chest 

2. Soreness about the breast bone, and 

between the shoulders 

3. Sharp, sudden, tearing pain below 

the nipple 

4. Pain darting from front part of 

chest to between shoulder blades 

5. Constant paiu between the shoulders 



Pain. 




indicates 


Acute bronchitis- 


'■ 


j-V,".! J b/onci'.itis. 


If 


Pleurisy. 


It 


Consumption. 



Consumption. Green sickness. Other 
chronic diseases. 



TEMPERAMENTS. CONSTITUTION, AND SYMPTOMS. 



131 



«m near the 
Oiial tubus. 
iUt upon the 

Water in 
ice of lungs. 
nors. 
n of perito- 



; asthma. 
:een sickness. 



on. Clironic 
lUH affections. 

tironic luryii- 



ia. 

lation of the 

largenient uf 

ilarged bron- 



leases of the 

if air-passages 

Congestion 
iphysema. 
jn of lungs, 
ige of innani- 



iimonia. 

, particularly 

er chronic af- 
d throat. 

consuuipti ju. 



The Pulse. 

^' ^W.rfi^lfir^''"'"' compression indicates Intiammatory affectionH. osi.ecially of 
Dy tiie linger the substance of large organs, as the 

liver, etc. 

I'rostration from disease. Nervous and 
clironic affections. Fear. Diseases 
of women and children, and old per- 
sons. 

Congestion of brain. Apoplexy. Dis- 
ease of heart. 

Inflammation of stomach, bowels, 
bladder, etc. Hysteria, and other 
nervous affections. 

Inflammation of membranes. Active 
bleedings. Lead colic, et«. 

Affections cliaracterized by debility. 

Inflammatory diseases. Hemorrhages. 
Apoplexy. Sometimes in disease of 
heart. 



Weak pulse, easily pressed down 



."?, Full pulse, as if the artery were in- 
creased in size 

4. Small pulse, opposite of full 

5. Hard, sharp, contracted pulse,- ,. 
brating like a cord under the finger 



- vi- 



«. Soft pulse, yielding readily to pres- 
sure 

7. Frequent pulse 

8. Slow pulse 



Relating to Digestion. 



1. Tongue trembling and dry, and di- 

minished in size 

2. Voracious appetite 

3. Diminished appetite 

4. Ii-.creased thirst 

5. Thirst gone 
(i. Vomiting 



7. Pain increased by pressure 

8. Pain relieved by pressure 

9. Urgent desire to go to stool 

10. Watery stools 

11. Mucous stools, like white of egg 

12. Hard and lumpy stools 

13. Clay-colored stools 

14. Yellow or dark-brown stools 

15. Dark-green stools 

16. Stools red, and streaked with blood 

17. Pitchy black stools 

18. Stools pure blood, with no colic 

19. Stools like rice-water 

20. Black stools 

21. Shreds of false membrane in stools 

22. Fat with stools 

23. Fetid stools 



indicates Typhoid and other low fevers. 

Pregnancy. Hysteria. Insanity. Some- 
times in dyspepsia. 
" In most acute diseases. 

Acute affections of stomach and bowels. 
Cerebral disease, with coma. 
" Early pregnancy. Colic. Disease of 

brain. Inflammation of stomach. 
Hernia. 
" Inflammation of internal organs. 

Over-distension of bowels. Neuralgia. 
Colic. 
'■ Dysentery. Sometimes in diarrhoea. 

Diarrh&a, Cholera. 
'' Chronic inflammation of colon. 

Constipation. Colic. Cancer of stom- 
ach. 
" Deficiency of bile. 

" Too much bile. 

Bile from children after taking cal- 
omel. 
■' Dysentery. 

" Meltena. 

" Bleeding piles. 

" - Asiatic cholera. 
" Iron taken in medicine. 

" Dysentery. Diarrha>a. Worms. 

Diabetes. ConsmniJtion. 
" Diseases attended by debility. 



The Urine. 



kuess. Other 



1. Diminished secretion of urine 

2. Retention of urine in the bladder 

3. Urine increased in amount 

4. Red or yellow sand deposits in urine 

(uric acid) 

5. White sediment in urine (earthy 

phosphates) 
B- Oxalate of lime deposits in urine 

7. Blood in urine 

8. Albumen in urine 

9. Mucus in urine 

10. Sugar in urine 



indicates Dropsy. Inflammatory and febrile 
diseases. 

" Paralysis. Typhoid fever. Hysteria. 

" Diabetes. Cold stage of fevers. Hy- 

steria. Various passions of the mind. 

" Fevers. Acute Rheumatism. Con- 

sumption. Dyspepsia. Great indul- 
gence in animal food. 

" Depressed state of the nervous system, 

of serious import. 

" Derangement of digestion. 

" Bleeding of kidneys, etc. - 

" Bright's disease. 

" Inflamed mucous membrane of ure- 

" thra, bladder, etc. 

Diabetes. 



132 



TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 



The Perspiration. 



!■ Profum {Mnpiratlon 

2. Diminished perspiration 

3. Night sweats 

4. Sour-smelling sweat 
6. Fetid smelling sweat 

6. Sweat with mouldy odor 

7. Smalling like ammonia 

8. Sweat having the odor of mice 

9. Sweat smelling like rottenstoue 



indicates Acute rheumatism. Decline of acuto 
" inflammations and fevers, beine 

sometimes critical. 

" ^n/'il**** **' **"*** disease. Dropsy. 

" Consumption. , 

" Rheumatism. Oout. 

" Some debilitating fevers. 

" Measles. Scarlet fever. 

" Typhoid fever sometimes. 

" Insanity. 
Miliary. 



The Temperature. 



1. (General heat of surface 

2. External local heat 

3. Hot forehead 

4. Hot scalp 

fS. Skin of chest hot 
1 6. Hands and feet hot. 

7. Acrid heat, burning the hand when 

applied 

8. Chflfs 

9. Low temperature 
10. Cold hands and feet 



indicates Fevers. 

Inflammation. 
Headache. 
Disease of brain. 
Inflammation in chest. 
Consumption. 
Typhus fever. 

Beginning of fever. 
Poor circulation. 

Nervous diseases. Dyspepsia. Impure 
state of the blood. 



The Temperature of the Body. 

The use of the thermometer is an important addition to the means 
of making physical examination, and is one of the improvements in 
modern medicine. 

It is intended to measure the heat of the oody. 

The best kind now in use is the self-registering. 

The bulb of the instrument is to be placed in the warmest part of 
the body, and should be allowed to remain there for eight to ten 
minutes. 

Some place it under the tongue ; some in the axilla. 

Sometimes it is necessary to introduce it into the rectum or vagina. 
In these parts the temperature is a degree higher than in other parts. 

The normal temperature of the body is from 98° to 99° Fahrenheit, 
in the great majority of persons. 

Exceptionally it may be half or a whole degree either above or be- 
low this range. 

The normal fluctuations are inconsiderable in comparison with the 
variations of disease. 

The natural variations in health are as follows : The temperature 
is at its minimum at five o'clock A. M. ; the maximum is reached in 
the latter part of the afternoon, and then decreases till five o'clock 

A. M. 

By means of the thermometer we are able to determine all differ- 
ences with precision. 



TEMPBRAMBNT8, CONSTITUTION, AND SYMPTOMS. 



188 



The increase of heat in different febrile diseases rarely exceeds 
110° Fahrenheit, ant* as a rule the amount of increase is a criterion 
of its severity. 

An increase to lOO^ Fahrenheit or 101° is evidence of mildness of 
the disease. 

If the thermometer indicates steadily 106° Fahrenheit, it is certain 
tliat the disease is severe. 

A persisting temperature above 106° Fahrenheit denotes that there 
is great danger, and an increase to 108° to 110° Fahrenheit is usually 
a fatal sign. 

The abnormal changes of temperature consist of more or less in- 
crease. 

Diminution below the normal standard is comparatively rare ; yet 
it sometimes occurs and is of some importance. 

In the course of typhoid fever, a sudden decrease may indicate in- 
testinal hemorrhage. Sometimes the temperature falls without im- 
provement in the other symptoms. This is an unfavorable symptom. 

The value of thermometric changes depends in no small measure 
upon the symptoms with which they are associated. 



: .,iw;j ?.i ^fe'teH.''. ' ->^ . ' -' ' >- '■ '~' ^ ' ' ' -' -"' ' •-•• 



Iff 



ULl 



^ 



SKIN DISEASES. 



The skin is the soft and pliant membrane which covers the entire 
surface of the body. The interior, like the exterior is likewise covered 
by a skin, which, from its always being moist, is called a mucous 
membrane. At the various openings of the body, the outer and the 
inner skins are united, — forming one continuous skin, — like the 
same piece of silk turned over the border, and covering both the out- 
side and inside of a bonnet. 

From this continuity or oneness of the skin and mucous membran ; 
springs an important medical law, namely, that a disesise of the skin 
may spread to the mucous membrane, and a disease of the mucous 
membrane may spread to the skin. We see this illustrated by the 
breaking out around the lips v/hich follow colds, and the itching of 
the nose of children when the mucous membrane of the bowel is irri- 
tated by womwj. 

The Skin is Composed of Two Layers. — These are separated from 
each other by the action of a blister. The thin portion which is raised 
up by the fluid of a blister is called the scarf skiti, the cuticle, or the 
epidermis; that which remains in connection with the body is the 
sensitive skin, the cutis, the derma, or the true skin. The two skins 
have very different offices to perform. The scarf-skin is horny and 
insensible, and serves as a sheath to protect the more sensitive skin 
under it. Were the scarf-skin taken off, we could not bear to have 
anything touch us. 

The derma, or true skin, and its glands, etc., are the seat of all the 
cutaneous diseases. These may be separated into four great divisions, 
— namely, diseases of the true skin, diseases of the sweat glands and 
tubes, diseases of the oil glands and tubes, and diseases of the hairs 
and hair glands. 

Then the diseases of the true skin are divided into 

Inflammation of the true skin ; 

Enlargement of the papilloe of the true skin ; 

Disorders of the vessels of the true skint- 
Disorders of the sensibility of the true skin ; 

Disorders of the color-producing function of the. true skin. 

The inflammation of the true skin is conveniently divided into two 
groups, — namely, 

Such as are marked by inflammation of the derma and mucous 
membranes, with constitutional symptoms of a specific kind, and 

134 




3 the entire 
k'ise covered 
I a mucous 
ter and the 
— like the 
Jth the out- 

i membran j 
of the skin 
ihe mucous 
ited by the 
itching of 
3wel is irri- 

irated from 
ih is raised 
'icle, or the 
)ody is the 
! two skins 
horny and 
sitive skin 
ir to have 

; of all the 

; divisions, 

jlands and 

the hairs 



rf 



m 




SKIN DISEASES. 



135 



Surli aH arc (liHtin^nnslu'd by iiiflaniniiitioii of the derma, withnut 
consfitutional symptoms of a specij'u; kind. 

Congestive Inflammation of tlie True Sl<in. 

The First of these Qroups. — those characterized by inflammation 

of the cutis, with constitntional symptoms of a specific kind, embraces 

measles, scarlet fever, varioloid, and cow-pox. 

Measles. — Rubeola. 

Measles is an acute inflammation of the entire skin, both external 
and internal, associated with an infectious and contsigious fever. 

Symptoms — The disease sets in with chills, succeeded by burning 
heat, listlessnesH, languor, drowsiness ; pains in the head, back, and 
limbs ; frequent pulse ; soreness of the throat ; thiret, nausea, vomit- 
ing, frequent dry cough and high-colored urine. These symptoms 
hicrease in violence for four days. On the third day the eyes become 
inflamed, cannot bear the liglit, and pour fourth a profusion of teai-s. 
This last symptom is called coryza. The nose likewise discharges a 
large quantity of watery secretion, and sneezing is frequent. The 
larynx, windpipe, and bronchial tubes become inflamed, and hoarae- 
iiess, soreness of the breast, etc., are the result. 

The redness of the skin and breaking out appear about the fourth 
day, and produce heat and itching. This breaking cut is character- 
ized by a patchy redness, which, on close inspection, is found to con- 
sist of numberless minute red points and pimples, collected into 
patches in the shape of a half or quarter moon. They appear first on 
the forehead and front of the neck, then upon the cheeks and around 
the nose and mouth. On the fifth day they reach their height in this 
region, and then appear upon the body and arms, and on the sixth 
day, upon the legs. The color of the skin, when the inflammation is 
at Its height, is of a bright raspberry red. The decline of the rash 
takes place in the same order in which it comes out. The redness 
fades on the sixth day upon the face ; on the seventh, upon the body 
and hmbs ; on the eighth, upon the back of the hands. The coiyza, 
the hoarseness, and the cough, decline about the seventh day, while 
a diarrhoea comes on about the eighth or tenth, — showing that the in- 
flammation of the mucous membrane is subsiding. When the inflam- 
mation disappears, the whole scarf-skin peels off in the form of a 
scaly scurf. The artist has given a good picture of the disease in the 
beautifully colored lithograpli, Plate I, Fig. 1. 

Treatment — When the disease is mild and regular in its course, 
scarcely anything will be required, except mild diet, slightly acid 
dnuks, with flax-seed tea, slippery elm, or some equivalent, to quiet 
the cough. Sponging with tepid water, if done with frequency, mod- 
erates the fever, and adds to the comfort of the patient. If the fever 



—t^a^asKB?- 



186 



HKIN DISEASES. 



runs high, take half an ounce of i-ochelle salt, and uae recipe 125. 
Should the eruption "strike in," apply leeches or cups over the in- 
ternal organ affected, if any, and recall the rash by sweating. 

Those who have been exposed to the contagion, and are liable to 
have the disease, should avoid all unnecessary exposure to wet or 
cold, — keeping the feet warm and dry, and the whole body well clad. 
With these precautions, and a mild, unstimulating diet, much of the 
force of the disease may be broken. 

During the first stages of the disease, bathing the feet once or twice 
a day with hot water, and freely using warm, sweating drinks, as 
saffron, summer-savory, pennyroyal, bilm, and mullein tea, and put- 
ting mustard drafts to the feet, will hasten the coming out of the 
eruption. 

Should the breaking out be delayed by excessive fever, give full 
doses of tincture of veratrum viride, or nauseating doses of ipecac, 
antimony, lobelia, or hive-syrup, and teaspoonful doses of compound 
tincture of Virginia snake-root. 

Besides the milder forms of the disease, cases occur, chiefly in 
broken-down constitutions, in which the rash delays its coming out 
till the seventh day, and is then mingled with dark and livid spots, 
which remain, ofteii, for ten or twelve days. The fever is of a low, 
typhoid kind, and the patient is extremely weak and languid. 

In this condition of things, the patient must be supported by tonics 
(77 and 59), and whisky, and expectoration promoted by some appro- 
priate remedy, if required. 

If at any stage of the disease there should be fixed pain in any 
part of the chest, which is made worse by coughing, or by taking a 
full breath, we may conclude there is some inflammation of the 
chest ; and it must be treated as directed for pneumonia. 



Scarlet Fever. — Scarlatina. 

This is likewise an acute inflammation of the entire covering of 
the body, both external and internal, connected with fever which is 
infectious and contagious. 

Symptoms. — The fever comes on somewhere between the second 
and tenth day after exposure. On the second day of the fever, the 
eruption comes out in the form of very small points and pimples, 
which appear either in patches, or constitute a general redness, of a 
bright scarlet color. In Platk I, Fig. 2, the artist has given a fine 
picture of the disease. 

The disease begins with languor, pains in the head, I ack, and limbs, 
with drowsiness, n&Uf»ea, and chills ; and these are followed by heat, 
thirst, etc. When the redness appears, the pulse is quick, and the 
patient is anxious, restless, and sometimes delirious. The eyes are 
red, the face swollen, the tongue covered in the middle with white 
mucus, and is studded with elevated points of extreme redness. The 



SKIN 0IBKA8B8. 



137 



3cipe 126. 

'er the in- 

ag. 

3 liable to 
to wot or 
well clad. 

auh of the 

36 or twice 
drinks, as 
., and put- 
3Ut of the 

', give full 
of ipecac, 
compound 

chiefly in 
oming out 
ivid spots, 
I of a low, 
lid. 

:l by tonics 
)me appro- 

lin in any 
y taking a 
3n of the 



jvering of 
r which is 



he second 
fever, the 
1 pimples, 
[ness, of a 
fQn a fine 

md limbs, 
d by heat, 
, and the 
eyes are 
irith white 
less. The 



tonsils are Rwclled, and the throat red. Tbn grciitrst dngren of led- 
iiusH is reaclied on the evening of the third or fourtli day from it« l)e- 
ginning, when a gentle moisture appearH, tlio diHease I>egi)i8 to decline, 
with itching, and the scai-f-Hkin falls off in branny scaU^s. 

A swelling or putliness of ti>e tlesli, which spreads out tin* tingers 
in a singular manner, seems to be peculiar to scarlet fever. 

In the first stage of the complaint, the tongue, as stated al)Ove, is 
covered with a fur ; but as it advances, the tongue often Ixicomes 
suddenly clean, and presents a glossy, fiery-red surface, which is 
sometimes, with the whole lining of the mouth, raw and tender. 

It is peculiar in this complaint, that the inflammation of the 
throat alwayp runs into a stiite of ulceration. As far us can be 
seen, on pressing down the tongue, the throat is swollen and of a 
deep, florid I'jid ; and on the tonsils may be seen white or gray 
ulcers. This makes swallowing very ditiicult, and aggravates the 
sufferings of the patient. The great amount of mucus in these 
parts causes also a continual rattling in the throat. 

The eustachian tube, which extentls up to the ear, is apt to get 
involved in the inflammation, and cause swelling and pain in that 

region. The glands under the ear and jaw 
sometimes inflame, and after a time they oc- 
Ciisionally break. Abscesses formed in the 
ear frequently produce some deafness which 
is not easily cured. 

In the cell-dropsy, which sometimes appears 
after scarlet fever, the crystals of urate of 
ammonia may often be found in the urine 
with the microscope (Fig. 72). 

This disease resembes measles, but may 

*■'<*• "• be distinguished from it by the absence of 

cough ; by the eruption being finer^ and of a more scarlet color (see 

plate) ; by the rash coming out on the second day instead of the 

fourth ; and by the ulceration in the throat. 

Treatment. — In ordinary cases, the treatment should be very 
simple. The apartment should be kept cool, and the bed-covering 
light. The whole body should be sponged with cool water as often as 
it is hot and dry, and the patient be permitted to take cooling drinks. 
Besides this, in many cases, very little is needed, except to give a 
few drops of the tincture of belladonna, night and morning. 

In some cases where there is a good deal of fever and soreness of 
throat, give tincture of veratrura (125) often enough to keep down 
the pulse. Give every half hour (an adult) till pulse reaches sixty. 
Aconite in drop doses to children every fifteen minutes. In addi- 
tion to this, the feet and hands should be soaked in hot water, with 
a little ground mustard, or pulverized ca3'^enne, stirred in. This 
bath should be continued twenty minutes, twice a day, for two or 
three days. 










rSMSS&K' 



.ai ii. l <wJli lM ii ll iiiiii ' iiii»i nr i i i i w ' i *' iiii > i ni iiiii r i H l » i T ' i n ' i " i " ' ' 



SKIN niHRAHRn. 






The cold 8tajr« having piwHcd, and the fovor Hot in, wiinn water 
may Iw ubjhI without the miiHtard, eU-. If tiic head Ik; iifTecU-d, um 
nuiHtui'd (IniftH upon the feet. Shouhl the JK)welH lie coHtivo, they 
may \x' gently o[)(auHl hy Honie very miUi physic. 

No Holid food Hhould bo aUowed ; but after the fiixt shock of the 

di8eit«e iH pusHed, dnnka, in reiwonablc (juantiticH, will Iw advisable, 

Buch au cold wattu', lemonade, barlMtrry and tamarind water, rice 
water, balm or tlax-Heed tea, and Home thin wat<*r-gruel. 

To promote the action of the skin, the HpiriUi of nitre, with other 
articles (125), adapting the dose to a child, will be found useful. 
The nitrate of poUwh iw UHeful, given in on»> to three-grain doses, 
dissolved in water, every three or four houm. 

Muriatic acid, foity-tive drops in a tumbler filled with wattu-, and 
sweetened, and given to a child in teiuspoonful doses, is a good remedy. 

In very violent attacks, the system sometimes inclines to sink im- 
mediately ; typhoid symptoms show themselves ; there is great pros- 
tration ; the eruption strikes in; the skin changes to a purple or 
mahogany color; the tongue is of a deep red, nr has a dark-brown 
fur upon it, and the ulcers in the throat become putrid. This is 
called scarlatiua maligna ; but it is only a severer form of the same 
disease. 

The treatment of this form must be different from that recom- 
mended above. It must Iw tonic. Quinia (66) must be freely given. 
Wine whey, mixed with toast-water, will be useful. Tincture of 
cayenne, in sweetened water, may be given often in small doses. 
Ammonia (135) may likewise be given as a stimulus. Gargles (245) 
(244) (243) are also required. 

A dropsical affection is one of the most frequent results of scarlet 
fever. It is believed that this seldom occurs, if the warm bath is 
daily used, as soon as the skin begins to peel off. After the dropsy 
has set in, give the warm bath twice a week, and encourage perspi- 
ration by the compound tincture of Virginia snake-root, and similar 
articles. The child should have a generous diet, at the same time, 
to bring up its strength. 

Anointing the skin with vaseline at night and washing off in the 
morning with suds removes the poisonous scales, and lessens the 
danger of contagion, as well as improves the activity of the skin. 
Nasal and aural catarrhal diseases are commonly observed to follow 
scarlet fever and need attention of a physician. Rheumatism like- 
wise is a frequent sequela, wliile nephritis or inflammation of the 
kidneys is often a sad reminder of the disease. These two compli- 
cations are to be treated as directed elsewhere. 



TABLE EXHIBITING THE DIFFERENCE BETWEEN SMALL T OX, VARIO- 
LOID, SCARLET FEVER AND MEASLES. 



SMALL-POX. 



VABIOLOID. 



first. Period between expocure and when dU- 
ea«e flnt abowa Itaelf li from five to twenty daya — 
oaokUy abowa itaelf in ten or twelve daya. 



First. Period of InoubRtfn*. more Irregnlar 
than Buiall- Pox — from five u < wty daya— av- 
eragea twelve daya. 




tm^ 



•iirm wdttT 
rented, put 
Htivo, they 

Jck of the 
IviHiiblu, — 
water, rice 



with other 
nd UNefiil. 
ail) doHes, 

watt(r, and 
)d remedy, 
o sink im- 
jreat pros- 
pur j)le or 
ark-brown 
1. This is 
the same 



*^ 



lat recom- 
Jely given, 
incture of 
lall doses, 
jles (246) 

of scarlet 
11 batli is 
he dropsy 
ge perspi- 
ud simihir 
iime time, 

off in the 
jssens the 

the skin. 

to follow 
itism like- 
on of the 
ro ' compli- 

)X. VARIO- 



nore irregnUr 
)Pty (Uyi — «T- 



m 



I 






SMALL POX 



■*■■'" 



dfeo 









o-^ 



Q- O*^ 






9^ 



* ..' e 






^o^ 









'f 



0r^O 









*j..-,ai;-.ii «'l*tf*, /S'jfefAVS 




■p^;. . .^v^;*p<- " 



Proof ress of M, ^ 

SnuxU Pox. *^' 





l?f<iajj.2'}il4»y.3'iday.5'^dMf. S^day. Hf'kUui. 



M.-»r^ (.4!«;fffii 



Progivssof 
Varioloid. 



m 



# i # 



/?.*«%. ?'^rfay. ^.'^<%. -^.'^^fcty. 5/^<%. 7/??V«y. 




Progress of 
Vaccination, 





4^hday. e^^oLay. 



a^hihxy. 



llf'^day. 




SKIN DISEASES. 



139 






;^^ 



Secnnit. The fever and temperature U high, bat 
ia less after rash appears. 

Third. The rash appears on third or fourth day 
and is seen on the forelieail or Kouie part of face. 

Fourth. The eruption first consists of pimples, 
then watery blisters wbioh become white and sink 
in the center. 

Fi/th. The tor.^e is coated and swollen . 

Sixth. The eyes do not run, and broncbitia does 
not appear. 

fieventh. Sore throat is often present but not to 
as great an extent as in Scarlet Fever. Delirium 
and convulsions may occur. 

Eighth. Beoondary fever appears after several 
days. 

Ninth. There are apt to be pocks and the eye- 
sight be weakened, but by modem treatment it 
can usually be avoided. 



8CABLET FETEB. 

Firtt. Period between contagion and when dis- 
ease first shows itself is usually from three to six 
days, but may be much longer. 

Second. Fever greatly increased and continues 
without abatement after eruption appears. 

Third. Eruption makes its appearance on sec- 
ond AV on the chest and neck and spreads over 
the l)ody during tl'« next twelve hours. 

Fourth, The eruption extends over the entire 
skin. 

Fifth- Eruption lasts from six to seven days 
when it begins to come off in larpe scales. 

Sixth. Tongue is covered with little red points. 

Seventh. There is little trouble with bronchitis 
or running of eyes. 

Eighth. Sore throat. 

Ninth. The mind is apt to be affected and there 
may be delirium. 

Tenth. Usually no seoondary fever. 

Eleventh. In Scarlet Fever there is great .dan. 
ger of the patient being left with kidney trouble, 
or the eyes, ears, or throat may be affected. 



Second. Fever high till rash is well developed 
and then a greater &provei.ient than in Small- 
Pox. 

Third. Eruption appears on third or fourth 
day. 

Fourth. Rash consists of pimples, may ^o on 
to pustules and blisters, but usually subi'ide be- 
fore advancing so far. 

Fifth. Tongue coated and swollen. 

Sixth. No nose or eye symptoms as a rule. 

Seventh. Bore throat mild. Delirium and sev- 
erity of diseiwe often marked at Iwginning but 
quickly subside. 

Eighth. Secondary fever less marked than In 
Small- Fox. 

Ninth. Instead of rapidly convalescing, the 
patient often shows an amount of weakness and 
anemia all out of proportion to preceding symp- 
toms. 

MEASLES. 

Firtt. Period between exposure and when dis- 
ease first shows Itself is from seven to fifteen 
days. 

Second. There Is a moderate fever. It does 
not decrease but increases alter eruption. 

Third. Eruption appears on fourth day on 
face and spreads over rest of body in about two 
days. 

Fourth. Eruption is orescent-shaped, rest of 
skin healthy. 

Fifth. Eruption lasts about five days, then 
peels off in scales. 

Sixth. Tongue has red edges and is coated. 

Seventh. The nose and eyes run and bronchitis 
is usually apparent. 

Eighth. Usually throat is not sore. 

Ninth. The mind is not affected. 

Tenth. The fever subsides after the third day 
and there is no secondary fever. 

Eleventh. The patient's eyes may be inflamed 
and consumption or bronchitis follow. 



Small-Pox. — Variola. 

This is another disease characterized by acute inflammation of 
the entire skin, both external and internal, connected with infectious 
and contagious fever. The eruption has the form of red points, 
which soon becom^ pimples, then vesicles, then flattened and scooped- 
out vesicles, then pustules, and finally hard brown scabs. These last 
fall off from the eleventh to the twenty-fifth day, and leave behind 
them small pits and scars. The fever is remittent, and precedes the 
eruption some three or four days, — ceasing when the eruption is 
developed, and returning when it has reached its height. The 
period between exposure and the attack of the disease, called incu- 
bation, is from five or six to twenty days, — being short in the severe 
cases, and longer in the milder ones. 

Symptoms. — The 'disease begins with languor and lassitude, with 
shivering, and pains in the head and loins ; with hot skin, and quick- 
ened pulse and breathinpf- -yi^h thirst, loss of appetite, and furred 
tongue ; with nausea, vo. iting, constipation, restlessness, and uni- 
vei-sal prostration. To these symptoms sometimes succeed <lifBcult 
breathing, cough, drowsiness, and even insensibility. The tongue, 
white at firet. soon becomes red at the point, and over the whole 



Jf 



140 



SKIN DISEASES. 



surface. The fever is highest during the night. The constitutional 
symptoms are more violent just before the eruption, but immediately 
subside, and soon disappear, when the breaking out is established. 
The eruption is at first in the shape of small red points, which are 
1ia'>d to the touch, and shaped like a cone, and are proportionate in 
number to the subsequent pustules. In Plate II the artist has 
well exhibited the developed disease, as well as the progress of the 
eruption from day to day. 

Treatment. — Like the two preceding disease.., the ordinary, un- 
complicated form of this requires only the most simple treatment. 
Not much is wanted, except confinement in bed, cooling drinks, cool 
and even temperature, frequent change of linen, and sponging the 
body with cool water. But when what is called the fever of inva- 
sion is past, and the eruption is fvlly developed, and has brought 
along with it the secondary fever, then some recipe, as (131), (355), 
(126) will be in place, and some gentle laxative to keep the bowels 
open (8), — also gentle injections (249), and opiates to relieve 
sleeplessness and nervous symptoms ; (366) (367) may be used if 
very sleepless. 

Should the system, at this period, appear to be sinking, a more 
generous diet, and a little wine may be allowed. If the brain 
suffers, apply cold ice-cloths to head, or an ice-bag behind the ears, 
and put the feet in a mustard bath (242). If the breaking out 
appears with difficulty, put the patient into a warm bath, and give 
extract of jaborandi (368). Gargles will frequently be needed for 
the inflammation, and dryness of the mouth and throat (243). 
Cold sponging may be considered as highly beneficial, in both the 
primary and secondary *ever. The belladonna likewise is a useful 
remedy, used in the same way as in scarlet fever. The plaster (288), 
applied to the face, will, it is said, arrest the formation of matter, 
and prevent the unsightly scars which so often cover the face of 
persons who have suffered from small-pox. Paint the face once or 
twice a day vnth glycerine, which will effectually prevent pitting. 
The use of collodion is still better. 

To avoid Pittins:, and the occurrence of unsightly scars of the 
face, several methods of dressing have been used. The simplest 
consists in covering in the vesicle with iodof orm-collodior , say, 
twenty grains of the former to one ounce of the latter. Having 
pricked the vesicle with an absolutely clean needle, one, for instance, 
that has been boiled in sodarwater for five minutes, a layer of this 
collodion should be applied a..d allowed to dry on at once. Should 
pus form under this coating it must be released by washing off the 
collodion with alcohol. The wound is then to be thoroughly disin- 
fected with carbolic acid water (one teaspoonful to pint of water) 
and the collodion again applied. 

This process will avoid most of the pitting. 



m^rr 



SKIN DISEASES. 



141 



Varioloid. — Varicella. 

Varioloid, or modified small-pox, begins with symptoms similar 
to those of small-pox, but much milder in degree. These symptoms 
are feverishness, nausea, vomiting, pains in the loins and head, and 
a quickened pulse. The eruption comes out on the third or fourth 
day, and looks like that of small-pox. It reaches its height the 
fourth or fifth day, and then declines without any secondary feve'-. 
The pustules dry up and form brown scabs which fall off in a few 
days, and leave slight pits, and a few red or purple spots. 

Varicella appears under a variety of forms, called " hives," " swine- 
pox," " chicken-pox," " horn-pox," etc. But they all have a family 
likeness, and need not be described. The treatment of all these 
forms must be conducted on the same principles with small-pox. 
Sponging the skin in all these inflamhaatory conditions has the hap- 
piest effect, and should seldom be omitted. 

Cow-Pox. — Vaccina. 

This disease exists to some extent among lower animals, and is 
identical with small-pox in man. The immortal Jenner taught the 
world that the pus taken from the cow having this disease, and in- 
troduced under the skin of man, would produce an eruption similar 
to that of small-pox, and that this would protect the system from 
the latter disease. This was an immensely important discovery, and 
will render the name of Jenner famous through all time. 

It is a question of great importance how far vaccination, or inocu- 
lation with the matter of cow-pox, does, in fact, protect tlxe system 
from small-pox. That it is a protection, to a certain extent, is 
doubted by none. That in some instances it protects through life, 
is likewise generally admitted. Is it a protection in all cases, and 
through the whole life? Perhaps not, though this is a disputed 
point. Probably the mild form of the vaccine disease does not im- 
press the system powerfully enough to last more than a certain num- 
ber of years. Most thinking physicians now believe it is wise to 
revaccinate occasionally, to make sure of the protection. It is done 
with little trouble, and may save a terrible infliction. Plate II, 
^^S- 4, gives a good idea of the appearance and progress of the 
eruption. 

The Second Group of diseases, characterized by inflammation of 
the true skin, without constitutional symptoms of a specific kind, are 
Erysipelas, Nettie-Rash, False-Measles, and Inflammatory Blush. 

Erysipelas. — St. Anthony's Fire. 

Erysipelas is a diffused inflammation of the skin, affecting only 
a part of the surface of the body, and is accompanied by a fever, 
which is generally thought to be infectious and contagious. The 



! f 



>«*MHMMM<iMMiai 



mknim 



wmM 



142 



SKIN DISEASES. 



local inflammation is disposed to spread ; it extends deep, and is 
attended by swelling, a tingling, burning, and pungent heat, and ])y 
a redness, which disappears when the skin is pressed by the fiuger 
and returns on remitting the pressure. 

Symptoms. — The constitutional symptoms are chilliness aiul 
shaking, succeeded by heat ; lowness of spirits, lassitude, pains in 
the back and limbs, pains in the head, quick and hard pulse, thirst, 
loss of appetite, white . and coated tongue, bitterness of moutli, 
nausea, vomiting, pain in stomach, and costivencss. 

These symptoms go before the local inflammation several days; 
they increase with the redness of the skin, and disappear upon its 
decline. The nervous system is sometimes severely affected, and 
indicated by low, muttering delirium. At the close of the inflam- 
mation there is generally a relaxation of the bowels, and the scarf- 
skin peels off. Sometimes matter forms under the skin, and occa- 
sionally mortification occurs. The face is the most frequent seat of 
the disease. It commonly begins on one side of the nose, and soon 
spreads over one side of the face, closing up the eye, and changing 
the features in a shocking manner. See Plate III, Fig. 1. 

Somewhere about the third, fourth, or fifth day, very minute blis- 
ters appear on the inflamed parts, filled with water, which increases 
until the blisters break and let it out. The disease comes to a head 
on the eighth or ninth day, when the blistered parts dry, and the 
skin begins to peel off. 

Treatment. — In the treatment two things are to be done, — to 
subdue the fever, and the local inflammation. The fever is assuaged 
by rest, mild diet, gentle laxatives (26), (21), (125) ; and by the 
use of tincture of veratrum. For the local inflammation, various 
things have been advised, but nitrate of silver, on the whole, has the 
preference. First wash the inflamed part with soap and water to 
remove any oily substance, and wipe the skin dry. Then moisten 
the inflamed and surrounding skin, and pass over it a stick of nitrate 
of silver, touching not only the inflamed part, but going even an 
inch beyond it on all sides. Or, a solution of nitrate of silver and 
nitric acid (214) will in many cases, according to Dr. Higginbottom, 
do even better. A solution of copperas (215) is a good application. 
So is (303). 

In mild cases, flour may be dusted on the inflamed part from the 
dredging-box. Warm fomentations are also useful, and cloths wet 
with water, and laid on. A solution of perchloride of iron, applied 
to the inflamed skin, is much used now, or water as hot as can he 
borne. 

In erysipelas the powers of the system are generally reduced, and 
tonics, such as quinine, wine, etc., are genemlly required. Dr. 
Robert Williams, — high authority in these matter's, — says he puts 
his patients upon milk diet, gently opens the bowels, and gives them, 
daily, from four to six ounces of port wine, together with sago, and 
that he seldom has to change this coui-se, whatever the symptoms. 



I 



ERYSIPELAS 



3ep, and is 
eat, and by 
the finger, 

liness and 

e, pains in 

ilse, thirst, 

of mouth, 

eral days; 

r upon its 

fected, and 

:;he inflani- 

the scarf- 

and occa- 

int seat of 

, and soon 

changing 

inute blis- 
increases 
to a liead 

y, and the 

lone, — to 
! assuaged 
nd by the 
1, various 
ie, has the 
water to 
1 moisten 
of nitrate 
[ even an 
nlver and 
inbottom, 
iplication. 

from the 
loths wet 
1, applied 
8 can be 

iced, and 
ed. Dr. 
be puts 
/es them, 
3ago, and 
ptoms. 




PI. 3. 



INFLAMMATORY BLUSH 



Fig.l 




■iiiT idirn'ii 



iii>T8iirr[im« 



■ii^l<ilir»Oiilii 



Ki i 



i 



1 1 



'^s m^^m _ 



^rn 



mt^ 



^iU^' 



SKIN DISEASES. 



143 



For the inflamed skin, a tea made of buckwheat meal is a good 
wash. Alcohol and water, or new rum, may be used for the same 
purpose. » 

Nettie-Rash. -- Urticaria. 

Nettle-rash begins with fever, which lasts two or three days, 
when wheals of various shapes, round, oval, and oblong, appear in 
the midst of red, slightly elevated patches, attended by great itching 
and tingling, as if the common nettle had been applied to the skin. 
The wheals go ofif during the day, and come again at night. The 
eruption is often a symptom of other diseases, or of mental anxiety. 
Sometimes it is the effect of articles of diet. Children have it occa- 
sionally while cutting teeth. A lighter form of the disease exists, in 
which the wheals appear and disappear at short intervals, according 
to the heat of the weather, the exercise, diet, etc. 

Treatment. — The treatment varies according to the cause of the 
disease. If tliis be anything offending the stomach, especially if it be 
putrid fish, an emetic (2), (4) will be required, followed by brisk 
physic (359). After which take a few doses of quinine (75). For 
external application, the lotion (216) or common vinegar and water 
(215) will be useful. Dr. "Wilson recommends corrosive sublimate, 
etc. (217), as the best lotion to apply outwal-dly. Soda bath better. 

The diet should be simple and cooling, ail stimulating food and 
condiments being avoided. Fruit, candies, and berries often the 



cause. 



Rose-Rash.— Roseola. — False Measles. 

Symptoms — The summer rose-rash appears first on the arms, face, 
and neck, thence it spreads over the whole body, producing tingling 
and Itching. It is usually preceded by the symptoms of fever-chills, 
succeeded by flushes of heat, languor, pains in the head, back, and 
hmbs, restlessness, quick pulse, and thirst. The rash appear in 
small irregular patches, paler than those of measles, and of a more 
roseate hue. There is some hoarseness from inflammation of the 
throat. The rash never continues more than five days, unless it be 
merely partial, in which case it sometimes comes and goes at inter- 
vals for weeks. If it "strike in," it generally produces disturbance 
of the stomach, headache, and faintness, which are relieved by its re- 
appearance. 

The autumnal rose rash is in more distinct patches than the former, 
of a^ circular figure, slightly elevated, and of a dark damask-rose hue. 
seldom any fever, or itching and tingling. 

Treatment.— For the firs^described form of the disease, light diet, 
acid drinks, and gentle laxatives; for the second, recipe 59 or 51, ac- 
cording to convenience. 



m 



iHri 



144 



8KIN DISEASES. 



Inflammatory Blush. — Erythema. 



Whvt is called marginated inflammatory blush, is a mottled, red, 
smooth fullness of the skin, occurring on the extremities and loins, in 
irregular patches, bounded on one side by a hard, elevated, red border. 
This species of disease attacks old people, and indicates some inter- 
nal disorder, which is dangerous. 

Another form of the complaint appears on the arms, neck, and 
breast, in extensive, bright-red, irregular patches, slightly elevated. 
The redness, at its height, is very vivid, and continues about a fort- 
night, when it assumes a pvirplish hue in the centre. 

Treatment. — Light diet, gentle purgatives (21), soda bath to al- 
lay the tingling and secure sleep, and the mineral acids (63), with 
bitter tonics, comprise all that is required, except sponging with 
water, and friction. 

Watery Pimples. 

We now come to a class of diseases character-zed by watery pim- 
ples. Wilson says they are distinguished by " effusive inflammation of 
the derma," which means that there is inflammation of the true skin, 
which causes water to be poured out on top of the derma, and under- 
neath the scarf-skin, causing the latter to be lifted up in the form of 
small or large blisters, or vesicles. At first the fluid in these pimples 
is transparent, but in a short time becomes milky. Sometimes this 
fluid al^orbs ; at other times, it dries up, and with the cuticle scales 
off as scurf. 



Eczema and Salt Rheum. 

Eczema is an inflammatory, acute or chronic, non-contagious skin 
disease characterized at first by redness, little pimples, vesicles or 
pustules and is attended by more or less burning itching. This pro- 
cess terminates either in the formation of crusts as the result of dried 
sticky serum, or else in the formation of fine scales. 

No skin disease has such a variety of aspects nor such grades of 
inflammation. There is generally more or less oozing of the blood- 
serum, which dries and thickens, forming crusts. There is usually 
more or less thickening of the skin, making it like leather ; there is 
generally some considerable scaling. 

Eczema may subside in a few weeks never to return, or, what is 
more probable, may lapse into a chronic state and continue for months 
and years, with bothersome symptoms, which are extremely annoying. 

Salt Rheum is a chronic eczema of this last variety. 

Treatment. — In the acute stage of eczema, soothing lotions, pow- 
ders, or ointments should be used, such as 372, 373, 374, Some are 



SKIN DISEASES. 



145 



)ttled, red, 
id loins, in 
red border, 
ome inter- 
neck, and 
r elevated, 
•ut a fort- 

)ath to al- 
;63), with 
ging with 



itery pim- 
imation of 
true skin, 
nd under- 
le form of 
le pimples 
times this 
icle scales 



ious skin 
esicles or 
This pro- 
t of dried 

grades of 
he blood- 
s usually 
; there is 

•, what is 
ir months 
,nuoying. 



)ns, pow- 
Some are 



better treated with powders, some by lotions; the itching «nd heat 
are best relieved by 373. 8 "" " "e*!- 

In the more chronic variety some stimulating ointments are needed, 
like 375 Carbolic ac.d, 10 or 15 grains to the ounce of oleate of 
zinc ointment, is an admirable remedy for the itching and burnine 
Salicylic acid, 10 grains to the ounce of benzoated zinc ointment 
llz'^r T^y ««'-^i««fl>le, while tarry preparations generally are 
the most satisfactory in this chronic stage. 

^.ill!, w ""'"^'^ however, w often so stubborn to treatment as the 
different forms of eczema. The cure often will be slow and medi- 

cTl wrnt ^ ''^'^^''* '''^ ^°^^^ ^^"^^^^« '' «--^ -<!-- «P- 

• ^K?*T "** J"®"** i" Children— After oiling freely the crusts over 
night and washing off wi^h suds in the morning, appl^ Salicylic acll 
1 part, tincture benzoin 2 parts, vaseline, 50 part«. The very chronic 
thick, and indurated skms require 360, and in many cases 219, espe- 

L^^i^ . V?' *^">^«]« regulated and the hygiene of the skin a^ 
tended to, while tonics and general systemic measures are often called 

Tetter^ Shingles.^ Herpes. 

After a slight feverish attack, lasting two or three days, clusters 
of small transparent pimples, filled sometimes with a colorIes8,Tom2 
times with a brownish lymph, appear on the cheeks or forehead, or 

mt^^Z'T '■ ~ ^""^ ^* *T' ^'^ *^« ^^^y- The pimples are a 
little larger than m eczema,- about the size of a pea. After a few 
days the vesic es break, pour out their fluid, and form brown or yel 

Z Si: T.*'" '^.'^"* '^' *?*^ day, leaving the surface^red 
and irritable. The eruption is attended with heat, itehing, tingling, 
orm ofl ^««^l«««"«f«'f P««ially at night. Ringworm is a cur ou^ 
form of herpes, in which the inflamed patehes assume the form of a 
nng. Shingles usually attack the aged about the ribs of one side, 
and are evidences of impaired health and nutrition. They are verv 
prostrating and require tonics from the start. ^ 

Treatment.— Light diet, gentle laxatives. If the patient be ad- 
vanced in life, and feeble, a tonic (75) will be desirable. For exter- 
nal applicatjon, belladonna (173), o J an'ointment of sulphuret of lime, 
(174), or elder-flower ointment, ete. (175). Equal parts of chloral 

Itch.— Scabies. 

n^l^'ft^^ -^'f"^^ *"" '^*'''' ^""^ "^^^«' *^°"gh it is much less com- 
mon than in former years. It is found frequently among the ^o^ 



••' r' irtiiiiii' 



■i^ 



146 



SKIK PI8KA8E8. 



whose nondition in life does not give them the means to guard at all 
pointw against it ; l)iit it is most common among such as neglect per- 
sonal cleanliness. 

Symptoms. — An eruption of distinct, cone-like, watery pimples, 
whicli are transparent at the summits, and are accompanied by an ex- 
cessive itching, which is made worse by high-seasoned food, by drink- 
ing liqUor, and by the heat of the bed. When these pimples are 
scratched and torn, a sticky, watery fluid is poured out, which forms 
small scabs ; and, in time, if the disease is not cured, these scabs be- 
ing torn off, extensive sores are made. 

Cause. — It will excite the wonder of many readers to state that 
animals of so small a size as scarcely to be seen with the naked eye 
exist in the skin of man. Yet such is the fact ; and it is the presence 
of these minute creatures, or the effect of their presence, which con- 
stitutes the disease called itch. The little creature (^acarus scabiei, 
by name), a species of mite, is one seventy-seventh part of an inch in 
lengtli ; and when closely inspected under the microscope, is really a 
beautiful, I may say an elegant, animal. Here are a front, a side, and 
a back view of liim, well done by the artist. 






Fro. 78. 



FIO. 74. 



FlO. 75. 



His Method of Attack. — When placed upon the skin, the little 
fellow, like the squirrel and other ground-animals, sets himself to 
make a hole through the scarf-skin with his head and fore feet. Into 
this he pushes his whole body. He then begins to burrow himself in 
the derma or true skin — making a channel many times his own 
length, at the end excavating a chamber where he sleeps, and whence 
he goes out to do his day's work at mining, or boring for food. When 
tired of this sleeping apartment, he digs onward and scoops out an- 
other. 

This travelling, and boring, and turning about in an organ as sen- 
sitive as the true skin, must, of course, occasion a tickling and itch- 
ing ; and from this circumstance the disease took its name of itch. 
But this itching is not painful. James the Fii-st is said to have re- 
marked that the itch was fitted only for kings — so exquisite is the 



SKIN DISRASIS. 



141 



uard at iill 
Jglect per- 

y pimplcH, 
I by lui ex- 
, by tlriiik- 
iinples are 
Wch forniH 
scabs be- 



state that 
naked eye 
e presence 
vhich con- 
Ma scabieu 
an inch in 
is really a 
I side, and 




the little 
limself to 
feet. Into 
himself in 
} his own 
id whence 
od. When 
)8 out an- 

au as sen- 
and itch- 
le of itch. 
) have re- 
iaite is the 



onjoymentofscratchiMjj. Probably it is a royal luxury. He ll.at as 
' ™^V'"'"8t persons would consent to have it all done by roval fin- 
ffers. They have been used for meaner purposes. 

Treatment.— Whatever will kill the little animal descrik-d above, 
will cure the itch. Various agentw have been employed for this pur- 
pose, but none have been found equal k, sulphur. The compound 
sulphur mntment is a sovereign ren.edy for the disease. Four ounces 
of this should be well rubbed into the skin, before the fire, morning 
and evening, for three or four days. This will put v end to the 
whole colony of these sovereign squatters upon forbidden soil. 

1 wo ounces of sulphuret of potash, and the same amount of soft- 
soap, dissolved in a pint of water, and applied well to the skin, is 
used in many cases with good effect. 

Caustic potaah, one part to twelve part« of water, applied in a sim- 
ilar way, 18 sartl to be a pretty sure remedy. 

A solution of the chloride of lime, used as a wash, will often effect 
a cure. 

The ointment of the American hellebore sometimes does well. 

liefore applying any of these preparations, let the skin be washed 
with warm water and soap, and well dried. Be sure the parasite is 
killed before ceasing treatment. Best to continue few days longer 
than what is apparently needed. ^ 

Rupia. 

This is from a Greek word which means dirt, from the dirtK!olored 
crusts which are formed after the breaking of the large waterv pim- 
ples. The vesicles are like those of eczema and herpes, except that 
they are laryer. This is distinguished from all other skin diseases by 
the formation of unhealthy, foul, and burrowing sores, which pour 
out a reddish matter in such quantities that it collects and dries upon 
the sore, and forms a crust of great thickness, — sometimes of the 
size of an oyster-shell. Rupia has its origin in a weakly and debili- 
tated constitution, and cannot be cured without renovating the whole 
system. It is a manifestation either of syphilis or lupus. 

Treatment.- Warm baths once or twice a week, with generous 
and nutritious diet. Tonic medicines (63) (51) C67) (61) (65) will 
be required. For external treatment, dust the surface of the ulcers 
with cream of tartar, or apply nitrate of silver (214) r219) r220^ 
white vitrol, etc. See syphilis. ^ ^ <. ">>' 

Pemphigus. — Pompholix. 

The first of these t^rms is from the Greek, and means a bubble : 
the second, pompho IX, is from the same language, and means a water- 
bubble This IS still more applicable to the disease in hand, which 
consists, in fact, in the raising up of the scarf^kin in the shape of 



148 



SKIN DIBIA8S8. 



hubbleH, containing a watery fluid. These hubbies ar<i just liko rom- 
mon blisters. They vary from the size of a split pea to that of n 
hen's egg. They rise up very rapidly, and break in Lwo or three 
days, leaving a raw surface which soon becomes co\-orcd by a thin 
crust. 

Treatment. — Similar to that for Hupia, with the luldition of iodide 
of potassium (140), and applying the stick nitrate of silver to the 
whole surface of the ulcer, and a short distance l)eyond it on all sides, 
or the ointment (176). See treatment for syphilis. 



Mattery Pimplei, 

Another natural group of skin diseases are distinguishod by an 
eruption of pimples, filled, not with water, like those just described, 
but with matter. The pimples of this class are not transparent, or 
whitish, but opaque and yellow from the first. The matter is poured 
out upon the true skin, and raises up the scarf-skin, in the same way 
at lie watery pimples. As in the preceding diseases, too, the drying 
up of the matter forms crusts. But these pimples are never so small 
as those of eczema, uor so large as those of pemphigus. 

Crusted Tetter. — Impetigo. 

This eruption consists at first of slightly-elevated pustules or pim- 
ples, closely congregated, with an inflamed border. These break, and 
the surface becomes red, excoriated, shining and full of pores, through 
which a thin, unhealthy fluid is poured out, which gradually hardens 
into dark, yellowish-green scabs. These scabs sometimes look like a 
dab of honey dried upon the skin. This has given impetigo the name 
of "honey disease," or honey scab. This honeyed look is well repre- 
sented in the crusts which form on the lips and ears of children. 
Sometimes these scabs cover nearly the whole face, and are called the 
milk crust. This is putting the agreeable words milk and honey to 
rather questionable uses ! When this crusted tetter invades the head 
or scalp, it causes the hair to fall, and becomes what is called a scall. 
Impetigo may be simple, or contagious, or syphilitic. 

Treatment. — The vapor bath, and water dressing. The following 
ointments are useful : oxide of zinc, white precipitate, or diluted ni- 
trate of mercury (178). Hydrocyanic acid (221), applied externally, 
has a fine effect. The crusts should first be removed by a weak lye 
made from hard-wood ashes, or potash ; then, after applying one of 
the ointments above, or the lotion, cover the part with oil-skin. If 
the crusts are on the head, the hair should be cropped off before the 
remedies are applied. When of syphilitic origin, treat as for that 
disease. 



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SKIN DI8EAS1E8. 



149 



Papulous Scall. — Ecthyma. 



The mattery pimple called ecthyma is developed on a highly in- 
flamed skin. The bladders are about the size of a split pea, and are 
surrounded by a broad ring of redness. They are generally separate, 
not clustered like impetigo. They are scattered over various parts of 
the body, and are followed either by a hard black crust, or by a sore. 
The disease is either acute or chronic. The latter attacks weakly 
children, and persons reduced by sickness or low living. 

Treatment. — For the acute form, give a generous diet, with oint- 
ment (176), and the cold sponge-bath on the sound parts. Use 
(176) (176) (214) (211) for external application. Hygienic treat- 
ment, tonics, and stimulants are called for ; iron, quinine, arsenic, and 
nux vomica. 



Scaly Eruptions. 

The scaiy eruption is called a dry tetter. It is an inflammation of 
the true skin, and is distinguished from the rashes and pimples by 
the alteration of the scarf-skin. The diseases forming this group are 
three in number, — lepra, psoriasis, and pityriasis. 

Leprosy. — Lepra, 

In this disease, the eruption makes its appearance as a small, sal- 
mon-red spot, raised a little above the surrounding skin, and consti- 
tuting, in fact, a flat pimple, almost as large at the top as at the bot- 
tom. On top of this pimple the scarf-skin becomes rough, and after 
a little while a thin scale is produced. New layers are added to its 
under surface, and it accordingly grows thicker. It has a bright, 
silvery lustre. These scaly spots multiply, and become the form of 
leprosy called lepra guttata, from the Latin gvtta, a drop, the scales 
looking like drops of water on the skin. 

But the eruption more frequently spreads out into circular patches, 
of the size of a fifty-cent piece. These generally appear below the 
elbows and knees, and on the breast and shoulders, and back of the 
hands. Sometimes the entire hand is covered with scales of a pecu- 
liar silvery whiteness. These patches heal from the centre. 

Psoriasis. 

This differs from lepra in the eruption being more irregular. The 
spots sometimes come out in thick clusters, and blend in various 
ways. Instead of appearing in distinct circular forms, as in leprosy, 
the patches are irregular, and of every size. Instead of one well- 
formed and thick scale, there are many small and thin ones. And 
instead of a depressed centre with rising edges, the surface m level. 
While leprosy is a circular dry tetter, this is an irregular dry tetter. 



150 



SKIN DISEASES. 



Treatment Pyrogallic acid in ointment, 10 to 40 gr. to oz. Ap- 
ply daily ; it discolors the skin for a while. Chrysoplianic acid in 
same strength is the best remedy known. It also discoloi-s the skin 
and inflames the neighboring skin for a while. Recently the thyroid 
gland of the sheep has been used in five-grain ta.blet8 three times 
daily as an internal medicine with much success. 

Pityriasis. 

This is much like the two preceding, except that it gives rise to 
a copious production of very small bran-like scales. Indeed, its name 
is from the Greek, and means chaff or bran. It is a branny tetter. 
It may occur on any part of the body. 

Treatment. — When the skin is highly inflamed and stiff with heat, 
pain, and itching, the diet should be light, and the drinks of a cooling 
and unexciting kind. The warm bath and gentle friction of the skin 
are useful. Laxatives or tonics may be employed, according to the 
indications, — frequently laxatives first, and tonics afterwards. The 
specific remedies for curing the disease are unknown ; iodide of potas- 
sium (140), arseniate of iron (68), Fowler's solution, in two-drop 
doses, three times a day ; or Donovan's solution, in five-drop doses, 
three times a day. For extevnal application, use a naphthaline oint- 
ment](177), zinc o'ntment, white precipitfite ointment, diluted nitrate 
of mercury ointment, or solution of corrosive sublimate (212). 



\ 



Dry Pimples. 

These are distinguished by the high degree of irritation of the 
skin which they create. They are exceedingly troublesome, not only 
from the distress and itching they occasion, but because they are 
likely, in consequence of this, to be torn into painful and obstinate 
sores. 

When appearing in children, they are called red gum, and tooth- 
rash. In grown persons, one form is named lichen, and another, dis- 
tinguished by excessive itching, prurigo. 

In this form of pimpljs, the fluid is not poured out upon the sur- 
face of the true skin, — as in several of the preceding diseases, — bat 
is collected within the tissue of this organ, and the pimples feel hard 
under the finger. 

The tooth-rash of infants is always accompanied with some fever- 
ishness, aused generally by irritation of the gums from growing teeth, 
occasionally by flannel worn next the skin. 

Lichen has a variety of forms. In one case the pimples are of a 
bright red, in another, bluish or livid. In one case they appear in 
circular groups, in another they produce great disorganization of tlie 
akin, and occasion terrible suffering. 



.MlStX:, 



SKIN DISEASES. 



151 



jr. to oz. Aj)- 
lianic acid in 
•loi-s the skill 
ly the thyroid 
i three times 



gives rise to 
eed, its name 
ranny tetter. 

iff with heat, 
1 of a cooling 
1 of the skin 
rding to the 
ivards. The 
ide of potas- 
in two-tlrop 
-drop doses, 
thaline oint- 
uted nitrate 

:2i2). 



ition of the 

le, not only 

le they are 

obstinate 

and tooth- 
nother, dis- 

»n the sur- 
ises, — but 
feel hard 

)nie fever- 
v^ing teeth, 

3 are of a 
appear in 
on of the 



Prurigo is a still more cruel disease tluin lichen. '. ..o pimples are 
not very manifest, but the skin is thickened or swollen, and con- 
densed. The suffering from it is terriMe. It gives one no sleep, 
night or day. That form of it called ant-bite prurigo gives the sen- 
sation of millions of ants eating the flesh, or as many red-hot needles 
piercing it. This renders the existence of many elderly persons a 
terrible burden. 

Treatment. — Careful diet, and gentle aperients and tonics, accord- 
ing to the condition of the system. Externally, the cold salt-water 
sponge-bath, and glycerine, vinegar and water, applied with a soft 
sponge. Tar and sulphur are among the more successful remedies in 
fighting this rebellious disease (362). Iron, quinine, cod-liver oil. 
For relieving the terrible itching of the private parts, which females 
sometimes suffer, I have found morphine (223), for external use, 
very effectual. 

Lupus. 

This makes its appearance in the form of one or more circular 
elevations, of a dull red or salmon-color, and partially transparent. 
When pressed under the finger, these elevations are found to be soft, 
and when the finger is removed, they are flat and whitened. They 
generally appear on the face, and particularly the nose. 

In another and worse form of the disease, the tubercles are harder; 
and after a time, they become covered with thin brown scabs, which 
are scratched off, and followed by others, 
and these by others, until ulcers appear, 
which are sometimes slow and sometimes 
rapid in their progress. The whole nose 
has been destroyed by them in a month. 
(See Fig. 76.) This is one of the dis- 
eases which Eriismus Wilson thinks, and, 
in my judgment, correctly, to be, like 
scrofula, the result of the syphilitic poi- 
son, filtered through the blood of several 
generations. It is a disease which is the 
most destructive in the shortest time of 
all diseases. 

Treatment. — The internal remedies 
are iodide of ai-senic (141), and iodide 
of potassium (140) ; the external, vine- 
gar of Spanish flies ; and to promote the 
healing of the ulcers, a weak solution of nitrate of silver (211) (214) 
is adapted. 

Hardly any disease has been treated by so many different remedies. 
At present the prospect of a cure is good, as certain anti-tubercular 




FlO. 76. 




1^.^: 



152 



SKIN DISEASES. 



lymph injections have been found effective ; but no time should be 
lost in immediately consulting a surgeon, as ite growth can be ar- 
rested, and the disease may be exterminated by early treatment. 

Warts and Corns. — Verruca — Tylod% — Clovtis. 

In the derma or true-skin there are a great many small arteries, 
veins, and nerves, unit d together, and formed into loops (see Fig. 
43), resembling, in shape, the peaks of miniature mountains. These 
are called papillce. These loops, frequently, without any apparent 
cause, take on a disposition to grow, and by extending themselves 
upward, they carry the scarf-skin along with them, which is thickened; 
and together they form what is called tvarts. Corns are formed by a 
somewhat similar growth of the papillae, brought about by the pres- 
sure and friction of tight boots and shoes. 

Treatment. — For warts, take a piece of diachylon plaster, cut a 
hole in the centre the size of the wart, and stick it on, the wart pro- 
jecting through. Then touch it daily with aqua fortis. Nitrate of 
silver sometimes answers well for touching it. They may be taken 
off very neatly, sometimes, by tying a string tight around them. 
Corns should be shaved down close, after being soaked in warm 
water and soap, and then covered with a piece of wash-leather, or 
buckskin, on which lead plaster is spread, a hole being cut in the 
leather the size of the corn. They may be softened, so as to be easily 
scooped out, by rubbing glycerine on them. Manganic acid destroys 
warts and corns rapidly. Bunions, which affect the joint of the great 
toe, must be treated with fomentations, and sugar of lead water 
(224), when there is considerable inflammation, with rest in a hor- 
izontal position. But the best cure for corns and bunions is to put 
away tight shoes. Wear a bunion-plaster for some time to take the 
pressure off of the corn or bunion. 

Mother's Marks. — Naevus. 

The small vessels of the skin, called capillaries, suffer certain al- 
terations of structure which pass under the name of mother's marks. 
These marks are simply a great dilatation of theie minute blood-ves- 
sels. They vary in size from a mere point to a patch of several 
inches square. 

The smallest of all is the spider mark. It is a small red point, 
from which several little straggling vessels spread out on all sides. 
Sometimes this is of the size and appearance of a red currant ; at 
other times, of a strawberry or raspberry ; and occasionally it is even 
much larger, and is compared to a lobster. 

When the circulation is active through them, or the individual is 
excited by exercise, or by moral causes, these marks are of a bright 
red color. Some are naturally livid and dark-colored, and look like 



b«.U4l 



SKIN mSRASKS. 



153 



me should he 
th can be ar- 
'eatment. 

• Clovus. 

mall arteries, 
ops (see Fig. 
tains. These 
any apparent 
g theniselves 
is thickened; 
i formed by a 
by the pres- 

plaster, cut a 
the wart pro- 
. Nitrate of 
nay be taken 
round them. 
ed in warm 
sh-leather, or 
? cut in the 
i to be easily 
icid destroys 
; of the great 

lead water 
est in a hor- 
)ns is to put 

to take the 



r certain al- 
ler's marks, 
blood-ves- 
of several 

red point, 
all sides, 
iurrant; at 
it is even 

dividual is 
a bright 
look like 



blackberries, and black currants. The blueness of these is owing to 
the vessels being still more stretched and dilated, and to the conse- 
(juent slower passage of the blood through them, which gives more 
time for its change from the arterial red to the venous blue. 

Treatment. — If the mark is not making progress, it had better be 
let alone, or only subjected to gentle pressuie by piitting a piece of 
soap-plaster over it. When its course is threatening mischief, it is 
sometimes cured by pencilling a small portion of its surface, from 
time to time, with nitric acid. They may be operated on with safety 
by electrolysis and other methods. 

Disordered State of the Nerves of the Skin. 

Itching. — Pruritus. This is supposed to be dependent on an al- 
tered condition of the nerves of the skin, and consists in a painful 
sensation of itching. There is no perceptible alteration in the ap- 
pearance or structure of the skin. This itching is thought, generally, 
to be a result of sympathy, through the nerves, with some diseased 
and excited condition of a distant part. The itching^ is brought on 
by the most trifling causes, and for hours may deprive the sufferer of 
every particle of repose. It more frequently affects the fundament, 
or the private parts, particularly the scrotum. 

Treatment. — As this disease is only a symptom of several others, 
the constitutional treatment belongs under the heads of these other 
diseases. The local applications for relieving the itching are, a solu- 
tion of sugar of lead (224), hydrocyanic acid (363), of corrosive sub- 
limate (212), diluted nitrate of mercury ointment, and poppy fomen- 
tations. Also (223). Tonics are often of first importance. Weak 
solutions of carbolic acid or soda water at tim6s suffice. 

Disorders Affecting the Color of the Skin. 

Colored Patches. — Maculae. The depth of color in the skin de- 
pends on the amount of a certain coloring matter, called pigment, in- 
corporated with the deeper and softer portion of the scarf-skin. In 
the scarf-skin of the inhabitants of northern latitudes, there is but 
little of this pigment ; in that of the dwellers of Africa, there is a 
great deal ; among the inhabitants of Southern Ev\rope, the quantity 
is intermediate between tlie two. 

The depth of color in the skin depends on the energy of its action. 
In the tropics, where light and heat are in excess, the skin is stimu- 
lated to great action, just as vegetation is, and the color is increased 
and intensified. This is illustrated every year before our eyes. In 
summer, under the heat of the sun and the flood of light, the pigment- 
forming power is increased, and the fairest skin is browned ; while 
the withdrawal of these forces leaves the winter's scarf without pig- 
ment, and blazoned. .. 



154 



SKIN DI8EASBH. 



What the sun aiul light do, uadei' iiiituml circumstances, (hscased 
action may effect. Hence we occasiDUiilly meet with alterations of 
color in the skin, from a disordered state of the system. We wit.'iesK 
the formation of patches of dark color and irregular shape on various 
parts of the body. Sometimes they are raised al)Ove the level of tlio 
skin, and are called moles. At other times, they have no elevation, 
and spread over the whole body. 

Occasionally, from some peculiarity of constitution, the pigment is 
diminished, and white patches appear all over the body. At other 
times, a black person will become completely white. Such are called 
albinos. 

In many cases the coloring of the skin has varieties of tint, as when 
pei-sons of light complexion, are, in the summer season, covered with 
yellow si)ots, like stains. These spots are known by the name of 
freckles, or, in learned language, lentigo. 

Treatment. — It is generally best not to meddle with a mole. If it 
be very unsightly, let it be removed by two incisions, biking out an 
elliptical portion of skin, and,clo8ing the wound with sticking plaster. 
In the case of bleached places, apply the shower bath, tonics, and a 
stimulating liniment (168) to the faded spots. For the change of 
color Ccalled sunburn, a liniment (191) of lime-water, etc., is the best 
preparation. For freckles, use recipe 360, or, perhaps, still better, 
364. 



Disorders *of the 5weat-Qlands. 

The perspiration is sometimes greatly increased above nature's de- 
sign. This is, technically, idrosis. In other instances there is too 
little sweating. This ^ called anidrosis. Sometimes the perspiration 
is so altered in its physical qualities as to have some peculiar smell. 
This is osmidrosis. In some rare instances, according to old writers, 
the sweat was changed in color. This was chromidrosis. And now 
and then a case occui-s of bloody perspiration, of which the most 
memorable case on record is that of the Redeemer of men, who, in 
the garden, sweat great drops of blood. Several cases of this are re- 
corded in medical l)ooks. It is called hcemidrosis. 

The proper action of the skin being so vitally important to health, 
these changes often involve very serious consequences. 

Treatment. — Either too much or too little sweating can generally 
be corrected by the cold or warm bath, friction, tonics, and proper 
clothing. Small doses of jaborandi, also ergot and strychnine, are 
among the best internal medicines (365). 

Disorders of the Oil -Glands and Tubes. 

That the skin may be liml)er, healthy, and fit for use, it is neces- 
sary to have it oiled every day. For this object, the Creator lias 




ices, diseased 
ilterations of 

We witness 
[)e on various 

level of the 
no elevation, 

e pigment is 
y. At other 
z\\ are called 

tint, as when 
levered with 
ihe name of 

mole. If it 
^ing out an 
:ing plaster, 
onics, and a 
I change of 
, is the best 
still better, 



lature's de- 
lere is too 
erspiration 
iliar smell. 
Id writers, 
And now 
the most 
n, who, in 
;lus are re- 

to health, 

generally 
id proper 
mine, are 



is neces- 
eator has 



SKIN DISEASES. 



155 



wisely provided, by placing in the true skin a largo number of very 
Huuill glands and tubes, whose office it is to prepare and pour out 
upo!i the surface the proper amount of oil. The gland, regular little 
oil-pot, is in the true skin ; and from it a ptece of hose or tube runs 
up through the scarf-skin, through which the oily fluid is poured out. 
Some of these tubes are spiral, others are straight. On some partH 
these vessels do not exist; on othera they are (juite abundant, — as on 
the face, nose, ears, head, eyelids, etc. They produce the wax of the 
ears; and on the head, they open into the sheath of the hair, and fur- 
nish it with a hair-oil or pomatum better than the chemist can make. 
These little vessels are always at work, when the skin is healthy ; 
and no persons need W afraid to wash all over every day, lest, as the 
Boston Medical Journal taught, the skin will be injured by having 
the oil removed from it. You might as well be afraid to eat a 
meal of victuals, lest the saliva should all Iw swallowed with it, and 
none be left for future use. There is oil enough where that upon 
the skin comes from, and the vessels which produce it are not injured 
by work, any more than the muscles of the legs are by walking. 

Qrubs or Worms. — But, unfortunately, the skin is not well taken 
care of in all cases, as in cities and towns where sedentary habits pre- 
vail. Here, the actions of the skin, instead of being regular and com- 
plete, are often sluggish and imperfect ; and the contents of the oil- 
cells and tubes, instead of flowing easily, become hard and impacted, 
and the vessels are not emptied. When this matter beconies station- 
ary, dry, and hard, it distends the tube, and fills it to the suiiace; and 
then coming in contiict with the dust 
and smoke of the atmosphere, the ends 
become black, and look like the heftds 
of worms. These spots are common 
on the nose and face of persons who 
have a sluggish skin. They may be 
squeezed out by pressing tlie nails on 
each side of them. These are called 
gruhs and tvorms, or, technically, come- 
dones. When this matter produces in- 
flammation of the tube, there is then a 
black spot in the middle of a red pimple, 
and the disease is called spotted acne. 
Now and then the oily matter becomes very hard, producing spine- 
like growths, and even horns (Fig. 77) ; and again, it collects and 
forms soft tumors, as wens, etc. These are technically called encysted 
tumors. Sometimes the action of the glands is too great, and oil is 
poured out so profusely that the face shines with it. At other times 
there is so little that the skin is dry and hai-sh. In the hardened 
oily matter, which constitutes grubs, are found small animals, which 
Ur. Wilson calls the "animal of the oily product of the skin." On 
page 156 are three views of him. , 




156 



SKIN DISEASES. 



Treatment— For roughness and harshness or skin, wasli with «.. 
and water every night, and rub well into the skin XThe fi T„ i 

V ;, a weejc. Vr, rub the skin every morning with a damp 






Via. 78. 



FlO. 79. 



FlO. 80, 



«ao„ ^ •'^ -^ , applied. Ihe spinous variety, or porcuninA dis- 

TrnTtwii I'dr F '^"'"'r^ ?• '*'r^ *^« "«« -^ the^olntm ft 
iifl* ^^; *^"' S^""^' stimulate the skin by washintr it 

W«l '""f rP""*^' '""''^ ^ •^^y' ^'^d rubbing briskly witi a oLe 
towel; and by using the corrosive sublimate (225) a/aTotion 
A spare diet will do much towards improving ih^ skin i^' many 

^^ S (352rrheal"-^"^' '^^^^^^ *^^ '°^^ ^^^'^ ^^ (^^^I 

Barbers' Itch. -Jackson's Itch. — Sycosis. 

iin^^^i!^ ""^"^ much like acne,- only differing from it in its loca- 
tion It appears chiefly on the haiiy parte of the face,- th? chin 

of theTec^' uV'^T '' *^ ,"'^^^ '"' ^h« «y«brows, 'and the nap 
ot the neck. It consists in little conical elevations, which maturate 

pimples are of a pale yellowish color. In a few days they burst and 
n stTflnUrZ ""!' ''''"V'^r ^*^^' '^^^"-'^ cruL.""These 

nesl'o'f the'ski:;." '""''' '^ ^ ^^^"'"^ «^"«^*^- "^ ^^^ -^ tight- 
duH ^.nl'^'^'J' supposed to be brought on frequently by using a 
fnlraVd%tT"o?yeai^^^^^^"^^^^^^^ 



.. -t-^ 



SKIN DISEASES. 



157 




wli with soap 
the bath, and 
sulphur, etc. 
vith a damp 



80. 

ice, the lini- 
rcupine dis- 
ing a large 
le ointment 

washing it 
[ith a coarse 
ation. 
in many 

first (360) 



SIS. 

its loca- 

the chin, 

the nape 

maturate 

m. These 

burst, and 

These 

pimples 

md tight- 

y using a 
'or many 



Treatment. — The most important part of the treatment is the re- 
moval of the cause. The beard must not be pulled with a dull razor; 
the shaving had better be discontinued altogether, and the beard be 
merely cropped off with scissors instead. All intemperance in eating 
and drinking, and exposure of the face to heat, must be avoided. A 
light, cool diet will do much towards curing the disease. 

The nitrate of mercury ointment, and a solution of oxalic acid, are 
the best applications. If one does not succeed, try the other. Black 
wash is to be used when the face is much inflamed. 

Disorders of the Hair and Hair-Tubes. 

The hair is an appendage of the scarf-skin, and is intended to be 
both useful and ornamental. 

It is subject to several disorders. It may grow too long, or too 
thick, or it may appear in an improper place. This last happens in 
the case of those little spots and patches which disfigure the face, 
and are '^alled moles. The hair may be defective in its growth, or 
may fall off prematurely from various causes, or in the natural course 
of things from old age. This last is called calvities. It may change 
its color, too, under a great variety of circumstances, and at nearly 
every age. It is not very uncommon to find a single lock varying in 
color from that which surrounds it. Old age, the winter of life, nat- 
urally brings the frosted locks; but they frequently appear also upon 
the heads of younger perso s. Strong mental emotions, such as fear. 
grief, or sorrow, may bring a bleaching of the hair in a brief period, 
or even suddenly. Byron, in his " Prisoner of Chillon," beautifully 
refers to this fact : — - . 

" My hair is gray, but not with years, 
Nor grew it white 
In a single night, 
As men's have grown from sudden fears." 

Porrtgo. — There is a troublesome disease of the hair and hair-tubes 
called porrigo. It begins with the formation of a thin layer of scurf 
either around single hairs, or in patches which enclose several. These 
patches frequently have a circular form, which give to the affection 
the character of a ringworm. The hair-tubes are generally a little 
elevated, in the shape of papillae, which gives to the diseased scalp 
the appearance of "goose-flesh." These hairs, losing their proper 
nourishment and healthiness, break off at unequal distances from the 
skin, leaving their rough ends twisted and bent, and matted into 
thick grayish and yellow jrusts. Upon the surface of these crusts 
may generally be seen the ends of a few hairs, looking like the fibres 
of hemp or tow. The scratching causes inflammation of the skin after 
a time, and matter is poured out, which still further mats the hair, 
and thickens the crusts. There are several varieties of this disease, 
differing slightly from each other ; but this general description will 
answer all practical purposes for this work. 




■«*?- 



158 



SKIK DIHEARRS. 



The reader will often notice ii diHease of tlio liair-plands, clmrarter- 
ized l)y a yellowish and dirty-looking powder, covering the acalp iuid 
hairs. This matter is eoUected at the mouths of the follieles, and 
considerable of it is strung upon the hairs like Insads. Pull out ii 
hair, and the roof will Ikj fk)und thin, dry, and starved in its ajjpear- 
ance. In this <lisease, it is difficult to keej) the hair cleansed, or to 
prevent its falling off. 

FavuSr — Still another disease, called /rt7'M«, is known hy the collec- 
tion of a yellow substance, at first, around the cylinder of the liair. 
This 8ul)staiu',e, after a ♦inie, spreads out upon the scurf skin, and 
dries into yellow crusLs, in the form of a cup, around the base of each 
hair. A numlier of these cups, collected together, look like the cells 
of a honey-comb. This disease is contagious, and is communicable 
by contjict to any part of the skin. 

Treatment. — For removing the hair from particular parts of the 
scalp, it is common to resort to depilatories. Of these, the recipes 
260, 261, 262, are frequently used, and are as good iw those adver- 
tised ; indeed, they are the same. Forceps are the Inist means. 

To prevent loss of hair, and to restore it when lost, the circulation 
should be stimulated in the small vessels of the scalp. With this 
view, washing the head every morning with cold water, drying it by 
friction with a rough towel, and brushing it to redness with a stiff 
hair-brush, are excellent. To these should l)e added some stimulating 
ointment (183), or liniment (257), (258), (2o9). These last are about 
the best known preparations for causing the growth of the hair. 

Ringworm of the scalp requires attention to the diet, and such 
remedies as will improve the general health, with stimulating appli- 
cations externally (267), (258), (259). 366 is the newest and best 
mode. 

To color the hair, several preparations are used. Of these, 163 is 
about the l)est. It produces a beautiful black. A preparation of sul- 
phur and sugar of lead ^264) is the famous compound recommended 
by General Twiggs, and extensively used. Preparations of nitrate of 
silver (265), (266), (311) a.e much in use in some quiirters. They 
perhaps give a finer black to thp hair, but they render it dry and crisp, 
and they will stain, the skin, if care is not used iii applying them. 

Use care in the use of these remedies. 

In Favus, the two great objects to be gained are, to remove all lo- 
cal causes of irritation, and to excite the diseased hair-glands to 
healthy action. The first object is affected by cutting off the hair 
with the scissors, and removing the crusts by washing the scalp with 
castile soap and water. It may be well first to wet the crusts through 
with corrosive sublimate (212), in weak solution. The washing with 
foap and water should be repeated every day, and b§ followed by 
rubbing into the scalp a stimulating ointment (183). A very weak 
solution of tlu! nitrate of mercury (226), applied every other day, 
with a camel's hair brush, sometimes produces excellent effects. 



'^ 



y 



iida, cliftnvcter- 
the scalp and 
folliclcH, iin«l 
1. Pull out ii 
in its a|)j)ear- 
leanaud, or lo 

by the oollec- 
' of the liiiir. 
;uif skiu, and 
hiiso of each 

like the cells 
;©niniunicable 

parts of the 
e, the reiiipes 

those adver- 

nieans. 
he circulation 
1. With this 
, drying it hy 
9 with a stiff 
e stimulating 
last are about 
the hair. 

iet, and such 
ilating appli- 
vest and best 

lese, 163 is 
■ation of sul- 
ecom mended 
of nitrate of 
rtere, They 

y and crisp, 
ng them. 

niove all lo- 
ir-glands to 
off the hair 
scalp with 
ists through 
ashing witii 
followed by 
very weak 
other day, 
effects. 



SKIN DISKABES. 



159 



Lice. 




PediculofliA or Lice is a contagious, animal, parasitic affection, 
chara(;t<'ii/tMl by the presence of pediculi in the skin and scratch- 
marks of the sufferer ensuing from the annoying itching. There are 
a number of varieties classified according to the peculiar parasite and 
its location. They all cause great discomfort and itching. 

The Pediculosis Capitis, or head-louse, is found in the scalp, and 
is a long, oval l)ody with six legs furnished with nails; it has an oval 
head with two prominent eyes and two horns. The ova or nits are 
small whitish iMxlies closely glued to the hair 
and look like small pieces of dandruff. One or 
two are deposited on a hair. 

They occur for the most part in poorly nour- 
ished children brought up under bad hygienic 
surroundings, and thence communicated to 
others. They cause extreme itching and scratch- 
ing, so that often the irritation is unbearable and 
the sticky serum of the blood mats together the 
hair, forming crusts. Sleep is often interfered 
with and ill health results. (See Fig. 81.) 

Pediculosis Corporis, or body-louse, is gen- 
erally the property of the clothing ; it is some- 
what larger than the head-louse and deposits it« 

eggs in the seams of the clothing, remaining on the body only long 

enough to gain sustenance. The young are hatched in five or six 

days. The louse reproduces again in 

eighteen days. As the parasite crawls 

about it produces extreme itching and 

the scratcliing follows, resulting in long 

lines of excoriation. The chief locations 

for this parasite are the back, chest, abdo- 
men and thighs. The middle-aged and 

elderly are more apt to be attacked than 

the young. Here unclcanliness again is a 

prime factor in their occurrence. (Fig.82.) 

Pediculosis Pubis, or crab-louse, is a 
smaller, shorter, stouter parasite than the 
two I receding, and attacks the pubes par- 
ticularly, but is also found in the axillae 
and over the eyelashes and beard of the 
male. Thoy may be seen clinging closely to 
the skin with remarkable tenacity. They 
occur on adults and pioduce the same lesions as the other varieties. 
They are generally the result of promiscuous sexual intercouree. 
( Fig. 83.) 



Kio. 81. 
BEAD- LOUSE, 




FlO. «i. 
BODT-LODSE. 




1«0 



SKIN DISEASES. 




Treatment. — The main object in the tieatr 
ment of these filthy diseases is the destruction 
of the parasite. The lesions they produce 
disappear with the disappearance of the ani- 
mal. It need hardly be said that strict clean- 
liness of person is a sine qua non. The rem- 
edies usually employed in their extermination 
are the mercurials, sulphur, carbolic acid, to- 
bacco, etc. 

cBA^LouBB. I^ case of the head-louse the most effica- 

cious method of treatment consists in saturating the head over night 
with petroleum and washing off with soap in the morning. In young 
children the hair may be cut to get rid the more easily of the nits, 
but this is not necessary. The applications of petroleum may have 
to be repeated several times and the hair frequently washed with soft 
soap, soda washes, vinegar, etc., to get rid of the nits. If the louse 
be of the body variety the treatment must be directed to the clothing, 
which is to be changed often and either boiled or baked. This pro- 
cess is to be repeated until no more parasites are found. The itching 
of the body is best allayed by carbolic acid lotions (one teaspoonful 
to pint of water). 

The crab-louse is best treated by the well-known mercurial oint- 
ment, or blue ointment, and is to be washed off with soap and water 
each morning. It must be persisted in till no more crabs are found 
and no further itching is noticed. 






Bed-Bugs. 

The best preventives against these annoying bugs is corrosive sub- 
limate and pyrethrum powder. Purchase a small bottle of the corro- 
sive sublimate tablets, usually sold at the druggists for surgical pur- 
poses, and dissolve one in a quart of water. This solution is to be 
freely used about the cracks of the bed, after it has been taken apart, 
and also about any wooden furniture of the room as well as the wood- 
work of the room. The powder is then to be used freely. This pro- 
cess is to be repeated several times. 

The bites themselves are best relieved by carbolic lotions, vinegar 
and water, ammonia and water, etc. 

Freckles. 

This is a disease of the pigment layer of the skin and consists in 
a deposit of the coloring matter of the skin in irregular shapes, 
of the size of a pin-head or pea, and are yellowish, brown or even 
blackish, occurring for the most part on the face and back of the 
hands. They may be few and scattered or exceedingly abundant 
and cover a large area. All ages are subject to them except in very 
young children. The light<;omplexioned are more subject to them. 



1 



SKIN DISEASES. 



161 



t in the treat- 
le destruction 
;hey produce 
B of the jini- 
t strict clean- 
t. The reiii- 
xterniination 
3olic acid, to- 
most effica- 
d over night 
g. In young 
5^ of the nits, 
m may liave 
lied with soft 
If the louse 
the clothing, 
. This pro- 
The itching 
teaspoonful 

rcurial oint- 
p and water 
8 are found 



rrosive sub- 
f the corro- 
irgical pur- 
)n is to be 
aken apart, 
s the wood- 
This pro- 

ns, vinegar 



consists in 
ar shapes, 
^n or even 
ck of the 
abundant 
pt in very 
; to them, 



while the red-haired seldom escape them. Sunlight develops them so 
that many have them conspicuously only in summer. The possession 
of freckles is a matter greatly of idiosyncrasy, as many people never 
have them, no matter how much they may be subjected to the sun. 

Treatment. — One's aim in treatment should be toward destro}'ing 
the pigment layisr by some corrosive agent, like corrosive sublimate, 
which perhaps is the best remedy. 

Two grains tc( the ounce in water will in most cases prove suffi- 
ciently strong. The susceptibility of the skin to this remedy and the 
extent of the area involved have much to do with the strength of the 
remedy employed. This remedy is poisonous and is to be used with 
care. Do not get it near the lips, but to effect a cure it must be per- 
sijted in for quite a while. 

A\' ashing the face in buttermilk several times a day is excellent. 

Corns. 

Of all the minor ailments of the human body, few are more dis- 
tressing than the inflamed corn. They consist of a thickening of the 
outside or horny layer of the skin. As a secondary change, conse- 
quent on long iriitatiou, the nerve and blood supply increase and an 
extreme tenderness is produced, amounting often to incapacity to 
walk or work. They are caused mechanically by the undue pressure 
of the boot against the joint or biy one toe pressing against another. 
Too short a boot, which causes pushing out of *he big toe joint, too 
narrow a boot, causing crowding of the large joints, are the more fre- 
quent causes of the com. 

Bunion. 

The bunion is produced by wearing too short a boot, as a rule, and 
consists in the gradual displacement of the big-toe joint, so that fi- 
nally there is an actual deformity. The corn usually is added to this 
deformity. 

Treatment. — The outer layers of the corn should be softened and 
scraped off by a sharp, thin knife. The softening process may be ef- 
fected by soaking in a soda solution, or better still, by the following 
mixture : — 

Salicylic acid one-half ounce 

Extract cannabis indica ten grains 

Collodion one scruple 

This is to be applied each night. Care is to be exercised in not 
paring the corn too closely lest bleeding occur and poisoning ensue 
from the unclean knife that may be used. Pressure of the boot must 
be avoided by the substitution of another form of boot and also per- 
haps by wearing a plaster with a hole in the center, thus distributing 
the pressure over a greater area. When trimmed the corn is to be 



i! 






r 



162 



SKIN DISEASES. 






likewise covered by a corn-plaster bound on the foot by strips of 
adhesive plaster. Painting with iodine often takes out the sore- 
ness and hardens the skin so that it may be more readily cut. In- 
flamed corns should be poulticed and treated like any pus wound. 
Spirits of turpentine will often take the soreness out of a corn. Ab- 
sorbent cotton, or better, wool, worn between the toes, will prevent 
or cure a corn between the toes. 



Dandruff. 

This is a Hjsease of. the sebaceous glands of the scalp, characterized 
by a large secretion of the sebaceous matter and forming crusts or 
scales. The secretion may be so thick and oily as to mat together 
the hair, or so dry as to fall off the head in a shower when the head 
is combed. It is the most frequent cause of baldness. Tlie crown 
of the head is the most frequent location of this disease. 

Treatment. — Inasmuch as those subject to this disease are often 
below par in health, such constitutional remedies as cod-liver oil and 
iron are valuable adjuncts in bringing about a cure. Should the 
amount of scales be considerable, especially if there are crusts, as in 
the case of little children, the best procedure consists in oiling the 
scalp over night wit'i some bland oil, wearing a flannel cap, and wash- 
ing off the oil in the morning with soft-soap and water. The follow- 
ing blood tonic is an admirable one for adults : — 

Tincture of iron one ounce 

Dilute phosphoric acid one ounce 

Syrup of lemon two ounces 

Take one-half teaspoonful in a wineglass of water three times daily. 
Use a glass tube to avoid staining the teeth. The scalp needs a 
shampoo once or twice a week ; the following will be found to be a 
suitable one: — 

Green soap eight ounces 

Alcohol four ounces 

Put a little here and there over the scalp and then rub up with 
warm water. The scalp may then be stimulated night and morning 
with a little of the following lotion :^ — 

Tincture of cantharides three dr9,chm8 

Tincture of capsicum three drachms 

Castor oil two drachms 

Alcohol two ounces 

Spirits rosemary two ounces 

Another good remedy for daily use : — 

Hydrate of chloral two drachms 

Water four ounces 



■Ml 



SKIN DISEASES. 



163 



by strips of 
ut the sore- 
ily cut. In- 

pus wound. 
1 corn. Al> 
will prevent 



iharacterized 
ig crusts or 
nat together 
en the head 
Tlie crown 

use are often 
liver oil and 

Should the 
trusts, as in 
n oiling the 
p, and wash- 

The follow- 



unce 
bnce 
unces 



imes daily, 
needs a 
ind to be a 



ounces 
unces 

) up with 
id morning 

Irtichms 

Irachms 

achms 

nces 

noes 



ichms 
nces 



The yolk of two eggs well rubbed into the scalp and afterwards 
washed off with hot water is ilso a good cleansing agent and sham- 
poo. 

For very stubborn cases the following lotion applied night and 
morning will be found efficacious : — 

Corrosive sublimate 12 grains 

Glycerine 4 drachms 

Alcohol 6 ounces 

Spirits rosemary 4 drachms 

Whatever method is pursued, the application must be persevered 
in and applied from twice daily to once every few days according to 
progress made and severity of case. . • 

Baldness. 

This disease is generally the outcome either of some constitutional 
weakness and requires general tonic treatment like iron and cod-oil, 
or is the result of some local lesion of the scalp proper. i' nen due 
to sypliilis, the hair falls out suddenly and quite extensively ; the 
eyebrows also saffer the same way. Its treatment is to be conducted 
on the same plans as directed under treatment of the syphilitio dis- 
ease. Eczema, scrofulous blood, etc., may also be the exciting cause 
of baldness. Baldness may ensue in areas only, and oftentimes is as 
complete as though no hair had ever grown there. This form is apt to 
be very stubborn and requires very irritating treatment, like blisters 
or the rubbing in of strong carbolic acid once a day for a number of 
days before ceasing treatment. 

The baldness of old age is of course irremediable, but may be ar- 
rested by attention to the general health and the employment of rem- 
edies mentioned under the consideration of dandruff. 

As has been mentioned, dandruff is the most fertile source of bald- 
ness. When once the scalp is clean and the dandruff is cured the 
following lotion will be found to be of great value in those cases of 
baldness characterized by the hair falling out in small patches : — 

Carbolic acid one drachm 

Alcohol one and a half ounces 

Castor oil two drachms 

Oil bitter almonds ten drops 

Strong carbolic acid itself may be rubbed in the inveterate cases. 
The following lotion also contains desirable ingredients : — 

Tincture cantharides . . . one and a half ounces 
Tincture capsicum .... one and a half ounces ' ; 

Castor oil two drachms 

Cologne one ounce 







MHi 



DISEASES OP THE BRAIN AND NERVES. 



Thf, brain and spinal column are the great centres of the nervous 
system. 

The brain produces sensation, thought, and voluntary motion. When 
this organ is diseased, therefore, we may expect one of these functions 
to be either disturbed or destroyed. 

Of Sensation there are various disturbances, pervsrsions, and sus- 
pensions, caused by disease of the brain and nerves ; such as nausea, 
giddiness, specks floa./ing Vnjfore the eyes, ringing in the ears, decep- 
tive tastes and sr lells, latolerable itching, neuralgic pains, boisterously 
high spir' a, depression without apparent cause, anxiety, and dread. 

Thought, in like manner, is disturbed and perverted in many ways. 
There is high delirium, dullness and confusion, loss of memory, weak- 
ened judgment, and every degree of stupor, down to l utire loss of 
consciousness. 

Voluntary Motion is perverted and destroyed in muscular twitch- 
ings, trembling of the limbs, spasmodic stiffness, involuntary jerk- 
ings, convulsions, muscular debility, and palsy. 

The brain is composed of three parts, — the cerebrum, the cerebel- 
lum, and the medulla oblongata. These are all contained witliin the 
skull bones, and are immediately covered by three membranes, called 
the dura mater, the arachnoid, and the pia mater. The dui mater is 
a strong, fibrous membrane lying next to the skull-bones. 1 arach- 
noid is a serous membrane, lying next below, and the pia matei hich 
means pious mother, is a vascular membrane, lying next to the brain, 
dipping into it in places, and containmg the vessels which bring to it 
all its nutrient materials. Hence its name. 

These membranes are all liable to be inflamed, — and so is the 
brain. 

Inflammation of the Dura Mater. 

The inflammation of this membrane does not often occur sponta- 
neously ; but it happens frequently from external injuries, as blows 
upon the head. 

After a blow upon the head which stuns him, a man may recover 
himself, and for some days remain in perfect health. Then he has 

164 






■'•^sattm 



tm 



DISEASES or THE BRAIN AND NERVES. 



166 



SBVE8. 



;he nervous 

ion. When 
le functions 

ns, and sus- 
t as nausea, 
ears, decep- 
wisterously 
nd dread. 

many ways, 
aory, weak- 
ire loss of 

liar twitch- 
itary jerk- 

the cerebel- 
witliin the 
lies, called 
mater is 
arach- 
tei, hich 
the brain, 
jring to it 

so is the 



sponta- 
as blows 

y recover 
1 he has 



liiiin in the head, is restless, cannot sleep, has a (lushed face, red eyes, 
hot skin, hard pulse, rigor, nausea, vomiting, — ending with convul- 
sions and delirium. 

This disease is often caused by what is called otitis, or inflamma- 
tion of the internal ear. In such ca»es, iiiHammation will arise within 
the tympanum, causing intense earache ; matter conies at length from 
the external ear, but the pain does not stop ; the patient shivers, be- 
comes drowsy, perhaps delirious, and finally sinks into stupor. The 
dura mater is inflamed. 

Treatment. — When the disease arises from inflammation in the 
ear, leeches are to be applied behind the ear, and blisters and other 
irritants afterwards. Other modes of treatment will be mentioned 
after the next two forms of disease. 

Inflammation of the Arachnoid and Pia Mater. 

Arachnitis. 

These two membranes are generally inflamed together. They 
are so intimately connected that each involves the other in its own 
troubles. 

Generally this is divided into three stages : — 

The Irritative, characterized by wakefulness, irritable temper, re- 
pugnance to strong light, and contraction of the pupils. 

Tlie Infiammatory Stage, known by transient pains in the head, 
alternating with similar ones in the bowels, increased restlessness and 
irritability, a quick and t«nse pulse, an expression of discontent on 
the face, the eye-brows knit and frowning, the eye-lids half closed, 
retching and vomiting, deep sighing, and torpid bowels. 

The Depressing Stage, in which the delirium is more continuous, 
the countenance has a look of surprise and stupor, the pupils are con- 
tracted or dilated, the white of the eyes injected and red, the pupils 
rolled up during sleep, constant sleepiness, inattention to surrounding 
objects, torpidity of mind, gradually increasing until complete coma 
closes all the senses. 

The disease does not always exhibit all these symptoms, or come on 
in the regular way described. Sometimes the first thing noticed is a 
long-continued paroxysm of general convulsions. Again these con- 
vulsions will come on after violent pains in the head, and are attended 
with screaming. 

Inflammation of the Brain. Brain Fever. 

Encephalitis. — Phrenitis. 

Acute and general inflammation of the brain and its membranes 
has two stages. ' 

The Stage of Excitement, in which there is intende and deep-seated 
pain in the head, extending over a large part of it, a feeling of tight- 



■■ '\ 



166 



DISEASES OF THE DRAIN AND NERVES. 



V 



rifcos across the forehead, throbbing of the temporal arteries, a Hushed 
face, injected eyes, looking wild and b? lliant, contraction of the pupils, 
great shrinking from light and violent sound, delirium, want of sleep, 
general convulsions, a parched and dry skin, a quick and hard pulse, 
a white tongue, thirst, nausea and vomiting, and constipation of the 
bowels. 

The Stage of Coliapse, in which there are indistinct mutterings, 
dull and perverted hearing and vision, double vision, the piipil from 
being contracted expands largely and becomes motionless, twitchings 
of the muscles, tremors and palsy of some of the limbs, a ghastly and 
cadaverous countenance, cohl sweats, profound coma, and death. 

The disease will not show all these symptoms in any one case. It 
runs a rapid course, causing death, sometimes, in twelve or twenty- 
four hours ; or it may run two o: three weeks. 

Treatment. — This should be energetic, and administered early. 
The measures usually employed are hot foot-baths., and the application 
of cold to the head., with occasional mustard poultice to legs. 

General Blood-letting. — This is much approved by many ; for 
myself, I do not like it. Wet cups and leeching are about tlie extent 
to which I would ever carry the abstraction of blood in these diseases. 
These may sometimes be applied with advantage to the neck, and be- 
hind the ears. 

Cold Applications. — These, applied to the head, are of great im- 
portance. First, shave the head, and put on cloths wetted in water 
as cold as it can be made, changing them often ; or, put powdered 
ice in a flexible bladder, and lay it upon the head, — taking care not 
to make it too heavy. Heat in a few cases is better borne. 

Cathartics. — These, while the inflammation is in the active stage, 
should be thorough and energetic. To effect it, many use calomel 
and other forms of mercury. They are not needed. Croton oil is one 
of the best articles (31), or colocynth, gamboge, etc. (82), without 
the oil, or the compound powder of jalap. 

In the stage of collapse, if tliere is pallor of the countenance, a 
feeble and flying pulse, great debility and tremors, coldness of the 
extremities, etc., give wine and other stimulants. 

See that the bladder is emptied every day. 

The feet, in the early stage of the complaint, should be bathed in 
warm water, or mustard and water (242). Mustard draughts must 
also be put upon the feet. 

The tincture of veratrum, given in full doses, to bring down the 
pulse, and produce sweating, must not be omitted. Give (351). 

Softening of the Brain. — Ramollissement. 

Inflammation of the brain, when it has run its course, sometimes 
leaves this organ, or portions of it, in a softened condition. The 



4p 



5s, a flushed 
f the pupils, 
int of sleep, 
hard pulse, 
tion of the 



mutteriugs. 
pupil from 

twitchings 
ghastly and 

death, 
le case. It 
or twenty- 

ered early, 
application 

rS. 

many; for 

the extent 

se diseases. 

ck, and be- 

f great ini- 

d in water 

powdered 

g care not 

tive stage, 
36 calomel 
I oil is one 
), without 

benance, a 
S8 of the 



)athed in 
its must 

own the 
J51). 



imetimes 
n. The 



niSEASES OP THE BRAIN AND NERVES. 



167 



same mischief may happen to the bruin from the blood-vessels which 
run to it being diseased, so as not to be able to carry blood for its 
proper nourishment. 

Symptoms. — The most remarkable symptom of this disease is the 
rigid contraction of the muscles which draw up the limbs ; the hand 
may be clenched and pressed against the shoulder, or the heel carried 
up to the hip. 

The other symptoms are various, — tingling and numbness in the 
ends of thu fingers ; perverted vision, and sometimes blindness ; par- 
alysis of one limb, or half the body; difficulty of answering ques- 
tions ; forgetfulness, making it difficult, at times, for the patient to 
remember his own name. General treatment is indicated. 

Suppuration and Abscess of the Brain. 

When a diseased brain is examined after death, sometimes matter 
is found mixed in with the softened portion. This shows that suppu- 
ration took ;jlace. At other times, the matter is found in a cavity, 
which shows that an abscess had formed during life. 

The symptoms of these mischiefs are convulsions in the earlier 
stages, and palsy in the latter. Surgical methods now often save 
life, and cause a cure in these cases. 

Induration of the Brain. 

Instead of softening the brain, inflammation sometimes does the 
very opposite, — it hardens it, — producing a change something like 
that which happens to white of Qg^ when dipped in hot water. 

Convulsions appear as the result of this change, as in suppuration 
and abscess ; palsy much more seldom. 

Tumors bf the Brain. 

Tumors infect the brain occasionally, — growing around it, on all 
sides, pressing themselves into its substance, and causing many dis- 
turbances. Cancers and hydatids are found there. The signs which 
these irritating bodies produce are like those of other diseases of the 
brain, and therefore cannot be distinguished daring life. Syphilis is 
often the cause of them, and, when due to this, may be cured. 

Delirium Tremens.— Drunkard's Delirium. 

Mania a Potu. 

This is often mistaken for brain-fever ; but it is quite a different 
disease. It is not the result of inflammation of the brain, but of irri- 
tation. It is important to distinguish it from inflammation, because 
the remedies wWch are employed for that would be injurious if used 
for this. 




V 

I 



I .i 



ij^ 



108 



DISEASES OP THE BRAIN AND NERVES. 



The Symptoms art; incosaant talking, fidgeting with the hands, 
trembling of the limlw, a rapid pulse, profuse sweating, utter sleep- 
lessness, and a mingling of the real with the imaginary in the hiiHy 
talk. The patient is apt to think some one is about to do him a 
great injury, yet is unwilling to be alone. His face is pale and sal- 
low (sometimes red and flushed), his eye is rolling, quick and ex- 
pressive, his speech stuttering and inarticulate, — bodily and mentally, 
he is busy day and night, and can with difficulty be confined to his 
bed or room. As the disease advances, and he has been long without 
sleep, he imagines vermin to be crawling upon his scalp and body ; 
troops of rats run across his bed, or look at him out of the wall ; 
giant boxers confront him, and he squares off for a round at fisti- 
cufis ; animals, figures of all shapes, and horrible monsters frighten 
his imagination ; devils laugh at liim, and dance before him. In long 
and sleepless houi-s, he Uilko and chatters with these spectral phan- 
toms, — now beckoning them, now shrinking from them, till he wears 
out and sinks from exhaustion. This is a disease of drunkards and 
opium eaters. The attack generally occui's in consequence of the 
withdrawal for three or four days of the accustomed stimulus. 

Treatment. — Opium and its preparations are the sovereign rem- 
edy. Give one-third of a grain of morphia; if this does not quiet the 
patient, give thirty drops of laudanum every two houra, till sleep is 
produced. Sleep will cure him, and notliing else will. A draught 
or two of his accustomed drink, brandy, gin, or whatever it may be, 
will also generally dispose him to sleep, if he be not already in drink. 

Recently, a very effectual remedy has been found in the use of 
tepid baths, prolonged from four to ten hours, in connection with 
cold applications to the head. In connection with this, small doses 
of opium are required ; but the treatment may yet prove to be very 
valuable by enabling us to dispense with excessive doses of opium. 
Twenty grains of chloral may be given every hour till patient sleeps. 

Inebriety. 

In the beginning of the present century insanity was regarded as a 
visitation of God's displeasure and not as a disease subject to scientific 
investigation and amenable to treatment. Inebriety is regarded now 
as insanity was some hundred years ago, the disease being consid- 
ered irremediable. Alcohol is a poison, and like other poisons is cap- 
able of destroying life. In large doses it becomes a powerful irritant 
or a narcotic producing coma and death. It being constantly intro- 
duced into the system produces a general disease in the system. We 
believe inebriety can be cured like any other disease, but is subject to 
relapses like other diseases. 

The " alcohol habit," under the title Inebriety, oftentimes has the 
symptom or outward manifestation of diseased conditions, which an- 
tedate the alcoholic craving, and are its predisposing and exciting 
causes which retard, and sometimes even prevent a cure. 



in 



DISEASER OF THE BRAIN AND NERVES. 



169 



m 



the liHiul.s, 
utter sleep- 
in the hiisy 
do him a 
ale and sal- 
ick and ex- 
id mentally, 
fined to his 
ong without 
and lx)(ly ; 
if tlie wall ; 
ind at fisti- 
ere frighten 
m. In long 
ctral phan- 
ill he wears 
nkards and 
ince of the 
ulus. 

!reign rem- 
it quiet the 
ill sleep is 
A draught 
it may be, 
ly in drink, 
the use of 
[ction with 
mall doses 
io be very 
of opium, 
ent sleeps. 



irded as a 

scientific 
rded now 
g consid- 
►ns is cap- 

1 irritant 
itiy intro- 
»m. We 

ubject to 

has the 
vhich an- 
exciting 



In thu popular, and too ofttm in tlu; professional mind, alcohol in 
regarded as the cause and root of the wliole evil of inebriety. We 
desire to assert that inebriety is frequently dependent upon caa'^es 
with which alcohol has nothing to du. There is a neurotic craving 
— it may lie congenital, it may be developed as the result of disease 
or accident. This craving demands the various forms of narcotic 
stimulants, those that first excite, then produce narcosis more or less 
complete. Alcohol fuUills this condition, is easily accessible, reason- 
ably inexpensive, and is the one drug that meets a morbid craving 
that seenus to be almost universal. 

We do not fail to recognize the deteriorating effects of alcohol 
manifested principally, at least, more pronouncedly upon the nervous 
system as seen in the various forms of insanity. We also note the 
degenerating effects of alcohol on lung, liver, kidney or other organs 
and tissues of the body ; or as a special poison in the same sense that 
lead, arsenic and tobacco produce their effects. 

We believe that the great majority of inebriates become so from he- 
redity, environment and disease, that produces physical degeneracy 
and pushes them over and plunges them into inebriety. 

The patient with fever craves and may drink water freely, exces- 
sively and injuriously. The diabetic is an aqua-maniac in a certain 
sense, but in neither case do we recognize the aqua-mania or water 
craving as the disease, but rather r.s proceeding from certain abnor- 
mal conditions whiclj we readily recognize. So the liquor thirttt is 
the result of morbid ('onditions that produce an abnormal desire, 
which alcohol seems, temporarily at least, to satisfy. 

The excessive use of Jilcohol, while it is oftentimes the cause of 
various diseases of the nervous system, and also a frequent cause of 
insanity, is also the precursor or initiatory symptom of certain disepses 
of the nervous system and also of insanity. 

The paretic will crave and use alcohol in the earlier stages of his 
malady. The victim of nervous syphilis is addicted to it, more es- 
pecially in the later stages, when the nervous system becomes in- 
volved. 

Any depressing, exhausting, or painful disease may produce the 
alcoholic craving, alcohol being sought for its stimulating properties. 

Alcohol, moreover, is second only to opium, ether, or chloroform 
as an anaesthetic ; indeed, has been used aa a substitute for the latter. 
Hence, persons find experimentally that alcohol relieves pain, and 
its use is carried to a harmful extent, its deleterious effects produced, 
and inebriety established. 

It is possible that a healthy individual, with good peraonal and^j 
family history, may use alcohol sociably or as a matter of custom, un- / 
til the habit becomes firmly established. 

The alcohol breaks down the constitution, invades and degenerates 
the nervous system, and thus develops inebriety, because the alcoho- 
lic degenerations, or even functional disturbances of the nervous sys- 



170 



DISEABRS OF THE BKAIN AND NEKVSa 



teni, are the very coiulitioiiH tinder which inebriety is estuhliHhed. 
We say this is i)OH8il)le, but wo assert again that l)tihinc{ the hu-^v 
majority of inebriates will Ihj found a defective family or persomil 
history, not only complicating but causing the inebriety ; retaidinp, 
oftentimes preventing a cure. 

It can be thus seen that inebriety is but a symptt)m — a flag of 
distress hung out by the nervous system. As some one hius aptly 
said, "neuralgia is the cry of a diseased nerve," so the " drink-craze'' 
is the cry of the neurasthenic for a stimulant, of the? puin-tortured 
nerve for an amesthetic, of the victim of insomnia for a hypnotic. 

Not any patient that applies for relief to the pliysician needs a 
more careful examination than does the inebriate. You may rest as- 
sured that there is some underlying cause, probably several that must 
be removed if we would restore the inebriate to his former habits of 
sobriety. If he is found suffering from the later manifestations of 
syphilis he will need special treatment for this condition, especially 
if the nervous system is involved ; a painful stricture of the urethra 
may require division. 

Chronic malarial poisoning with its complicating disorder of stom- 
ach, liver and spleen, will demand special treatment. In a cfuie on 
record the irritation of a tape-worm produced a tendency to the ex- 
cessive use of alcohol, which tendency passed away when the wonn 
was expelled. 

In a word, a large majority of inebriates are diseased persons, and 
tliat primarily and antecedent to their inebriety, which is appended 
to and aggravates their diseased condition. 

Special diseases, therefore, require special treatment, irrespective 
of the inebriety, if we would cure the inebriate. In this connection 
we may ask, are there any drugs that we can substitute for alcohol 
that will take its place, and satisfy the inebriate, as a substitute for 
alcohol ? 

Opium and the salts of morphia will do so in a marked degree, al- 
though cocaine, chloral and the bromides have been so used. 

The use of opium or morphia is not uncommon among inebriates 
who desire to " leave off alcohol." The inebriate, as a rule, is a con- 
genital neurotic. From birth almost, he reaches out for some drug 
that will gratify or meet his neurotic craving. The alcohol and the 
opium habit to the inebriate are convertible habits, and the inebriate, 
like a pendulum, will swing from alcohol to opium ; not infrequently 
the two habits are combined, as in the form of tinct. opii, constitut- 
ing a mixed habit, in which the effects of both alcohol and opium 
have to be considered. Occasionally a case is presented in which 
morphia is used hypodermically, and the alcohol used in the usual 
manner. In cases where opium addiction is associated with the habi- 
tual use of alcohol, the opium habit is of paramount importance and 
the alcohol assumes a secondary place. 

The fact that opium can sutetitute alcohol is the keynote to many 
vaunted secret cures, in the so-called " narcotic treatment " for alco- 




estHblishod. 
>'' the liiij,r(. 

01' personal 
■; retaidiiiy, 

— a flag of 
i« has aptly 
Iriiik-craze " 
uin-t«rturt'(l 
i.Vpnotio, 
ian needs a 
may rest as- 
al that must 
pr hahits of 
'estatioiLs of 
I, especially 
the urethra 

ler of stoni- 
a case on 

"■ to tlie ex- 
the wonu 

ersons, and 
J appended 

rrespective 
connection 
or alcohol 
Jtitute for 

degree, al- 

inebriates 

is a con- 

^me drug 

and the 

nebriate, 

iquently 

eonstitut- 

id opium 

n which 

le usual 

the habi- 

ance and 

to many 
for alco- 



re 



DIBIASEB OF THE BRAIN AND NIRVES. 



171 



hoi. It simply substitutes one habit for another, and as long as the 
victim is taking the so-called remedy he is reasonably comfortable. 
Mut I admit if the " narcotic treatment " was carefully practiced, in 
judicious hands it might, in conjunction with such other remedial 
measures as would best eradicate the primal causes of the inebriety, 
prove useful, if not curative, in cases oi inebriety. 

Are there any drugs that are specifically l)eneHcial for the treatment 
of inebriety as such ? We would state that drugs that act directly as 
a stimulant to the nervou., lystem are of value. Strychnia is a type 
of this class of drugs, and one of the best of it class. 

Luton, of Rheims, Belgium, was the first to point out its value in 
alcoholism. Then the Russians used it largely and it was known as 
tiie " Russian treatment," and finally, the Americans adopted its use 
in such cases. 

Strychnia has proved serviceable as both abortive and curative in 
acute alcoholic delirium, as well as useful in the more chronic forms 
of alcoholism. It seems to be tolerated in such cases — in cases of 
alcoholic poisoning under normal conditions, we have no record of 
the value of strychnia as an antidote ; interesting experiments might 
l)e made on the lower animals with the view of determining this 
point. Strychnia is an excellent cardiac tonic, and one of the best 
respiratory stimulants, and might be used in general medicine in 
cases in which aicohol is oftentimes prescribed. 

Oxide of zinc, during the past twenty years, has been used with 
advantage in cases of chronic alcoholic intoxication. 

Quinine has been used more particularly in the later or convales- 
cent period of the treatment of alcoholism. 

The so-called " Red Cinchona Cure " for a time interested the pub- 
lic. Rational medicine does not recognize any special drug or speci- 
fic remedy as a universal cure for inebriety, nor does clinical experi- 
ence form any basis for such a claim. From the very nature of the 
case, such a remedy would be impossible. The aetiology of inebriety 
is dependent on such a variety of causes and its environments and 
complications so numerous that any one remedy could not fulfill all, 
or even meet the more important of these conditions. However val- 
uable drugs may be to meet certain indications in the various condi- 
tions incident to inebriety, we believe that so far as the curative 
treatment of inebriety is concerned, drugs must assume a secondary 
place, valuable as they may be in their respective spheres. 

In the treatment of the alcohol habit we place first: Restraini and \ 
seclusion in a special asylum for a definite period, and totat abstinence J 
duri'iig this period. 

In a few words, concisely expressed, this statement includes the 
plan now adopted by the leading asylums of this country and of 
Europe for the recovery of the inebriate. It involves restraint, 
(legal, if need be), seclusion, a special institution, in which all the 
latest and best methods of dealing with the inebriate are procurable, 
a sufficient period in which to apply these measures, and we need 




172 



DIHRABK8 or TIIK BRAIN AMD NRRVIS. 



V 



hurdl)' iiclJ, a long period of total abstinence from ail alcoholic limiois. 
Wo need hardly add that diet, rest, recreation, liygienic Hnrronndin^p*, 
and the exhibition of appropriate drugs are all included in the al)ove 
plan. 

The cauHes of degeneration Iniing removed, i\w fa(!torH of regenera- 
tion l)eing brought into action, new formation of nerve, nniHcle uiii) 
tissue must supplant degenerated tissue, if haply organic disease him 
not resulted in irrepamble injury. 

We have hinted at an hysterical element in the history of inebriety. 
The inebriate, whatever may be his condition, is largely intluenced 
by his surroundings. 

In the light of such an hysterical element in the clinical history of 
inebriety, we can readily account for the apparent success of the so- 
called temperancie movements that sweep over comn unities periodi- 
cally and effect many apparent euros, or rather, in the language of 
the day, reformations. Such an element will also explain why, after 
such a tidal wave of excitement, relapses take place oftentimes in 
large numbers, and the period of excitement is followed by a period 
of reaction. 

The occurrence of relapses is readily accounted for by the fact that 
the stimulus of the period of excitement buoys up the inebriate for 
the time Ixjing, during which strong mental emotion is a powerful 
factor. He is keyed up, as it were, for the time, and sustained by a 
moral stimulus. When this is withdrawn, reaction, followed by cor- 
responding depression, sets in, and the old method of stimulation is 
again imperatively demanded and yielded to. 

Why some inebriates go through such a period of excitement and 
do not relapse, and why othere do, can be accounted for by the fact 
that the former are in a reasonable degree of physical health, and are 
not bui'dened, dragged down and handicapped, either by disease that 
is non-alcoholic, or that is the result of alcoholic degeneration. The 
inebriates so affected are not influenced, or if at all, only temporarily, 
by the so-called " temperance revivals " that appear and disappear 
with almost stated regularity in large and small communities and we 
must add do good, but only in the channel indicated. 

It is also operating through this hysterical feature of inebriety 
that charlatanism may effect a temporary, possibly a permanent suc- 
cess in a certain class of cases. 

In cases where the hysterical element largely preponderates, we be- 
lieve psycho-therapeutical agencies, or even those that appeal to 
purely mental conditions, will be of service, but they will not cure a 
cirrhosed liver, lung, or kidney, or remove the physical causes upon 
which the inebriety may depend. In addition to those measures that 
appeal to the higher moral nature, there ought also to be combined 
such as meet certain intelligent wants. To this end all reasonable 
amusements, entertainments, and especially such occupations as will 
interest the person and keep him busy, should be encouraged, if not 
made compulsory. 



V . 






DI8KAHE8 OK THE tiUAIK AND NKKVKS. 



173 



f>li(' liiiuors. 
rroundingH, 
" the above 

^f regeneni- 
nuiHcIe mid 
•liHi'iise iuM 

•f in(d)riety. 
' iiiHuenoeU 

il luHtoryof 
of the 80- 
ies peiiodi- 
Higiiage of 
why, ftfter 
/ontimeH in 
by a period 

le fact that 
ebriate for 
V powerful 
[lined bv a 
red by cor- 
iiuhition is 

mient and 
)y the fact 
h, and are 
sease that 
The 
nporarily, 
isappear 
8 and we 

inebriety 
nent suc- 

68, we be- 
ppeal to 
ot cure a 
868 upon 
urea that 
jorabined 
iBsonable 
as will 
, if not 



Incidentally I may mention hypnotism iw having Imhmi used espe- 
cially by French [ihysiciauH, with some l)eneflt in cases of chronic al- 
coiiolism. I have no data to give, and have not had any personal 
experience with it. 

The Bi-Chloride of Gold cure, known as the Keeley cure, is in 
many cases successful, but not in all. Would advise its use as a List 
resort; though we think its use sometimes leads to insanity and 
suicide. It cures at all events for the time being. 

If the t(!mper.in('e advocates would supply light, warm, cheerful 
places of resort with h(tt and temperance drinks, supplied with pool 
imd billiard bibles where the poor could spend their evenings and 
meet each other and amuse themselves at v reasonable expense, and 
establish cooking schools for the wives vf. • • they could learn how 
to cook nourishing and palatable food which would supply the body 
with the nourishment which it must have and recjuires, we believe 
it would do more towards tempci'ance than all the laws that could 
be passed. 

Enlars^ement of the Brain. — Hypertrophy. 

This is chiefly a disease of childhood. It consists in an unnatural 
growth of the brain. Sometimes the skull grows with it, and there 
may not be any, or only slight, symptoms of disease. 

The complaint is sometimes congenital, — the child being born 
with a head far above the natural standard Jt size. Sometimes a 
child's head, from this disease, will reach the size of p'' adult's by 
the time it is five or six yeara old. This is not necessarily a disease, 
though children that suffer from it are very apt to die finally of some 
affection of the brain. 

Symptoms. — Dullness of intellect, indifference to external objects 
great irritability of temper, inordinate appetite, giddiness, and an ha- 
bitual headache, which at times is very severe. In addition to these, 
there are, at times, convulsions, epileptic fits, and idiocy. There is a 
peculiar projection of the parietal bones, which serves well to distin- 
guish this disease from acute hydrocephalus. 

Treatment. — As far as possible, suspend and repress all exercise 
of the mind. Take the child from school as soon as the disease is 
discovered, and put it to the most active muscular exercise in the 
open air. The moment there is any excitement of the brain, or heat 
on the top of the head, apply cold water, ice, or cold evaporating 
lotions. If, as the child grows up, the signs of mischief increase, the 
diet must be simple, and carefully regulated. Bread and milk only 
is sometimes advisable. 

Shrinkin,? of the Brain, — Atrophy. 

This is a disease in which the volume of the brain is diminished. 
Thei-e are' two forms of 't; one is congenital, the brain not being 



i ' i 



174 



DISKABE8 OF THE BKAIK AND NERVES. 






properly developed at birth ; the other occurs in consequence of dis- 
ease either in the membranes or the arteries. The symptoms are not 
distinguishable during life from those of other brain affections, and 
therefore it can only be treated according to general jjrinciples. 

Water in the Head. — Acute Hydrocephalus. 

This, like enlargement of the brain, is likewise a diseaso of child- 
hood, and often attacks scrofulous children. 

Being an inflammatory disease, if, is important to have early notice 
of its existence, and, if possible, to be aware of its approach ; which 
we may be, frequently, by observing the following premonitory 

Symptoms ; namely, a disturbance of the digestive functions, indi- 
cated by a capricious appetite, — the food at one time being disliked, 
at another devoured greedily; a foul tongue, offensive breath, enlarged 
and sometimes tender belly, torpid bowels, stools light-colored from 
having no bile, or dark from vitiated bile, fetitV, sour-smelling, slimy 
and lumpy. The child loses its healthy look, and grows paler and 
thinner. Its cv-stomary spirit and activity are gone ; it is heavy, lan- 
guid, dejected ; it is fretful, irritable, uneasy ; and sometimes is a lit- 
tle tottei-ing in its gait. 

After these warning symptoms, the disease may begin in one of 
three ways : — 

The pains in the head become more severe and frequent, and are 
sharp and shooting, causing the little patient to wake and shriek out. 
As the drowsy state advances, the shrieking gives place to moaning. 
Beside these symptoms, there are stiffness in the back of the neck, 
pain in. the liml)s, great tenderness of the scalp, vomiting, sighing, 
intolerance of light, knitting of the brows, increased disturbance of 
stomach and bowels. This stage may last ten ' o fourteen days, the 
chi'd growing more weak and peevish. 

.iVnother form of attack is marked by acute pain in the head and 
high fever, convulsions, flushed face, brilliant eyes, intolerance of light 
and sound, pain and tenderness in the belly, stupor, great irritability 
of stomach, causing retching and vomiting upon every attempt to sit 
up in bed. 

The third mode of attack is very insidious, — the early symptoms 
being mild and hardly noticeable, or not even occurring at all. In 
such case, the convulsions or palsy come suddenly, without notice, 
bringing swift and unexpected destruction. This has soraetiriies been 
called water-stroke. 

The First Stage is the period of increased senisibiiity and excite- 
ment, caused by inflaaimation, in which the pulse is quick and irreg- 
ular. 

The 5econd Stage is one of diminished sensibility, or lethargy, dur- 
ing which water is effused upon the brain, and the pulse is slow. 



■'*»»■ TSBB 



DISEASES OF THE BRAIN AND NERVES. 



17B 



ence of dis- 
;om8 are not 
ections, and 
iciples. 

alus. 

wo of child- 

oarly notice 
ach; which 
nitory 

ictions, indi- 
ng disliked, 
th, enhvrged 
olored from 
dling, slimy 
8 paler and 
I heavy, lan- 
mes is a lit- 

ti in one of 

;nt, and are 
[ shriek out. 
to moaning, 
f the neck, 
ng, sighing, 
turbance of 
sn days, the 

le head and 

ace of light 

irritability 

empt to sit 

symptoms 
at all. In 
3ut notice, 
tithes been 

md excite- 
I and irreg- 

^argy, dur- 
slow. 



The Third Period is one of palsy and convulsions, with squinting 
of the eyes, rolling of the head, stupor, and a rapid, thread-like pulse. 

Treatment. — The first or inflammatory stage of the fever is very 
important, and must be controlled for five or six days. Scammonv and 
croton oil (33) may be chosen for this purpose. Apply cold water, 
ice, etc., to the head. Use tinct. veratrum viride or (355). 

In the second stage, put blisters upon the back of the neck, and one 
upon the bowels if they are very tender. 

In the third stage, effusion having taken place, use the warm bath, 
or the vapor bath, — also digitalis, squills, and iodide of potassium, 
(144), (128), (302), (130). The effusion, if permanent, may be 
drawn off. 

Confine the child to a darkened room, of moderate temperature, — 
excluding all noise and causes of excitement, and let him lie upon a 
hair mattress, with his head somewhat elevated. 

Diet. — Gruel only during the stage of excitement, — during that 
of collapse, it should be nourishing, but mild and easy of digestion, 
as beef tea, plain chicken or mutton broth, and animal jellies. At 
the same time, support the patient by the cautious use of the aromatic 
spirit of ammonia, ten drops every four hours, valerian, wine whey, 
and infusion of gentian, columbo, or qua8><ia, (64), (66). 

Dropsy of the Brain. — Chronic Hydrocephalus. 

Acute hydrocephalus is an inflammation; chronic hydrocephalus, 
now to be considered, is a dropay. It often begins before birth. It 
consists in the accumulation of enormous quantities of water within 
the brain, sometimes within its ventricles, at other times upon its 
surface. When it occurs soon after birth, it advances slowly and 
imperceptibly, — the enlargement of the head being the first thing 
noticed. 

The skull being tender in infancy, it separates at the fontanelles, 
as the fluid accumulates, and the head, at times, attains an enormous 
size, — so great that the child cannot carry it upright, but lets it droop 
laterally upon the shoulder, or forward upon the breast. 

As the disease advances, the senses become blunted, the child is 
deaf or blind, the intellect is weakened, perhaps idiocy appears, the 
flesh and strength pass away, convulsions and paralysis come in their 
turn, and a stupor is apt to occur which ends in death. 

Treatment. — The remedies may be external, or internal, or both. 

Internal Remedies. — These should be purgatives (33), (31), or 
diui-etics and alteratives (302), (145), (144). 

External Remedies. — Apply an ointment of the iodide of potas- 
sium to the «(;dlp every night (185). A tight bandage applied over 
the whole head will sometimes have a favorable effect. Another ex- 



1 1' 






:^ 



{; 



.Xiffyre' 



176 



niSEABKS OF THE BRAIN AND NEKVE8. 



pedient is to puncture the skull and draw off the water. Tapping 
the brain has effected a cure in many cases, and perhaps promises the 
most relief of any remedy we have. In newly-born ciiildren with this 
affection, it is the best means. 



FIO. 84. 



m 



Diseases of the Spinal Cord. 

Thkiie are few diseases more interesting, as a study, 
than those which affect the nervous cord which runs 
through the centre of the back-bone. This cord is a 
continuation, an appendage or tail of the brain. (See 
Figure 84.) It is the seat, and centre of certain ner- 
vous functions, called reflex, by which so many move- 
ments take place which are not under the control of the 
will. 

In order that we may feel what takes place in any 
part of the body or limbs, and that the will may have 
power to move such part, it is necessary that nervous 
matter should be continuous and unbroken between the 
part in question and the brain. 

If the spinal cor- . be cut, broken, or crushed at any 
point, all those parts which receive nei-ves from helow 
the injury, lose their power of motion and their feel- 
ing. When the injury \s in the upper part of the cord, 
the breathing and the circulation will stop, and death 
is the immediate consequence. If the middle portion 
of the cord be the seat of the injury, the bowels and 
other organs may lo6e their motion and feeling ; if the 
lower portion, then the lower limbs only will be the 
sufferers. 

Diseiise or injury in the upper part of the cord is 
therefore much more dangerous than the same thing 
the lower. 



Inflammation of the 5pinal Cord. 

The membranes which surround the cord may be inflamed just as 
those are which enclose the brain ; but as the cavity running through 
the spine is quite small, there cannot very well be inflammation of 
the membranes without its involving the cord at the same time. 

Symptoms. — Pains, often intense, running along the spine, extend- 
ing out into the limbs, and made worse by motion. They are similar, 
in some respects, to rheumatic pains. There is rigid contraction, and 
sometimes violent spasms of the muscles of the back and neck, — so 
great, at times, as to bend the body back into the shape of a hoop ; 
also a feeling of constriction in various parts, as if they were girt by 
a tight string; a sense of suffocation; retention of urine; a most 



DISEASES OF THE BRAIN AND NERVES. 



177 



'. Tapping 
jfomises the 
en with this 



aa a study, 
which runs 
8 cord is a 
rain. (See 
certain nei- 
nany move- 
introl of the 

iace in any 
1 may have 
aat nervous 
aetween the 

shed at any 
from below 
[ their feel- 
of the cord, 
, and death 
die portion 
bowels and 
ing; if the 
will be the 

;he cord is 
lame thing 



led just as 
lig through 
imation of 
time. 

le, extend- 
Lre similar, 
Action, and 
leck, — so 
|f a hoop; 
pre girt by 
a most 



obstinate constipation and frequent chills or rigoi-s. The pain which 
is felt along the cord is aggravated by rapping upon the spine, but 
not by pressure. 

The above symptoms are supposed to be the result of inflammation 
predominating in the membranes. When its seat is more particularly 
in the substance of the cord, the symptoms are, — convulsive affec- 
tions of the head and face, inarticulate speech, loss of voice, squint- 
ing, and difficulty of swallowing, if the extreme upper part of the 
cord is iaflamed; if the disease l)e slightly lower, difficulty of breath- 
ing. Irregular action of the heart, and tightness of the chest; if lower 
still, vomiting, pain in the belly, sensation of a cord tied round the 
abdomen, pain and heat in passing water, retention of the urine, ina- 
bility to retain the urine, desire to go to stool, or involuntary stools. 

Spasm and stiffness, then, are the results of inflammation of the 
merabranes ; convulsions and palsy, of the same affection of the cord. 

Treatment, — When the inflammation is acute, apply a few leeches 
or wet cups along the sides of the spine. In chronic inflammation, 
powerful friction, or mustard draughts, stimulating liniments (1 90), 
or plasters, will generally answer the purpose. 

Apoplexy. 

Apoplexy is that condition in wliich all the functions of animal 
life are suddenly stopped, except the pulse and the breathing ; — in 
which there is neither thought, nor feeling, nor voluntary motion ; in 
which the person falls down suddenly, and lies as if in a deep sleep. 

Modes of Attacki — There are at least thi'ee ways in which this ter- 
rible disease may make its assault. 

The First form of atta jk is a sudden falling down into a state of 
insensibility and apparently profound sleep, — the face being gen- 
erally flushed, the breathing stertorous or snoring, the pulse full and 
not frequent, with occasional convulsions. 

From this mode of attack some die immediately, others get entirely 
well, and others get off with the exception of paralysis on one side, 
or the loss of speech, or some one of the senses. 

• 

The Second form of attack begins with sudden pain in the head. 
The patient becomes pale, faint, sick, and vomits, — has a cold skin 
and feeble pulse, and occasionallj' some convulsions. He may fall 
down, or may be only a little confused, but will soon recover from all 
the symptoms, except the headache, — this will continue, and the pa- 
tient will sooner or later become heavy, forgetful, unable to connect 
ideas, and finally sink into insensibility, from which he never rises. 

This mode of invasion, though not appearing so frightful as the 
first, is of much more serious import. 






M 



i 



178 



DISEASES OF THE BRAIN AND NERVES. 



In the Third form of attack there is sudden loss of power on one 
side of the body, and also of speech, but not of consciousness. The 
patient retains his mind, and answers questions either by words or 
signs. This may be called paralytic apoplexy. The patient may 
either die soon, or get well, or live for years with imperfect speech, 
or a leg dragging after him, or an arm hanging useless at his side. 

The Persons Attacked are apt to have large heads, red faces, short 
and thick necks, and a short, stout, square build, though it occui-s 
often among those ^^hn are thin, pale, and tall. The tendency to it 
increases in advanced life. 

The Forerunners of apoplexy are headache, vertigo, slight attacks 
of palsy, double vision or seeing two objects when there is but one, 
faltering speech, inability to remember certain words, sometimes a 
sudden forgetfulness of one's own name, a frequent losing of the 
thread of ideas attempted to he pursued, and occasionally an unac- 
countable dread, for which no reason can l)e given. 

Erciting Causes. — Whatever hurries the circulation of the blood, 
as strong bodily exercise, is an exciting cause. So are all those things 
which cause the blood to flow towards the head, as coughing, sneez- 
ing, laughing and crying, straining at stool when costive, lifting heavy 
weights, singing, and playing on wind instruments. To these may 
be added, exposure to the sun, the bad air of crowded rooms, holding 
the head down, or turning it around to look backward, tight cravats 
worn about the neck, and exposure to severe cold. 

Treatment. — If the patient have the appearance of suffering from 
fulness of blood in the head, as evinced by redness and turgescence 
of the face and throbbing of the temporal arteries, and if the pulse 
be full and hard, feeling like a tense vibrating rope under the finger, 
place him in a half-recumbent posture, with his head raised ; loosen 
his clothes, particularly his neck-cloth and shirt collar, and whatever 
may press upon the neck, and then as quickly as possible apply cold 
wet cloths to his head, changing them often. Ice is still better, if it 
may be had. Apply wet cups to the nape of the neck, and mustard 
draughts to the soles of the feet. — at the same time applying tight 
ligatures around the limbs, to pievent the blood from returning 
rapidly in the veins. The ligatures should be gradually removed 
when the patient recovers his consciousness^ Also administer a 
stimulating, purgative injection (246), and place t vo drops of ci-oton 
oil, rubbed up with a little pulverized loaf sugar, far back upon the 
tongue. Repeat the injection every fifteen minutes, till the Ixtwels 
are thoroughly moved. This is one of the few diseases suitable for 
bleeding. 

If the patient be old, and the pulse small and feeble, with no ful- 
ness or beating of the temporal arteries, or swelling of the veins of 
the neck and forehead, the countenance being pinched, and the skin 



DISEASES OF THE BRAIN AND NERVES. 



179 




ower on one 
sness. The 
by words or 
patient may 
feet speeeli, 
b his side. 

I faces, short 
^h it occui-8 
ndency to it 

light attacks 
B is but one, 
sometimes a 
asing of the 
Jly an unac- 

jf the blood, 
those things 
rhing, sneez- 
iifting heavy 
) these may 
ams, holding 
tight cravats 

ffering from 

turgescence 

if the pulse 

ir the finger, 

ised ; loosen 

lid whatever 

apply cold 

better, if it 

,nd mustard 

(lying tight 

returning 

ly removed 

minister a 

)S of croton 

upon the 

the bowels 

lUitable for 

irith no ful- 
Ihe veins of 
Id the skin 



liloodlesB and cold, the cupping, purging, and applying the ligature 
iiuist be omitted. In this case it will l)e lietter to apply warm 
ttannels and hot bricks to the surface, and administer ammonia 
and camphor (283), (135) internally. 

To prevent future attacks, gentle tonics should l)e used, and the 
skin should be kept healthy by daily bathing and friction. The 
towels must not 1 >e permitted to become costive. The diet should 
Im light, chiefly vegetivble, and almost entirely so in hot weather. 
The food should be well chewed. Tho mind should be kept cheer- 
ful and hopeful, and free from great excitement. The sexual 
passion should l)e restrained, and very rarely indulged. Intoxicating 
drinks should be abandoned, if used, and all tight cravats l)e dis- 
carded from the neck. Direct rays of the hot sun in summer should 
\m carefully shunned. No food should be taken for three hours 
lief ore retiring, and a mattress only, of some degree of hardness, 
should be slept upon, — the head being always well elevated. To 
these precautions, I would add dipping the feet every night before 
retiring in cold water; and, if any tendency to cold feet be sx- 
perienced, dusting pulverized cayenne in the bottoms of the 
stockings. 

Sunstroke. — Coup de Soleil. 

This is much like apoplexy; in fact, it is a kind of apoplexy. It 
occurs in warm climates, or on very hot days in temperate regions, by 
exposure to the sun. 

It begins by hesidache, tliirst, dizziness, and sometimes difficult 
breathing and bilious vomiting. The patient drops down senseless, 
ivs in apoplexy, and unless immediate relief is obtained, soon dies. 

Treatment. — Take the patient immediately into the shade, and 
employ about the same remedies as for apoplexy (361). Apply ice 
to the head. 

Palsy. — Paralysis. 

Palsy is a loss of the power of voluntary motion and feeling, one 
or both coming on, sometimes gradually, but more often suddenly, 
and extending at one time to a part, at another time to the whole 
lx)dy. It is a kind of station-house on the way to apoplexy, where 
passengers stop, not merely to stay over night, but to rest many days, 
or even years. 

A great injury inflicted upon the brain, either by pressure or other 
cause, will induce a complete loss of motion and feeling, and this ex- 
tending to the whole structure, brings likewise a loss of conscious- 
ness, which is apoplexy. A smaller degree of pressure, or a less 
injury upon the same brain, would occasion a loss of motion only, or, 
if a loss of feeling were experienced also, it would only extend to a 
part of the body, and consciousness would remain. This would be 
palsy. The disease is like apoplexy in kind, but stops short of it in 
degree. 






t < 



180 



DISEASES OF THE BRAIN AND NRRVKR. 



Hctniphlegia. 

When palsy affects an entire half of the body, dividing it through 
the centre of the face, necl: body, etc., from head to foot, it is called 
hemipMegia. It is more nearly allied to apoplexy than any other 
form of the disease, and is generally ushered in by pretty well-marked 
apoplectic symptoms. 

Symptoms Sometimes there are no premonitory symptoms ; but 

often before the attack there are flushed face, swelling of the veiris 
about the head and neck, verti a sense of fullness, weight, and 
sometimes pain in the head, ring the ears, drowsiness, indistinct 

articulation of wordis, or even loa.s peech, confusion of mind, loss 
of memory, and change of disposition, — amiable persons being made 
sullen and peevish, and irritable ones mild and simpering. After 
the attack, the countenance generally acquires a vague expression ; 
the mouth is drawn to one side ; the lower lip on the palsied side 
hangs down, and the spittle dribbles away. The speech is altered, 
and the mind is generally impaired. 

In some instances, the patient recovers in a longer or shorter time ; 
in others, little or no improvement takes place, and the patient, after 
remaining helpless, often for a long time, dies either from gradual 
exhaustion, or suddenly from apoplexy. 

Causes. — Hemiphlegia and paraphlegia are caused by pressure 
upon the brain, by the effusion upon it of blood or water, by a tumor, 
by mechanical injuries, by the striking in of eruptions, and by intem- 
perance in eating and drinking. Paraphlegia often results from dis- 
ease or injury of the spinal marrow. 

Paraphlegia. 

This form of palsy divides the body transversely, at the hips, and 
confines itself to the lower extremities, and to the parts about the 
pelvis. 

Symptoms. — When it arises from affections of the brain, it is at- 
tended by pain in the head, giddiness, drowsiness, dimness of sight, 
and impaired memory. Numbness is sometimes felt in the upper ex- 
tremities as a forerunner of this form of palsy. At first there is a 
slight stiffness and awkwardness of the motion of the legs, which 
continue to increase till a cane is needed to balance the body and 
make it steady. From a paralysis of the neck of the bladder, the 
stream of urine grows more feeble, and finally dribbles away involun- 
tarily. The bowels are for a time costive, but when the circular 
muscle which closes the fundament becomes palsied, the feces pass 
without consent of the will. 

When disease of the spinal cord is the cause of the complaint, it 
is apt to come on gradually ; languor and weakness are felt in the 



DISEABL:^ Or THE BRAIN AND NRRVES. 



181 



' it through 
it is called 
any other 

irell-marked 

ptoms ; but 
f the veins 
veight, and 
1, indistinct 

mind, loss 
jeing made 
ng. After 
sxpression ; 
ulsied side 

is altered, 

orter time; 
tient, after 
m gradual 

Y pressure 
ly a tumor, 
. by intem- 
8 from dis- 



hips, and 
ibout the 



it is at- 
of sight, 
upper ex- 
here is a 
rs, which 
x)dy and 
dder, the 
involun- 

circular 
ces pass 

)laint, it 
in the 



knees, the legs are not easily directed in walking, — Ixsing throv/n 
across each other, causing tripping and stumbling. By degrees the 
loss of power increases in the thighs and legs, until at length the 
whole lower extremities become palsied and useless. 



Local Palsy. 

Palsy is called local when it is confined to a single limb, or muscle, 
or locality. One of these forms is called /acmi palsy. It affects one 
half the face only, and is a good specimen of these affections. It 
removes all power of expression from one half of the face, and leaves 
the features still, blank, and unmeaning. With the affected side of 
the face, the patient cannot laugh, or weep, or frown, or express any 
feeling or emotion, while the features of the other side are in full 
play. Among the ignorant, who do not comprehend the extent of 
the evil, the drolluess of the expression excites laughter. 

Shaking Palsy. 

The nature of this form of palsy is well expressed by its name. 

Symptoms. — The first symptom of this complaint is a weakness 
and tremor of the head or hand. In about a year the other hand, or 
the lower extremities become affected ; and the patient begins to lose 
his balance in walking. Then the trembling becomes perpetual ; no 
limb or part remains still. Reading and writing are no longer possi- 
ble, and the hand cannot even carry the food to the mouth. The 
balance cannot be maintained in walking ; there is a tendency to fall 
forwards, and to avoid it, the patient is obliged to run or move 
quicker, and upon the toes. 

At a later period, the tremor continues during sleep ; there is in- 
creased weakness ; the body is bent forward, the speech becomes in- 
distinct, swallowing difficult, and the bowels torpid. At last the 
urine and feces pass involuntarily, and delirium and coma bring life 
to a close. 

Lead Palsy. 

In this disease the muscles of the forearm are palsied, so that the 
wrists " drop," as it is said, and the hands hang down when the arms 
are stretched out. It is caused by the gradual introduction of lead 
into the system. It is a disease, therefore, peculiar to painters, — 
particularly those who use carbonate of lead, or white lead, as it is 
called. It is generally the sequel of painter's colic. 

Treatment. — A sudden and severe attack of palsy requires the 
same treatment as apoplexy. When the bowels a^re obstinately con- 
stipated, they must be moved by scammony and croton oil (31), (32) 
and by injections (246). 



182 



niSBABKS OF THR BRAIN AND NKRVE8. 



When all tho syniptomH of (lutennination of l)l()o(l to the head have 
disappeared, and t\w diHeawe hius Ixjconie strictly clironic, excitinjr 
remedieH must he employed, as frictions, stimulating liniments, blis- 
ters, stimulating baths, cold affusion, and electricity. Among the in- 
ternal remedies, strychnine has the best reputation (85), (80). The 
tincture of the poison oak is well recommended (284). An altera- 
tive (145) should likewise be used. 

Apply counter-irritants along the track of the spine, such as blis- 
ters, the moxa, the compound tar-plaster, and the pitch-plaster. 

At firat the diet should l)e light ; but after the more aciive symj)- 
toms have disappeared, it should l)e nutritious, and sometimes stimu- 
lating. Flannel undeVclothes should always be worn next the skin. 

For lead palsy, the best remedies are iodide of potassium, or sul- 
phuretof potassium. The dose of either of these is from three to ten 
grains, three times a day, dissolved in water, one ounce of the salt to 
six ounces of water, and taken in simple syrup. The affected limb 
should also be soaked an hour each day in a gallon of water, with 
half an ounce of sulphuret of potassium dissolved in it. 

Hydrophobia. — Rabies. 

The bite of the mad dog, or mad wolf, or other hydrophobic ani-, 
mal, is the most dangerous of all poisoned wounds, because it is apt 
to be followed by a disease for which there is no cei^tain remedy. 
Fortunately, the human subject is not as susceptible to the effects of 
the poison as some of the lower animals ; for only about one-tenth of 
those bitten are attacked by hydrophobia. 

Symptoms. — The interval between the bite and the appearance of 
the disease varies from twelve days to two months. The wound 
heals like any other bite of a similar animal. After a time, the scar 
begins to have darting, lancinating pains, which, if it be a limb that 
was bitten, run up towards the body. Sometimes it feels cold, or 
stiff, or numb, or becomes red, swelled, or livid, and occasionally 
breaks open, and discharges matter. The patient feels a strange anx- 
iety, is depressed in spirit, has an occasional chill, and disturbed 
sleep, and spasmodic twitches. The pulse is above its natural state, 
both in quickness and strength, and the nervous system is very im- 
pressible. The senses are all more acute; trifling noises produce 
agitation, and the eyes are so disturbed by the light that the patient 
sometimes hides himself in a dark place. The appetite is lost. This 
is the first stage. 

Thirst now appears, and he attempts to drink. But the moment 
water approaches his mouth, a spasmodic shudder comes over him ; 
he pushes it back with horror ; the awful fact of his condition flashes 
upon him ; and he cries out, " What I have dreaded has come upon 
me." 

Thenceforward he can swallow no fluids ; complains of pain and 



ip uMiia 



head havo 
!, exciting 
lent*!, hlis- 
»iig the in- 
86). The 
An alteia- 

;h as bliH- 
ster. 

Dive syinp- 
Ties 8timu- 
t the skin, 
im, or Kul- 
iree to ten 
the salt to 
ected limb 
^ater, with 



ihobic ani-, 
e it is apt 
n remedy. 
! effects of 
le-tenth of 

earance of 

he wound 

, the scar 

limb that 

s cold, or 

[casionally 

nge anx- 

disturbed 

ral state, 

very im- 

produce 

le patient 

1st. This 

moment 
/er him; 
^n flashes 

le upon 

)ain and 



DISEASES OF THE ORAIN AND NERVES. 



188 



stiffness about his neck ; is thrown into convulsions by the sight of 
water, or even the sound of liquids agitated in a vessel, or by a 
breath of air blowing upon him, by a bright light, oi- by the glare of a 
mirror. His throat is full of a viscid, glary matter, wliich he con- 
tinually tries to clear away. Thus, between convulsions, in which 
lie struggles, and sometimes strives to bite his attendants, and com- 
parative stillness, during which he suffers great depression of spirits, 
lie passes three or four days, and then dies either in a spasm, or from 
exhaustion. 

Treatment. — Cut off the bitten part, or apply dry cupping, or 
suction, at once. Also the caustic potash. The internal remedies 
heretofore employed have had little success. Perhaps nothing now 
known promises more than to have the patient vaccinated by the 
recently discovered virus. The tincture of scullcap, in two or three 
dram doses, will allay the nervous agitation, and is always worth 
using. It has been proposed to clear the throat of the tough mucus 
by cauterizing it with a strong solution of nitrate of silver (219), ap- 
plied with a shower syringe. The remedy is worthy of a trial. 

Some of the Western physicians declare the red duckweed, or scar- 
let pimpernell, to be an absolute remedy for this disease, and cite 
some quite remarkable cases of its success. Four ounces of this 
plant, in the dried state, are directed to be boiled in two quarts of 
strong beer or ale, until the liquid is reduced one half. The liquid 
is to be pressed out and strained, and two drams of laudanum added 
to it. The dose for a grown person is a wane-glassful every morning 
for three mornings. A larger dose is required if the disease have 
begun to show itself ; and if the case be fully developed, the whole 
may be taken in a day. The wound is to be bathed with the same 
decoction. The medicine, it is said, produces profuse sweating. It 
is worth a trial. 

Considerable has been said of late of a remedy used in some parts 
of Europe, and said to be effectual. It is the " golden cenotides " 
{cetonia aurata), or common rose-beetle, found in large quantities on 
all rose-trees. A similar insect is said to infest the geranium-plant. 
When collected, they are dried and powdered ; and given in this 
form, relieve excitement (so it is said) of the brain and nerves, and 
throw the patient into a sound sleep. Immediate suction and disin- 
fection of the wound is admirable, followed by caustics. 

Muscular and Nervous Derangements from 

Wounds. 

In some persons, a very small local injury will produce violent dis- 
turbance of the nervous system. Some will faint and be thrown into 
convulsions and vomiting from causes scarcely greater than the prick 
of a needle ; and, before Morton gave the world the boon of ether, it 



i 



184 



D18RA8K8 OF THK liRAIN AND NKRVBR. 



wHH not very unoominoii for (lerBoiiH to die under tliu ku'iUi of tlx* 
Hurg«5on. Olio of tho most serious disturbancws from wounds, of )i 
nervous and niusuular uhuructor, is 



V 



Locked Jaw. — Tetanus. 

This is spnsmodic contraction, with rigidity, or stififness, of the 
voluntary musules. Sometimes this rigidity is {urtial, at other tinieH 
univeraal throughout tlie system. 

Tetanus is produced hy two causes, exposure to cold (idiopatiiic), 
and bodily injuries, particularly the injury of a nerve (tniuniatic; te- 
tanus). This last is the most frequent, — p'irhaps the only form of 
the complaint. 

The Symptoms are long-continued, violent and painful contraction 
or cramp of the voluntiiry muscles. At first there is diiTiculty and 
uneasiness in turning the head, with inahility to open the mouth 
easily, — then the jaws close gradually, but with great firnnieHs ; 
swallowing now becomes difficult, and a pain, starting from the 
breastbonti, pierces through to the back, — probably caused by cramp 
of the diaphragm or midriff. The cramps now extend to the muscles 
of the body, the limbs, the face, the tongue, etc., which continue in a 
state of rigid spasm, — being swelled and hard in the centre, — till 
the disease yields, or tho patient dies. At times the abdominal 
muscles are so tense as to make the belly as hard as a board. Occa- 
sionally the patient is drawn backward into tho shape of a hoop, so 
as to rest on his head and heels (epiathotonos) ; at other times he iri 
drawn forward in the shape of a ball (emprosthotonoa) . All the con- 
tractions are attended with intense pain. It is the racking of the en- 
tire body with cramps like those which sometimes attack the calf of 
the leg. So violent are the contractions that the teeth are dometimes 
broken by them, and the tongue is often badly bitten. In the mean 
time, the appearance of the sufferer is frightful. The forehead is 
wrinkled, the brow knit, the eye-balls motionless and staring, the 
nostrils spread, the corners of the mouth drawn back, the set teeth 
exposed, and all the features fixed in a ghastly grin. 

Treatment. — The only known remedies for this disease are chlo- 
roform and ether, taken either into the stomach, or by inhalation, in 
quantities sufficient to contr:)! the spasm, and to be pursued as long 
as they continue to occur. The costiveness must be removed by one 
or two drops of croton oil, administered in a spoonful of gruel. Re- 
lieve the nerve or remove the foreign body from wound. 

Epilepsy.— Epileptic Fits. 

This disease has been sometimes called the failing aickneaa, but 
generally passes under the more vague title of fit$. 



DISBASEH UK THE lilUIN ANU NKRVBH. 



185 



nif(( (if till' 
oiiiuIh, of u 



lesH, of tlie 
uther timeH 

(Uoputliio), 
uiiniitic te- 
lly form of 

contraction 

RRculty and 

the mouth 

firmnt'HH ; 

5 from the 

i by cranij) 

he muscles 

ntinue in a 

ntre, — till 

abdominal 

,rd. Occa- 

a hoop, so 

limes lie m 

.11 the con- 

of the en- 

le calf of 

sometimes 

;he mean 

irehead is 

iiring, the 

set teeth 



are chlo- 
alation, in 
■id as long 
ed by one 
■uel. Re- 



kneM, but 



Symptoms. — The diseaso in characterized by a temporary Iosh of 
fonBciouHnesH, strong spasnm and intervals lietween the tits. The at- 
tack is sudden, generally witlumt warning, and attended with a loud 
cry, when the piuient falls down, is senseless and convulsed, struggles 
violently, breathes with enibarrasHment, has a turgid and livid face, 
foams at t'le mouth, bites his tongue, has a choking in the windpipe, 
and appears to 'o at the point of death. I'resently, in from five 
minutes to half an hour, and by degrees, tiiese symptoms diminish, 
and at length cease; and the patient falls into an apparent sleep. In 
a short time more he recovei-s, and is aj)parently well. These attacks 
come again and again, and at irregular intervals. 

This is the worst form of the disease ; there is another class of 
oases in which the symptoms are much lighter, — there being no tur- 
gescence of the face, no foaming at the mouth, no cry, no convul- 
sions ; but merely a sudden and brief suspension of consciousness, a 
fixed gaze, a feeling of confusion, or a totter, from all of which the 
recoveiy is speedy. 

Causes. — These are numerous, — as worms, disturbance from indi- 
gestible food in the stomach and Iwwels, difficult teeth-cutting, ner- 
vous irritation, either direct or by sympathy, sexual excesses and 
masturbation, disease or injury of the brain or spinal marrow, gall 
stones in the excretory duct of the liver, stone or gravel in the kid- 
neys and bladder, fright, distress of mind, passion, great loss of b^ood, 
and many others. 

Treatment. — But little can be done during the fit, except to pro- 
tect the patient from being injured by the violence of the coBvulsions. 
To do this, place a piece of leather, cork, or other substance not too 
hard, between the back teeth to prevent the tongue from being bitten. 
Remove the neckcloth, and unbutton the shirt-collar. If the stomach 
and bowels are suspected to be overloaded, give an injection (246). 

The treatment during the intervals must depend on the cause of 
the disease. If worms be the cause, expel them ; if the attacks be 
excited by difficult teething, Icnce the gums ; if by uterine disturb 
ances, search out the nature, and give the treatment recommend jd 
under the proper head ; if masturbation, command its entire discon- 
tinuance as the only hope of relief ; if the complaint arise from in- 
digestible food, great attention must be given to the diet and general 
health. 

In all cases, indeed, the diet should be carefully regulated, being 
light, nutritious, and easy of digestion. The sleep should be taken 
at regular houi-s, and daily exercise in the open air be insisted upon. 
The bowels must be kept regular, by the food, if possible ; if not, by 
mild laxatives. Apply along the spinal column 195, once a day, rub- 
bing it well in ; also, now and then, mustard poultices. 

In addition to these remedies, give pills of iron and quinine (72). 
one after each meal, — also oxide of zinc (270), which is one of our 



186 



DIIKAHEB OP THK HRAIN AND NBRVRS. 



very bent remedieH. Of tho pills, one nhould Ik; taken three timcN ;i 
day. Kruniitle nf Hodium, 1 driiin in 24 luiurH, nioHtly at Iwdtime. 

We can Holdoni go amiHH in giving medicine calculated to relievo 
nervous irritation, and to huild up the general HyHtem. For tliiH pur- 
pose, the valtM'ianate of quinine, and tho extract of hlack cohosli (7i)) 
are well adapted. Citrate of iron and strychnine (316), is a very val- 
uable remedy. 

It is said that a black silk handkerchief thrown over tho face of ii 
person in a fit, will immediately bring them out of it. It is an ex- 
periment easily tried ; and having seen it in a respectable medical 
journal, I give it for what it is worth. The bromides in large doses, 
long-continued, sometimes cure epilepsy (367). 



Catalepsy. — Trance. — Ecstasy. 

Cataleptic fits are simply what is known to all the world under 
the name of trance ; and ecstasy is a modification of the same nervous 
disorder. It is a state in which the mind becomes so intensely al>- 
sorbed in something outside of its earthly tenement, that it withdraws 
all control over the body, and all -apparent co:i'iection with it, leav- 
ing it as if dead. There is a very light tick'ng of the heart, just pe: 
ceptible to a cultivated ear, but the breast does not rise and fall with 
breathing, tho features are all inexpressive and still, the eyes are wide 
open and motionless, apparently staring after the departed intellect; 
and the body and limbs are entirely passive, — remaining unmoved 
where they are placed by others, however tiresome and uncomfortable 
the position. In a word, a person in catalepsy is, in appeamnco, like 
a marble statue, or like a human body suddenly turned to stone, or, 
like Lot's wife, to a pillar of salt. There is as little feeling, or 
thought, or consciousness, as if the bowl had been instantaneously 
brokei< at the cistern, and the apparent death were real. 

It is a peculiarity in this disease that the patient, on recovery 
fron a fit, lakes up the thread of conscious life just where it was 
broken by the attiick. Thus, if she were lifting a cup ci water to 
the mouth, she would hold it steadily, with the mouth open, till the 
return of consciousness, and then place it to the lips, as if no inter- 
ruption had occurred ; or, if convei-sing, and in the midst of a sen- 
tence, the unfinished words would be uttered at the end of the fit, 
even though it should last many days. 

Persons in a cataleptic fit have much the appearance of one in the 
mesmeric state ; and the statue-like position in which an attack fixes 
a patient, reminds one of the manner in which the psychologists, so 
called, will arrest a man under iheir influence, and mttke him im- 
movable, with one foot raised in the act of stepping. 

The disease attacks females much more often than males. 

The premonitory symptoms are much like those of epilepsy, and 
the treatment should be about the same. 



three times ii 
it Iwdtinip. 
0(1 to relieve! 
For tliiH iMii- 
: cohosii ('(!•) 
is II very val- 

tho face of a 

It is an ((X- 

:4ihle niedieui 

» large doses, 



world under 
lame nervous 
intensely iil>- 
it withdraws 
ivith it, leiiv- 
art, just pe; 
and fall with 
3ye8 are wide 
ed intellect; 
ug unmoved 
iicomfoTtable 
earance, like 
to stone, or, 
! feeling, or 
antaneously 

on recovery 
here it was 
rf water to 
)en, till the 
if no inter- 
st of a sen- 
1 of the fit, 

one in the 
attack fixes 
ologists, so 
ce him im- 

BB. 

ilepsy, and 



DISEASEtl or TlIK IIUAIN ANU MKRVIS. 



Saint Vltu8*8 Dance.— CAorga. 



187 



This diaeaae is chiefly confined to children and youth between the 
ages of eigh*. and fourteen. Hut few cases occur after pul)erty. 

Symptoms. — The coniplaiht affects mostly the muscles and the 
limlw. It excites curious antics, — such as we should suppose would 
occur if a part of the muscles of voluntjvry motion had hatched a 
mimic reUdlion, broken away from the control of the will, and in 
sheer niiHchicf and wantonness, were tripping their fellow muscles, 
and playing tricks with the patient. A few of the muscles of the 
face or lindw Ixigin their mischievous pranTcs by slight twitches, 
which, by degrees, l)ecomo more energetic, and spread to other parts. 
The face is twisted into all kinds of ridiculous contortions, as if the 
patient were making mouths at 8dmel)ody. The hands and arms do 
not remain in one position for a moment. In attempting to carry 
food to the mouth, the liand goes part way, and is jerked back, starts 
again, and darts to one side, then to the other, then niouthward 
again; and each movement is so quick, and nervous, and darting, 
and diddling, that ten to one the food drops into the lap. If the at- 
tempt be made to run out the tongue, it is snatched back with the 
quickness of a serpent's, and the jaws snaj) together like a fly-trap. 
The lower limbs are in a state of perpetual diddle ; the feet shuffle 
with wonderful diligence upon the floor, as if inspired with a cease- 
less desire to dance. 

It is supposed by some that the disease consists in a partial palsy 
of a part of the muscles. The will in that case not being able to 
control the palsied muscles, when it commands the others to move, 
tlieir action is not balanced, and they twitch the face and limbs into 
all the capricious and fantastic shapes we witness. 

Others, and probably with more truth, hold that the "seat of the 
disease is in the cerebellum or little brain. It is supposed to he one 
of the functions of this organ to preside over and regulate the loco- 
motion, — that it holds the office of chief engineer, and that its 
duties are to keep the muscles in subjection to the will. The com- 
bined and consenting action of several muscles is needed for every 
movement. It is the business of the cerebellum to maintain this 
oneness of purpose and action — to see that no muscle flinches so as 
to disturb the harmony of the movement. When the cerebellum is 
diseased, all is confusion, — just as the locomotive runs from the 
track when tho engineer is smitten with palsy. 

The disease is not dangerous, but when it continues for many 
years it is apt to weaken the mind, and it sometimes very nearly 
destroys it. 

Causes. — Whatever excites and weakens the nervous system, as 
powerful emotions of the mind, overworking the mind, reading ex- 
citing novels, eating too much meat, fright, striking in of eruptions, 
self-pollution, etc. 




I 



m 



188 



DISEASKS OF THE BRAIN AND NERVES. 



Treatment. — In the first plane, remove all causes of excitement. 
Take the patient from school, and require some sort of cheerful out- 
door exercise, daily. Take away all books, and be careful not to do 
anything to occasion anger or fear, or any kind of injurious excite- 
ment. Apply spinal ice-bags gradually and regularly. 

In the second place regulate the diet — making it more animal 
ard stimulating if it has been to low, and more vegetable and cool- 
ing if it has been too high. 

In the third place, if the above changes have not been sufficient 
for the purpose, open and regulate the bowels with some gentle 
phyBio (30), (34) for a few days. 

In the last place, build u^^^ the nervous system with oxide of zinc 
pills (270), three a day ; or iron (63), (80), or black cohosh, scull- 
cap, etc. (79), or the compound valerian pill (81). Sulphate of 
zinc (82) will sometimes succeed ^hon the oxide fails ; and where 
there is scrofula, the iodide of zinc is to be used. 

To these remedies should be added the shower-bath, beginning 
with tepid water, and making it a little colder every day. If the 
shower-bath frightens the patient, or is not otherwise well borne, take 
the sponge bath. " Fowler's Solution " has the most marked effect 
on the disease. Three drops gradually increased till coryza ensues ; 
stop and begin again. 

Chronic Chorea. 

This can hardly be said to amount to a disease. It consists rather 
in uncouth tricks, arising from some slight disorder of particular 
muscles, and grown into a fixed habit, such as shaking of the head 
every three to twenty seconds, repeated squinting of the eyes in con- 
nection with a peculiar knitting of the eyebrows, wrinkling of the 
nose, shrugging of the shoulders, lifting the ears up and down, or 
even moving the whole scalp back and forth. These movements are 
commonly made without a consciousness of it ; and generally there 
is no power to suspend them without a painful effort which cannot 
be easily continued. 

No medical treatment is of any avail. These tricks can only be 
corrected by great wajtchfulness and effort on the part of the person 
suffering from them, and in many cases, not even by such means. 



Cramps. 

Cramp is expeiienced .n the calves of the legs, the thighs, the 
stomach, the breast, the womb, etc. It is a very painful, sudden, and 
violent contraction of one or more muscles. The part is sometimes, 
as the phrase is, " drawn up into knots." When it attacks the stom- 
ach, it is" a very dangerous affection. Women are subject to it about 
the third or fourth month of pregnancy. 

They occur more frequently at night as the result of over-fatigue 



i>i Uii liii»rii|-Y'V.'j 



DISEASES OF THE BRAIK AND NERVES. 



189 



excitement, 
heerful out- 
il not to do 
ious excite- 

lore animal 
3 and cool- 

ti sufficient 
)me gentle 

ide of zinc 
hosh, scuU- 
Julphate of 
and where 

beginning 
ly. If the 
borne, take 
rked effect 
'za ensues ; 



sists rather 

particular 

f the head 

3'es in con- 

ng of the 

down, or 

lements are 

lly there 

ch cannot 

m only be 
^he person 
leans. 



pighs, the 
iden, and 
bmetimes, 

(the atom- 
it about 

pr-fatigue 



and indigestion during the day. These spasmodic contractions often 
occur in the abdomen and are accompanied by diarrhoea due to indi- 
gestion. Abdominal cramps are also a symptom of locomotor ataxia 
and other spinal diseases. The cramp of swimming is often due to 
an over-straining of some one group of muscles not hitherto much 
used, the sudden fatigue causing cramp. They may be also of ner- 
vous origin. Rheumatism is not infrequently the sole cause of pain- 
ful muscular spasms. 

Causes. — Drinking cold water when very hot and perepiring, ex- 
posure to damp night air, debility, indigestible food, and excesses in 
eating and drinking, and particularly over-straining the muscles. 

Treatment. — Moderate the excessive labor and straining of the 
muscles which produce the cramps. When an attack occurs in the 
legs, tie a cord or handkerchief tight around the leg above the af- 
fected muscle. This will generally produce instant relief. Aiso 
briskly rub the parts with hot water, alcohol, ammonia, spirits of can- 
phor, paregoric, or laudanum. 

When it occurs in the stomach, apply warm fomentations, or what 
is better, a mustard paste (165). Take hot Jamaica ginger or neuro- 
pathic drops. The bowels, if confined, should be opened with an in- 
jection. 

Cramps of the limbs which afflict women in the family way, can 
only be mitigated, not cured, till after confinement. As a palliative, 
high cranberry bark, scuUcap, etc. (87), will be found useful. 

Pain of the Nerves. — Neuralgia. 

This disease affects one tissue only, — the nervous ; and has one 
83anptom, — pain. 

In apoplexy, the nerves, rendered powerless and senseless by an ex- 
ternal force, are like a man under a bank of earth which has slid 
down upon him. In palsy, they are suddenly bereft of feeling and 
motion by a blasting scourge within, — as one is smitten down by a ' 
pervasive charge from a magnetic battery. In epilepsy^ the nerves 
are grasped and for a time held senseless by an unseen power, in 
which they struggle, as a man strives in the folds of the anaconda. 
In catalepsy, they are suddenly stiffened into senseless strings, for 
such automatic use as the bystander may, for the time, choose to 
make of them. In chorea, they are set to dancing by an invisible ex- 
hilaration, as a man is suddenly crazed by brandy. 

In neuralgia, the nerves are neither crushed, nor collapsed, nor re- 
strained for a time, nor stiffened, nor exhilarated. They simply have 
their sense of feeling intensely exalted ; they are filled with pain. 
The pain is generally of a peculiarly darting, piercing character. The 
patien, sometimes calls it tearing pain. It comes on in sudden par- 
oxysms, with intervals of freedom between. The attacks are some- 



190 



DISEASES OF THE BKAIN AND NERVES. 



times like an electric shock, and are so agonizing as to bring a tem- 
porary loss of reason. Occasionally there is great tenderness of the 
parts affec ' and some fulness of the blood-vessels in the neighbor- 
hood ; but generally the signs of inflammation are all absent, except 
pain. 

Neuralgic pains occur in almost every part of the system. One of 
the most familiar forms of the disease is known under the name of 




. Tic Douloureux. 

It occurs in those branches of the fifth pair of nerves which go to 
the face. (See Fig. 85.) Sometimes 
one, sometimes all of the three branches 
are affected, but more often the middle 
branch only. When the uppor branch 
is the seat of the disease, the pain is in 
the forehead, the brow , the lid, and some- 
times the ball of the eye. The eye is 
generally closed during the pain, and 
the skin of the forehead is wrinkled. 
When the affection is in the middle 
nerve, the pain is preceded by a prick- 
ing sensation in the cheek, and twitch- 
ing of the lower eyelid. Soon it spreads 
in quick and piercing pangs over the 
cheek, reaching the lower eyelid, the 
sides of the nostrils, and the upper lip. 
If in the lower branch, it sends its light- 
ning shafts to the chin, the gums, the 
tongue and even up the cheek to the ear. 

Face-Ache. — There is a species of nervous pain called face-ache, 
which does not quite amount to tic douloureux, but is nevertheless 
veiy afflictive. It occurs principally in the jaw, which seems to be 
filled with pain. No one spot seems to be more affected than another. 
From the jaw the pain often goes to the whole head, but it has not 
the stabbing intensity which generally characterizes neuralgia. It 
often proceeds from defective teeth. 

Hemicrania. 

This is a neuralgic pain, confined to one side of the head, — gen- 
erally the brow and forehead. Sickness of the stomach often attends 
it, and in many cases it is periodical, — coming on at a certain hour 
every day, and lasting a given time, and then passing away. . 

It may be caused by whatever debilitates the system, as hysterics, 
suckling an infant too long, or low diet. In fever and ague districts 
it is frequently produced by miasm. In many instances, the cause 
cannot be discovered. 



FlO. 86. 



DIBEASKS OF TUB BRAIN AND NBRVES. 



191 



ring a teni- 
ness of the 
le neighbor- 
ient, except 

m. One of 
3 name of 



which go to 




face-ache^ 

levertheless 

lems to be 

,n another. 

it has not 

Igia. It 



|ad, — gen- 
attends 
un hour 

I hysterics, 
districts 
the cause 



Sciatica. 

This is a pain beginning at the hip, and following the course of 
the sciatic nerve. Occasionally it is an inflammatory complaint; 
sometimes is connected with an affection of the kidney; but fre- 
quently it is a purely neuralgic or nervous pain ; and I have there- 
fore thought it best to place it here, with nervous diseases. 

Besides the various forms of neuralgia now noticed, the disease 
occurs, — sometimes with great severity, — in the female breast, in 
the womb, in the stomach, in the bowels, in the thighs, in the knee, 
and even in the feet. In many of these cases the disease is not where 
the pain is felt, but in the brain or spinal marrow, and consequently 
the true source of the complaint very often escapes detection. An 
excellent Episcopal clergyman in Northern New York, the Rev. M. 

B , with whom I studied Latin and Greek preparatory to college, 

had a neuralgic pain in the knee so intense, persistent and exhausting, 
that the limb had to be cut off at the thigh to save his life. 

Treatment. — This must be as diversified as the causes of the dis- 
ease. For a general Bi use 368. 

For tic douloureux, and some other forms, give internally, valerian- 
ate of ammonia (88); also 89, 90, 91, 92, 93, 316, and 84, as tonics. 

For external use in tic douloureux, and other neuralgic affections, 
the prescriptions 188, 196, lb/,' 198. 

For the face-ache, above mentioned, muriate of ammonia (134), in 
half dram doses, is a very valuable remedy. 

When the disease is caused by miasm, and has a periodic character, 
like ague, it must be treated with quinine (67), (79), and if there be 
a low state of the blood, iron (72), (93) must be given at the same 
time. The galvanic battery often acts like magic in neuralgia. 

The shower-bath, exercise in the open air, and whatever else will 
build up the general health, must be used according to circumstances. 

Neuralgic pain of various kinds often yields readily to some one of 
the many coal-tar products like phenanthrene, antikamnia and ammo- 
nol: say 10 grains of either every two to four hours according to the 
intensity of the pain. The last named product is quite harmless and 
produces no numbness or faintness which is said to follow at times 
the use of some of the others. 

Avoid rich or fatty foods. Live on a plain nourishing diet. Take 
exercise out of doors as much as possible. 

Derangement of Mind. — Insanity. 

Most writers on this disease have attempted a definition of it. I 
have never seen one which suited me. Here is mine. Insanity is a 
wrench of marCs nature, which sets his intellectual and moral faculties 
awry in their relations with the external world. 



:;f 



192 



DISEASES OF THE BRAIN AND NERVES. 



Ill a state of mental and moral health, he looks straight at the out- 
ward world, and sees it as it is ; insanity gives him an angular con- 
nection with it and he sees it as it is not; its objects have all changed 
their relative places ; objects at the right in the panorama of life have 
moved to the centre, or gone quite over to the left ; whil'i things at 
the top have gone to the bottom, and those in the lowest places have 
taken the highest. With the thoroughly insane, the world has gone 
back to chaos. 

These persons have their sensibility very much altered and per- 
verted. Errors of the senses and illusions cheat them. In niaiiv 
cases, they cannot read because the lettei-s are mingled in a confused 
mass. They often do not recognize their friends, and regard them 
as strangers or enemies. 

They become awkward in the mechanical use of their hands, and 
their touch loses the power to coirect the errors of the other senses. 
Hence they are cheated in regard to the size, form, and thickness of 
bodies. 

They are haunted, at times, with smells which have no existence, 
and thjey hear voices distinctly speaking to them from clouds, or from 
trees ; and these voices have the familiar tones of a friend, reliitive, 
or enemy. 

The insane lose the power of comparing ideaa. They associate 
things the most unlike, and often in a ridiculous way. 

They also lose the control of themselves, and come under the do- 
minion of their passions ; and then they will do acts which they them- 
selves disapprove. One of strict integrity, of unblemished morals, and 
of excellent standing, becomes insane, and immediately steals what he 
does not want, makes infamous i )roDosals, and indecent gestures, and 
is in every respect the opposite of ^lis past self. 

The insane often become averse to those who were previously 
among the most <lear to them. For acts of kindness, they repay 
abuse. They fly from their best friends. This is the result of their 
fear and jealousy ; for they are very cowardly and jealous. This alien- 
ation from friends is almost a characteristic of insanity, and is one of 
its saddest features. The moral affections are always disordered, per- 
verted, or annihilated in insanity. So much is this a leading feature 
of the disease, that it is only when the insane begin to recover their 
moral affections, when they begin to wish to see their children and 
friends, to fold them onc« more in their arms, and to enter the family 
circle and renew its joys, that we can count upon any certain signs 
of a cure. 

The insane have a thousand strong fancies in regard to themselves. 
One thinks himself inspired of God, and charged with the convei-sion 
of the world ; while another, equally sincere, believes the devil has 
entered into him, and that the pains of hell are already taking hold 
of h'm, and he curses God, himself, and the universe. Still another 
is the " monarch of all he surveys," and much more ; he governs the 



-Al-:^ 



DISEASES OF THE BKAIN AMD NERVES. 



193 



t at the out- 
.ngular con- 
all changed 
, of life have 
\<i things at 
places have 
>rld has gone, 

•ed and per- 
i. In many 
n a confused 
regard them 

r hands, and 
other senses. 
. thickness of 

no existence, 
3uds, or from 
end, relative, 

hey associate 

mder the do- 
sh they them- 
|d morals, and 
teals what he 
gestures, and 

previously 
they repay 
3sult of their 
This alien- 
md is one of 
ordered, per- 
,ding feature 
•ecover their 
children and 
sr the family 
sertain signs 

I themselves. 
_ convereion 
le devil has 
taking hold 
Still another 
[governs the 



world, and directs the stars. One has all knowledge, and affects to 
teach the wisest. Another is proud, and withdraws from his fellows, 
bidding them not to come into his presence without proper acts of 
homage, — calling himself, it may be, a king. 

There are five kinds of insanity. I will speak of each of them 
briefly. 

Melancholy. — Lypemania. 

This is characterized by moroseness, fear, and prolonged sadness. 
The melancholic person is lean and slender, with black hair, and a 
pale and sallow countenance. His skin is brown or blackish, and 
dry and scaly. His physiognomy has a fixed appearance, the muscles 
of the face are drawn tight, the eyes are motionless, and directed to 
one point, the look is askance and suspicious, and the general expres- 
sion is one of sadness, fear, and terror. He desires to pass his days 
in solitude and idleness. He walks as if aiming to shun some dan- 
ger. His ey< iind ear are on the watch for evil. 

These persons do not sleep much. They are kept awake by fear, 
jealousy, and hallucinations. If their eyes close, they see phantoms 
which terrify them. 

Their secretions are disordered. The urine is either abundant and 
clear, or scanty and muddy. They sometimes retain their urine for 
days. One patient did not dare to make water lest he should drown 
the world, but was finally persuaded to it by the assurance that he 
would extinguish a fire which was devouring a city. 

Insanity on One Subject. — Monomania. 

This is a chronic affection of the brain, not attended by fever, and 
characterized by a derangement of the intellect, the affections, or the 
will, upon one subject only. The patient seizes upon a false princi- 
ple, and draws from it injurious conclusions, which modify and change 
his whole life and character. In other cases the intellect is sound, 
but the affections and disposition being perverted, their acts are 
strange and inconsistent. These they attempt to justify by plausible 
reasoning. 

Mania. 

This is also a chronic affection of the brain, generally without 
fever. The countenance of the maniac is sometimes flushed, at other 
ti .es pale. The hair is crisped ; the eyes injected, shining and hag- 
gard. Maniacs dislike the light, and certain colors horrify them. 
Their ears are sometimes very red, and are disturbed by a tingling, 
and a rumbling sound. Noise excites and disturbs them. They suf- 
fer from false sensations, illusions and hallucinations; and their ideas 
come with great rapidity, and are confused and without order. Their 



Ui 



194 



DISEASES OF THE UUAIN AND NRKVKS. 



affections are in a state of turmoil, and their judgments are all erro- 
neous. 

Unlike the monomaniac, their delirium extends to all subjecte. 
Their entire intellect, affections and will, are a chaotic wreck. 

Dementia. 

Herk is another chronic affection of the brain, without fever, in 
which the sensibility, the intellect, and the will, are all weakened. 
Demented persons have not the power to concentrate their minds on 
anything, and can form no correct notions of objects. Their ideas 
float after each other without connection or meaning. They speak 
without any consciousness of what they are saying. 

Many of them have lost their memory, or, like old person-*, they 
rememl)er nothing recent, — forgetting in a moment what is just said 
or done. 

The demented have neither desires nor aversions ; neither hatred 
nor love. To those once most dear to them, they are totally indif- 
ferent. They meet friends long absent without emotion, and part 
from their dearest ones without a pang. The events of life passing 
around them awaken in them no interest, l^ecanse they can connect 
themselves neither with the past nor the future ; they have no remem- 
brances nor hopes. Their brain is inactive ; it furnishes no ideas or 
sensations. They are no longer active, but passive beings ; they de- 
termine nothing, but yield themselves to the will of others. 

They have a pale face, a dull eye, moistened with tears, an uncer- 
tain look, and a physiognomy without expression. They sleep pro- 
foundly, and for a long time, and have a voracious appetite. 

Idiocy. 

Idiocy is in the condition in which the intellectual faculties have 
never been manifested. We are not to infer disease from it, any more 
than we infer it in the lower animals from the absence of intellect. 

In idiocy there is no mind, oecause the brain is not large enough 
to be the organ of intelligence. It always dates back, therefore, to 
the beginning of life. Everything about the idiot betrays a defective 
organization. The demented person, the monomaniac, etc., once had 
intelligence ; the idiot, never. They, in many cases, may be cured ; 
he is hopelessly incurable. They had blessings which have been taken 
from them ; to him, none were ever given. They were once the pride 
and hope of their friends ; he, from his birth, was the smitten and 
blasted one of his family. He never reaches an advanced age, — 
rarely living beyond thirty years. 

These remarks are sufficient to show the difference between idiocy 
and other forms of mental d mgement. In the other forms of in- 
sanity there are brains enougli, but they are diseased ; in this there is 
no disease ; the smallness of the brain is the primal and fatal defect. 



•'.i_j_^__ 



DISEASES OF THE DKAIN AND NRIiVES. 



195 



are all erro- 

ill subjectB. 
reck. 



lut fever, in 

11 weakened, 

sir minds on 

Their idesw 

They speak 

•erson-i, they 
t is just said 

iither hatred 
totally indif- 
)n, and part 
life passing 
can connect 
fe no remem- 
3 no ideas or 
igs ; they de- 
jrs. 

rs, an uncer- 
ey sleep pro- 
)ite. 



.culties have 
it, any more 
f intellect, 
urge enough 
therefore, to 
; a defective 
,c., once had 
ly be cured ; . 
been taken 
Ice the pride 
mitten and 
ced age,— 

Iween idiocy 
forms of in- 
this there is 
Katal defect. 



This form of menUil derangement is caused by a defective develop- 
ment of the brain. That the other forms are produced by disease of 
the brain, there can be no doubt. 

Some have supposed insanity to be a mental disorder merely, hav- 
ing nothing to do with the body. They might as well suppose the 
delirium of fever to he a disease of the mind only. 

Insanity is an unsoundness of the brain and nerves which proceed 
from it, in every instance. At first it is probably only excitement of 
the brain ; but this, long continued, becomes a chronic inflammation. 
The brain and nerves of an insane person are undoubtedly sore, and 
hence the painful thoughts and feelings which afflict them. When 
the soreness is much increased, they are violent and furious ; when 
it subsides, they are calm. In consequence of this inflammation and 
soreness of the brain, an insane person can no more think, or reason, 
or will, or feel correctly, than a person with an inflamed stomach can 
dig6st food well, or than one with inflamed eyes can see v/'ell. 

Causes of Insanity. — Hereditary predisposition ; painful subjects 
of thought or feeling long revolv od in the mind ; injures feelings 
which cannot be resented, mortified pride, perplexity in business ; 
disappointed affection or ambition ; great political, religious, or social 
excitements ; sudden and heavy strokes of misfortune in the loss of 
property and friends ; and in general, whatever worries the mind for 
a long time, and creates a deep distress, may be a cause of insanity. 

But one of the most prolific causes, and worthy of special mention, 
is masturbation, or self-pollution, — a vice contracted by thousands of 
ycung people, both male and female. 

Besides the above, I may mention several physical causes, as con- 
vulsions of the mother during gestation, epilepsy, montlily disorders 
of women, blows upon the head, fevers, loss of sleep, syphilis, exces- 
sive use of mercury, worms in the bowels, and apoplexy. 

Chances of Cure. — Idiotism is never cured. 

Melancholy and monomania are cured when recent, and do not de- 
pend upon organic disease. 

Dementia is sometimes, though seldom, cured. 

Chronic insanity, of long standing, is not easily cured. 

Insanity which has been produced by moral causes, acting suddenly, 
is generally curable ; if the causes have acted slowly and long, the 
cure is more doubtful. 

Excessive study causes insanity which is hard to cure. 

If caused or continued by religious ideas, or by pride, it is not 
often cured. , 

Insanity caused and maintained by masturbation is cured with 
great difficulty. 

Treatment. — The treatment of the insane is now almost confined, 
as it should be, to public hospitals. In these institutions, all the 
means are provided which humanity has been able to devise, to lift 



106 



DISKARKS OF THK BRAIN AND NKRVKS; 



t'roui these unfortunate beings the terrible shadow which iK uiMtii 
thera. Here they have safety, comfort, recreation, friendly guardians, 
rest, and medicine. 

They have safety from the annoyances which well-meaning but 
mistaken friends at homo almost always commit in contradicting, iind 
reasoning with, persuading, and threatening them ; for only in these 
humane institutions has it been well learned that to do so is no wiser 
than to pei-suade, scold, or threaten a neumlgic pain in the face, an 
inflammation in the stomach, or a felon upon the finger. They are 
safe, too, from the impertinent scrutiny of neighbors, the hootings of 
unthinking boys in the streets, and especially from the causes, wliat- 
ever they are, which have produced the disease. And so far, this is 
just the treatment they want, — no contradiction, no impertinent 
scrutiny from neighbons, no abuse in the streets, and a withdrawai of 
the causes which have produced the disease. 

In these institutions, too, they have comforts. They have clean 
rooms, galleries, lodges, bathing-rooms, yards and gardens for exer- 
cise and walking, safe, quiet, well-aired bed-rooms, and clean and 
comfortable beds ; cheerful dining rooms, and plain, wholesome, and 
nutritious food. And this, likewise, is the treatment they require. 

They have recreation, — dances, cards, l>ack-gammon, chequei-s, 
chess, billiards, nine-pins, walking parties, riding parties, gardening, 
and an indulgence in those arts of painting, music, drawing and 
architecture for which they may have a taste. And suc;h recreations 
are powerful instruments in the cure of all disorders of the nervous 
system. 

Here, too, they have friendly guardians, who have long studied 
their complaints, and have imbued their souls with a sympathy which 
goes down into the depths of their sufferings, and allies itself with all 
their sorrows ; — men and women who are willing to act the part of 
guardian angels ; to be their friends ; who know how to gain their 
confidence ; and who use the influence acquired by love, in leading 
them back towards health and happiness. And this, too, in curing 
the insane, is of great consequence, for none can do them good till 
they have their confidence, and this can be gained only by love and 
wisdom. 

In these insane asylums, they find rest. When the brain is hot 
from inflammation, and they are raving from delirium, they are here 
withdrawn from the noisy crowd, and shielded from the rude shocks 
of the world. If need be, they are placed in solitary rooms, where 
silence spreads its soothing stillness through their excited brains. 
And it is of the greatest importajice that the sore and torn feelings 
should rest ; for rest allays excitement, and 'irings sleep ; and with- 
out a proper amount of sleep recovery is : possible. 

Finally, in these institutions, they receive the best medical treat- 
ment. They have warm and cold bathing, judiciously administered ; 
they have simple cathartics when the bowels are bound, as salts, cas- 



■'>^«k;;S' •^•j'*3«'j(t?jyk»?-ii£i<u*-\^::<»i*A'^ij.*^ 



iv. 



DISEASES OK THE BRAIN AND NERVKS. 



197 



;h is updii 
guardians, 

janing but 
[ictiiig, and 
ly in these 
is no wiser 
lie face, an 
They are 
bootings of 
uses, \vhat> 
far, this is 
ni pertinent 
hdrawal of 

have clean 
s for exer- 
clean and 
esome, and 
T require. 
, chequei-H, 
gardening, 
iwing and 
recreations 
le nervous 

ig studied 

ithy which 

with all 

le part of 

jain their 

n leading 

in curing 

good till 

love and 

lin is hot 
are here 
e shocks 
us, where 
brains, 
feelings 
and with- 

cal treat- 
nistered ; 
lalts, cas- 



tor oil, and magnesia ; tonics for debility, such aa quinine, iron, cas- 
sia, columbo, chamomile ; and quieting medicines for their excite- 
ment, such as opium, morphine, cicuta, hyoscyamus, belladonna, stra- 
monium, scuUcap, and valerian. Prescription 74 is a combination 
n)uch used. Here, too, broth, gruel, and milk, are administered by 
the forcing pump to such as Uike a fancy not to eat, — an expedient 
which has saved many lives. Fruits of all kinds, as strawberries, 
cherries, currants, plums, apples, peaches, and grapes, are allowed 
freely. Cold water, sweetened or otherwise, is the drink. To these 
things are added lively conversation, and whatever will divert the 
mind from reflection, and internal imaginings and revery. 

Thus I have indicated, very briefly, the treatment which the insane 
receive in public institutions. That the chances of recovery in these 
humane retreats is much greater than at home, does not admit of a 
doubt. When it is not convenient to send an insane person to a hos- 
pital, the treatment should be as near like the one here sketched as 
circumstances will permit. 

Hypochondria. 

The common names of this disease are low spirits, spleen, vapors, 
nypo, and the blues. It produces constant fear, anxiety, and gloom. 
Business, pleasures, the acquisition of knowledge, and all the useful 
pui-suits of life, become insipid, tasteless, and even irksome to the hy- 
pochondriac. His mind is full of the belief that something dreadful 
is about to befall him. He is either going to be sick, or to die, or 
lose his property or friends. He has no mind to engage in any busi- 
ness, nor does he wish to go anywhere, or to see anybody. Night 
and daj'^ his spirits are down to zero, and his heart has a load too 
heavy to bear. He is wholly occupied with his troubles and his feel- 
ings. He thinks he has various diseases, and wears out his friends 
by talking of his sufferings. He feels of his pulse often, looks at his 
tongue in the glass, and several times a day asks a friend if he does 
not look pale or sick. 

The external senses manifest symptoms of derangement as well as 
the thoughts, feelings, emotions, and passions. There are roarings in 
the ears, like a waterfall, or the noise of a distant carriage. Floating 
black specks, or bright sparks, are seen before the eyes. These indi- 
cate a slight fulness of the blood vessels, and perhaps, in some in- 
stances, sparks of electricity passing to or from the eye, and are in no 
proper sense subjects for the alarm they cause. At one time the per- 
son will feel as large as a barrel, at other times not larger than a 
whip-stock; the head will feel light or heavy, large or small. The 
skin will twitch in different parts, or feel numb, or have the sensation 
of spiders crawling on it. The smell and taste become perverted ; 
the hypochondriac will smell odors and flavors, at times, where there 
are none. 






108 



DIHKA8K8 OF Till BRAIN AND NKRVB8. 



V 



These errors of tin' HenneH arc all owing to soiin' Hliglit dJHordt'r of 
the organH of sense ; and they are no more wonderful than that the 
mind should perceive personal danger, poverty, and death itself, when 
none of these things are impending. 

These persons are subject to fainting turns, when the hreatliing 
will appear to stoj), the body become cold, the face pale ; there will 
be distress in the region of the heart, which will apparently stop l)eat- 
ing, and the ])erson will feel as if dying. At the same time the mind 
will remain clear. These nervous spells are alarming, but pass off 
without danger. 

These persons become changed in their moral dispositions. They 
are jealous, fjike a joke as an affront, and feel the greatest distress at 
any apparent lack of attention or neglect on the part of friends. 
They put the worst construction upon the actions of friends. They 
are irritable, fretful, peevish, and fickle. 

The complaint is distressing, but does not appear to shorten human 
life. 

The seat of the disease is in the brain and nerves. It is caused hy 
anxiety, care, disappointment, working the brain too hard, diseases of 
the liver and stomach, costiveness, sedentary habits, excessive vene- 
real indulgence, and masturbation. 

Treatment. — This cHsease is more easily prevented than cured. It 
would be almost entirely prevented in this country if in childhood we 
were all taught to be contented with humble competence, to love ac- 
tive labor, and to think it honorable, instead of struggling after 
wealth, and falling into unhappiness when it does not come. 

Remedies. — Of all the remedies for this complaint, that which is 
most important is active employment out of doors. The human body 
was made for motion. Without it the blood cannot be distributed to 
the several organs. The senses, — the eye, the ear, the touch, — 
should be much in communion with nature. In this way they are 
strengthened. Nature is their great physician. Man is a creature of 
aensation ; and if too much occupied with feelings, thoughts, and deep 
reflections, the nerves will be irritated, and begin to give deceptive 
sensations. A very nervous man should fly to some active occupa- 
tion, if he would be rid of suffering. 

The open, fresh air is very important to restore the system to 
soundness. 

Temperance, both in eating and drinking, will do much for this 
class of patients, yet they are the very persons who eat largely, and 
they often fly to the excessive use of stimulants to drive away their 
sorrow. By so doing, they aggravate the disease. 

Amusements are very important for hypochondriacs. Lively com- 
pany, cheerful and witty conversation, with mirth and laughter, lively 
songs and instrumental music, are all desirable ; and so are gunning, 
fishing, riding, billiard-playing, und travelling. 



. 1 . ~v- ^ . 



niBKABKS OF THK HKAIN AND NRRVR8. 



199 



•liHonltT of 
ill that the 
iUelf, when 

) breatliinfj 
; tlwre will 
y Htop l)eat- 
le th(! mi IK I 
)ut pa8H off 

0118. They 

b distress at 

of friends. 

nds. They 

rten human 



Never allow these patientw to Im- alone, and to have time to brood 
over their mi.sery. See that they go early to l)ed, and rise betimes in 
the morning. The warm bath, the (!old shower, or sponge ba'h, with 
brisk frietion, arc. not on any account to be omitted. The diet should 
bo light, nutiitious, ;«ii(l generous ; but fate, acids, liquors, and coffee,, 
must Im* forbidden. 

But little medicine will be required. If there be costiveness, let 
cracked whaat lie eaten ; if this does not answer, a little rliubarb 
and bicarlioiiate of potassa (85), or leptaiidrin, podophyllin, etc. (86), 
may be given as required by the .symptoms. A teaspoonful of cal- 
cined magnesia once a day, or the infusion of tboroiighwort, drank 
cold, will often answer an excellent purpose. A 1m)w1 of warm 
motherwort tea, with a teaspoonful of spirits of camphor in it will do 
well in fits of fainting when there is a sensation of dying. A tea- 
spoonful of sulphuric ether mayl)e given at the same time. If there 
be debility, tonics are sometimes useful (50), (49), (54), (55). 



8 caused l)y 
, diseases of 
essive vene- 

m cured. It 
tiildhood we 
to love ac- 
'gling after 
ne. 

at which is 
uman body 
tributed to 
touch, — 
ly they are 
reature of 
I, and deep 
deceptive 
ve occupa- 

system to 

for this 
rgely, and 
iway their 

ively com- 
ter, lively 
gunning. 



Hiccous^h. — Singultus. 

Thw is a sudden, jerldng spasm of the midriff, occurring every few 
niomentti in bad cases, causing the air to he driven out of the lungs 
with such suddenness as to produce a noise something like the invol- 
untary yelp of a puppy. It is generally caused by acidity of the 
stomach, which irritates the nerves distributed to i^ neighborhood, 
and is not diflRcult to remove ; but when it occurs towards the close 
of some acute and gi-ave disease, it is sometimes a sign that dissolu- 
tion is at hand. 

Treatment. — Startle the person suffering, by exciting surprise, or 
fear, or anger; or let a few small draughts of cold water l)e taken in 
quick succession; or, let the brf;ath be held as long as possible. If 
the stomach is sour, take a te».jpoonful of bicarbonate of soda, dis- 
solved in half a tumblerful ot cold water. To expel wind from the 
stomach, if it be present, take some warm aromatic essence of pep- 
permint, ether, or conpound spirits of lavender. But one of the 
most effectual remedies is heavy pressure made upon the collar hones. 
It is simple, and very effectual. Cocaine, one-eighth grain every fif- 
teen minutes, is a very simple and often efficacious remedy. 

Fainting. — Syncope. 

Fainting is preceded by a distress .about the heart, a swimming 
of the- head, sometimes sickness at the stomach, colt'ness of the hands 
and feet, and a loss of sight, or a sense of things growing dark. The 
breathing diminishes, the pulse becomes small, the face deadly pale, 
and the patient wilts down, and becomes more or less unconscious of 
what is passing around. 

Whatever causes debility, particularly of the nervous system, will 



-weic- 



200 



DIBRA8C8 OK THE BHAIN AND NKHVB8. 



predispoHe to fainting. Peraons much wetiktuuMl l)y dlHeivHc, faint 
easily, especially when tiiey attempt to stand Htill. When on their 
feet, such persouH HJiould keep moving. Fainting Ih HonietinieH in- 
duced by Hudden surpriHeH and eniotionH, hy violent pains, by the 
aight of human blood, and by irritation of tlie coats of the stomach 
by indigestible food. 

Treatment. — I^ay the ]>atient upon the baek,with the head low; let 
freah air into tlie room instantly, and apply gentle friction. Sprinkle 
a little coM water upon the face, and hold spirits of camplutr, etlier, 
hartshorn, or vinegar to the nose, — rubbing a little of the spirits of 
camphor U})on the forehead, and about the nostrils. As soon iis tiie 
ptitient can swallow, give a teaspoonful of compound spirits ot lav- 
ender, with ten drops of water of ammonia in it. 

Persons subject to fainting should not go into crowded assenihlies 
where the air is biid ; neither should they wear tight dresses, or allow 
themselves to get excited. Cold bathing, a well-regulated diet, and 
vegetable tonics, will do much to break up the habit. 



V 



\ 



Dizziness of the Head. — Vertigo. 

This affection makes objects which are stationary appear as if 
moving, or as the phrase is, " turning round." When seized with it, 
one will have a sensation as if falling, and objects about him will 
seem to be in motion. 

It is caused by irritation of the nerves of the stomach in dvspep- 
sia, by long application of the mind, by a weakened nervous system, 
by hysterics, and by a fulness of the blood-vessels of the head. 
When it proceeds from most of these causes, it is not dangerous ; but 
when caused by impending apoplexy, it is a symptom of very serious 
import. 

f Treatment. — Find out the cause and remove that, and the dizzi- 
/ BjBss will disappear. If it come from dyspepsia, eat lightly ; if from 
' costiveness, open the bowels either by coarse food, by daily cold 
\ water injections, or by some gentle physic. Avoid coffee, ardent 
I spirits and late suppers, and take much exercise. Keep the feet 



Iwarm, and the head cool. See to the liver ^d heart. 



/ 



Disturbed Sleep. — Nijr'- 



.. — Incubus. 



In this complaint the sleep is di generally by some fright- 

ful image. Whatever of an alarm. ^naracter is presented to the 
raind in sleep, causes fear, or some other painful emotion, the same 
as when awake. And when the attempt is made to resist, or to flee 
from the danger, it is ineffectual, because the muscles are locked fast 
in sleep. The fear being increased by the inability to escape, the 
sleeper makes all sorts of horrible noises, indicating distress of mind. 
The danger seen is as real to the sleeper as if he were awake, and he 



niBEAHES OF THE BKAIN AND NEKVB8. 



201 



AciiHo, faint 
iMi on tlieir 
uutinieH in- 
liiis, by tho 
he Htomach 

!ad low ; let 
I. Sprinklo 
|»li()r, otlicr, 
w Hpii'iUt (if 
8()on aH tli(5 
irits ot lav- 

[ asseuiblies 
es, or allow 
d diet, and 



ppear an if 
zed with it, 
ut him will 

in dvspep- 
3U8 system, 
the head, 
jerous ; but 
rery serious 

:i the dizzi 
|ly ; if from 
laily cold 
:ee, ardent 
sp the feet 



/ 



9US. 

bme fright- 
Ited to the 
the same 
, or to flee 
locked fast 
Escape, the 
Is of mind. 
Ike, and he 



tries to do jiiHt what he would if awake. Sometiniea the Nonsution is 
that some h(!avy weij;fht, or perhaps some horribh' monster, is iipoii 
the breast, nearly pressing the brcatii out of the l)0(iy. 

At times, the power of motion 'is not almcnt, and then disturbed 
dreams may eanse one t(» talk, or to rise and walk, or run. Children 
will laugh or cry, or scream, which shows that their minds are agi- 
tated by different passions. Persons who indulge gloomy ..nd troub. 
lous thoughts in their waking hours are apt to be disturbed with 
sleep-walking, sleep-talking, and frightful drear.is, as of falling down 
precipices, during the hours for repose. 

There is nothing very wonderful al)out these disturbances of sleep. 
It is only neciessary that there should be an unusual sensitiveness of 
the brain, or that a hearty supper, eaten late, should irritate the 
nerves of the stomach, atul that distressing tlioughts should be dwelt 
upon during the day and evening, in order to produce all the walk- 
ing, talking, dreaming of hobgoblins, shipwrecks, fires and polar 
beai-s, which distress so many unfortunate sleepers. 

In night-walking there is simply a little more wakefulness than in 
night-talking, and in this latter, more than when one falls from a high 
place, and in this perhaps slightly more than in real ineuhuif, when 
one is in tin greatest peril, but cannot move at all. 

Treatment. — When sleeping persons groan, or make any noise 
indicating nightmare, shake them, and they will come out of it at 
once. As these troubles are often caused by a weakened still e of 
the nerves, much out-door exercise should be taken. The diet should 
l)e simple, and well regulated. The suppers should be light, and 
never taken late. The evening should be spent in some pleasant 
amusement, which will drive awoy care ; and the last hours of wake- 
fulness be occupied with pleasant reflections. One afflicted witli 
nightmare should not lie upon the back, nor with the hands over the 
head. Acidity of the stomach, and costiveness, if they exist, should 
be removed by neutralizing mixture. 

Headaches. 

These are not alwajrs caused by disorders of the brain and nerves, 
but they frequently are, and this seems the proper place to speak of 
them. 

It is unwise ever to neglect headaches. They are sources of great 
suffering, and often lead to serious derangements of the health. In 
childhood they have a more serious meaning than in adult life. 
They often indicate the approach of scarlet fever, or measles, or of 
other diseases. 

Headaches are more common among the civilized than the uncivil- 
ized ; more frequent among females than among males ; among those 
of sensitive feeling than among the more obtuse ; among those who 
think much than among those who think little ; among the sedentary 
than among the active. 



•■Sfssssr- 



....ikU~kiMi»^' ^ 



202 



DISEASES OF THE BRAIK AND NERVES. 



ni 



Causes of Headaches. -They are dependent on various causes, 
as derangement of the circulating system, of the digestive organs, of 
the nervous system, etc. Among those dependent on disturbance of 
the circulation, are 

Headaches from Eye Diseases. — Myopia, or nearnsightedness ; 
Hypermetropia, or far-sightedness ; Astigmatism, or the inability to 
see equally well horizontel and vertical lines, as well as other irieg- 
ularities of vision, are frequent sources of headache. These head- 
aches are caused by overtaxing certain groups of muscles, or by fixing 
the eyes too long on one objective point, as experienced in prolonged 
study or reading, especially under unfavorable circumstances. These 
headaches are more or less similar in their symptomatology. The 
ache is generally dull, situated mostly in forehead and over eyes, but 
may also be spread from base of brain to the eyes ; oftentimes it is 
accompanied by nausea, especially after prolonged use of eyes under 
improper conditions. 

The treatment of these headaches consists in absolute rest of the 
eye, in case of overwork, and the fitting, by a competent oculist, of 
such glasses as will rectify the irregularity in the eye proper. 

Astigmatism is a common source of headaches, and often is so in- 
sidious in its development as to escape attention. A rough test 
may be made by drawing several horizon*^"' and several vertical 
lines in close proximity, and then placing pt fio»;>e distance (15 to 20 
feet) from the eye. If either set cannot i « as clearly seen without 
blurring as the other, you have good cause t,^ su' iect Astigmatism, 
and should consult an oculist. Do not dally .„i these eye-head- 
aches, as you will be doing -v permanent injury to your eyes. 

Tea and Coffee Headaches — In the nervous, and oftentimes in 
the gouty and rheumatic person, the use of tea or coffee will cause 
violent headaches. Tobacco likewise after prolonged use shows a 
tendency to head'^ches. The ie luxuries of life should be discontin- 
ued at once for at least or j month. An extra strong cup of black 
coffee, to be sure, will stop the headache for the time being, but only 
adds fuel to the fjre in the long run. Bromo-caffeine, as ordinarily 
sold by the druggists, taken in teaspoonful doses every half hour, 
will relieve the malady. We would strongly advise any one that has 
constant or periodical headaches, if he uses eithe" tea or coffee, and 
especially coffee, to leave them off entirely for three months. It may 
be the sole cause, and if caused by tea or coffee, there is no possi- 
bility of their cure by medicines while you continue their use. 

Plethoric Headaches. — These are dependent on a general fulness 
of blood. They are of two kinds. One is occasional, and lasts but 
a few hours. The other lasts for dajrs or weeks. It occurs most 
often in the night or morning. Persons whose occupations require 
stooping have it most. A little dizziness is generally felt on rising 
up from a stooping posture. It is brought on by the bad air of 



DISEABKH OK THE BKAIN AND NKRVE8. 



203 



•10U8 causeH, 
fe organs, of 
sturbance of 

sightedness ; 

inability to 

other irieg- 

These head- 

or by fixing 

in prolonged 

nces. These 

ology. The 

krer eyes, but 

sntimes it is 

f eyes under 

rest of the 
it oculist, of 
oper. 

'ten is so in- 
. rough test 
eral vertical 
ce (15 to 20 
seen without 
astigmatism, 
sse eye-head- 
yes. 

tentimes in 
; will cause 
jse shows a 
>e discontin- 
up of black 
ig, but only 
ordinarily 

half hour, 
ne that has 

coffee, and 
It may 

is no possi- 

use. 

sral fulness 
lasts but 

Bcurs most 

|)ns require 
on rising 

I bad air of 



crowded rooms, and is attended by costive bowels, short breath, and 
a white furred tongue. 

Tfie persistent headache is accompanied by a sense of fulness, and 
sometimes of throbbing over the brows and temples, with a sensation 
of dizziness, and of mist before the eyes. The sufferer feara exertion 
and is constantly looking for a rush of blood to the head. Nature 
sometimes relieves this form of headache by a diarrhoea, or by bleed- 
ing from the nose. 

There is another form of plethoric headache, differing slightly from 
the above, in which there is too much blood, and it is made too fast, 
but it does not circulate so rapidly. The muscles are not very firm, 
and the heart does not propel the blood with much force. This form 
of headache is connected with congestion. 

Headaches of Indigestion. — These are caused either by taking 
improper articles of food, or by eating too much of those which are 
proper. The sensation in the head is not always a pain, but some- 
times only a dull weight, attended by languor and disinclination for 
exertion ; a tongue white in the centre, and pale red at the tip and 
edges ; cold and numb fingers ; slight nausea ; languid and feeble 
pulse ; dim and indistinct sight ; eyes aching when employed ; and 
difficulty in fixing the attention. 

Sick Headaclie. — This has received its name from the constant 
nausea or sickness at the stomach which attends the pain in the 
hf ^d. 

This headache is apt to begin in the morning, on waking from a 
deep sleep, or after sleeping in a close room, and when some irregu- 
larity of diet has been committed on the day before, or for several 
previous days. At first there is a distressingly oppressive feeling in 
the head, which gradually merges into a severe, heavy pain in the 
temples, frequently attended by a sense of fulness and tenderness in 
one eye, and extending across the forehead. There is a clammy, un- 
pleasant taste in the mouth, an offensive breath, and the tongue cov- 
ered with a yellowish-white fur. The sufferer desires to be alone, 
and in the dark. The hands and feet are cold and moist, and the 
pulse feeble. 

Accompanying these symptoms, there is a depressing sickness at 
the stomach, which is increased by sitting up, or moving about. 
After a time, vomiting comes, and relief is obtained. 

Bilious Headaclie. — This is most common in summer and au- 
tumn. It a^icts persons of dark complexion with black hair and 
melancholy dispositions. There are two kinds, one is due to an ac- 
cumulation of bile in the system ; the ^<ther, to a large secretion of 
bile. 

Ir; the first variety the skin is dingy and sallow, the spirits de- 
pressed, the bowels costive, and there is wind in the stomach, with a 
dull, aching pain on the right shoulder. The pain is in the forehead, 



204 



DISEASES OF THE BRAIN AND NERVES. 






eyebrows and eyelids, and the " white of the eye " is a little yellow- 
ish. The tongue has a brown fur, and is cracked in the centre. 
There is a bitter taste in the mouth on waking in the morning, after 
restless nights, and frightful dreams. 

In the second variety, which is due to an " overflow of bile," the 
symptoms are much like those of the first kind, but the pain is not so 
continuous. In addition to the symptoms named, there is a throb- 
bing, rending pain in the head, the skin is hot and the face flushv 1, 
the limbs are sore, and there is a luminous halo or ring around ob- 
jects looked at, and a feeling of giddiness. 

Nervous Headaches. — These are more common among females 
than males. They occur most frequently among persons of high sus- 
ceptibility, who are easily elevated, and as easily depressed. They 
are often connected with indigestion. 

The pain is usually acute and darting, and is made worse by light, 
with a feeling as if the temples were, being " pressed together," and 
a " swimminess " in the head. There is sometimes a sense of sink- 
ing, with a dread of falling, and great despondency and restlessness. 
The bowels are generally costive, and the sight dim. The pain comes 
on most commonly in the morning, lasts through the day, and abates 
in the evening. 

Hysteric Headache There is a nervous headache dependent on 

the hysterical condition. It is generally confined to one small spot, 
frequently over the eyebrow, and is sometimes compared to a wedge 
or nail driven into the skull. 

Headache from Exhaustion. — Still another species of nervous 
headache arises from extreme exhaustion, produced by great loss of 
blood, by diarrhoea, or by over-suckling. The pain is generally on 
the top of the skull, and is often compared to the beating of a small 
hammer on the head. 

Brow Ague. — This is intermittent in its character, and is brought 
on b}' exposure to cold and moisture in damp and marshy districts ; 
and in this respect is much like ague. 

Meg^rims. — This is most frequent among females. It is often de- 
pendent on the same causes as Brow Ague, and is also produced by 
long and exhausting watching over sick children, distress of mind, 
and indigestion. 

In both the above forms, the pain is intermittent, seldom lasting 
long, but being of a sharp, piercing character like that of tic doulou- 
reux. Tin pain of Megrims usually begins at the inner angle of the 
eye, and extends towards the nose ; the parts being red and sore, and 
the eye-ball tender. In Brow Ague, pain and great tenderness cover 
an entire half of the head, compared by the patient, sometimes, to 
" an opening and shutting of the skull." It begins with a creeping 
sensation over the scalp. 



DISEASES OF THE BRAIN AND NERVES. 



205 



ie yellow- 
be centre, 
ling, after 

bile," the 
1 is not so 
i a throb- 
ie flushv 1, 
round oh- 

g females 

high 8U8- 

id. They 

J by light, 
ther," and 
e of sink- 
jtlessness. 
lain comes 
bud abates 

endent on 
mall spot, 
) a wedge 

nervous 
it loss of 
erally on 

a small 

brought 
iistricts ; 

often de- 
duced by 
of mind, 

lasting 
I doulou- 
Jle of the 
lore, and 
tes cover 
limes, to 
ireeping 



Rheumatic Headaches. — These generally affect persons who have 
been subject to rheumatism, and are often brought on by uncovering 
the head when sweating. The pain is usually in the brow, (he tem- 
ples, or the back of the head, and is dull and aching, — rather an in- 
tense soreness than a real pain ; and the painful part is excessively 
tender upon pressure. The skin is moist, but not hotter than natural. 

Treatment. — In considering the treatment, I will take up the same 
order in which I have spoken of the different forms of headache. 

Plethoric Headaches. — Not much medicine should be taken for 
these, if it can be avoided. A diuretic (131) may be taken twice a 
day, and an occasional dose of gentle physic at night, followed by (7) 
in the morning. This will generally give great relief. 

Meat should be taken but once a day, and the whole diet should 
l)e spare, the appetite never being fully satisfied. All spirituous drinks, 
including distilled and fermented, should be let alone, and coffee like- 
wise. 

Much exercise should be taken in the open air. The hair should 
be kept short, and the head elevated during sleep. Bleeding at the 
no3e, when it occurs, must not be too suddenly stopped. Two drops 
of the tincture of aconite root with three of the fluid extract of gel- 
semium repeated once a half hour for three or four times will be 
found to be of great value in the treatment of this form of headache. 

The hot-water bottle applied' to thr o part of the spine between the 
head and shoulder blades will also give great relief. 

Congestive Headaches. — The exercise, diet, mode of sleeping, 
etc., should be the same as in plethoric headaches. In this complaint, 
there is too much blood in the head, and it inclines to stagnate. The 
feet and hands are cold ; and gloves and stockings of wool, and other 
bad conductors of heat from the body, must be worn. 

Occasionally a little gentle physic (319) is desirable to induce the 
bowels to act every day. If there is great debility, iron (71), (74), 
(75), (320), will be required. The ic3 bag applied to the last six or 
eight inches of the spine will call the blood to the extremities. The 
aconite and gelsemium recipe as given above is also very useful. 

Headache of Indigestion. — If the pain come immediately after a 
meal, and can be traced to something eaten, an emetic (2) may be 
taken, if the person be tolerably strong. If the pain come on some 
hours after eating, take rhubarb and magnesia (28), (14), or fluid 
magnesia. \VTien the system is debilitated, take a warm draught 
(322) in the morning after a light breakfast, or twice a day, a bitter 
with an alkali (323). If the stomach be very irritable, bismuth, at 
meal times (324), (326). When it occurs after a debauch, take re- 
cipe (325). 

Sick Headache. — When it results from food taken, a draught of 
warm chamomile tea, or a little weak brandy-and-water, will generally 



:<1 



PI 



206 



DISEASES OF THE BKAIN AND MEKVEU. 



I it 



/ r 



give relief. If the sickness continue, soda and water, with a little 
ginger may do well, or a mustard poultice upon the stomach (166) 
may be required. As soon as it can be kept on the stomach, a dose 
of physic (826) must be tivken ; and if relief does not come after the 
operation of this, give a bitter and an aromatic (327). The patient 
must have perfect rest. If there be great lack of tone in the system, 
the mineral acids (328), (329) will be excellent. 

The diet must he carefully regulated, Jis in plethoric and conges- 
tive headaches. Cocaine, one-eighth grain every fifteen minutes till 
the nausea stops, and then a dose of physic is an excellent method of 
treatment. Ten grains of amenonol (ammonol) every hour will 
stop the pain, and very often tlie same amount of phenacetine will 
accomplish the same result. 

Bilious Headaches. — These are generally connected, more or less, 
with some affection of the liver. 

During an attack, if the suffering be great, attended by nausea, 
give an emetic (2). In milder cases, give Tecipe (321). If there be 
costiveness, give recipe (330) at night, and (7) in the morning. 

A few doses of podophyllin, leptandrin, etc. (34), (36), (39), to re- 
lieve the liver when the bile does not flow fast enough, will diminish 
the frequency and force of the attack. The fluid extract of dande- 
lion, taken for some time, often does good service. 

The diet should be light, and chiefly vegetable, and exercise in tlie 
open air must not be omitted. The daily sponge-bath, with friction, 
is excellent, 

Nervous Headaclies. — The first thing to be done is to relieve the 
pain, and this may generally be accomplished either by preparation 
(331), or (332), or (333), or (88), or (93), or two or three drops of 
tincture of nux vomica in a spoonful of water, taken three times a 
day. 351 will be found usually to be of most service. 

In simple nervous headache, diet is of the greatest importance ; in 
hysterical cases, exercise ; in headaches from exhaustion, tonics (81), 
(79), r63), (73), (64), (61), (60). 

Of the simple remedies found on the druggists' counter bromide 
of caffein in effervescent form is very efficacious. 

Riieumatic Headaches. — Take a light diet, with but little animal 
food. Wear warm clothing, and avoid exposure to wet feet and damp- 
ness generally, and go to a mild climate, if convenient. 

When the local pain is great, apply hot fomentations, or a stimula- 
ting liniment (334), or a mustard poultice, to the back of the neck. 
In the beginning of the treatment, a little physic at night (335) is 
useful. 10 grs. potassium iodide, gradually increased, in water, is 
the best medicine. 

Before closing this chapter on headaches, let me enter a respectful 
protest against the indiscriminate use of the thousand and one reme- 
dies advertised to cure headaches ; for in a great majority of cases it 



with a little 
omach (166) 
mach, a doso 
>me after tlie 
The patient 
1 the system, 

and conges- 
minutes till 
it method of 
y hour will 
lacetine will 

nore or less, 

by nausea, 
If there be 
jrning. 
(39), to re- 
ill diminish 
b of dande- 

rcise in the 
th friction, 

relieve the 
jreparation 
36 drops of 
3e times a 

rtance ; in 
nics (81), 

sr bromide 

tie animal 
md danip- 

a stimula- 
the neck. 
; (335) is 
water, is 

•espectful 
•ne reme- 
f cases it 



DISEASES OF THE BRAIN AND NERVES. 207 

given away by patent ^edi^Cl^L'^^^^^^^ 
cures for headaches. These vendera hav?l ''''""*^'^«^ ^heir specific 
since the introduction into LlSrof thA Ti '" '^"'"''«^« "^ ^^^e, 
samples of headache cures may S found "°^^-<^'; Products, so that 
little while. For the molt Z7 thJ °" ''"^^ doorsteps every 

H. acetenilide or antiSnr^cauro'f T^^^ "^ ^^** '^ ^"«^^ 
with other coal-tar producte It l\ cheapness as compared 

them all,oftencausing Wueness of tt'T'^'^fl'^" ""^^^ ^^™f"l of 
dizziness, faintness, etc^ W other 8imS«r^^''/"?"""«^ °^ *^« heart 
ger may be expected, and yet no on^oulbf ^^^^^^ "'"^^ '^^°- 

without the consent and a^ppiSri of thf f^.^r*'? ^ *''" ^^"^^dies 
of phenacetine for an aduKDeated f^"/"""^^ Physician. 8 grains 
will cure more headaches of ^1 5^117° ^?"' *'°'^' ^« doubt 
drug. LactopheninandLlnolaresirn7.^" '^^ °'^^^ «^"^^« 
headache which have the ^^^1^ J^ Jf ^^"^^^ "^"^^dies for 
duct« without any of their iScte AnfT^ '^'^'"* ^ ««^^-*^^ P^o- 
cine of the coal-tar group, enioys a Jart^ff^ ' proprietaiy medi- 
but for general neuralgic pa n and,???' "1 '^"^^ ^°' headaches 
eve^two to four houS a?^rdL"g^o^K TrL^t-^^^^^ ^°- 
stop a large proportion of these aches ^^^f^^^^.'^^ "^ the pain, will 
the bromides are always safe and nffl ^ ^^'^""^ combinations of 
aches, especially if neTe-elemen? is Itrnr ' !?"''^* ^" ^'^""^ head- 
caffein, bromoieltzer, bromc^oda eiV '^''' '^T''''''' ^romo- 
small bottles in an eff rvesc'rand' p^iaS: f^"'"^ ^^' "^ ^ 



«.Ts>^!S5;3aiEEas3 



DISEASES OF THE THEOAT. 



The diseases which seat themselves in the throat, and in the great 
cavity of the chest, have occupied a large share of my attention for 
the last ten years. My practice in these complaints has been largo, 
— being drawn from every part of the United States, and the British 
Provinces. No class of diseases from which men suffer are more nu- 
merous than these, and none have so generally baffled the skill of the 
profession. For this reason, I wish to present here a brief, practical, 
and common-sense view of these complaints, which shall be of real 
value to the thousands of families who consult these pages. 

Increase of Throat Diseases. — A striking increase in the number 
of throat diseases has been witnessed within the last few years. A 
person suffering from any of them will find, on speaking of his com- 
plaint, that a number of his neighbors are afflicted with troubles of a 
similar kind. I have thought that in some of their forms these dis- 
eases have fastened upon the throats of not less than half our popu- 
lation. And when it is considered that they are the natural, and if 
unmolested, the certain harbingers of lung disease, it is wise to make 
a note of the above fact. As I shall describe them in the nasal cavi- 
ties, the pharynx, the fauces, etc., they all have a natural proclivity 
downwards. From these upper cavities they pass, by one short step, 
into the larynx, — the cavity where the voice is formed, — and then, 
by another equally short and easy stage, into the body of the wind- 
pipe. It is a singular fact that their progress is always from the 
upper breathing passages downward, and never from the lower pas- 
sages upward. They afford a parallel to the order of progression in 
the moral world, in which evil tendencies are toward a lower depth. 

A Mistake Corrected. — Before describing the several diseases 
which belong to this family, I wish to correct the mistake which so 
generally classes them all under the term Bronchitis. 

They all consist in a simple inflammation, acute or chronic, either 
of the mucous membrane lining the several cavities to be spoken of, 
or of the small glands or follicles connected with that membrane ; 
and each disease takes its name from its particular location. Thus, 
the inflammation of the membrane lining the upper part of the throat, 
or pharynx, is called Pharyngitis. Inflammation in the top of the 

208 



i. -..JiBMH 



in the great 
itention for 
been largi;, 

the British 
re more nu- 

skill of the 
jf, practical, 
. be of real 



the number 
V years. A 
of his corn- 
roubles of a 
IS these dis- 
f our popu- 
iural, and if 
ise to make 
nasal cavi- 
|1 proclivity- 
short step, 
and then, 
the wind- 
Is from the 
lower pas- 
jgression in 
|wer depth. 

il diseases 
|e which so 

bnic, either 
spoken of, 
lembrane ; 
hn. Thus, 

(the throat, 
pop of the 



DISEASES OF THE THHOAT. 



windpipe, or larynx, is Laryngitis. In the windpipe, or trachea, it ia 
IVachitis. In the bronchial tubes, it is Bronchitis. As the bronchial 
tubes exist nowhere except in the lungs, below the division of the 
windpipe, there can be no Bronchitis in the throat. Nevertheless, it 
is the same disease with Laryngitis and Pharyngitis, and differs from 
them only in being in a more dangerous place. 

As the windpipe descends into the chest, it divides below the top 
of the breast-bone into two branches, one going into the right, the 
other into the left lung. These branches divide and subdivide very 
minutely, and send their ramifications into every part of the pulmon- 
ary tissue. Thus situated, Meckel has compared the windpipe to a 




Fro. 86. 

hollow tree with the top turned downward, — the larjmx and trachea 
representing the trunk, and the bronchial tubes, with their innumera- 
ble subdivisions, the branches and twigs. (Fig. 86.) 

If the reader will now understand that the trunk and branches of 
this bronchial tree 're hollow throughout, and lined with a delicate 
and smooth mucous membrane, and that the diseases to be described 
are inflammation either upon this membrane or the small glands con- 
nected with it, causing swelling,Tedness, unhealthy discharges, rough- 
ness, etc., he will have a good general idea of them. 

Nasal Catarrh. 

I TAKE these diseases in the order of their location. Nasal Catarrh 
consists in inflammation, which begins behind and a little above the 



■WRSrTBBBSSSS!?' 




310 



DISEASES OF THE THROAT. 



m 



veil of the palate, and extends upward from thence into the nose. It 
is an exceedingly troublesome complaint, and afflicts great numbers. 
It passes under the name of Catarrh in the Head. 

The inflammation is not confined to the nasal cavities. It extends 
frequently to the air-cavities, called antrums and ainvses, which cover 
a considerable portion of the face, and extend to the lower part of the 
forehead. Persons sometimes feel as if their whole face were in- 
volved in the disease, and were almost in a state of rottenness, — so 
great is the amount of matter discharged from the head. Such free 
discharges cannot be wondered at when we reflect that all the air 
cavities in the face are lined with the same mucous membrane which 
lines the nose, and that they all communicate w ith the nasal cavities. 

The " horn ail," among cattle, is a similar inflammation of the inner 
surface of the horns ; and the " horse distemper " is an inflammation of 
the air cavities in the head of the horse, and is much the same disease 
with our catarrh in the head. 

The catarrh often creates a perpetual desire to gtoallow, and gives 
the feeling, as patients express it, " as if something were sticking in the 
upper part of the throat" 

When the inflammation has existed a long time, and ulceration 
has taken place, puriform matter is secreted, and drops down into the 
throat, much to the discomfort of the patient. Indeed, this is one of 
the most distressing features of the complaint, as this matter often 
descends into the stomach in large quantities, causing frequent vom- 
iting, and a general derangement of the health. Many times the suf- 
ferer can only breathe with the mouth open. Upon rising in the 
morning a great effort is required to clear the head and the extreme 
upper part of the throat. There is occasionally a feeling of pressure 
and tightness across the upper part of the nose ; and the base of the 
brain sometimes suffers in such a way as to induce headache, vertigo, 
and confusion. The smell is frequently destroyed, and sometimes 
the taste. The inflammation sometimes gets into the Eustachian 
tubes, the mouths of which are behind and a little above the veil of 
the palate, and extends up the lining membrane to the drum of the 
ear, causing pain or deafness, and occasionally both. In addition to 
this catalogue of evils, there is often added inflammation and elon- 
gation of the uvula or soft palate. 

Treatment. — The following is a fair illustration of my mode of 
treatment: — 

Mr. , of Boston, came under treatment for a bad case of ca- 
tarrh in the head, complicated with follicular disease of the pharynx, 
or upper part of the throat. In addition to nearly all the symptoms 
mentioned above, he had a stench from the nose exceedingly offen- 
sive to all about him. So much had the disease worn upon him that 
he had become bilious, sallow, dejected, and low in strength and flesh. 

When it is said that to all these were added a cough and loss of aj)- 
petite, with insidious approaches of hectic, it will not be surprising 



BT?-,-^ 



DISEASES OF THP! THROAT. 



211 



the nose. It 
it numbers. 

It extends 
wrhich cov(!r 
: part of the 
ce were in- 
snness, — so 
Such free 
/ all the air 
brane which 
isal cavities. 
of the inner 
immation of 
lame disease 

', and gives 
ioking in the 

I ulceration 

wn into the 

lis is one of 

latter often 

quent vom- 

nes the suf- 

jing in the 

le extreme 

of pressure 

jase of the 

he, vertigo, 

sometimes 

Eustachian 

the veil of 

•um of the 

,ddition to 

and elon- 

ly mode of 

[a&e of ca- 
pharynx, 
[symptoms 
iigly offen- 
him that 
I and flesh, 
[loss of aj)- 
surprising 



tliat his friends saw the most serious results impending, even tliougli 
assured by me that the disease had not yet tiikisu a firm hold of Km 
lungs. The first tiling done for him was to cut <»ff the uvula. Five 
days after, I began to bathe the whole nasal cavity, thiee times a 
week, with a shower syringe, by pushing the smooth bulb up behind 
the veil of the palate, and throwing instantaneously a most dv<^licate 
shower of medicated fluid up both sides of the septum. The upper 
part of the throat was likewise bathed by the use of a shower syringe 
made expressly for that part, and the larynx, or place where the voice 
is formed, by a long, bent instrument made to reach this part of the 
tliroat. The solution used consisted of half a dram of crystals of ni- 
trate of silver dissolved in one ounce of soft water. 

The nitrate of silver powder was inhaled once a day with the pow- 
der inhaler. In this way the nasal cavities and throat were kept 
cleansed, and the articles used gradually subdued the inflammation, 
setting up a new and healthful action in place of the diseased one. 
The stomach was relieved of the offensive matter which had daily 
and nightly gone down into it, and the system of the poisonous ef- 
fects of its absorption. The great danger which threatened the lungs, 
and which would soon have been realized in their destruction, passed 
away. The skin gradually resumed its P'-oper color ; the aopetite, 
flesh, spirits, and strength came back, and Mr. B. has been oince in 
the enjoyment of good health,. pursuing his business cheerfully. 

When the above treatment fails, as it does occasionally, I am in 
the habit of changing the solution, using sometimes a weak solution 
of acid nitrate of mercury, twenty drops to an ounce of water. In 
other cases, a solution of sulphate of zinc serves a good purpose. A 
dilution of the tincture of arnica-flowers is a preparation of some 
value in these cases. There are other preparations, too numerous to 
mention, which I am in tKe habit of using. I will add, that the 
nitrate of silver powder, snuffed once a day, a pinch at a time, is far 
more successful than any other snuff ever made, but should be used 
only in severe cases» and with caution. 

Nasal catarrh is such a common affliction in the Eastern States, as 
to be a widespread curse. Douching the nose with salt and water 
(warmed) cleanses the nose of the foul mucus. The douche should 
be from a bag hanging only a little higher than the head, or it may be 
given by means of a common, blunt-pointed syringe, care being taken 
not to use too strong force, nor to point the syringe in the direction 
of the eyes. The stream of water should be directed straight ahead 
parallel with the floor ; the mouth must be open, and the patient as- 
sume the position of the countryman when gazing or gauking at the 
sights on his first visit to the city. The water then runs down the 
throat and also out of the other nostril. This process should be em- 
ployed on both sides till the head is clean. The cablets put up by all 
wholesale druggists, called "Carl Seller's alkaliae tablets," is the best 
remedy for a nasal douche. The subsequent treatment is best ad- 



!t-?«?«H9SSS? 



212 



DI8EA8RR OF THR THROAT. 



W1 



vised b}' a physician, and usually consistH in thu use of soiue inloila- 
tion or spray. 

Inflammation of the Pharynx. — Pharyngitis. 

This is an inflammation of the upper and back part of the throat, 
or all that part which can be teen when the mouth is stretched open. 
It causes a redness of the mucous membrane lining the part, which 
is deep in proportion to the intensity of the inflammation. This 
complaint is generally connected with the one I am about to desciilMi; 
and since the treatment is the same the reader is referred to what 
next follows. 

Adenoid Growths. 

In young children a very disagreeable catarrhal affection often ex- 
ists in the naso-pharynx just behind and above the uvula. This is 
caused by continued catarrh till at last small growth's occur like 
proud-flesh, and not infrequently block up the passage from the nose 
to the mouth, to that extent that not only is loud snoring produced at 
night, but breathing becomes difficult by day. In severe cases the njv 
per jaw becomes angular, and the face assumes a peaked, pinched look. 
These growths are extremely common in children, and are produc- 
tive of much mischief. The inability, in severe cases, to properly 
breathe deprives the lungs of their proper amount of oxygen, so that 
the little one suffers in nutrition and growth. 

Treatment consists in scraping away with a scoop, or even with 
the finger, these soft, granulating masses. The effect is almost mar- 
vellous : the child breathes quietly, without snoring, the color re- 
turns to the cheeks, and the blood receives a new supply of food from 
the full supply of oxygen. In modern times, nothing has been in- 
augurated in the treatment of children's throat and nose diseases so 
beneficial and happy. 

Clergymen's Sore Throat. — Follicular Pharyngitis. 

This disorder made its appearance in this country in 1830, and the 
attention of the profession was first drawn to it, as a distinct disease, 
in 1832. Some have supposed its origin to have had a hidden con- 
nection with the epidemic influenza which spread over the civilized 
world in 1830, and affected all classes of persons ; but this is only 
conjecture. In its early developments it attracted notice chiefly by 
its visitations upon the throats of the clergy. Hence its popular 
name of Clergymen s Sore Throat. It was soon found, however, to at- 
tack all classes of persons indiscriminately, whether engaged in any 
calling which required a public exercise of the voice or otherwise. It 
was noticed more by public speakers and singers, on account of the 
greater inconvenience it gave them. 

The disease consists in a chronic inflammation of the mucous fol- 



DI8EABBS OF THE THROAT. 



918 



tine iiilialii- 

igitis. 

tlio throat, 
tched open, 
part, which 
tion. This 
to descrilw; 
ed to what 



in often ex- 
a. This is 
occur like 
ni the uose 
iroduced at 
vses the nj)- 
iiched look, 
ire produc- 
to projiprly 
jen, so that 

even with 
ilmost mar- 
color re- 
food from 
been in- 
Idiseases so 



wngitis. 

iO, and the 
act disease., 
Idden con- 
civilized 
kis is only 
[chiefly by 
popular 
Iver, to at- 
\d in any 
prwise. It 
it of the 



Holes, or glands, connected with the mucous membrane which lines 
the throat and windpipe. The ottice of these little glands is to secrete 
ii fluid to lubricate the air pa.ssages. When inflamed, they spread an 
acrid, irritating Huid over surrounding part8, which excites inflamma- 
tion in them. Hence a geneml inflammation of the upper [)art of the 
throat or pharyngitis usually attends the follicular diseiwe, and I 
shall speak of the two together. This inflammation of the glands 
and the membrane, being neglected, iis it generally is, lingers on from 
month to month, or from year to year, making in some cases slow 
progress, in othera more rapid, — made a little worse and its step 
slightly quickened by every fresh cold, and finally results in ulcera- 
tion. The expectoration thenceforwanl becomes puriform, and finally 
undistinguishable from that of consumption, with all the symptoms 
of which the patient finally dies. Indeed, l)efore its nature was un- 
deiTntood by the profession, it wiw considered the most fatal form oi 
consumption, l)ecause it could Ikj affected only in a very small de- 
gree, if at all, by medicines taken into the general system. For the 
milder cases one will find great comfort in the use of the troches of 
cubebe and ammonia, the inhalation of benzoin with steaming water, 
also from such throat-tablets as the Chloramine. 



Inflammation of iVIucous Membrane and Qlands 
of Larynx. — '■ Follicular Laryngitis. 

A FEW strong and beautifully formed cartilages unite to form a 
curious and convenient box or cavity at the top of the windpipe, 
called the larynx. Across this enclosure are stretched two remark- 
able ligaments, called the vocal cords. They are from half to three 
quarters of an inch in length, and are rendered more or less tense by 
the small muscles with which they are connected. Just above these 
cords are two cavities, which, with the ligaments, act an important 
part in the formation of the voice. Here is produced the sound, 
which is modified and articulated by the tongue, the lips, and the 
r.i'^al cavities. 

When disease reaches this cavity, and the fluid secreted to lubri- 
cate ihese cords becomes acrid, the voice, from this and other causes, 
is made hoarse ; and when, at length, these ligaments are altered in 
structure by inflammation and ulceration, the voice suffers a gradual 
extinction. I haro treated a large number suffering entire loss of 
voice, and am happy to say it has been generally restored, where the 
lungs have not been involved in the disease, '^here is often also a 
little sensitiveness, or even soreness, in some cases, in the region of 
the larynx, which may be felt by pressing upon that prominence in 
front of the throat, called Adam's apple. 



icous fol- 



214 



DI8RA8R8 OF TIIK THROAT. 



t^ 



Inflammation in the Windpipe.— Tracheitis. 

This complaint and the one preceding it differ only in their local- 
ity from those deHcribed in the upper cavities ; and they are more 
alarming, IwcauHc two removes nearer the citadel of life. Happily, 
we know that the seat of these diseases may be easily reached, and 
we have a shower syringe, so arranged as to pour the remedial i.gent 
directly upon them, without any loceniting disturbance of the parts. 

Symptoms. — The approach of these disorder is often so insidious 
as hardly to attract notice, — sometimes for. months, or even yeans, 
giving no other evidence of their presence than the annoyance of 
something in the throat to be swallowed or hawked up, — an increased 
secretion of mucus, and a sense of wearisomeness and loss of power in 
the throat, after public speaking, singing, or reading aloud. At 
length, upon the taking of a severe cold, the prevalence of an epi- 
demic influenza, or of an unexplained tendency of disease to the air- 
passages and lungs, the throat of the patient suddenly becomes sore, 
its secretions are increased and rendered more viscid, the voice grows 
hoarse, the difficulty of speaking is aggravated, and what was only 
an annoyance becomes an affliction, and a source of alarm and dan- 
ger. These diseases clearly belong to the family of consumption, and 
need early attention. 

Causes. — It is amusing to reflect upon the theories which writers 
were in the habit of constructing, a few years since, to account for 
the throat affection among the clergy. It was attributed by some to 
speaking too often, by others to speaking too loud. One class of 
writers thought it arose from muffling the neck ; another, from a 
strain of voice on the Sabbath to which it wajs not accustomed on 
other days. 

The cause lies deeper than any of these trifling things. As it con- 
cerns ministers it may generally be expressed in two words, — labor, 
anxiety. 

The clerical order are placed just where they feel the force of the 
high-pressure movements of the age. They are the only class of 
recognized ingtructors of adult men, and are obliged to make great 
exertions to meet the wanta of their position. The extremely trying 
circumstances in which they are often placed, too, in these exciting 
times, by questions which arise and threaten to rupture and destroy 
their parishes, weigh heavily upon their spirits, and greatly depress 
the vital powers. And when we add to this the fickle state of the 
public mind, and often the shifting, fugitive character of a clergy- 
man's dwelling place, and the consequent liability to poverty and want 
to which himself and family are exposed, we have a list of depressing 
causes powerfully predisposing to any form of disease which may 
prevail. 



niSEASEB OF THE THROAT 



216 



heitis. 

their looal- 
y are more 
Happily, 
cached, and 
ledial i.gent 
f tlie parts. 

so insidiouH 
even years, 
noyance of 
bii increased 
of power ill 
vloud. At 
I of an epi- 
I to the air- 
comes sore, 
voice grows 
it was only 
n and dan- 
[uption, and 

lich writers 
iccount for 
by some to 

e class of 
ler, from a 

tomed on 

I As it con- 
3, — labor, 

|rce of the 
class of 
[ake great 
|ely trying 
exciting 
Id destroy 
ly depress 
Ite of the 
la clergy- 
land want 
Bpressing 
lich may 



It will Im) pardoned me, I think, if I Kuggest here, that tho nature 
of a clergyman's calling is of so serioiiH a eh. \ctor, that ho some- 
times (;arri(!H himself with too much Hcdateness, keeps himself too 
much braced up, and does not allow himself hours enough of that 
cheerful, light-hearted abandon, which is essential to the health of 
every sedentary man of mental habits. The hard-thinking and hard- 
working minister, who will retain his health and save his throat, must 
have some moments, at UniHt, when the weighty responsibilities of his 
oJfice are lifted up from his soul, and he becomes, for the hour, the 
jocund, playful boy of earlier days. How far he can consistently re- 
lax and let himself down, or in my view of the matter, raise himself 
up to the simplicity and mirth of childhood, he alone can be the judge. 
As a physician, I prescribe ; as a minister, he must decide how far 
my prescription can be followed. 

Reading Sermons. — There is one practice, which, though it has 
not much to do with inducing this disease, does frequently aggravate 
it when once established ; I mean the habit of reading sermons from 
manuscripts, — especially when it is done in a sort of mechanical 
way. Every person who has suffered from throat-ail has doubtless 
noticed that to read aloud, for half an hour, from a book, occasions 
more fatigue and irritation in the throat than extemporaneous speak- 
ing, in the same tones, for one or two hours. The reason is, that in 
the latter case the mind conceives the thought in season for the or- 
gans of speech to fall into a natural attitude, and utter it with ease. 
The two work hannoniously together, — the instruments of articula- 
tion following the mind, and easily and naturally uttering its concepn 
tions. Whereas in the case of reading, the mind itself is, at least 
partially, ignorant of what is coming until it is just upon it, so that 
the organs of speech, being warned of what is to be done only at the 
moment their service is required, do their work under a perpetual 
surprise and constraint. The difference is, in some respects, like that 
between walking freely at large, without regard to where the feet are 
put down, and being obliged to step exactly in the footprints of some 
traveller who has gone before. In the latter case, the muscles tire 
much sooner, because they work in fetters. 

I have thus spoken particularly of the clergy, though it is not by 
any means they only, but all classes Oi people who are afflicted with 
tliis dangerous malady. 

These diseases often begin with a cold. But colds are seldom taken 
except when the nervris system is depressed, so that they are, in fact, 
to be traced back to the same cause which I have assigned to catar- 
rhal or throat complaints themselves. 

These Complaints Worse at Night. — It is worthy of note, that all 
these complaints, and many others, are worse during the night. This 
is easily explained when we remember that the atmosphere has the 
least amount of electricity in it at three o'clock in the morning, and 
that the first minimum atmospheric pressure, which happens twice a 



I 



216 



DISEA8K8 OF THE THROAT. 



day, occurs not far from the same hour. From three to four in. thr 
mom'.ng, therefore, the nerve-power sinks to its lowest ebb; and those 
diseases which owe their existence to anxiety, overwork, etc., suffer, 
at this time, their greatest daily aggravation. Death occura, too, more 
often during these hours, than in any other poi-tion of the twenty- 
four. 

Treatment. — Some years ago these diseases were thought to be 
incurable ; and by all the appliances of medical art then known, they 
were so. But time has brought a successful method of treatment, as 
well as a clearer knowledge of their nature. 

This treatment consists in what is called topical medication, or the 
applying of the medicine directly to the diseased part. The medici- 
nal agent more extensively used than any other is a solution of crys- 
tals of nitrate of silver. This substance is not, however, adapted to 
every case, — other articles succeeding better in some instances. Mod- 
ern chemistry has given us a variety of agents from which the skilful 
physician may select a substitute, should the nitrate of silver fail. 

The operation of appljdng this and other substances to the air pas- 
sages, is a delicate one, requiring tact and experience. Surgeons had 
supposed it an anatomical impossibility to introduce an instrument 
into the larynx ; but this has been practically demonstrated to be a 
great mistake. 

Instruments. — The instrument devised and used by Dr. Horace 
Green is a piece of whalebone, bent at one end, to which is attached 
a small, round piece of sponge. This, dipped in the solution, is dex- 
terously introduced into the laryngeal cavity, and applied directly to 
the diseased part. 

I formerly used this instrument myseK, and am happy to know, 
that, notwithstanding its defects, it was generally successful. Yet 
where the larynx was highly inflamed, with a swollen and ulcerated 
condition o*. the epiglottis and lips of the glottis, I am sure I some- 
times had the singular powers of the nitrate of silver put at defiance 
by an irritation evidently produced by the eponge of the probang. 
Upon its introduction, in such cases, the parts contract upon and 
cling to it, and suffer aggravated irritation, almost laceration, upon 
its withdrawal, however carefully effected. 

Laryngeal Shower Syringe. — Such defects in the probang led me 
to contrive an instrument, which I call a Laryngeal Shower Syringe. 
It is in the form of a syringe, the barrel and piston of which are 
made of glass, silver, or gold, as may be desired. To this is attached 
a small tube, made of silver or gold, long enough to reach and enter 
the throat, and bent like a prolong, with a globe or bulb at the end, 
from a quarter to a third of an inch in diameter, pierced with very 
minute holes, which cover a zone around the centre about one-third 
of an inch in breadth. 

This silver bulb I daily introduce into highly inflamed and ulcer- 



DISEASES OF THB THROAT. 



217 



' four ill til,' 
<; and thoso 
, etc., suffer, 
irs, too, more 
the twenty- 
ought to be 
known, they 
treatment, as 

jation, or the 
The medici- 
ition of crys- 
r, adapted to 
ances. Mod- 
h the skilful 
ilver fail. 
) the air pas- 
Surgeons had 
1 instrument 
ited to be a 

r Dr. Horace 
ii is attached 
ition, is dex- 
d directly to 

)y to know, 
jssful. Yet 
id ulcerated 
lure I some- 

at defiance 
le probang. 
It upon and 

ition, upon 

ing led me 
\er Syringe. 

which are 
lis attached 

and enter 
}.t the end, 

with very 

one-third 

land ulcer- 



ated larynges, generally without any knowledge of its presence on 
the part of the patient, until the contained solution is discharged. 
The instrument, being charged, is carried to the proper place, when a 
delicately quick pressure upon the piston causes veiy fine streams to 
flow through the holes in the form of a delicate shower, and all sides 
of the walls of the larynx are instantaneously bathed. 

How Introduced. — The introduction of this instrument into the 
larynx is easy. Upon the approach of any foreign substance, the epi- 
glottis instinctively drops down upon the entrance to the larynx, 
guarding it against improper intrusions. It has been found, however, 
that when the root of the tongue is firmly depressed, this cartilage 
cannot obey its instinct, but stands erect, its upper edge generally ris- 
ing into view. Availing himself of this, the surgeon has only to de- 
press the tongue with a spatula, bent at right angles, so that the left 
hand holding it may drop below the chin out of the way, and as the 
epiglottis rises to view, slip the ball of the instrument over its upper 
edge, and then with a quick yet gentle motion, carry it dovmward and 
forward, and the entrance is made. I have often admired the faith- 
fulness of this epiglottic sentinel, who, when overborne by superior 
force, stands bolt upright, and compels us to enter the Sacred temple of 
speech directly over his head ! 

Pharyngeal Shower Syringe. — For washing the upper part of the 
throat, I construct the instrument with a straight tube, with holes 
over the outer end of the globe, and extending to the centre. This 
washes instantaneously the fauces and pharynx, but does not throw 
the solution back upon the tongue. Its main advantage over the 
probang is, that it Imthes every part of the fauces and pharynx in- 
stantaneously, and does not subject the patient to the coughing and 
gagging which follow the slower and rougher process of drawing the 
sponge from side to side across the cavity of the throat. 

Nasal 5hower Syringe. — Inflammations in the back passages to 
the nose, called catarrh in the head, have been almost inaccessible by 
any reliable healing agent, and consequently incurable. The probang 
could only reach a short distance, and occasioned great suffering. I 
have had a syringe constructed with the tube bent at an angle of 
forty-five degrees, and the ^lobe, very small, pierced with a few fine 
holes at the upper end. Carrjang this globe up behind the velum 
palati, with a single injection I wash both passages clear throu gh. I 
have had the pleasure of curing a large number of bad cases, of many 
years' standing, to the surprise and delight of the patients. 

About nineteen-twentieths of the physicians who have examined 
these instruments, and so far as my knowledge extends, all who have 
used them, think them much better than the probang. As to patients, 
I have yet to see one who will allow the sponge to be used after try- 
ing both. 

Have Superseded the Probang. — In my own practice the syringes 



■onti 



mmmm 



218 



DISEASES OF THE THROAT. 




have superseded the probang altogether. My reasons may be briefly 
stated. I have already said there is less irritation produced. A piece 
of sponge drawn over an inflamed surface, especially when clung to 
by the irritated and quivering paits, mast necessarily, in some cases 
at least, aggravate the symptoms of disease. To tliis consideration 
add the comfort of the patient during the operation. It is so quickly 
and delicately done with the syringe, that it is scarcely known when 
tiie act is performed. The straight syringe does not touch the throat 
at all. On touching the probang to the throat, the nitrate of silver 
unites with the mucus upon the surface, instantly covering the sponge 
with an albuminous pellicle, something like that which lines the shell 
of an Q^g, preventing, in a degree, the further pressing out of the 
solution, and rendering its contacts with other parts of the surface 
comparatively powerless. For this reason, the sponge pushed down 
into an ulcerated bronchus, as Dr. Green recommended, must be ut- 
terly valueless as a remedial agent. Mopping, as it does in its whole 
course, a larynx and trachea, lined in some cases with puriform niat> 
ter, and generally with mucus, every inch of its descent doubles the 
gravity of this objection. Let it be considered, too, that in applying 
the remedy to an ulcerated larj'nx, the sponge cauterizes the healthy 
parts above, in its descent, and thus unfits itself lor doing much for 
the diseased part ; whereas the syringe retains its solution till it 
reaches the affected place, and then pours a clean shower directly 
upon it, and upon no other part. 

Considering these manifest advantages of the syringes, I am sur- 
prised that any physician should still use the probang, — especially as 
one of these instruments, the Nasal Syringe, accomplishes an object 
which the probang cannot effect at all, not even in a rough way. I 
have wondered, too, how any parent can allow a child, suffering with 
croup, to be tormented by having a sponge pushed down its throat, 
when a syringe would give it so much less pain. 

I will mention briefly one or two cases of croup and diphtheria, se- 
lected from a great number treated by me for the last few years, where 
the syringes were successfully used, after several attempts to use the 
probang had been made, and failed, and where the pain caused by 
using was so small, and the relief so instantaneous and complete, that 
the patients were anxious for my return to use it again. 

I was called to see a little boy of Mr. R., five years old, who had 
had an attack of membranous croup some days previous ; and when 
I saw him the voice had sunk to a whisper, and the cough was en- 
tirely muffled, so that I had no doubt of the fatal termination of the 
case, and expressed my opinion to that effect to the astonished parents. 
The probang had been used by the physician in attendance, which 
had caused so much suffering that for the two days previous the par- 
ents had prohibited its use. It had no doubt increased the irritation, 
besides nearly causing strangulation. 

It was, therefore, with great reluctance that they consented to let 



DISEASES OP THE THROAT. 



219 



I to let 



me use the syringe, which I did, to the great relief of the little suf- 
ferer, and to the entire satisfaction of the parents. 

The strength of the solution of the crjrstals of the nitrate of silver 
used was 20 grains to the ounce of water, which I injected freely, 
once in three hours for the first day, and then two or thi-ee times a 
day for two or three days. His recovery was rapid and complete. 

I will now mention the case of a young woman, with diphtheria, 
where the syringe was used with success. 

I was called to see a young lady, who had an attack of diphtheria 
the day previous. Found her in bed, very much prostrated, breath- 
ing with great difficulty, and uttering at every inspiration a croupal 
sound, which at times was followed by a short, convulsive cough. 
The face was flushed, pulse 124, small and feeble, and she complained 
constantly of a sense of suffocation and of great distress in the lar- 
yngeal region. 

On inspecting the throat, the fauces and the pharyngeal mem- 
brane, as far down as it could be seen, presented the appearance of a 
high degree of inflammation. One of the tonsils was nearly covered 
with the diphtheric membrane, and the upper and back part of the 
throat were thickly studded with small white or cream-colored spots. 

The physician in attendance had tried first a swab, or mop, as she 
termed it, and then the probang, which gave her so much pain that 
he was obliged to give it up. He then gave up the case as hopeless. 
At my earnest solicitation she consented to the use of the syringe. 
With a solution of the crystals of the nitrate of silver, of the strength 
of 60 grains to the ounce of water, I injected freely the fauces and 
the upper part of the cavity of the larynx. For a few moments the 
difficulty of breathing and feeling of strangulation was increased, 
but very soon a large amount of viscid, ropy mucus was discharged. 
In the course of half an hour after the use of the syringe, the symp- 
toms had improved, the respira- 
tion was less laborious, so that 
in a short time the patient ob- 
tained some sleep. I was after- 
ward called, aa she thought her- 
self worse, but found that an 
application of the caustic with a syringe was all that was required. 
There was no further trouble with the case. 

These syringpo or similar ones can now be bought of any large 
dealer in surgic-.i i.istruments. Figure 87 represents the syringes as 
they lie in a case. 

Mode of Using. — The glass barrel and piston of my instruments 
are delicate, but they ueed not be broken. I handle them with the 
same east, that I do a spoon in feeding myself, and not in a very dis- 
similar wfvy. The Ir^st three fingers are placed on the under side of 
tlie barrel, with the thumb on the upper side, — the index finger be- 
ing poised over the end of the piston, ready to drive it home at the 




rio. 87. 




. rrM«iiaHCKMMP« 



220 



DISEASES OF THE THROAT. 



V \ 



proper instant. The motion of the piston should be quick, so as to 
cause the streams to leap out in jets ; yet delicate, that they may not 
impinge with too much force upon the diseased surfaces. 

They should be rinsed with water immediately after being used. 
But even with this precaution, a small residuum of the nitrate re- 
mains and crystallizes, and after a time partially closes the holes. 
They must then be picked out with the point of a needle. 

When the silver tube becomes detsvched from the glass, it may be 
fastened on with common sealing wax ; first melting the wax and 
sticking it around the glass; then heatirg the silver over a lamp, and 
pressing it on. 

Amount of Solution to be Used. — The amount of solution to be 
used should be small. Half a dram is enough. The piston of the 
syringe need be drawn up only from an eighth to a third of an 
inch. Strangling is not often produced by these operations ; but to 
make its prevention still more sure, let the patient be directed to fill 
the lungs with a long inspiration while the operator is depressing the 
tongue. 

Strength of Solution. — The strength of the solution in ordinary 
cases of chronic folliculitis, etc., should generally be about forty 
grains of the crystals of the nitrate of silver to the ounce of water. 
But in all acute diseases of the air passages, it should be considerably 
stronger, — varying from one to two drams. A preparation of this 
strength is powerfully antiphlogistic and sedative. In those cases of 
chronic disease, where the inflammation is of a low grade, and the 
mucous membrane is in a relaxed, atonic condition, looking either 
sodden and pale, or of a dark color, like the cut surface of beef some 
days exposed to the air (as is often the case in throats of literary dys- 
peptics), then a solution of fifteen to thirty grains to the ounce is 
sufficient. This strength acts as a stimulant, and is well suited to 
throats in such condition, but would be injurious in high grades of 
inflammation. Catarrh in the head generally requires only about this 
strength. I am sorry to say, the topical mode of treating throat affec- 
tions has been in some places injured, in the public estimation, by a 
lack of knowledge and judgment on the part of the operator, in 
choosing the strength of his solution. 

To determine the proper frequency of the operation, also requires 
judgment and experience. In an ordinary case of chronic disease, 
the treatment may begin by showering the throat once a day for a 
week. Then the operation should be repeated three times a week, for 
a shorter or longer period ; then twice a week, and at last once a week. 

Attendant Diseases. — Among the persons I am treating for dis- 
eases of the air passages, many are dyspeptic and suffer with depres- 
sion of spirits. So often doea this symptom present itself that I re- 
gard it as almost one of the peculiarities of throat disease. Persons 
thus depressed generally have the dark and dingy look of the face 
which indicates functional derangement of the liver. They are often 



DISEASES OF THE THROAT. 



221 



emaciated, nervous, hypochondriacal, irritable in temper, and are ex- 
hausted by an excessive secretion of urea. The urine of such per- 
sons is always acid, and loaded with crystals of oxalate of lime. 

An explanation of this fact has been attempted, by supposing that 
the oxydation of carbon (of which these persons have a superabun- 
dance), imperfectly accomplished in inflamed respiratory organs, is 
vicariously effected in the capillaries of the kidneys, — oxalic acid 
(C2O2) instead of carbonic acid (COj) being the result. 

The crystals of oxalate of lime are octahedral in form, .d, in the 
field of a good microscope, are beautiful objects for inspection. 

Lawyera, clerygmen, statesmen, and, in general, those who labor 
hard mentally, with but little bodily exercise, and who have a great 
weight of care resting on them, are the persons who suffer most from 
this complication. Generally the inflammation in the throat is of a 
low grade, and must not be treated with a very strong solution of ni- 
trate of silver. 

Of course when these attendant diseases exist, something more is 
needed than the local treatment. For the troubles just described, the 
treatment for hypochondria and dyspepsia will be proper. 

Elongation of the Uvula. 

The uvula is the small teat-like or 
pendulous orptn which hangs down 
from the palatine arch, just over the 
root of the tongue. It is very apt to 
get inflamed, and its parts becoming re- 
laxed, it stretches out lengthwise, so 
that its lower extremity sometimes rests 
upon the tongue. (Fig. 88.) When 
this happens, it flaps about, backward 
and forward, and to the right and left, 
— touching the throat at various points, 
and by the tickling sensation produced, 
exciting a most incessant, uncontroll- 
able, and racking cough. Some of the 
most distressing coughs I have ever 
heard have been produced and kept up 
by this cause alone. Many a fatal con- 
sumption has begun in this way. When 
long inflamed, it often gets much out 
of shape, being sometimes bent nearly 
double. 

Treatment. — In some cases, the 
uvula, thus elongated, may be reduced 
back to its natural size, by an astrin- 
gent gargle, composed of an infusion of 
white-oak bark, with a little alum dis- 




FlO. 88. 



-JP 



222 



DISEASES OF THE THROAT. 



solved in it (282) ; but it will generally stretch out again and again, 
upon the appearance of any fresh cold, and, therefore, the only certain 
cure is to cut it off. 

To do this, take hold of it with a pair of common forceps, and 
having stretched it down a little, clip it off above the forceps, with a 
pair of curved scissors. Nearly the whole of it should generally be 
removed. To take off a part only leaves a stump, which is often 
more objectionable than the whole organ. Its removal never injures 
the speech in the least. In many cases of nasal catarrh, this organ 
is a sort of diseased centre, from which inflammatory action spreads 
upward into the nasal cavities, and no medicine or power on earth 
can effect a cure until this offending member is snipped off. 

Acute Inflammation of the Tonsils. — Tonsilitis. 

The tonsils are chiefly a collection or mass of small mucous folli- 
cles or glands. They secrete a portion of the fluid which keeps the 
throat moist. 

There is a class of persons who suffer about every winter, some- 
times oftener, with an attack of acute inflammation of these glands, 
which causes gioat suffering for several days. The trouble usually 
is ushered in by high fever, backache, headache and often by chills ; 
the temperature often reaches to 103° and 104° F. ; swallowing is 
difficult on account of the swollen glands, while pain in the ear is 
not infrequent. The tonsils are at first swollen, reddened and in- 
flamed ; later a whitish patch of secretion forms on the surface of 
the gland and is distinguished from that of diphtheria by being 
whiter and less tenacious; if removed, the underlying surf ao 3 does 
not bleed as in the case of diphtheria. It is, however, very difficult, 
at times, to distinguish between the two diseases at first. 

Another form of Tonsilitis occurs without patches, and is in 
reality an inflammation of the substance of the gland itself. This 
variety, often called Quinsy, goes on developing into an abscess, the 
anterior pillar of the fauces becomes intensely red, swollen and 
shiny. 

Treatment. — For the more common variety some antipyretic to 
reduce the fever and allay the intense aching of the head and bones 
is properly indicated. For this purpose 10 grains of Phenacetine 
(for an adult), repeated every two to four hours according to the 
effect produced, is quite efiicacious. Ammonol in same dose may 
also be used. Some simple astringent and soothing gargle will next 
be found to render signal relief. Tannin, 30 gr., strong Carbolic 
Acid (96%), 30 drops, Glycerin, 1 oz., and peppermint water, 3 oz., is 
an admirable gargle for the average case : this should be used hourly. 

Equal parts of Glycerin, Alcohol and Water makes a very sooth- 
ing gargle, while equal parts of Peroxide of Hydrogen and Water is 
preferred by many. The diet should be limited in amount and con- 
sist only of liquids. 



' rK'l 



DISEASES OF THE THROAT. 



223 



md again, 
ly certain 

:ceps, and 
ps, with a 
lie rally be 
1 is often 
er injures 
ihis organ 
»n spreads 
on eartii 



.silitis. 

C0U8 foUi- 
keeps the 

ter, some- 
se glands, 
le usually 

by chills; 
lowing is 
the ear is 
id and in- 
surface of 

by being 
rfao3 does 
r difficult, 

and is in 
If. This 
scess, the 
)llen and 



)yretic to 

md bones 

lenacetine 

ig to the 

lose may 

Iwill next 

Carbolic 

3 oz., is 

hourly. 

by sooth- 

I Water is 

and con- 



The second variety, tending to pus formation, is to be treated sur- 
gically by first applying a solution of cocaine and lancing. The 
relief resulting from evacuating the pus is immediate. 

It has been found that Tonsilitis is apt to be recurrent and that 
he who has suffered once is very prone to have one or more attacks 
annually thereafter. This class requires constitutional treatment in 
the intervals as outlined below. 

These inflammations are likewise found to be an expression often- 
times of rheumatism, and need corresponding treatment. But the 
only cure is to be found by cutting off the tonsils, after the inflam- 
mation has subsided. This will put an end to the attacks at once. 

Tonsils which are subject to these periodical attacks of acute in- 
flammation are always more difficult than others to operate ujion, as 
they are almost invariably bound down very tight to the throat, and 
cannot be raised up for convenient excision. 

Chronic Inflammation of the Tonsils. 

In many of the follicular diseases of the throat, these glands are 
affected by a chronic inflammation, and are found enlarged, and 
sometimes very much hardened. In such cases they secrete a thin, 
unhealthy, irritating fluid, which is spread over the throat, increasing 
and perpetuating its disease. Much of this secretion finds its way 
into the stomach, and thence into the circulation. 

In the throats of many young persons and children, these glands 
are permanently so large as nearly to fill the fauces. The respiration 
of many children thus afflicted is difficult, and when asleep they can 
only breathe with the mouth open. The defective breathing of such 
children often occasions contractions of the chest, and thus lays the 
foundation for consumption. From these diseased parts, the inflam- 
mation often spreads upwards, into the posterior nares, and many 
times entei-s the eustachain tubes, causing deafness or pain in the ears. 
Such children often breathe as though they had a bad cold in the 
head. Their health and safety require an immediate attention to 
this state of things. 

Chronic inflammation of the tonsil, likewise the recui-rent acute 
form, may be dependent on poor blood or rheumatism. Those causes 
are met by blood-building medicines like Syrup of the Iodide of Iron 
in 10-drop doses three times daily, cod liver oil, and by some one of 
the many preparations of iron, arsenic, and strychnia combinations. 
It is found that genemlly the excision of the tonsil may be averted 
by visiting the surgeon, who will hunt out the little crypts or holes 
with which the gland is studded, and by gently cutting the narrow 
bridges which separate these holes, destroy these cavities. These 
little holes retain small particles of food and decomposed secretion, 
which after a while, if allowed to remain, set up a follicular tonsil- 
itis. The size of the gland is thus greatly diminished and the little 



■ 



224 



ItlSKASES OK THK THROAT. 



secreting follicle destroyed. Many a little Hufferer can thus bo spartMl 
the harsher method of excision, and bear with good grace, especially 
if cocaine be used, what otherwise might be a painfiil and bloody 
operation. But, as has been said, excision in many cases must be 
resorted to. 

Curability of Throat Diseases. — I have dwelt somewluit upon 
the preceding fonns of tliroat disease, because they prevail to a fear- 
ful extent, and are, in thousands of cases, but the first staj^es of fatal 
disease of the lungs. 

If not counectetl with lung disease in the heyinning, my experience 
in treating them enables me to say, emphatically, they are generally 
curable. 

But patients often put the question to me — " If cured, will I ever 
have the complaint again ? " My answer is — " Unless I can plant 
in your constitution a better protection than your Maker put there at 
your creation, you will of coui-se be liable to a second attack." But 
then, where the lungs have been entirely free from disease, I have 
never yet seen a case of 8inii)le throat complaint relapse and become 
dangerous after proper treatment with the syringes. Let not those, 
therefore, who have been benefited, but not entirely cured by this 
treatment, undervalue what hius been done for them. Even in such 
cases, the advantage derived to them amounts to just the value they 
attach to the continuance of life. 

Danglers of Delay. — In closing these remarks, let me warn the 
reader against the dangers of delay. Many of those who finally seek 
medical attendance in these complaints, fiist try all nostrums, and 
tamper with their disease till the case is either critical or hopeless. 
Too many wait till they are near enough to the engulfing whirlpool 
to hear it roar, before they seek in any practicable way to escape its 
dangers. 

Many persons neglect a slight inflammation of the pharynx, which 
might have been cured in a few days, but which, from long neglect, 
has gradually crept down the windpipe, spread over the widely dis- 
tributed mucous lining of the bronchial tubes, and thus become cur- 
able only in a partial degree, and after long and tedious treatment. 
Hundreds of persons are now suffering from slight attacks of this 
sort, who might be rid of the affliction in a week or a fortnight, but 
who will either carelessly give it no attention at all, or resort to use- 
less nostrums, until it has run through its primary stages and invaded 
the constitution, and will finally die of some of the forms of pulmo- 
nary disease. 

A Cold. — Influenza. 

A SLIGHT attack of the disease about to be described, affecting only 
here and there -a person, and lasting only for a few days, is called a 
cold. When it affects a large part of the community at the same 



DI8EASK8 OF THE THROAT. 



225 



be spaiiMl 
sspecially 
id bloody 
I must be 

bat upon 

to a feai- 

38 of fatal 

xperienco 
generally 

«rill I ever 
can plant 
it tbere at 
3k." But 
se, I have 
1(1 become 
not those, 
3(1 by this 
Bn in such 
/alue they 

warn the 
nally seek 
■rums, and 

hopeless. 

whirlpool 

escape its 

nx, which 
neglect, 
i^idely dis- 
come cur- 
;reatment. 
of this 
ight, but 
irt to use- 
invaded 
if pulmo- 



[jting only 

called (t 

I the same 



time, lasting many days, or even weeks, it is then an epidemic, and 
passes under the name of infliiema. In tliis latter form, it sometimes 
spreads over a whole country, and has at times, as in 1882 and 1894, 
extended to nearly the whole civilized world. It often shows marked 
severity in its progress, and leaves serious results behind. 

Symptoms. — A tingling, with drjiiess, and a sense of fulness in 
tiie mucous membrane of the nose, are among the first indications of 
an attack of this complaint. Sneezing is a common symptom. Soon 
pain is felt in the forehead, and breatliing through the nose becomes 
difficult. The eyes are red and watery, the throat is sore ; there is a 
dry cough, hoarseness, thirst, general lassitude, chills, and a desire 
to get near the fire. The mucous membrane of the nose^ throat, 
windpipe, and breathing-tubes is inflamed, red, swollen, and some- 
times painful. 

In a short time, water begins to run from the nose and eyes, and 
the cough becomes a little more moist. There is also a slight dis- 
charge from the throat and tubes, which gradually increases, and, at 
length, as the disease declines, and becomes less acute, the expectora- 
tion is thick and yellow. 

Aching of the back and limbs, thirst, loss of appetite, flashes of 
heat, and chills whenever the patient is exposed to air a little cooler 
than he is accustomed to, are almost constant attendants upon the 
disease. 

Causes. — It is r ot always easy to say what tho causes of this com- 
plaint are. Frequently, it can be traced to an improper exposure to 
cold or dampness ; but in a great majority of cases, especially when 
it takes the form of influenza, the causes are not obvious. They 
probably exist in some peculiar states of the atmosphere, and in a 
depression of the nervous system. 

The influence upon disease of the different degrees of density in 
the air which surrounds us, and of other circumstances affecting it, 
have not been much studied. Some valuable facts will be drawn 
from this source before many years. The putting upon the body, or 
taking from it, several tons of pressuie every time the barometer rises 
or falls, must have, of itself, no small influence upon its health. The 
comparatively new science of Phjrsical Geography, by spreading be- 
fore us its interesting facts in regard to temperature, storms, atmos- 
pheric currents, etc., is opeiijiig the way for the physician to learn a 
great deal more about the cftuses of disease than he now knows. 

Treatment. — In mild cases, only the most simple treatment is re- 
quired, — such as remaining in the house for a few days, soaking the 
feet in warm water, taking a gentle sweat, drinking warm infusions 
of flax-seed, mullein, slippery elm, or warm lemonade, and taking 
only a spare vegetable diet. If the bowels be costive, some gentle 
phjrsic (84), (41) may be used. A laxative drink (132) will like- 
wise be useful. 






226 



DISEASES OP THE BRAIN AND NERVES. 



At the outset, eapecially when the nose nins water, a small rloRp of 
atropia, jj^ grain, taken every two honrs till the throat is dry, will 
entirely arrest the disease at this point. The coryza pill found at 
the druggists' is a more valuable remedy still. 

When the attack is more severe, sweating must he induced by de- 
cisive meaMures. This may Ikj affected by the spirit vapor-bath, or 
by putting the patient in bed, j)utting l)ottles of hot water to the feet 
and sides, and administering warm drinks, and the compound tinc- 
ture of Virginia snakeroot. Five drops every hour of the tincture 
of veratrum viride will often cause very free perspiration, and will 
reduce the inflammatioji upon the mucous surface. 

An emetic is sometimes very useful. To produce vomiting, use 
the powder of ipecac, ten to twenty grains, or the compound tincture 
of lolwlia. 

It soothes the inflamed mucous surfaces very much to inhale the 
vapor from half a j)int of hot water, with five drops of tincture of 
veratrum viride, or the same amount of the tincture of aconite root. 

If the cough is severe, use the preparations recommended under 
bronchitis and consumption. 

In the latter stages of the diseiuse, if there be debility, — as there 
generally is, — quinia, iron, nux vomica, etc. (75), should be taken ; 
or, to su[)port the nervous system, the extracts of scullcap, and bone- 
set, and the sulphate of quinia (81) will be found useful. At this 
stage of the complaint, the diet should be more liberal and nourishing. 

The patient should not venture into the open air until the unpleas- 
ant sense of chilliness, peculiar to the disease, ceases to be produced 
by exposure. 

La Grippe. 

This is a variety of influenza with which the world has l>ecome 
well acquainted within the last few years. Its history is interesting 
and its symptoms and results are sevei'e and annoying. It is one of 
the most severe forms of catarrhal disease of the nose or throat with 
which we are acquainted. It owes its origin to a germ which found 
its birth in the filth and pollution of eastern Europe, and has visited 
the globe with terrible ravages on several occasions since the Middle 
Ages. It spreads by travelling the most frequented paths of com- 
merce, and attacks those in a depressed state of health. The varieties 
of la grippe are as numerous as that of any other disease. The catar- 
rhal form is much like that of ordinary head influenza, only it is more 
severe and prostrating ; the bronchial assumes the influenza type, at 
first, but soon attacks the lungs and sets up a severe, prolonged and 
harassing bronchitis ; the intestinal variety, besides producing the 
general symptoms of malaise, fever, cough, severe aches and pains, 
gives rise to a diarrhoea which lasts many days and is very debilita- 
ting; the most common variety, however, is the rheumatic, which is 
ushered in by chills, fever, muscular pains, coryza, cough and general 



imiiU doRft of 

iH dry, will 

ill found at 

luced by dt;- 
ipor-buth, or 
r to the feet 
1 pound tinc- 
the tincture 
on, and will 

omiting, use 
ind tincture 

o inhale the 

tincture of 

iconite root. 

nded under 

— as there 
i be taken ; 
p, and bone- 
il. At this 
nourishing. 
;he unpleas- 
•e produced 



hfis l)econie 

interesting 
It is one of 
throat with 
^hicli found 

has visited 
the Middle 
ihs of com- 
he varieties 

The catar- 
y it is more 
iza type, at 
longed and 
ducing the 

and pains, 
ry debilita- 
te, which is 
ind general 



DISEASES OF TIIE THROAT. 



227 



rheuraat c pains. The chamcteristic feature of all of these forms is 
the great prostration which accompanies these symptoms and thTolv 
stim«)y with which it clings to the patient. 

The sequelae of the dise.wc, though much exaggerated, are numer- 
ous^ The aged are often left infirm with heart wtakness the Zng 
^mglL """" '" ^'««'^««''*'^d the middle-aged with cLS 

Many an undiscovered disease has passed unnoticed under the dis- 
ZZl: " ^"^^''-^ ^^ ^f. "-l"»l't served as a bn«.d mantl ". 
cover our ignorance of real disease and been made an easy refuge for 

a dZ;;r'"^V'*'y ^"^ "'^r'^ ^' «„!«« cannot be uveLstlmated 
and death has not infrequently resulted. 

Treatment— Tlie onset is to be met with large doses of quinine 
say 10 grains on retiring, by phenacetine and stlol, 10 grains each 
t..ken with some hot lemonade on retiring. Tliis lattef may tere 
peate eveiy three hours. The coryza is checked by small repe^tid 

blets bought at the druggist's - one taken every two houi-s till the 
^ZX/Sn^"" '^^^ ^ ^^^ '^ ''^^' ^--^ T^« ^«^ility is t: 

Acute Inflammation of the Epiglottis. 

This is the disease by which our country lost its most loved and 
uncSrr^. TT' ^n^' Washingtoi/ This complaint was not 
undei^tood at the time of his death, - the intelligent physicians who 
attended him supposing it to be inflammation of the windpipe. Fmm 
their very clear description of the symptoms, we now know it to have 
been an acute inflammation of the epiglottis and glottis. 

^rom the rapid inflammation of the epiglottis, water is effused into 
h hp'n '^f'' '" iT *" P"^ 1"P' "'^'^ P^^^^'^* it fr«°^ shutting down 

wi&'''*""-*"^i'^ ^'^^^^ ^^^^"« ^i*^^ ^ severe chill, accompanied 
with some pain, and a sense of stricture or tightness in the upper and 
m nfS sw.n *.h^-t. The,e is eough, witS difficult and som ime 
painful swallowing These symptoms are soon followed by quick 
andsoorr' b^^^t^^g-. Speaking aloud is from the first ifficult, 
thp W i^ "'' impossible. As the complaint runs it« rapid course 

^te^Trlng^^^^^^^^^^ "^°^^ '^«^^"^^' ^"^ '^^^ -- --^^s^f- -ml 

nitm W fn vl" ^'?'& 7"^.«^iately to the parts a strong solution of 

to on^ I i l ?' '''^''*'°^ «^«"^^ b« of *he strength of ninety 
to one hundred and twenty grains to the ounce of soft water. It 



228 



UmEAUKH OF THE THKOAX. 



Hhould be applied oveiy hour or two till the feeling of suffocation 
subsides, and should be done with the laryngeal shower syringe, 
though if this is not at hand the sponge probang may be used. 

While this local treatment is being employed, libeml doses, from 
five to twenty drops, of tincture of veratrum viride should be given 
every hour, watching the effect, and discontinuing when the pulse 
sinks too low. 

Hot fomentations applied externally, and filling the room with 
steam, m recummeiidud in cases of croup, would bu usef 

Mu m ps. — Parotitis. 

This disease appeal's ruost often among cliildren ; but as it is not 
confined to them, I have not placed it among their complaints. 

Symptoms. — It begins with soreness and stiffness in the side of 
the neck. Soon a swelling of the parotid gland takes place, which is 
painful, and continues to increase for four or five days, sometimes 
becoming very large, and making it difficult to swallow, or open the 
mouth to receive food. After the fouith or fifth day the swelling 
subsides, and disappears in from seven to ten days. 

Both glands generally swell about the same time, but sometimes 
the swelling appeara in one only after it has subsided in the other, 
and occasionally the swelling is wholly confined to one side. 

When the swelling is great, there is heat, and sometimes fever, 
with diy skin, quick pulse, fuired tongue, constipated bowels, and 
scanty and high-colored urine. 

The affection is sometimes translated, as we say ; that is, in females, 
the breast swells, and in males, the testicles become swollen and pain- 
ful. This accident generally happens in consequence of taking cold 
from some imprudence. 

The disease is contagiuus ; that is, it is communicated from one 
person to another. 

Treatment. — In mild cases, very little treatment is required. 
Keeping the face and neck warm, avoiding exposure to cold and 
damp, drinking warm infusions of balm, spearmint, or sage, and ap- 
ply a poultice of flax-seed over the glands until the patient is fully 
relieved ; or the compound powder of jalap, if there be costiveness, 
is about all that is required. The diet should consist of rye hasty 
pudding, or brown bread and sweetened water. 

If the case be severe, and other glands swell, physic must be freely 
used, leeches must be applied, and cooling lotions, or poultices. 
Sweating must also be induced by the compound tincture ol Vir- 
ginia snakeroot, or by a vapor bath. 

In young girls mumps often attack the ovaries and make the in- 
valid a great sufferer for a few days ; the testicle of the male is simi- 
larly affected at times. These complications call for soothing appli- 
cations and rest in bed. 



mmi 



suffocation 
er syringe, 
used. 

doses, from 
d be given 
I the pulse 

room with 



w it is not 
lints. 

;he side of 
le, which is 
sometimes 
ir open the 
e swelling 

sometimes 
the other, 
le. 

mes fever, 
Jwels, and 

in females, 

and pain- 

iking cold 



from 



one 



required. 

cold and 
e, and ap- 
it is fully 
)8tivene88, 
rye hasty 

; be freely 
poultices, 
•e ol Vir- 

:e the in- 
le is simi- 
ing appli- 



DISEASES OP THE CHEST. 



Consumption.-^ Phthisis. 

At the head of the .liseases of our cUniute stands Consumption,— 
flt wieir head both .is it respects prevalence and fatolity. SmaU-^x 

ri „T/r''' '"^ '^°^r"t ^'^ ^"'^^« ^» *heu visitations; but S 
are all their aggregated slaughters compaied with the ce,iseless, silent 

;::s Jt ^i s^ tiT^ -''''' -^^^ ^^^y ^" «^«^^ ^-^ p^- th^ 

Boston, from its population of 476,000, loses by consumption about 
twenty per week, eighty per month, or about nine hundred per 
annum. An equal mortality from any disease not often amon/us 
would send our citizens in terror to^^the countiy, and causXe 
stoutest hearts to feel that "in the midst of life we are in death " 
Massachus|etts loses about seven thousand per annum; New England 
not less than twenty thousand; and with the State of New York 

vear ?' WhT'""" "^ ^^'^^^g^f di««««« «well to forty thousand a 
year! What an army I Picked from the choicest I All sundered 
vTld ^rwf".^ ^' and leaving more blight and sorrow behind than 
wou d perhaps twice or thrice the number whom any other pestilence 
woiUd have selected. The magnitude of the evil places the^question 
of the remedy before aU others that peitain to the healing art. 
ih. ■ fu"^^^ number of deaths occur in Massachusetts, beinff in 

nni'^ — ^^"'^ °^.""^ '"^ ^""^^y *^^« ^^"*i^«d a»d fifty. The smallest 
number is »n Georgia, being about one in two thousand one hundred 

Th; nLi, Tv^^f^^o ^ "'°'*^ unfavorable as a place of residence. 
Ihe Northern Middle States, Western Central and Pacific Coast 
Stetes are most favorable. The most healthful for consumptives, I 
sTcnFn <^ '^ the following order: Georgia, New Mexico, Wiscon- 
sin Colorado and Califorma. A permanent residence in any of them 

iTfp Z? '"P'^^rf '^ ^''^'^ ''' ^'^^ «^g^«' ^""^ ^i" S'^'^4 prolong 
ite, unless in the last stages, in which case I would strongly advis! 
tne patient to remain at home among friends and home comforts. 
Alter a change of climate it is dangerous to return unless a perma- 
nent cure has taken place. 

Methods of Examining the Chest.— Before speaking further of 
oonsumption, I propose to do what has never been done, namely, to 

229 




230 



DIJBA8ES OF THE CHEST. 



inbu^ict the general reader very briefly in the method of examining 
the chest to learn the existence of disease. Perhaps this will bt^ 
considered a departure, in some slight degree, from my purpose to 
make this entire book intelligible to the general reader. If so, my 
reply is, that there are many school teachers, mechanics, masters of 
vessels, and farmers, who have niquiring minds, ar i sagacity enough 
to learn the physical signs of chest-diaease, and to make them, in 
many cases, practically useful; and that even readers of little re- 
flection cannot fail to comprehend a portion of my explanations. 

Position of the Patient. — In performing percussion upon the 
front of the chest, the patient should be required to sit in a square 
position, with the arms hooked over the corners of the back of the 
chair, and the head thrown a little back. 

Instrument with which to Thump. — The index and middle 
fingers of the right hand are to be brought together, into a line, and 
used as the percussing instrument. The blow given with these is to 
be smart and quick., rather than heavy. 

Medium to Thump Upon. — Either the index or middle finger of 
the left hand is to be pressed firmly upon the surface of the chest to 
be percussed or struck, and thus used as a plexiraeter. 

Auscultation. — Listening for the purpose of hearing within the 
chest the sounds produced by breathing, talking, coughing, etc., is 
called auscultation. 





Fia. 90. 



Fig. 91. 



Instruments with which to Listen. — The naked ear is generally 
considered best for hearing low and delicate sounds ; but for hearing 
loud and rough ones, it is not so good as the stethoscope, repre- 
sented by Fig. 90. A still better instrument is the double-eared 
stethoscope, Fig. 91. It magnifies the sounds very much, and is apt 
to confuse an examiner not accustomed to it ; but when the ear is 
once familiar with it, the aid it affords is very valuable. 



mmmm 



niSEASES OF THE CHEST. 



231 



examining 

this will K' 
purpose tt» 
If so, niy 
, masters of 
city enough 
ke tliem, in 
of little re- 
nations. 

n upon the 

in a square 

back of the 

and middle 
) a line, and 
li these is to 



lie finger of 
the chest to 



f within the 
liing, etc., is 



IS generally 

[for hearing 

jope, repre- 

juble-eared 

and is apt 

the ear is 



The examiner should pass from side to side, continually comparing 
the sounds upon one side, with those upon the other. 

The patient must bo calm, and the examiner in no hurry. 

Healthy Sounds. — To become skilful either in percussion or aus- 
cultation, the examiner's ear must first be trained to healthy sounds. 

These are best heard in the child, iu whom they are louder than 
in the adult. 

In describing the healthy sounds in the different regions of the 
chest, I shall refer the reader constantly to Figs. 92 and 93. 

C^lavicular Region. — This, in Fig. 92, is represented by 1, 1. 
Urjon thumping upon the collar-bones, the sound given out at the 
breast-bone end should be very clear ; less clear in the middle ; and 
dull at the shoulder end. 

Subclavian Region. — This is represented by 2, 2, and lies be- 
tween the collar-bone and the fourth rib, on both sides. It covers a 
considerable portion of the Tapper lobe of the lungs. The sound 
upon striking this place should be very clear. 




Fig. so. 



FlO. S3. 



The Mammary Region, represented by 3, 3, extends from the 
fourth id the seventli rib, on each side. In the upper part of this 
region, the healthy sound is clear ; but at the bottom of it, on the 
right, the sound is deadened by the liver; on the left, by the heart. 

The Infra-Mammary Region, 4, 4, lies between the seventh rib 
and the edge of the cartilages of the false ribs. On the right side, 
the liver makes the sound dull; but under the left side lies the 
stomach, which is hollow, and the sound is generally quite loud. 




I 

II 



it 



DISEASES OF THE CHEST. 



In th« 5ternal Region, 5, 6, 7, wLicb covei-s the breast-bone, the 
sound is generally clear. 

The Axillary Region, 8, 8, is in the arm-pits. In this the sound 
should be clear. 

The Lateral Region, 9, 9, is immediately below the above, and 
yields, likewise, a clear sound. 

The Lower Lateral Region, gives a dull sound on the right side, 
and on the left a very hollow one. 

Fig. 93 represents the back part of the chest. In looking at this, 
we see the 

Acromial Region, represented by 11, 11. In this space the sound 
is dull, but it has not much meaning. 

The Scapular Region, 12, 12, covers the part occupied by the 
shoulder-blades. It gives rather a dead sound. 

The lntra-5capular Region, 13, 13, lies between the shoulder- 
blades, on each side of the back bone. If the patient's arms are 
crossed, and the head bent foi-ward, a clear sound will be obtained. 

The Dorsal Region, 14, 14, covers the base of the lungs, and, in 
health gives, a clear sound. 

Observation. — If, now, on thumping upon the chest, we find a 
(lull, dead sound in any spot where a clear one oug'at to be yielded, 
we are to conclude that underneath there is not the usual quantity 
of air ; but we cannot tell merely, by percussing, whether tubercles 
are deposited there, "or the lung has become solid by inflammation, 
or water has been poured out into the cavity of the pleura. This 
point must be determined by auscultation, etc., to be explained 
gradually as we go along. 

Auscultation of Breathing. — On applying the ear or the stetho- 
scope to the chest, two sounds are heard which immediately succeed 
each other, — the louder is produced by the ingoing breath, or in- 
spiration ; the weaker by the outgoing breath, or expiration. These 
sounds will be further explained as we go along. 

Auscultation of the Voice and Cough. — The chest of a healthy 
person speaking communicates to the ear no distinct sound, but only 
a vibratory sensation, called, in technical language, the pectoral fre- 
mitus. 

.Over the larynx and windpipe, the examiner may hear natural 
pectoriloquy ; between the shoulder blades, in the space correspond- 
ing to the roots of the lungs, natural bronchophony. 

Philosophy of Chest Sounds. — The fullness and clearness of 

sound upon percussion, depends upon the amount of air in the chest. 

The sounds called breathing murmurs, are caused by the expansion 



shoulder- 
arms are 
btained. 

:s, and, in 

ve find a 
B yielded, 
quantity 
tubercles 
mmation, 
ra. This 
explained 

16 stetho- 
r succeed 
th, or in- 
. These 

I healthy 
but only 
':oral fre- 

' natural 
Tespond- 

jness of 
he chest, 
cpansion 



DISEASES OF THE CHEST. 

and contraction of the airKiell.s or vesicles, as the air passes in and 
out ; hence they are called vesicular murmurs. 

The friction of the air against the sides of the windpipe and large 
bronchial tubes causes the blowing sound heard in those parts. 

In children a larger amount of air enters the lungs, and the air 
vesicles are expanded with more force; hence their breathing has a 
ouder sound, which is called puerile respiration. This kind of 
breathing, heard in the grown person, is a sign of disease. 

I he lung tissue is a bad conductor of sound; and the voice is ac- 
cordingly heard only over those parts where large bronchial tubes 
are near the surface ; heard elsewhere, it indicates disease. 

Division of Consumption. — Consumption raay be divided into 

ZS ^ w^'" "' T^ '^' ^^°^''^^^1- The former has a on- 
stitutional, the latter a local origin. 

^irst Stage of Tubercular Consumption. 

Physical Signs.— Dullness of sound on and under the collar- 
'riten?ir'Th-^"n"^'^ expirationaugmentedboth indur^ bn 

^^^Occasionally a pulmonaiy, crumpUng sound. Dry, crackling rat. 

The resounding of the voice increased at the top of the lungs. 

General Symptoms. — A sense of weariness and languor. 

Occasionally, slight, %ing pains about the chest and fhou dera 

A peculiar sensitiveness to the effects of cold «"«^^aer8. 

Breathlessness on moving quick, or ascending a hill or stairs. ' 
Ju 7 'i^f'' ^ blue lividity of the lips and^ roots of the Wer- 
nails, and coldness of the hands and feet. ^ 

tlie rntMvij'J^ *T.'^''' "^'^/* *^^« '^'^y ''^Se, a cessation of 
tiie monthly turns. These usually stop later in the disease. 

at S?!orof°th«'r^^' ^r"'"*^"^ °^ *"^^^^«« ^^^^' ^l^ay« begins 
tenest on tl« ^Zf':^T'''\^''^ ^*^«^ *h«"&bt they 'appeared 
oltenest ou the nght side first; Louis, Andral Watson, Sir James 
Clarke and others, believed they appeared more often on the U sWe 

appear first about as often upon one side as upon the other. 
structionnTC'^ crumpling sound is caused by a mechanical ob- 
lurint Th. / expansion of the lungs. It is generally heard only 

dtedVv blow^^ "'' "^ the breath. The soi^d is like that prS^ 
uiicea by blowing upon very fine paper. ^ 



234 DISEASES OF THE CHEST. 



Second 5tas;e. 

Physical Signs* — Marked dullness of sound on the collar bones, 
and extending below them. 

Inspiratory murmur diminished in duration and intensity ; expira- 
tory murmur augmented in both. 

In upper lobes of lungs, moist, crackling rattles, succeeded by 
mucous rattles. Also bronchial respiration, or tubular breathing. 

In lower lobes of lungs, puerile respiration. 

Sounds of the heart heard under the collar bones. 

Bronchophony heard in the same parts as bronchial respiration. 

Qeneral Symptoms. — A quickened pulse ; slight fever towards 
evening, oftentimes amounting to quite high fever. 

Great susceptibility to the effects of cold, and liability to take cold 
easily. 

Bowels generally costive ; oftentimes seat of pain. 

The eye has a peculiar whiteness and lustre. 

The skin and mouth bcQome dry in the afternoon ; chills occur 
about midday, followed by fever, during which the cheeks are flushed. 

As the second stage advances to its close, a dry, burning heat 
aflflicts the palms of the hands and soles of the feet. 

Night-sweats occur at this time. 

Observations. — A hollow, elastic body, containing air, gives, 
when struck, a clear sound. The dullness of sound on percussing 
the chest, arises from the absence of air in the air-cells, — these 
having been pressed together, or obliterated by the deposit of a mass 
of tubercles. The destruction of these cells causes the cessation of 
the respiratory murmur. 

This stage of the disease is often accompanied by an inflammation 
of the mucous membrane lining the air-tubes. The air, pushing its 
way through the mucous secretions in these tubes, forms bubbles, the 
bursting of which causes the rattle. The crepitant rattle is produced 
by inflammation around the tubercles. The moist, crackling rattle 
is caused by the softening of the tubercles. 

The lungs, rendered more solid by the deposit of tubercles, become 
better conductors of sound ; and this causes the beating of the heal-t 
to be heard as far off as under the collar bones. 

Bronchial respiration gives the idea of air blown through a tube ; 
cavernous respiration, of air passing into a large enclosed cavity. 

Third Stage. 

4 

Physical Signs. — In this stfl.ge cavities are formed. If the cavi- 
ties be small, and considerable tuberculated lung surrounds them, the 
sound, upon percussion, is still dull. 



DISEASES OF THE CHEST. 



235 



liar bones, 

y; expini- 

ceeded by 
athing. 

iration. 
ir towards 

• take cold 



lills occur 
re flushed, 
ning heat 



an', gives, 
percussing 
i, — these 
of a mass 
ssation of 

aniniation 
ishing its 
bbles, the 
produced 
ng rattle 

become 
the heatt 

a tube; 
,vity. 



;he cavi- 
;hem, the 



If the cavity he large, and near the surface, there is occasionally a 
tympanitic sound with musical tone. 

Sometimes a sound is heard like striking a cracked pot. 

Gurgling; cavernous rattle ; cavernous breathing; amphoric breath- 
ing; now and then, metallic tinkling; pectoriloquy; cavernous cough. 

General Symptoms. — Great loss of flesh, and weakness ; diarrhoea 
and nightflweats ; swelling of the feet and legs ; sore mouth ; and 
raising of matter with specks of tubercle in it like crumbs of cheese. 

Observations. — The gurgling rattle is caused by air displacing 
liquids, and the formation and bursting of bubbles. It resembles the 
sound produced by blowing through a tube immersed in soap-suds. 

Cavernous breathing is notliing more nor less than the sound pro- 
duced by air, breathed in and out, entering and retiring from a 
cavity. The air appears, sometimes, to one listening with the stetho- 
scope, as if it were sucked into his ear during inspiration, and blown 
back again during expiration. 

Amphoric respiration is simply an augmentation of cavernous 
breathing, and results, of course, from an increase of size in the 
cavity. 

In pectoriloquy, words uttered by the patient seem to pass through 
the stethoscope into the ear of the listener. The cavity pliould be 
empty, moderate in size, and have dense walls, in ordei to furnish 
the best specimen of this sound. 

Air suddenly driven backward through the windpipe, and out of 
the mouth and nose, by smart raps upon the chest over a cavity, 
gives the sound of the cracked pot. It is best heard when the pa- 
tient's mouth is partly open. The same sound is produced, on the 
same principle, by locking the fingers of the two hands, and joining 
the palms, so as to leave a small space or cavity between them, and 
then expelling the air from that cavity, by gently striking the back 
of one hand upon the knee. 

Causes of Consumption. — The hurcan constitution, as shown by 
Liebig, in his profound work on Animal Chemistry, is governed by 
two forces, the nervous and the vegetative. The former disposes the 
particles composing the body to a state of motion ; the latter inclines 
them to a position of rest. 

In vegetative life there is motion in one direction only, so to speak; 
that is, niution which tends to the opposite of motion, namely, rest. 
In vegetables, whose life is wholly under this power, there is no waste ; 
for here, all ultimate particles, having once taken a place of rest, 
remain undisturbed. In a tree, a layer of matter once deposited, 
alwajrs remains. Hence there is growth as long as the tree lives. 
There is no power to break up and destroy. 

But in the animal body there is motion in two directions, or a 
circuit of motion. Particles which under the vegetative force have 
been put to rest, are perpetually being displaced by the nervous energy, 



236 



DISEASES OF THE CIIKST. 



and reduced to unorganized amorphous compouiicls, to bo burned in 
warming tlie sj^tem, or cast out by the several excretory processes. 

So constant Ls the action of these two forces, that John Hunter 
compared the human system to a whirlpool, into which the particles 
of matter are per[)etually poured, under the influence of the vegeta- 
tive power, and out of which they are as constantly whirled by the 
nervous force. 

By a little reflection upon these antagonisms, the reader will see 
that it is just when the vegetative force transcends tlie nervous, that 
the body increases in weight, and acquires that state in which tlie 
blood corpuscles alxiund, and the tendency, if to disease at all, is to 
that of the inflammatory kind. It is the tonic condition of the sys- 
tem. Nutrition is more rapid than destruction. New particles are 
laid down faster than old ones are taken up. The body grows. 

On the other hand, when the nervous force overmastei-s the vegeta- 
tive, when the outward or centrifugal motion of the whirlpool prevails, 
then it is that the body is attenuated, the blood thinned and made 
serous, and the consumptive or atonic condition is established. Noxo., 
there is too much motion. The nutritive particles, instead of tending 
to a state of deposit for the rensupply of waste matter, become fugi- 
tive in their habits, perpetually fleeing, like convicts escaped from 
prison. Introduce this power, in excess, into the vegetable kingdom, 
and the matter deposited upon the tree, instead of remaining to swell 
its bulk, would be driven off by the nervous force ; and the tree, in- 
stead of growing, would be annually lessened, become sickly, and die 
of consumption. 

In Tubercular Consumption, the system is like a field deluged by 
a flood ; nothing can take root. The repeated shocks of the nervous 
battery sent to the absorbents so quicken them in their work of re- 
moving waste matter, that they dislodge much which is not yet worn 
out, and assist in casting out of the system not a little designed to be 
used in its renewal. A healthy deposit is thus prevented, and nutri- 
tion is at an end. The nutritive arteries, those little builders of the 
human frame, are overmastered by the stimulated lymphatics ; the 
constructive material is wrested from them, and borne beyond theb 
reach, and the body wastes from want of nourishment. The blood 
becomes thin and watery; and from the increased serous portion, 
chiefly albumen, are deposited upon the lungs and other tissues the 
albuminous tumors called tubercles. 

Here is found the cause of that peculiar smalliieas of bone and 
muscle, and thinness and tallness of person, so peculiar to consump- 
tives. The absorbents, under the power of a very active nervous 
system, take down " the house we live in " faster than the nutritive 
arteries, confused by the motion around them, can effect its recon- 
struction. It is simply an unbalancing of the antagonistic forces, 
which build and pull down our earthly tenement. The men that de- 
molish are more numerous and better fed than the artisan buildere. 



1 



DISEASES OF THE CHEST. 



287 



burned in 
rocesses. 
11 Hunter 
! particles 
le vegetii- 
ecl by tlio 

r will see 
V0U8, that 
vhich the 
> all, is to 
f the sys- 
cticles are 

'0W8. 

he vegeta- 
1 prevails, 
md made 
3d. Now, 
)f tending 
ome fugi- 
iped from 
kingdom, 
\g to swell 
le tree, in- 
y, and die 

eluged by 
e nervous 
rk of re- 
yet worn 
ned to be 
nd nutri- 
rs of the 
tics ; the 
nd their 
he blood 
portion, 
sues the 



It is this destructively nervous force which gives to consumptive 
persons their proverbial mental activity ; which causes them often to 
dazzle the world with the splendor of their gifts, and to bless their 
friends with the warmth of their affections. They are usually the 
choice spirits, the idols of their relatives, and the favorites of the com- 
munity in which they live. Their mental movements, and the exer- 
cise of their affections, are characterized by brilliancy and warmth. 
Of all persons, they are best fitted to enjoy life, and to impart happi- 
ness. Loving all, they are by all loved in return. They are speci- 
mens of partially etherealized humanity, stepping lightly across the 
earth, to whom friends passionately stretch out their arms, and em- 
brace — their shadows I 

These views will appear the more reasonable, if we consider that 
in children the vegetative power is very active, while the nervous 
energy is comparatively weak. The preponderance of the former 
over the latter causes the rapid growth of children. The little arterial 
builders work faster than the lymphatic demolishers. This explains 
why so few children die of consumption. 

But from the age of seventeen to thii-ty-five, when the vegetative 
power is losing something of its extraordinary activity, and the nerv- 
ous force is showing its highest capabilities, — then it is, as this 
theory indicates, that tubercular consumption does its dreadful work, 
— then, that *he outward world of this physiological Maelstrom casts 
upon the shores of mortalit}'' so many thinned, exhausted, and lifeless 
human forms. More than three-fourths of all who sink under this 
disorder die between the ages just named. The brain, between these 
points of time, acquires its full size and force. 

This disease prevails most, too, in those countries where an enlight- 
ened civilization gives to the nervous system its fullest development, 
as in Great Britain, France, and the United States, and in those 
where the nutritive process is most retarded by a relaxing climate ; 
and it is scarcely known among those people who are but little en- 
lightened and have small brains, and among those who live in high 
and invigorating latitudes. As the most enlightened, however, are 
generally found in temperate climates, and those with the least culti- 
vated brains in low latitudes, the rule is not perfectly explained by 
facts ; yet it shows itself sufficiently to establish its validity, and to 
afford another proof of my theory. 



)ne and 
fonsump- 
nervous 
lutritive 
recon- 
forces, 
I that de- 
lilders. 



Bronchial Consumption. 

The persons exposed to bronchial consumption are generally of an 
opposite habit to those described above, — having the nervous force, 
in health, well subordinated to the vegetative, the assimilation good, 
and the blood well supplied with red globules. They have usually a 
full habit and an active circulation. The absorbents, and other ves- 
sels in the lungs, working in the midst of a large amount of caloric 



238 



DISEASES OK THE CHEST. 



^i: \ 



evolved by an energetic i-espiration, often ttike cold, which brings on 
lung-fever and pleurisy, and these lay the foundation for the ultimate 
destruction of the lungs. For the same reason, the skin of this class 
of persons becomes diseased, and more often the inner skin, or mu- 
cous membrane, and most often that portion of mucous membrane 
which goes down into the lungs and lines the air-tubes. It is inflam- 
mation of this which constitutes bronchitis, and which lays the foun- 
dation for true bronchial consumption. 

As that class of persons who are exposed to the tubercular form of 
the disease suffer a general loss of carburetted hydrogen in its several 
forms, colliquative diarrhuia, sweats, increased breatliing, and all con- 
ditions that carry fat out of the system, so those who suffer from 
attacks of the bronchial tj-jjc of the disorder are generally afflicted 
with the opposite condition. They have too much carbon. 

It is well ascertained that carburetted hydrogen, accumulated in 
the system, acts as a poison. And that class of bilious persons who 
are subject to this disease often have their excretions badly performed. 
For this reason, carbonaceous compounds accumulate in the system, 
and give rise to the symptoms of morbid poison circulating in the 
blood. This led Dr. Madden to suspect the presence of such poison 
in the blood of all consumptive persons. Ht( saw the evidence of it 
in numerous cases, and not distinguishing the one class from the 
other, he inferred its presence in all. 



ill 
{ 



Constitutional Difference. 

The constitutional difference between the two forriis of consump- 
tion appeai-fi to be this : the tubercular type is usually attended, in its 
origin, by a tolerably good state of the digestive function, in connec- 
tion with bad assimilation ; while the bronchial form generally has 
its foundation laid in connection with bad digestion, accompanied 
with healthful assimilation. In the former case, the food is well di- 
gested, the pabulum is properly prepared, but the nutritive arteries do 
not use it for renewing the tissues. In the latter case, the digestion 
is bad, the pa^bulum poorly elaborated ; but the re-constructive vessels, 
under the control of a well-developed system of organic nerves, use 
it to the best advantage. In the one case there are good brick-waA;er«, 
and lazy hvick-layers ; in the othei:, the reverse. 

It happens, however, that before the fatal close of the disease, tu- 
bercular patients usually become afflicted, more or less, with bad 
digestion, and bronchial patients with defective assimilation ; so that, 
in the end, they present us with much the same class of symptoms. 
Starting from opposite poles in life's celestial sphere, they meet at 
the culminating point of death, and disappear under identical aspects 
of the heavens. 



~1 



DISEASES OF THE CHEST. 



239 



^ brings oil 
he ultimate 
if this class 
iin, or mu- 
menibraiiu 
ft is inflam- 
8 the foun- 

lar form of 
its several 
nd all cou- 
uffer from 
ly afflicted 

nulated in 
irsons who 
jerformed. 
le system, 
ng in the 
ich poison 
ence of it 
from the 



consurap- 
ied, in its 
n connec- 
3rally has 
ompanied 
i well di- 
rteries do 
digestion 
e vessels, 
irves, use 
k-makers, 

sease, tu- 
A'ith bad 
; so that, 
Tuptoms. 
' meet at 
.1 aspects 



Exciting Causes of Tubercular Consumption. 

IHE preponderance of the nervous force hein r f>,» uf„+ u- u 

burned by the steam-engine are scarcelT^nL ^T ^'^^^ 

^.^N„r are the pa«si„„» aud aentimente le,, exerci.ed, or le„ destruc 

ature, sleeping in damp sheets, etc. Th^se eS til f ^f P^'" 
or depress the vee-etativp nr ,-r,fl \T *"® nervous force, 

tubes,^or the subTt^^^e of the unTn tl """'T ^'^"^ «^ *^« '^i- 
encloses them, so Tto induce one form n^ S.^°^^?^°^ ^'^^k which 
the principles I have explained ' ''^'' '^ consumption on 

due^t: XtfofTbtrlsTthTr^^^^^^^^ ^r.o^. no.^^.ys, to be 
cords, the upper mrts of fS f ^^'^ neighborhood of the vocal 

of th sare^^P's^tuberlrTV"'' ""' ^"^^q^^^^' ^t the ba.es 

5«.7;«., which croi^IytseeT^th'.^rh"^^^^ ''^- ^^^''^^^ 
and then only after beinj steinpd w,Tk . ^^ ^?'''^'' microscope, 
they absorb TliPSfl S ^'^ f '**''' ^'^^^'^^ colors which 

bacflli, and appear u^^^^^^^ ^'' "^ the rod-shaped variety of 

rods about TS :n leUh Th?'"^' '' ^^"^' ^'^^^^^ 1^»«« or 
person meaS tuWculos^^of some pa^oH "•''' ^P"'"'" «^ ^ 
they are associated with tL preseTc/of Jl ^^^'J'rP'^'^S^^ i when 
the microscope) they are a p^ooToTth^^dtrbel^^^^^^^^^ Z^ 



'{ 



240 



mSKARKS OF THK CHEST. 



L . ".,*■-/■' 



proper. The examination of one's sputum, therefore, in the early 
part of any prolonged and suspicious cough, becoi: es an alwolute ne- 
cessity, since thereby one is made aware, in the earliest stages, of 
this dreadful disease, and an opportunity offered of attacking it at once 
in ita incipiency. This modern discovery has given rise to much 
experimentation in treatment with the aim in view of killing out the 
germ. Robert Koch of Berlin announced to the world, a shoit time 
ago, that he had discovered an agent, which he called Tuberculin 
that would eradicate these death-producing germs, but time has 
shown his efforts to bo unsuccessful as yet, although promising of 
great results in the future. These germs are contagious in character 
so that we now can explain why mjtny contmct consumption in whose 
ancestral blood there never existed any tubercular taint. 

We know that husband may impart the disease to wife and mother 
to daughter if only the system is in a receptive state to offer a lode- 
merit to the germs. These tiny but most enduring bacilli retahi 
their life for an indefinite time in the midst of dust and other dried 
secretions, so that a practical point is that all persons suffering from 
tuberculous diseases should be exceedingly careful where they spit 
and with whom they sleep. To raise the sputum into small paper 
cups which may be burned is a common and very prudent custom 

Ihis discovery, while not disproving the old theory of heredity 
nevertheless explains many a case of acquired Phthisis, and clears uj 
many an old-fashioned theory. 

These are indisputable facts from which the medical profession at 
present hope to derive practical benefit by the discovery of some 
germicide which may be applicable and safe for internal administra- 
tion. 

Can Consumption be Cured ? — In many caaes it can. It may be 
cured, first, by the absorption of the tubercles. The celebrated John 
Hunter shows, in his work on the blood, that the absorbent vessels 
have a sort of elective a#m«y, by which they take up and remove "all 
adventitious new matter, as tumors" (tubercles are albuminous tu- 
mors), more easily " than those parta which were originaUy formed " 
Were this not so, an activity in these vessels equal to the removal of 
tubercles would cause them to waste all the tissues, and aggravate 
rather than cure consumption. Probably this does occur where 
proper hygienic means are not used to quicken the excretions. This 
hygienic treatment, to be spoken of hereafter, is not generally em- 
ployed, -certainly not as effectually as it should be. Here is the 
source of Laennec's fatal remark, so often quoted and so widely en- 
dorsed, that nature's efforts towards effecting a cure are injurious, 
and those of art are useless." Laennec's position cannot be true, if 
Hunter s statement is correct. If the absorbents, by an elective in- 
stinct, take up adventitious matter rather than the natural tissues, 
filv^ reason why they reverse this rule in consumption is, that by 
a weakened state of the constitution, the ultimate particles are not 



DISEASES OF THE CHEST. 



241 



1 tho early 
il)8olute ne- 
t stages, of 
ig it at once 
ie to much 
ing out tlio 
I shoit time 
Tuberculin, 
it time has 
romising of 
n character, 
on in whose 

and mother 
offer a lodg- 
lacilli retain 
other dried 
ffering froiu 
re they spit 
small paper 
it custom, 
of heredity, 
nd clears up 

)rofession at 
pry of some 
1 administni- 

It may be 
)rated John 
mt vessels 
remove "all 
iminous tu- 
[ly formed." 
removal of 

aggravate 
3cur where 
lions. This 
[nerally em- 

[ere is the 

widely en- 
injuriom, 

be true, if 
lelective in- 
1ml tissues, 

is, that by 
lies are not 



well put together^ and are more easily Uiken apart than those of the 
adventitious tul)ercular tumors ; and if we would restore these vessels 
to their natural activity, we must improve assimilation, and knit the 
unloving molecules into a firmer brotherhood. We must make the 
flesh hard, so that the absorbents cannot pick it to pieces. Do this, 
and "nature's efforts to effect a cure" will not "bo injurious." 

A second form of euro is the reestablisbment of the assimilative 
function, the building up of the geneml health, the arresting of the 
tubercular deposit, the reducing of tubercles already formed to an 
indolent state ; and then, by a strict observance of the laws of health, 
keeping them in that condition through life. 

A third mode of cure is the healing of the cavities after the tuber- 
cles have softened, broken down, and been expelled in the form of 
expectoration. 

A fourth method of cure is a change of tubercles to calcareous 
matter. These calcareous tubercles, Laennec says, "are consequent 
to tuberculous affections that have been cured" And Andral, at one 
time, hoped to learn how to effect cures by changing tubercles to 
" the calcareous phosphate." 

I have had several cases of cure by this last method, and have 
quite a collection of calcareous substances which my patients have 
coughed up, — one of which was raised in my presence by a lady 
who was a few years before in hopeless consumption, but is now in 
good health. 

Treatment. — This should be of two kinds, local and general. 

The local treatment of consumption is by the inhalation of vapors 
and powders into the lungs. It has been practised, more or less, by 
individuals, for many yeai-s, particularly in Europe ; but for some 
unaccountable reason, the profession generally have never used it, 
and do not know much about it. I had the honor, some years ago, 
to bring it freshly before the American public, in some articles writ- 
ten for popular reading, since which time it has been rapidly gaining 
public confidence, and is now attracting much attention. Convejdng 
the rsmedy directly to the diseased parts, it strikes the common- 
sense mind as eminently reasonable and necessary. 

I shall speak of inhalation, therefore, very earnestly, not as a 
palliative of consumption only, but as far more, as a remedy. After 
long and patient use, my experience allows nie to say, that I know 
it, in many cases, to be such ; and knowing this, I should be criminal 
not to press it upon the public; for it is the great multitude of 
sufferers, pressing fast through the gate of death, who need to hear 
words of hope. 

Consumption a General Disease. — It is not denied that con- 
sumption is a general disease, needing constitutional treatment; but 
it has also a local development in the lungs, first in the form of al- 
buminous tumors, called tubercles, and then, after the softening. 



I T t' 



242 



DISEASF.S OF THE CHEST. 



breaking down, and discharge of these, in the more formidable shape 
of ulcerous cavities, whicli, beginning at the summit, devour thu 
lungs down to the base. Can it be reasonable to api)ly no remedy 
directly to this local disease ? Not so does our profession deal witli 
other local diseases. To an inflamed skin we apply poultices, cold 
compresses, solutiouK of acettite of lead, nitrate of silver, etc. ; to 
leprous or scaly affections, sulphuret of potash, bichloride cf mer- 
cury, zinc ointment, nitrate of mercury ointment, sulphur, creosote, 
etc. ; to weak and inflamed eyes, sulphate of copper, sulphate of 
zinc, nitrate of silver, and opium ; to chronic ulcers upon the skin, 
tannin, pulverized rhubarb, opium, or cinchona ; and to an inflamed 
tliroat, nitrate of silver and other articles. These are but specimens 
of the thousand cases in which we use local remedies. Why, then, 
when the mucous membrane, ,vhich lines the air tubes, becomes in- 
flamed through all its branches, should we neglect, by the inhalation 
of medicated vapor, to apply a remedy directly upon the whole in- 
flamed surface ? Why, when tubercu' matter is l)eginning to be 
deposited upon the surface of the air cells, and of the small bronchial 
tubes, shouhl not the vapor go right to those parts, and cause, as it 
woidd, the immediate expulsion of tliiu offending and dangerous 
matter ? 

Uneducated common sense sees the reasonableness of these sug- 
gesvions at a glance. Many a person, with jjulmonary disease, dies 
of suffocation, not because there is not muscidar strength to expel 
the matter which is strangling him, but because the lungs below the 
large pellets of mucus, which plug up the bronchial tubes, cannot be 
inflated, and have therefore no means of driving out the offending 
substance. Yet a proper medicated vapor, drawn in with the breath, 
would either dissolve the mucus, or rouse up the expiring membrane 
to cast it off. 

If the reader were to place one end of a stethoscope directly over 
the disease upon the breast of a person in the third stage of consump- 
tion, and should then ask him to talk, the words spoken would seem 
to rise up through the instrument, and enter, well articulated, into 
his ear. This, in technical language, is c»X\edi pectoriloquy, — a word 
signifying chest-talking. It implies a cavity in the lung. If now the 
patient be asked to cough, a gurgling and splasliing sound will be 
heard. This denotes that the cavity is partly filled with fluid, which 
is dashed about by the air explosively driven through it by the portion 
of lung below. Here we have an excavated ulcer, with aU its filthy 
contents, composed of pus, mucus, serum, and dissolved tubercles, 
lying in it day and night to aggravate its unhealthy condition. What 
more reasonable, what more necessary, than that a soothing, altera- 
tive, or astringent vapor should be drawn into this cavity, to cause 
its sides to heal, and its absorbents to remove this fluid? A surgeon 
who should permit an ulcer upon the surface of the body to remain 
in that condition without a local dressing would be deemed unfit to 
practise his profession. 



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DISEASES OF THE CHEST. 



248 




Both in tubercular disease and in simple bronchitis, the bronchial 
tubes almost always suffer some physical change. The raucous 
membrane lining these tubes is generally softened. At other times 
the tubes become enlarged through their whole length, so that many 
of them, from tJie size of a quill, reach the bigness of the finger of a 
glove. In still other caseS; the straining produced by coughing 
causes a tube to belly out at some point, forming a sack, which is 
generally filled with mucus or purulent matter. At still other times, 
a tubercle will press against a tube so as to flatten it and convert it 
into a musical instrument, the air, as it is diawn laboriously through, 
producing a high or low note, according to the size of the pipe. 
These physical changes are all produced by causes which the inhala- 
tion of a suitable vapor, at tlie proper time, would almost infallibly 
remove. How strange that this remedy, — so simple, so effectual, 
so easily comprehended, — should have been so little used I 

Right at this vital point in the lungs, where the blood runs in a 
ceaseless current, — where the whole of it goes every two minutes to 
renew its vitality by contact with atmospheric air, — we have, in 
thousands of cases daily occurring, inflammation Avith roughening or 
softening of membrane, with its consequent harsh breathing ; we have 
mucus, tough or glairy, to impede and interrupt respiration ; we have 
tubercles in the hard or soft state, adding to the general embarrass- 
ment, and not only lessening the vitality of the blood, but disturbing 
all the sympathies of the system ; — and yet the practice has been, 
and is, to attack these central distm-bers of life only through the cir- 
cuitous path of the stomach, lacteals, etc. 

I have investigated faithfully the effects of the various substances 
proposed for inhalation by European physicians, and have explored a 
wide field of new remedies, not before used, several of which have 
proved to have qualities of great remedial power. 

The chief remedies I employ for inhalation are the following . 

Alterative Inhalant, composed of iodine, six grains ; iodide of 
potassium, twelve grains ; tincture of ipecac, one ounce ; tincture of 
balsam of tolu, six drams ; ethereal tinctui-e of conium, one and a half 
drams ; alcohol, half a pint. These are to be mixed. The dose is 
one to two teaspoonfuls, to be inhaled ten or fifteen minutes, in 
about a gill of hot water. 

The ethereal tincture of conium is made by keeping a dram of 
powdered conium in one ounce of sulphuric ether a week. 

The above inhalant is used in the tubercular forms of consump- 
tion, particularly that of the scrofulous kind, and in mauy cases of 
bronchitis. 



Expectorant Inhalant. — Take pleurisy root, half an 
squill, one ounce ; ipecac, two drams ; black cohosh, two 
queen's root, one ounce and a half; American hellebore, two drams; 
diluted alcohol, one pint. Grind the roots, etc., and add the alcohol. 



ounce ; 
ounces ; 



244 



DISEASES OF THE CHEST. 



Let the whole stand one week, shaking or stirring daily. Draw off 
and filter through paper. Two teaspoonfuls make a dose, to be in- 
haled same as preceding. 

This is to be used when the cough is hard and dry, and the expec- 
toration difficult. It makes the raising easy, lessening the soreness 
of the chest, and the harshness of the cough. 

Soothing, Febrifuge Inhalant. — Take belladonna leaves, half an 
ounce ; black cohosh, two ounces ; American hellebore, half an ounce ; 
poke-root, two drams ; aconite root, one ounce ; diluted alcohol, one 
pint. Grind the roots, etc., add the alcohol. Let the whole stand 
one week, stirring daily. Pour off and filter through paper. Dose, 
one to two teaspoonfuls, to be inhaled as the preceding. 

This is excellent in all cases where the skin is hot, the pulse 
quick, the tongue and mouth parched, the chest sore, and the system 
suffering during the whole or a part of each day, from a general 
feverish condition. It is proper in all the forms of chest disease. 

Astringent Inhalant. — Take of wild indigo, one ounce ; catechu, 
half an ounce ; Peruvian bark, one ounce ; golden seal, one ounce ; 
diluted alcohol, one pint. Mix, and let the whole stand one week, 
stirring daily. Drain off, and filter through paper. Add two di-ams 
of creosote. One to two teaspoonfuls to be inhaled as preceding. 

This is to be used when the expectoration is profuse and easy, un- 
attended by fever, either in the latter stages of chronic bronchitis, 
when the mucous membrane of the tubes is in a relaxed condition, 
or, in the third stage of tubercular disease, for the purpose of con- 
stringing, cleansing, strengthening, and healing. 

Antiseptic Inhalant. — Take wild indigo, one ounce ; belladonna 
leaves, half an ounce ; diluted alcohol, one pint. Mix, and let the 
whole stand one week. Pour off, and filter through paper. Then 
add solution of chloride of soda two ounces. Dose, one to two tea- 
spoonfuls, to be inhaled as the preceding. 

This is used in cases of gangrene of the lungs,, generally distin- 
guished by considerable expectoration having a very fetid smell. 

Anti-Hemorrhagic Inhalant. — Take witch-hazel bark, two 
ounces ; black cohosh, four ounces. Grind, and add one pint of 
diluted alcohol. Let the mixture stand one week, stirring daily. 
Pour off, and filter through paper. Add to this two drams of creo- 
sote. Dose, one to three ieaspoonfuls, to be inhaled as preceding. 

This is an excellent remedy for bleeding from the lungs. When 
there is a tendency to bleed, it should be used for a long time. It 
may frequently take the place of No. 4, as an astringent inhalant. 

For immediate relief give strong solution of salt water. 

Object of Inhalants. — Being vaporized and inhaled, these articles 
enter every air-cell throughout the lungs. Their object is to soothe 
and mollify inflamed mucous surfaces, to reduce enlarged bronchial 



■ >i nn* i<ii m i iijn ii (, M 



riSEASES OF THE 0HB8T. 



24r 



. Draw off 

le, to be in- 

i the expec- 
ihe soreness 

ves, half an 
[f an ounce; 
alcohol, one 
^•hole stand 
per. Dose, 

b, the pulse 
[ the system 
a a general 
disease. 

36 ; catechu, 
one ounce; 
I one week, 
[ two dmms 
eceding. 
id easy, un- 
bronchitis, 
I condition, 
lose of con- 
belladonna 
md let the 
per. Then 
to two tea- 

:ally distin- 
smell. 

bark, two 
ne pint of 
ring daily, 
ns of creo- 
'eceding. 
TB. When 
time. It 
nhalant. 

ese articles 
to soothe 
bronchial 



glands which press upon neighl)oring parts and ciiuse bleeding, to 
stimulate the absorbents to take up and remove tubercles, to dissolve 
tubercles out of the pulmonary tissue, to cause ulcerous cavities to 
expel their mattery contents, and to stimulate their sides to take on 
a healing process. They should be used from three to six times a 
day, the inhalation continuing from ten to fifteen minutes. 

Other Inhalants. — Great numbers of other articles have been 
used, which I have not space to describe. I will mention, however, 
that the following are sometimes employed with advantage : — 

For an Expectorant Inhalant, take alcohol, four ounces ; tincture 
of camphor, half an ounce ; tincture of tolu, two drams ; naphtha, 
one dram ; benzoic acid, thirty grains ; oil of bitter almonds, four 
drops. Mix. 

For an Anodyne Inhalant, take alcohol, four ounces ; naphtha, one 
dram ; benzoic acid, thirty grains ; chloroform, twenty-five drops ; 
tincture of henbane, half an ounce. Mix. 

For an Astringent Inhalant, take alcohol, four ounces ; naphtha, 
one dram ; benzoic acid, thirty grains ; chloroform, one dram ; tannin, 
eight grains. Mix. 

Mode of Inhaling. — For inhaling these, a sponge is fitted into a 
glass cup, to which a flexible tube is attached. A small quantity of 
the mixture is poured upon the sponge, and the vapor arising is 
drawn into the lungs through the tube. 

To the expectorant inhalant may be added, occasionally, half a 
dram of nitric acid. 

These latter formulas are the principal ones used by those who 
practice what is called cold inhalation. 

A very common mode of inhaling volatile remedies is by saturat- 
ing a little cotton, contained in a wire basket, with the desired oil or 
fluid, and placing it over the mouth and nose. It is to be worn 
throughout the day. Oil of peppermint, creosote, menthol, oil of 
eucal3rptus, etc., etc., are among the more common remedies thus 
used. 

A good inhaler can be bought of any dealer in surgical instruments. 

Constitutional Treatment. — The rapid breathing in consump- 
tion creates too much oxydation of the blood, — so much, that the 
muscles, especially the heart, are usually of a bright red. To prevent 
the patient from being literally burned up by oxygen, the blood 
must be de-oxydated as fast as possible. 

While there is too much of oxygen, there is, at the same time, a 
deficiency of carbon. Hence the cold hands and feet, and the gen- 
eral inability to bear frosty weather. The little nutritive arteries, in 
these thin-blooded persons, stand shivering and torpid with cold, un- 
able to perform their allotte.1 function of nutrition. There is not 
fire enough, and fuel must be had in the form of carbon. Hence one 
of the advantages of cod-liver oil. This oil, too, as carbon, devoui-s 



246 



DISEASES OF THE CHEST. 



the oxygen of the blood, and prevents its destroying the patient. 
Phis idea also explains the fact mentioned by Beniiet and others, 
that in their post-mortems they found the evidences of healed ulcei-s 
in numerous persons who had been spirit-drinkers while living. Ami 
Liebig helps the explanation by saying that alcohol, taken into the 
system, circulates in a free state in the blood, and devours its oxygen. 
To which I beg to add, that the malaria of intermittent and bilious 
fever districts, has been pretty satisfactorily proved to be an instable 
organic body, consisting of sulphur, carbon, and hydrogen, all of 
which have an affinity for oxygen, and devour it in the system. 
Consumption is not found in such districts 

As I am here treating of the chemical effects of remedies (and to 
this test most remedies must finally come), I will mention that tar- 
trate of antimony and potassa arrests the circulation in the pulmonary 
arteries, — which fact gives a complete and luminous view of its 
power to prevent oxidation. But I am obliged to detract from its 
merits, by stating that it also retards the circulation in the capillaries 
of the system generally, and so hinders c?e-oxidation. 

Phosphorlis. — There is an article which has more recently pre- 
sented itself to the notice of the profession, to which I wish to invite 
special attention. I refer to phosphorus. This agent, for a time, 
challenged our notice in the shape of phosphate of lime ; but we could 
never feel sure that this article was dissolved in the fluids of the 
body. We now use, and with far more marked effect, the hypo- 
phosphites of lime, soda, potash, and iron. These are used in tlie 
form of the syrup of the hypophosphites. The dose is a teaspoonful 
before each meal. The effect unon tubercular disease is immediate 
and gratifying. 

Need of Phosphorus. — Cerebric acid contains nitrogen and phos- 
phorus, and is t'.ie peculiar component of the brain and nervous sys- 
tem. By combustion and the changes of oxidation in the brain, the 
phosphorus of cerebric acid is converted into phosphoric acid ; so that 
every act of the brain produces phosphoric acid. How rapid, then, 
must be the consumption of the phosphoric element of the cerebric 
acid, in that highly active p,nd excitable state of the nervous system 
which I have described as peculiar to consumption. And how neces- 
sary, in order to save the brain from destruction, to meet this increased 
demand for phosphorus, by introducing it into the system. 

Mulder regards the fibrin of the blood as the carrier of oxygen; and 
by this oxidation, the fibrin becomes converted into the binoxide r.nd 
trioxide of protein, — its phosphorus and sulphur (for it ccitains 
both) being converted into phosphoric and sulphuric acids. Adding 
phosphorus and sulphur, therefore, as medicinal agents, would seem 
to be the proper way to supply the fibrin with materials destructive 
of its freight of oxygen. 

It is well known that the salts of phosphoric acid are essential for 



DISEASES OF THE CHEST. 



247 



the patient. 
t and othci's, 
healed ulcers 
living. And 
ken into the 
rs its oxygen, 
t and hilioiis 
)e an instable 
rogen, all of 
I the system. 

edies (and to 
bion that tar- 
he pulmonary 
3 view of its 
ract from its 
the capillaries 

recently pre- 
wish to invite 
t, for a time, 

but we could 

fluids of the 
ct, the hypo- 
! used in the 
a teaspoonful 

is immediate 



jen and phos- 

nervous sys- 
the brain, the 

acid ; so that 
V rapid, then, 

the cerebric 
rvous system 

d how neces- 
this increased 
3m. 

oxygen; and 
biuoxide r.nd 
)r it ccatains 

ds. Adding 

would seem 
s destructive 

essential for 



the formation of azotic compounds, — conii«)und8 wlii(^h are neces- 
sary to sustain animal life. It should be reiuumbcrcd, too, as collat- 
erally illustrating this fact, that the tribasic phosphates of potash, soda, 
lime, and magnesia, j)lay an important part in the growth and perfec- 
tion of plants. They are always found in the seeds of the cerelia, and 
no mature grains are produced where phosphates are absent from the 
soil. For the production of abundant grain-crops, it is necessary 
that these salts should exist in the soil, or be applied to it in manures. 

It is known, moreover, that in all chronic diseases distinguished by 
wasting of tlie tissues, a much larger quantity of phosphates is ex- 
creted by the kidneys than in the normal state. Hence there is no 
healthful growth ; and the human organism, like the soil, exhausted 
of its phosphates by successive croppings, brings nothing to perfec- 
tion, and needs to have its drained salts re-supplied. 

I cannot but call attention here to the inorganic substances found 
in healthy human blood. According to very careful analyses, by 
Schmidt : 



1000 parts of blood-corpuscles, contain : 

Chlorine 1.686 

Sulphuric Aeki 0.066 

Phosphoric Add 1.134 

Potassium 3.328 

Sodium 1.052 

Oxygen 0.667 

Phosphate of Lime 0.114 

Phosphate of Magnesia .... 0.073 



1000 parts of liquor sanguinis (serum 
and fibrin), contain : 

Chlorine 3.664 

SulhuricAcld 0.115 

Phosphoric Acid 0.191 

Potassium 0.323 

Sodium 3.341 

Oxygen 0.403 

Piiosphate of Llrao 0.311 

Phosphate of Magnesia .... 0.222 



Iron is omitted. Now, I venture the prediction, that out of these 
figures, mainly, in connection with those which represent the consti- 
tuents of the saliva, the bile, the gastric juice, the pancreatic secretion, 
and the organic compounds of the blood and tissues, are to be evolved 
within a few years a correct and partially demonstrative system of 
medication. In consumption, all the inorganic bodies represented by 
the above figures, with the exception of oxygen, are deficient in quan- 
tity. By reflecting upon the proportions of these several bodies, par- 
ticularly upon the large amount of clilorine and soda in the plasma, 
and of potassium in the corpuscles, the mind can hardly fail to obtain 
useful hints. I have not hesitated to make one of these hints the 
ground of a very free use of alkalies, — particularly in the form of 
bathing. 

Sugar of Milk. — There is one other medicinal article which I deem 
worthy to be mad prominent, and to be placed side by side with cod 
liver oil and the hypo-phosphites. I refer to sugar of milk. It belongs 
to that class of non-nitrogenized articles which Liebig has denomi- 
nated supporters of respiration. Its great affinity for oxygen is well 
worthy to be taken into the account, in considering its value in con- 
sumption. So great is this attraction, that, with ammonia and other 
alkalies, it has the power of reducing some of the metallic oxides. 



248 



DISEASES OP THE CHEST. 



When taken into the stomach, it is rapidly alworbed into the blood, 
which, being an alkaline fluid, augments its great de-oxidating power 
to a considerable degree. It unites rapidly with oxygen after enter- 
ing the blood, forming carbonic acid and water. A part of it, how- 
ever, does not enter the blood in an uncompounded state, but is 
changed in the stomach into lactic acid ; and this, in the blood, be- 
comes an alkaline lactiite. But the portion thus changed appears 
also very useful ; for Lehmann says : " We know of no substance 
which could better act in the blood as food for the respiration, than 
the alkaline lact^ates." 

Corroborative of these views is the fact that all those kinds of 
milk, such as goat's, ass's, etc., which contain the largest amount of 
sugar of milk, have at different times, and in various countries, ol>- 
tained a reputation for curing consumption. Goat's whey, in which 
this article abounds, and from which it is largely manufactured, has 
been celebrated for its virtues in this line. Ancel speaks of it as an 
excellent remedy ; and Pereira says, " Sugar of milk, in consumptive 
cases and chronic 'diseases of the digestive organs, is a most valuable 
aliment." 

One of the best forms of taking sugar of milk is that of a gruel, 
which is quite palatable, and may be freely eaten by consumptive 
persons. 

Creosote, Quaicol, etc. — Modern researches having proved that 
consumption, as well as many throat and other diseases are propa- 
gated by germs or bacilli, as explained on page 239, medical investi- 
gators have for a long time been seeking some agent that would 
destroy these germs without at the same time injuriously affecting 
the human system. A few years ago Dr. Robert Koch, a celebrated 
German scientist, who had long been investigating the consumption, 
cholera, and other microbes, thought he had discovered a lymph that 
would destroy or at least counteract the consumption bacillus ; but 
unfortunately it proved a failure. Creosote, carbolic acid, guaicol 
and similar drugs kill the germ when outside the body, and for this 
reason most therapeutists of to-day use these remedies in as large a 
quantity, and for as long a time as tho system will tolerate. At all 
events, whatever may be the outcome of thecustom at present in 
vogue, creosote certainly arrests the rapid proliferation of germ-life 
in the lungs, improves the appetite and digestion, lowers the temper- 
ature, and apparently helps the patient. The only offset to the use 
of this class of remedies lies in the fact that one cannot thoroughly 
disinfect the blood sufficiently to kill these germs completely. Creo- 
sote made from beechwood, taken in three-drop doses with a wine- 
glass of milk, after food, three times a day, is the usual form of 
administration. This dose should gradually be increased till ten and 
even twenty drops are taken at a time. The carbonate of creosote is 
a more elegant and perhaps more effective form of the drug. This 
medicine may also be procured in the form of capsules .and pills. 



■-~-i»<B«a>i iir«Mist'jtaitaw'< 



:he blood, 
ng power 
fter entei- 
f it, how- 
te, but is 
blood, be- 
d appeal's 
substance 
tiou, than 

I kinds of 
imount of 
ntries, ol)- 
, in which 
tured, has 
)f it as an 
isumptive 
t valuable 

f a gruel, 
isumptive 

oved that 
are propa- 
al investi- 
hat would 
k affecting 
celebrated 
sumption, 
onph that 
lUus; but 
d, guaicol 
d for this 
IS large a 
. At all 
resent in 
germ-life 
e temper- 
,0 the use 
loroughly 
y. Creo- 
h a wine- 
form of 
I ten and 
reosote is 
g. This 
pills. 



DISEASES OF THE CHEST. 



249 



By Dr. Cyrus Edison's recently discovered product &f carbolic 
acid, iusepsin, it is claimed that seventy per cent of consumptive 
oases can be cured. It can only be administered as a hypodermic 
injection, however, at the hands of an experienced practitioner. 

The Coug^h. — The best article I have ever used for this is the 
"Pulmonic Cherry Cordial." I was five years in compounding this 
article to suit me, and I believe it to be the very best cough prepa- 
ration ever made. Dose, from one to two teaspoonfuls. 

Pulmonic Cherry Cordial. — Wild-cherry bark, ground, 10 pounds 
ipecac root, 20 ounces ; bloodroot, 24 ounces ; squill root, bruised, 12 
ounces ; pulverized liquorice root, 5 ounces ; cochineal, bruised, 2 
ounces ; anise seed, 32 ounces ; fennel seed, 8 ounces ; orange peel, 
16 ounces ; acetate of morphine, 12 drams ; alcohol, 8 gallons ; water, 
8 gallons ; pulverized white sugar, 40 pounds ; sulphuric acid, 1 
ounce. 

Directions for making. — Grind all the articles to a coarse powder 
except those directed to be bruised or pulverized, and put them all 
to the alcohol except the wild-cheriy bark, the water, the sugar, and 
the sulphuric acid. Let them stand one week, shaking or stirring 
thorouglily twice a day. Then, having kept the wild-cheny bark two 
days in a covered vessel, with water enough ujjon it to wet it through, 
place it in a percolator, and run eight gallons of water through it. 
Add this to the alcohol and other ingredients. Let the whole stand 
tliree days longer, stirring as before, twice a day. Draw off, and fil- 
ter through paper. Now add the sugar, and lastly the sulphuric acid. 
The acid is intended mainly to improve the color, by acting chemi- 
cally upon the cochineal. The color is a fine cherry red, tinged with 
orange. 

I have given the directions for making sixteen gallons — this being 
the smallest quantity in which I make it. Any person can easily 
make the calculation for reducing the quantity. The assertion pre- 
viously made that tliis is the " best cough preparation ever made," I 
see no cause to modify in the smallest degree. Were it kept in 
every apothecary shop, and were physicians to prescribe in pul- 
monary complaints, adding a little syrup of squills or wine of ipecac 
when a more expectorant effect is wanted, or a little morphine if 
greater narcotism is sought, it would save them much trouble in com- 
pounding cough syrups, and give them much more satisfactory re- 
sults. I have compared its effect, again and again, with the best 
other preparations in use, and I pledge my word that it will succeed 
in twice as many cases as any other compound that may be chosen. 
Let physicians try it; and I will be responsible for ever hair's 
breadth in which they find this proportion of successful results 
abridged. 

When a more quieting effect is needed, a little morphine may be 
added to this preparation ; if a more expectorant influence is required, 
add a few drops of the tincture of veratrum viride. For the great 






MM 

mm 



■\ ■'» 



■ — "" ■>»" 



250 



DISEASES OF THE CHEST. 



majority of cases, it will l)e found to be right without any addition. 
When this is notathand, my of the preparations (108), (112), (100), 
(113), (110), etc., may be used. Another good preparation is Dr. 
King's consumption cure. 

Night Sweats. — The very best preparation for these sweats ia a 
compound of the oxide of zinc, one dram ; extmct of conium, half a 
dram ; to be made into twenty pills, of which one or two are to be 
taken every night. The sponge bath also does much to check these 
sweats, and vinegar baths (369). Atropia, ^U of a grain on retiring, 
and especially Agaricin, ^ grain, will cause the sweats to stop abso- 
lutely. 

Diarrhoea. — This is a most exhausting symptom in the latter 
stages of consumption. The only remedy which has much effect in 
controlling it is the iris-nitrate of bismuth. This should be given in 
doses of thirty grains immediately after, or at the time of each meal. 
These doses are much larger than used to be given ; but they will 
do no harm. Given to tliis extent, I find the bismuth very effectual. 

Iron.— This preparation, in some of its forms (316), (73), (159), 
(102), is almost always needed in consumption. If the scrofulous 
habit be strongly marked, give syrup of iodide of iron, in thirty-drop 
doses, three times a day. It should be taken in a glass of water. To 
the feeble administer Gude's pepto-mangan in teaspoonful doses three 
or four times daily. This is one of the simplest and most effica- 
cious forms of iron we have. 

External Irritants These are needed where there is much in- 
flammation and soreness of the chest. Blisters should very seldom 
be used. Croton oil, from two to half a dozen drops, rubbed over 
the sore part, generally answers very well. Sometimes the mustard 
paste, applied to the extent of producing redness, two or three times 
a week, is sufficient. Nitric acid, reduced with water to a strength 
a little above the strongest vinegar, answers a good purpose for 
keeping up an irritation. 

Atmospheric Inhaiation.-- -It has been said by Laennec and others, 
that asthma has sometimes the effect of arresting tubercular consump 
tion. Dr. Ramadge thought this was effected by an expansion of 
the vesicular structure of the lungs ; and he reasoned that the same 
expansion, by mechanical means, would secure a similar end. To ef- 
fect this, he made his patients take long breaths through a tube con- 
structed for the purpose. 

It is manifest that the philosophy of atmospheric inhalation was 
not understood by Dr. Ramadge, nor has it been by any of his fol- 
lowers in this country. 

Rokitansky thinks the tubercular habit depends upon the excess 
of fibrin in the blood ; and says that the reason of consumption being 
arrested by pregnancy is, that this condition offers a mechanical ob- 



• •TmriiiiBHJSMMiSWi'''''''' 




' I 



IHSEASKrt OK THK CHEST. 



261 



ly addition. 
I2),(10!t), 
ition is Dr. 



sweats is a 
lium, half a 
ro are to Ihj 
check these 

on retiring, 
) stop alwo- 

a the latter 
ich effect in 
be given in 
f each meal, 
ut they will 
ry effectual. 

:73), (159), 
B scrofulous 

thirty-drop 
f water. To 
I doses three 

most effica- 

is much in- 
very seldom 
rubbed over 
the mustard 
: three times 
} a strength 
purpose for 

c and others, 
lar consump 
jxpansion of 
lat the same 
end. Toef- 
1 a tube con- 
halation was 
ly of his fol- 

a the excess 
nption being 
jchanical ob- 



stacle to the transmission of blood tlu-ough the lungs, — thus pre- 
venting its excessive oxidation, ai'd keeping it in a venous state. 
This destroys the fibrinous condition, on which he thinks tuberculosis 
depends. 

Now this ift precisely what is done by atmospheric inhalation. The 
trachea divides, on its entrance into the lungs, into two branches, 
which again divide ana subdivide until the tubes become smaller 
than can be seen, each terminating in a minute air-cell. Over this 
entire surface the air is intended to be brought into communication 
with the blood for the purjjose of oxidating it. By forcible inhala- 
tion, the air-vesicles are inflated to the extent of their capacity, by 
which means the extreme branches of the pulmonary arteries are so 
flattened between these extended cells, as to be able to convey but a 
small amount of blood, and but little is oxidated. This furnishes a 
mechanical obstruction to the transmission of the blood, and secures 
the defibrination of which Rokitansky speaks. 

This is my view of the philosophy of atmospheric inhalation. The 
benefit results, not from a larger amount of oxidation, as is generally 
supposed, but from a smaller. Asthma does the same thing by pro- 
ducing spasmodic contraction of the extreme bronchial tubes, and 
preventing air fro.n entering the cells. 

The same end is gained in part by certain kinds of employment, as 
glass-blowing, playing upon wind instru .lents, and the like. Writers 
of distinction mention cases of recovery from incipient consumption 
by a vigorous use of the lungs in singing. Dentists subject their 
lungs to a similar process of expansion in the use of the blow-pipe ; 
the writer has known several instances in that profession, in wldch 
recoveries have taken place. 

The Conclusion to which I come is, that atmospheric inhalation 
may be used with great advantage in some ciises, but should never 
be resorted to. except under the direction of a competent physician. 
In a congested state of the lungs, with hsemorrhagic tendencies, or 
with inflammation and soreness, it is well fitted to produce fatal 
bleeding and is of course dangerous. 

External Use of Water. — As a relaxation from severe exertions, 
the ancients had frequent recourse to bathing. Those who contended 
in the race, throwing the javelin, and wrestling, at Rome, plunged 
into the Tiber while warm and panting with their efforts. That this 
promoted prowess and physical endurance, none can doubt. 

Louis, the great French authority on pulmonary diseases, lays 
down several rules to be observed by consumptive patients, and par- 
ticularly mentions cold bathing. 

Few things give tone to the capillaries of the skin like cold water, 
systematically applied. It rallies the powers of the constitution, and 
improves assimilation. And by it another object is gained of scarcely 
less importance, — that of gfuarding the system against taking cold. 






Mil 



fc:JiKUIii^'^^- 



^^t£Uy,^'t^ 



:?"fSm:.iZ^f^:^:'W^;gSl::rj 



352 



DISEASES or THE CHEST. 



Those in the daily habit of applying cold water to the whole perann 
seldom suffer from colds ajul catarrhs ; they generally l)ecome har- 
dened so as to endure the assaults ol the elements. 

Consumptive persons should generally use the sponge bath, with 
cold water, if it can be endured, otherwise the tepid bath, to be fol- 
lowed, in all cases with brisli rubbing, with a coai-se towel. If a sense 
of chilliness and discomfort fol'ows tlie bath, a large poition of the 
water must be squeezed from the sponge, so as to use but very little, 
and the washing must be speedy, and the rubbing more lively than 
usual, — beginning with tepid water, and gradually lowering the 
temperature till it can be borne cold. A large teaspoonful of salera- 
tus to each quart of water should be used. 

Diet. 

The diet, like all other parts of the treutment, must have reference 
to the present condition of the patient. If the disease take the bron- 
chial form, and rapid breathing, and other conditions calculated to 
carry fat out of the system have not yet supervened ; or if the pa- 
tient have thii-st and hectic, the diet must be spare and simple, — 
consisting chiefly of milk and farinaceous sulwtances. 

But in all cases where the disease is tubercular, or, being bronchial, 
has reached the stage of emaciation, the very earliest moment at 
which the fever can be subdued should be improved to build up the 
patient with a generous diet. I have seen cases where the stuffing 
sometimes resorted to for fattening turkeys for Thanksgiving would 
seem to be almost justifiable. A good rule is to give the most gener- 
ous diet that can be taken without disturbing the stomach, or increas- 
ing the feverish symptoms. Animal food with a good quantity of 
salt should be f i eely taken. Pat meats, if well received by the stom- 
ach (and they generally are if taken cold), are particularly useful. 
The same is true of sweet butter and cream. 

Out-Door Exercise.— Without exercise, as a general thing, the 
consumptive patient will die. Exercise involves muscular exertion, 
which is attended by the tension, compression, and greater compact- 
ness of the muscles used. This compression of the muscles within 
the sheaths (fasciae) which enclose them sends out their blood, and 
pushes it forward towards the surface. Reaching the extremities of 
the arteries, the blood passes through capillary tubes, almost incon- 
ceivably fine, into the capillary veins of similar fineness, whence it 
flows through larger and larger veins back to the heart. At the mo- 
ment of its passage from the capillary arteries to the capillary veins, 
it ceases to be red or arterial, and becomes purple or venous blood. 
The oxygen in the arterial and the carbon in the venous blood unite, 
forming a literal combustion, just such as we produce in our stoves 
and grates by bringing together the carbon of the wood and the oxy- 
gen of the atmosphere. By this combustion our bodies are warmed. 



I 




olo person 
come hiir- 

batli, with 
to be fol- 

If a HCllHti 

ion of tlie 
very little, 
ively than 
ering the 
I of salera- 



) reference 
! the bron- 
3ulated to 
if the pa- 
simple, — 

bronchial, 
loment at 
ild up the 
le stuffing 
ing would 
lost gener- 
or increas- 
uantity of 
the stom- 
■ly useful. 

hing, the 
exertion, 
corapact- 
es within 
)lood, and 
emities of 
58 1 incon- 
w. hence it 
t the mo- 
ary veins, 
us blood. 
)0d unite, 
ur stoves 
I the oxy- 
warmed, 



DI8KASK8 OK THE ClIKHT. 



263 



and the little secreting, exhalant, and other vessels, are raised to a 
teniperaturo that enables them to work. 

Every muscular contraction and compression helps push along the 
venous blood in larger quantities to she right auricle of the heart, 
which, receiving a fuller supply of its natural stimulus, contracts more 
energetically, forcing the fluid into the right ventricl'^. From thence 
it is expelled with increased energy likewise along its only pathway, 
the pulmonary artery, into the lungs. Rushing in here in greater 
volume than natural, a demand is made for deeper inspirations of 
air to vitalize and fit it for its descent by the pulmonary vein, to the 
left auricle. Coming here also as the natural stimulus, in larger 
quantities than usual, it gives increased energy to its own j)ropulsion 
into the loft ventricle, from whence it is driven out through the arte- 
ries to all parts of the system, by the powerful strokes of that strong 
muscle. 

Thus it goes its round, u"ged on by exercise, parting with its oxy- 
gen more and more freely in the capillaries, giving more activity to 
the vessels of th^ skin and other tissues, increasing the depth and 
strength of breathing by carrying more venous blood to the lungs ; 
improving the digestion, carrying a better elaborated pabulum to the 
nutrient arteries, and causing them to work it up more diligently in 
renewing the tissues. 

Nor is this all. Every wrench of a muscle forces some old, worn- 
out particles from their places, tallowing none to remain except such 
ii8 are firm, and able to bear the brunt of exertion. The flesh of those 
who exercise much becomes hard and enduring. 

I say then to the consumptive, if you would live and not die, exer- 
cise, exercise, exercise. It is the first, second, and third thing. If 
you ask for the modes of exercise, I say take it on foot, out of doors, 
every day, to the extent of a small amoui. of fatigue. Don't be 
frightened by a single cloud, or even by a cohort of them. You have 
as good a right to be out as the clouds ; and they will not look more 
angry, but rather more agreeable from finding you abroad in their 
company. The elements of rature are at war with organic life. 
Against them the vital principle has to maintain a perpetual struggle ; 
and he who loses the power to meet and gain the victory over them 
by out-door exercise, is beginning to die. 

Go abroad, therefore, often. Try it again and again. Extend 
your walk a little every day. Stretch it out to the distant fields. 
Gather flowers from the top of the hills and from the bosom of the 
valleys, and bring them home as trophies of your victory. 

If not able to begin with walking, ride as often as possible in a 
carriage. The jolting of a "ehicle will jog the blood along much 
better than no exercise. 

Horseback riding is still bet* It combines., in some measure, 
the passive exercise of carriage iding, with the active exertion of 
walking on foot. 



264 



DISEASES OF THE CHEST. 



Numerous other modes of exercise may be resorted to with advan- 
tage. Dumb-bells, adapted in size to the strength of the patient, 
and used with caution, are highly serviceable. The battledoor, the 
footb ill, bicycle riding, pitching quoits, and the athletic sports of the 
gymniisium, all have their appropriate place. The greater the variety 
the bettei", as by it all parts of the system are brought into play, and 
both the mind and the muscles ;;3t the change which they need. 

It is hard to impress patients with the importance of this subject. 
Say what you will, they somehow or other get the idea that a mod- 
erate amount ci: 'ixercise, taken when they feel like it, is all that is 
required. Fatal mistake 1 Whatever the physician may do, the pa- 
tient has a great deal to do for himself. He must strive to develop 
Ids physical powers to the utmost. He must train himself as runners 
and fighters do when preparing for their surprising feats ; for he is 
running against the swiftest disease (or the surest winner) of our cli- 
mate, and fighting with the elements. 

If he regards life as not worth this exertion, of course he will not 
make it ; but I beg him to consider that without it recovery will be 
uncertain, and in many cases, impossible. Do as I have directed, and 
if your medical attendant is skilful, the current of health will, in 
many cases, begin to flow back to you. Life will renew to jou its 
policy of insurance, and multiply your days. 

Travelling: — Consumptive patients have generally been sent to a 
southern climate. But where the case involves dyspepsia and affec- 
tions of the liver, low latitudes are generally unfriendly. Liver com- 
plaints are the bane of a southern climate, and a sallow complexion is 
the inheritance of a southerner. 

Tubercular persons, chilled by our northern climate, are sometimes 
temporarily relieved by the warmer atmosphere of the south. But 
the relief is only temporary ; for, having lost the powSr, as they im- 
agine, to bear the frowns of our northern sky, they are dying, and 
will die anywhere unless they recover this power. And the way to 
retrieve a lost advantage over an enemy, is, not to retreat to a point 
where recovery will be harder, but to meet him at once. If the con- 
stitution cannot bear up against an enemy under the bracing of a 
northern atmosphere, it will be still harder to do so under the wilting 
of a southern. 

After all, the objects aimed at should be change and travelling. 
The exercise involved, the constant exertion required in getting from 
place to place, the agreeable sensations produced by the motion of 
cars and steamboats, the ever varying change of sights and sounds, 
and the constantly increasing stock of one's ideas of men and things, 
— these are what rally the constitution, and open anew the springs 
of life. 

Especially should all journeys for health be taken, if possible, with 
an object in view. Let the consumptive start with the view of see- 
ing the cave of Kentucky, the prairies of the West, tlie great lakes 









1 advan- 
patient, 
loor, the 
ts of the 
3 variety 
(lay, and 
jed. 

subject, 
a mod- 
[ that is 
I, the pa- 
develop 
I runners 
'or he is 
i our cli- 

will not 
y will be 
cted, and 
\ will, in 
I _j'ou its 

sent to a 
md affec- 
iver com- 
plexion is 

ametimes 
th. But 
they im- 
ying, and 
le way to 
,0 a point 
the con- 
ing of a 
le wilting 

ravelling. 
ting from 
aotion of 
I sounds, 
id things, 
springs 

ible, with 
w of see- 
eat lakes 



DISEASES OF THE CHEST. 



255 



of the North, the falls of Niagara, the fortress of Quebec, the Sague- 
nay river, the doctor, who he has reason to think will cure him, — 
anything which he is willing to make exertion to see, and that he is 
sure his eyes will rejoice in beholding. 

I have thus spoken of consumption more at large than of other 
complaints, becarse it is the great disease of the world, and is in- 
creasing with the advancement of civilization. 

Acute Bronchitis. 

This is an acute inflammation of the mucous membrane lining the 
air-tubes in the lungs. , It is generally quite a serious disease. 

Physical Signs. — The sound upon percussion is generally good. 
If there be any (' illness, it is commonly in the lower and back part 
of the chest. This occui-s only in " Capillary Bronchitis." 

The breathing murmurs are sometimes more, sometimes less in- 
tense than natural. Occasionally they are almost extinct. 

In the early stage, sibilous and loud rattles. 

In the more advanced stage, mucous rattle. 

Now and then sub-crepitant rattle accompanies the inward-drawn 
breath. 

General Symptoms. — The disease begins with chills followed by 
fever ; tightness across the chest, difficulty of breathing, hoarseness, 
loss of strength, costive bowels, and a quick and hard pulse. Water 
runs from the eyes and nostrils, and there is a dry, harsh, croupy 
cough. 

After a few days, mucus begins to be raised. This expectoration 
gradually becomes more copious, and is opaque, yellowish, or green- 
ish, and occasionally streaked with blood. This mucus is verj' ropy 
and adheres to the vessel. 

There is more or less pain in the chest ; pain across the forehead, 
which is increased by coughing; and a pale and anxious countenance. 

In severe cases, the tightness across the chest is extreme, with a 
sense of suffocation, causing the patient to call for the opening of 
the windows. There is great diificulty of breathing ; a paleness and 
lividity of the cheeks and lips ; a loud wheezing and rattling in the 
throat, followed by cold sweat, insensibility and death. 

In children the disease comes on like a common cold, attended by 
a sore throat, a great desire to drink, but a disinclination to take 
food. But two or three swallows of drink can. be taken at a time 
for want of breath. The phlegm is frequently vomited up spon- 
taneously. 

Observations. — The loud and sibilous rattles are produced by 
similar causes, namely, the passage of air along tubes whose interior" 
is dry and rough from inflammation, or whose calibre Is contracted or 
altered in form by the swelling of the membrane, effusion upon its 



■»■' 

I: V- ■■' 






m 



DISEASES OF THE CHEST. 



inner surface of a tough, mucous substance, or a pressure upon its 
external surface of tubercles, swollen glands, aneurismal tumors, 
etc. The two sounds differ mainly in the key upon 'which they are 
pitched, — the sonorous, or low-keyed, conihig from the larger tubes; 
the sibilous, or high-keyed, from the smaller, — just as the low notes 
of an organ come from the large pipes, and ihe high notes from the 
small ones. 

. The sibilous rattle has been compared to the chirping of birds, the 
squeaking of puppies, the whistling of air passing through a key- 
hole, etcj; the sonorous, to the snoring of a sleeping person, tlie 
cooing of doves, and the sound of the bass-string of the violoncello 
rubbed with the finger. 

Causes. — It is generally brought on by a sudden cold, by changes 
of the weather, and by inhaling irritating substances. It is a second- 
ary result, too, of scarlet fever, measles, small-pox, hooping cough, 
and the remittent fever of infants. 

Treatment. — In mild cases, give warm balm or flax-seed tea, hot 
lemonade, or other similar drinks, — at the same time soaking the 
feet in hot water, and, on retiring to bed, apply bottles of hot water 
to the feet and sides, to produce sweating. If the bowels be costive, 
some gentle physic, as rhubarb and magnesia, or salts and senna, may 
be taken. 

In the case of infants, an emetic of wine of ipecac, or compound 
tincture of lobelia, should be given, and followed with slippery elm 
and flax-seed tea. The compound tincture of lobelia, with tincture 
of veratrum viride, may be continued for a time as an expectorant. 

In more severe cases, both of adults and children, an active emetic 
is required, — perhaps the compound powder of lobelia is as good as 
any. This must be followed with tincture of veratrum viride, in full 
doses, so as to reduce the pulse at once, and keep it down to the 
natural standard. This is one of the very best articles in this com- 
plaint, and will generally very much lessen its violence and duration. 

If there is much difficulty of breathing, the air of the room must 
be kept moist, as recommended in croup. 

The room should also be kept warm, — decidedly warmer than in 
the case of other fevers. 

A gentle perspiration should be kept up by small doses of com- 
pound tincture of Virginia snake-root, and by frequently bathing the 
surface, or else by tincture of veratrum. 

Mustard should be applied to the chest, and to the soles of the feet. 

The cough may be managed by preparations (104), (106), (110), 
freely given. 

The diet should be confined to barley-water, toast-water, apple- 
water, rice-water, and. a solution of gum-arabic. 



1 upon its 
il tumore, 
[1 they are 
ger tubes; 
low notes 
from the 

E birds, the 
igh a key- 
person, the 
violoncello 

by changes 
18 a second- 
ing cough, 

eed tea, hot 
loaking the 
E hot water 
} be costive, 
senna, may 

• compound 
slippery elm 
ith tincture 
ipectorant. 
ctive emetic 

as good as 
iride, in full 

own to the 
this com- 
id duration. 

room must 

mer than in 

ses of com- 
bathing the 

of the feet. 
06), (110), 

rater, apple- 



mSEASES OK THE CHEST. 



Chronic Bronchitis. 



m 



This is an inflammation of the mucous membrane of the air-tubes, 
which continues a great length of time, without any sudden or re- 
markable changes. 

Physical Signs. — The percussion-sounds are similar to those of 
acute bronchitis. When a bronchial tube is dilated, we sometimes 
have dullness around the '»Led part. 

The breathing murmur w always accompanied by a mucous, sono- 
rous, or sibilant rattle, — sometimes by a subcrepitant. 

When dilatation of the tubes exists, the intensity and duration of 
the sound of the ingoing breath is decreased, — of the outgoing 
increased. 

In this state of the tubes, we also have cavernous breathing, bron- 
chophony, sometimes pectoriloquy, and bronchial or cavernous cough. 

General Symptoms. — A cough is generally present, which is in- 
creased in wet weather, and by every slight cold. This comes on in 
paroxysms ; is generally worse in the morning ; and is relieved by 
raising freely. The matter raised is generally yellowish, but some- 
times whitish and sticky; and in the latter stages is thick, and 
sometimes very much like that of consumption. Indeed, the disease 
often ends in bronchial consumption. • 

Remarks. — The breathing is bronchial or cavernous when the 
dilated portion of the tube is empty; if it contain fluid, the 
mucous rattle will be heard. 

Dullness on percussion will exist if a dilated tube press upon the 
surrounding portion of lung so aa to condense or make it solid. 

Dilatation of the tubes occurs only in chronic bronchitis of long 
standing. Its physical signs are much like those of a cavity in ad- 
vanced consumption. The examiner may learn to distingfuish them 
by considering that in consumption, dullness precedes the cavity, while 
in bronchial dilatations, 'the cavity precedes dullness. 

The dilatation or swelling out at some point of a bronchial tube 
is caused by obstructions to the passage of air through it, — just as 
an India-rubber tube, partially closed up at a given point, will bulge 
out just in front of the obstructed place, when air is forcibly blown 
through it, and just as the left ventricle of the heart enlarges when 
the blood is obstructed in its passage through the aortic valve. 

Causes. — It often occurs as the result of acute bronchitis, and 
also of measles, hooping-cough, etc. But taking cold, and damp and 
changeable weather, are more frequently its causes. It most often 
follows chronic inflammations of the throat, which, being neglected, 
pfradually creep down the windpipe into the tubes, and become very 
ol)stinate in their character. 






m 



DISEASES OF THE CHEST. 




Fio. 94. 



T iment. — Medicinal inhalation is one of the best remedies for 

this complaint. The inhaling powder has, in many cases, great 

efficiency. The dose is about what can lie on a ten-cent piece. It 

should be used once a day, in an instrument represented in the cut. 

This instrument I had constructed for my use. It consists mainly 

of a glass tube and a receiver, — 
the latter being something like a 
tube-vial, pierced with fine holes 
around the lower end. The pow- 
der is poured into the receiver, 
which is placed in the larger tube, 
and twirled between the thumb and finger while inhaling. 

When the powder cannot be easily got down into the tubes in the 
lungs, — as often happens, — the inhalation of medicated vapor will 
do better. If the expectoration be diflicult, the expectorant inhalant, 
described under "consumption," should be used; if the expectoration 
be too profuse and free, the astringent inhalant must be taken. 

The cough preparations recommended for consumption, also (113), 
(112), will be the proper ones in this complaint. 

The daily alkaline bath, and brisk friction, are particularly service- 
able. 

Out-door exercise is almost as necessary in this disease as in con- 
sumption. 

Enlargement oi the Air-Cells. — Emphysema. 

This disease consists in » Tgement of the air-cells, the oblitera- 
tion of their vessels, and the wasting .:f their walls. 

Physical Signs. — Thumping upon the chest gives a clearer and 
louder sound than natural, — one which is tjonpanitic, or drum-head 
like. 

The murmur of the ingoing breath is diminished both in duration 
and intensity, — of the outgoing breath, it is increased. 

Dry, crepitant rattle attends the ingoing breath only; occasionally, 
sibilous rattle. 

Qeneral Symptoms. — Habitual shortness of breath, and very 
great difficulty of breathing, occurring in paroxysms, which cause 
the patient to rush to the open window for air. 

There is generally a cough, and the matter raised is frothy, liquid, 
and mucous, or watery. 

The face has a peculiar dusky color, and the countenance an anx- 
ious, melancholy expression. The nostrils are thick, and the lower 
lip full. The muscles of the neck are large, and the gait of the pa- 
tient is stooping. The strength is wasted in proportion to the diffi- 
culty of breathing. 

Emphysema tends to produce disease of the heart, Brighrs (liseisc, 
and venous congestions in the head. 



DISEASES OF THE CHEST. 



259 



medies for 
ises, great 
piece. It 
n the cut. 
8ts mainly 
eceiver, — 
iiig like a 
fine holes 
The pow- 
B receiver, 
arger tube, 

ibes in the 
vapor will 
Lt inhalant, 
pectoration 
iken. 
also (118), 

rly service- 
as in coQ- 



sema. 

le oblitera- 

clearer and 
drum-head 

n duration 

casionally, 

and very 
hich cause 

thy, liquid, 

ice an anx- 
the lower 
of the pa- 

o the diffi- 

il's disi'i-^i'. 



Observations. — The tympanitic sound is caused by the increased 
luuount of air in the cells. 

The air-cells have lost their elasticity, the air., in a great degree, 
remains in them, — not passing in and out, — hence the absence of tlic 
vesicular nuirmur. 

The crepitant rattle attends the ingoing breath oiily, and is sup- 
posed to arise from the expansion of the lungs which are in a drier 
state than natural. It has been compared to the sound producd by 
blowing into a dried bladder. 

Treatment. — To whatever extent the air-cells are destroyed, to 
that extent, of course, the disease is incurable. It may, however, be 
palliated and relieved to a great extent. 

Generally, bronchitis exists in connection with emphysema ; and 
when this is found to be the case, the remedies for that disease must 
be employed. (370) often is curative. 

The inhalation of tincture of stramonium, in one or two teaspoon- 
ful doses, the same as the alterative inhalant is used, will be useful. 

To be taken internally, an excellent preparation may be made by 
uniting one dram of etheral tincture of lobelia with two drams of 
tincture of ipecac, and two ounces of ammoniac mixture. The dose 
is one or two tablespoonfuls. Half-grain to gi-ain doses of extract of 
cannabis indica are excellent to relieve the difficulty of breathing. 

Tne diet must be very carefully regulated, as overindulgence at the 
table aggravates the symptoms. 

Change of air is often highly beneficial ; but it is impossible to 
predict its effect beforehand in each individual case. 

Swelling of the Lungs. — Hypertrophy of the Lungs. 

This can hardl}-^ be regarded as a disease. It jifenertilly takes place 
in but one lung, and is the result of the inaction of the other. Thus, 
when one lung is diseased, the other has to do the work of both ; and 
being overworked, it enlarges, as the heart or an arm does when very 
much exercised. 

The only treatment required is to eat sparingly, and exercise Avith 
great moderation, so aa not to increase the rapidity of the breathing. 

Pulmonary Apoplexy. 

This is generally the result of a disease of the heart, particularly 
of the mitral valve. 

Physical Signs. — Percussion yields a clear sound, except where 
the en^'orgement of blood is large, and near the surface, — in which 
case, it is dull. 

TLe sound of breathing is feeble or absent over a limited space. 



2eo 



DISEASES OF THE CHEST. 



Bronchial breathing is heard in some places, and bronchophony in 
part, in the same regions. 
Mucous rattle is also heard. 

Observations. — In this disease the small air-tnbes and air-cells are 
the seat of bleeding ; and the blood becoming coagulated here, closes 
these vessels against the entrance of air. This explains the feeble- 
ness or absence of the breathing murmur. 

The fluidity of blood in the immediate vicinity gives rise to the 
mucous rattle. 

Qeneral Symptoms. — These are, difficulty of breathing, tightness, 
and dull pain in the chest. The mucus raised is tinged or streaked 
with blood. The blood raised is darkish, and dirty-looking. This 
last symptom, the dirty look of the blood, is peculiar in tills disease. 

Treatment. — The most important remedy is dry-cupping upon the 
chest. This will often arrest the d'sease at once. Counter-irritation 
by croton-oil is also useful. A free movement of the bowels by a 
preparation containing croton-oil, or elaterium (31), (33), has an ex- 
cellent effect. 

Air in the Cliest. — Pneumothorax. 

This disease consists in the presence of air in the cavity of the 
pleura. Generally, there is also water in the pleural sac at the same 
time ; the water, being the heavier fluid, occupying the lower part of 
the cavity, and the air the upper part. 

Physical Signs. — Tympanitic or drum-like sound over the upper 
part of the side. Dull sound over the lower part. Breathing mur- 
mur diminished or suppressed. Amphoric 1 reathing. Metallic tink- 
ling. 

Qeneral Symptoms. — Great oppression of the chest, and difficulty 
of breathing ; generally attended by palpitation of the heart, and fre- 
quently by severe pain under the breast-bone, on the affected side. 
The patient generally has to remain in the sitting posture, and can- 
not lie an instant on the sound side. 

If, on percussion, one side of the chest sounds louder than the 
other and the breathing murmur is heard distinctly on the side which 
gives only a moderate sound, and is not heard at all on the loud- 
sounding side, we may be sure it is a case of air in the chest. 

Observations. — The metallic tinkling is like the sound produced 
by dropping a pin's head into a metallic dish, or like the distant tink- 
ling of a sheep-bell, or the gentle pulling of the string of a violin. 

It is supposed that when the fluid in the cavity of the pleura hap- 
pens to be higher than the orifice, the air, when it enters at each 
in-drawn breath, forces its way up through the fluid, in the shape of 



DI8EA8K8 OF THE CHEST. 



261 



lO 



phony 



III 



ir-cells are 
here, closes 
the feeble- 

■ise to the 



, tightness, 
r streaked 
ing. This 
lis disease. 

g upon the 
r-irritation 
)wel8 by a 
has an ex- 



'^ity of the 
t the same 
fer part of 

the upper 
hing mur- 
tallic tink- 

i difficulty 
rt, and fre- 
icted side. 
!, and can- 

■ than the 

side which 

the loud- 

JSt. 

produced 
stant tink- 
i violin, 
leura hap- 
^ at each 
B shape of 



bul jlt's, and, bursting at the surface, gives the tinkling sound. This 
sound is sometimeH produced, too, by the failing of drops of liquid 
from the upper part of the cavity, upon the surface of t'^e fluid. 

The amphoric breathing is like the sound produced by blowing 
obliquely into an empty cask. One writer says he heard the same 
sound when out shooting on a rough day, produced by the wind blow- 
ing sideways into the guu-barrel. 

Treatment. — I would recommend the use, two or three times a 
(lay, of the antiseptic inhalant, mentioned under the head of con- 
sumption. 

To this should be added dry-cupping over the whole chest, which 
generally gives great relief. Blisters may also be used. 

Sweating must be encouraged in the manner recommended under 
acute bronchitis. 

For the difficulty of breathing, give half-grain doses of cannabis 
indica, or five-drop doses of tincture of aconite, or one-sixth of a 
grain doses of svapnia. Extract of belladonna, or of stramonium, is 
I'lso worthy of trial. 

Water in the Chest,— Hydrothorax. 

This disease consists in a collection of water in the cavity of the 
pleura. 

Physical Signs. — There is a dull sound over the effusion. 

The breathing murmur is diminished, and gradually disappear 
altogether over the space occupied by the effusion. 

Bronchial breathing is heard in the same part. 

When the amount of fluid is small, egophony is heard in the mid- 
dle regions of the chest. 

Bronchophoi.y is heard when the effusion is larger. 

General Symptoms. — Either upon lying down, or using active 
bodily exercise, the patient finds his difficulty of breathing increased. 
When in bed, he lies with his head and shoulders raised, which, by 
causing the fluid to settle at the bottom of the cavity, prevents, in a 
measure, its pressure upon the lungs, and gives him a little rest. 
His sleep is interrupted by sudden starts with alarm and terror. The 
pulse is hard, the thirst great, the urine scanty and high-colored, and 
has a sediment. After a time the feet swell, the face is pallid and 
livid, and the countenance expresses anxiety and alarm. There is a 
short, dry cough. 

When the quantity of fluid in the chest becomes large, the patient 
cannot lie down at all, and only gets short and disturbed naps in the 
sitting posture. 

Of all the symptoms, the starting in sleep is the most cei-tain sign 
ot the disease. 









)^3i^^d&S^^M^-- 



262 



niSKASKH OK THE 0HE8T. 



Causes. — In some rare cases, this may occur .\n a primary disease, 
— that is, as a disease not dependent U)>on any other m its cause. 
The greater numlwr of cases, however, arc secondary. They arise 
from organic disease of the heart, or liver, or stomach. Inflammation 
of the pleura is a very frequent cause. 

A plethoric, or full state of the systen., predisposes to this com- 
plaint, — particularly in those persons who indulge freely at the 
table. 

It may arise, too, from the striking in of skin eruptions ; from the 
free use of liquors ; and from frequent excessive bleedings or purg- 
ings. 

Treatment. — Dry-cupping is a valuable remedy, and should al- 
ways be practised. 

The chest should be painted with the tincture of iodine, and a 
good degree of substantial soreness be kept up. 

The internal remedies are purges (31), (14), (30), and diuretics 
(123), (129), (130), (131) when the patient is not very weak. 

The iodide of potassium, in doses of five or six grains, once in 
three or four hours, is an excellent remedy. The following is a good 
form of taking it: iodide of potassium, one ounce ; fluid extract of 
pipsissewa, two ounces ; water, half a pint. Dose, one teaspoonful. 

The skin should be bathed and rubbed daily, three or four times, 
with much friction. Tapping the chest should be done when the 
fluid persists any length of time, otherwise a simple hydrothorax may 
become a doubly serious empyema or pus in the chest. 

Pleurisy. — Pleuritis. 

Pleurisy, or pleurisy fever, as it is sometimes called, is an in- 
flammation of the pleura, or the membrane which lines the chest, 
and, at the same time, is folded back so as to cover the outer surface 
of the lungs. 

The pleura, as is elsewhere explained, is a short sac or bag, whose 
inner sides are kept moist, so that they may slide easily upon each 
other as they are moved by the alternate contractions and expansions 
of the lungs in the act of breathing, and whose outer sides are made 
to grow, — one to the inside of the chest, and the other to the out- 
side of the lungs. 

Pleurisy and lung-fever, then, must be kindred diseases, and exist, 
more or less, together. In truth there is almost always some affec- 
tion of the pleura in lung-fever, and some affection of the lungs in 
pleurisy. The pain in Iqng-fever is owing to some inflammation of 
the pleura ; and the appearance of the rusty-colored phlegm in pleu- 
risy indicates that the lungs have been reached by the inflammation 
of the membrane which covers them. 

Physical Signs Flatness on percussion, at the lower part of the 

chest, which ascends as the effusion of water increases. 



II 



. tf.iiii« iiMimtrntin^ummmimmimmimm 



D18EAnE8 OK THR CHEST. 



263 



ly (lisoiiHp, 

itH cause. 

I'hey iiiise 

lamination 

this coni- 
\y at the 

from the 
1 or purg- 

should al- 
ine, and a 

i diuretics 
lyeak. 
LS, once in 
; is a good 
extract of 
aspoonful. 
our times, 
when the 
liorax may 



is an in- 
the chest, 
«r surface 

ag, whose 
3on each 

xpansions 
are made 
the out- 

and exist, 
)me affec- 
lungs in 
mation of 
a in pleu- 
immation 

art of the 



If the efftised fluid is not great, tliere is puerile hreathing at the 
top of the lung. 

Friction sound is heard occasionally in first stage of disease. 

Ego])hony is heard when the amount of fluid in the pl*)UiU is 
small. 

As the amount of water increases, bronchophony appears. 

General Symptoms. ■ — This disease is most frequently introduced 
by shiverinffs, which are soon succeeded by high fever, with a pecu- 
liarly hard, resisting pulse; sharp, stabbinff pain in the side, — gener- 
ally just below the ni[)ple, but sometimes extending to the shoulder, 
arm-pit, and back ; hurried and intelrupted breathing ; and a short, 
dry cough. 

The pain is greatly aggravated by motion, coughing, or an attempt 
to take a long breath. It holds the patient under constant and 
powerful restraint. We find him lying upon his back, or his well 
side; his countenance full of anxiety, — fearing to move, cough, or 
even breathe needlessly ; and often crying out fro»n the keen torture 
these necessary acts inflict in spite of all his caution. 

At a more advanced stage, when the tenderness has somewhat 
abated, he will prefei to lie on the diseased side, as this leaves the 
healthy lung more o c liberty. 

Observations. — The first effect of the inflammation of the pleura 
is to dry up the moisture with.which its inner surfaces are lubricated, 
or made smooth and slippery. As a consequence, these surfaces be- 
come rough, and rub harshly upon each other, and produce a sound, 
in the early stages of pleurisy, like that of rubbing two pieces of wet 
leather together. It may be imitated by rubbing the finger back and 
forth upon a table. It is sometimes a creaking noise, like that of 
new shoes. 

As the disease advances an important change takes place in the 
state of things. Instead of an unnatural dryness, a watery fluid is 
poured out copiously from the inflamed surfaces of the pleural sac. 
This is called the period of effusion. This generally, though not al- 
ways;, relieves the pain. But, by compressing the lung, causes dan- 
gerous difficcl'cy of breathing. 

The air-cells are compressed by the effused fluid, and are not 
penetrated by air. Hence the al)sence of the breathing murmur. 

The pouring out of water between the layers of the pleura, com- 
presses the lung, and removes it from the walls of the chest. Hence 
the dullness or deadness of sound upon percussion. 

When listening with the stethoscope, the voice of the patient 
sounds feeble and interrupted, like the bleating of a goat, and is 
hence termed, egophony, or goat-voice. 

This peculiar voice is heard only when the effusion of water has 
been moderate in quantity, and only a thin layer of liquid lies be- 
tween the ribs and lung. It is caused by the voice passing over this 



264 



DISEASRS OK THE CHEST. 



thin layer, which is thereby thrown into vihratiom, or wav}', quivering 
motions. When thus agitated, the fluid reacts upon the voice, 
making it sharp and tremulous. 

When the effusion has become large, these effects cease ; but an- 
other sign then shows itself, and distinguishes pleurisy from the 
healthy state, and likewise from the solid, hepatized state of the 
lung in lung-fever. It may be discovered thus : 

If the hand be laid flat upon the chest of a healthy person, while 
he is speaking, a vibration or thrill will be left. If, in like manner, 
the hand be laid upon the chest of a person having lung-fever, with 
hepatized lung, this thrill will be found still more perceptible. But 
when the hand is placed over the place of watery effusion on the 
chest of a person having pleurisy, there will be discovered, when the 
person speaks, no thrill whatever. The absence of this thrill, then, is 
one of the very best signs of pleurisy with effusion. 

Persons recover from pleurisy sometimes very rapidly, before effu- 
sion has taken place. It is then said they have had an attack of dry 
pleurisy. When liquid has been poured out, even in considerable 
quantity, it is sometimes reabsorbed, and the patient recovers per- 
fectly. In other instances, it compresses the lungs, interferes seri- 
ously with breathing, reduces his strength, and he sinks rapidly. 

Treatment. — Pleurisy has been divided for description and treat- 
ment into three stages, following the natural events of the inflamma- 
tion. The first stage comprises the period from the first onset to the 
time when effusion commences. The second stage, or stage of effu- 
sion, extends to the time when the liquid begins to diminish ; and 
the third stage consists of the period occupied by the absorption of 
the liquid. 

Should the quantity remain stationary or diminish very slowly 
after the lapse of two or thi-ee weeks, the disease becomes chronic. 

The indication for treatment during the first stage is to arrest the 
progress ( f the disease, to diminish its intensity, to limit the amount 
of morbid products, and to relieve suffering. 

If the patient is robust, has a hard, frequent pulse, accompanied 
with extreme pain and fever, blood-letting is indicated. The abstmc- 
tion of ten to fifteen ounces of blood will give great relief and 
diminish the intensity of the attack ; but if the patient is not seen 
early, and is of a feeble constitution, some other measures should be 
substituted for it. The mass of blood may be lessened by saline 
cathartics, such as the sulphate of magnesia, or the bitartrate of 
potash in combination with jalap. 

The effect of a full dose of Epsom salts is equal to the abstraction 
of a pint of blood from the system. Depletion is obtained this way 
without the impoverishment of the blood. 

The frequency and force of the heart's action may also be affected 
by the nauseant sedatives, such as tartarized antimony and ipecacu- 
aixha, and by the direct sedatives, such as the tincture of aconite and 



M8EA8KB OP THR CHEST. 



265 



iivering 
I voice, 

but aii- 

•oin lilt! 

of the 

Q, while 
manner, 
er, witli 
e. But 
on the 
irhen the 
, then, 18 

ore effu- 
ik of dry 
siderable 
vers per- 
eres seri- 
idly. 

md treat- 
nflamnia- 
»et to the 
B of effu- 
liHh; and 
rption of 

•y slowly 
ihronic. 
irrest the 
amount 

>mpanied 

absti-ac- 

[elief and 

not seen 

[hould be 

by saline 

irtrate of 

3tra.ction 
this way 

affected 
ipecacu- 
lonite and 



nf veratrum viride; therefore, if blood-letting is contra-indicated, the 
tinit thing U) be done is to give the sulphate of magnesia, and follow 
it with some diaphoretic like (130), to alleviate the painful stitch in 
the side "nd to tmnquillize the system. 

It is well to administer salicylate of soda in 10-grain doses every 
three hours till a little ringing is heard in the eai-s, then once in four 
hours. This drug increases the action of the skin anil kidneys and 
overcomes the rheumatic element present in most if not all pleurisies. 
The diet should be dry, all liquids Iwing excluded, that the abstrac- 
tion of water from the chest may be favored. 

Nothing gives so much and such immediate relief to pain as a 
subcutaneous injection of morphine. Aconite also is a valuable 
sedative in this stage. It may be given in half or whole-drop doses 
every fifteen minutes for two hours ; then afterwards a drop, to be 
repeated hourly till some impression is made upon the heart's action. 
Smaller doses are to be given if the pulse becomes feeble. 

In the second stage, if the acute symptoms have yielded to treat- 
ment, as they usually do, the object of treatment is to promote the 
absorption of the fluid. This is done by the judicious use of saline 
cathartics and by diuretics, for the Iwwels and the kidneys are the 
natural pumps of the system. 

The application of counter-irritants is also of use for this purpose, 
such as the tincture of iodine, and small blisters, which are to be 
allowed to remain on till vesication, and then the blister is to be 
dried up and a new one applied. If at any time during this stage 
the effusion is rapid and excessive, so as to endanger life, it is to 
be drawn off by puncturing the chest between the fifth and sixth 
ribs on the side with a small trocar, and the fluid is to be drawn off 
by suction. 

Convalescence commences when the liquid begins to be absorbed ; 
and active medication should then cease, and that course should be 
pursued which will lead to the restoration of the general health. 
This is done by tonics, a nutritious diet, and other hygienic means. 
If the effusion ceases to be absorbed or the process takes place very 
slowly, then that state of things exists which is called chronic pleu- 
risy. Then the main objects of treatment are to effect the removal 
of the fluid, and to develop and sustain the powers of the sjrstem. 
Under these circumstances, it is better to discontinue remedies which 
act upon the bowels and kidneys, at least for a time, and try general 
treatment. This consists of tonics, stimulants, and general exercise 
in the open air, and with this the surgical removal of the fluids from 
the cavity of the chest. 

The operation is now so much improved, and is so safe and simple 
and attended with so little pain, that it has become an every-day 
practice, and an operation which was only resorted to as an extreme 
measure to save life, is now admissible whenever the pleural cavity 
remains filled with liquid, after only a brief trial of the remedies 
assigned to promote absorption. - 



:-\" 



266 



DIHRAHKH OK THK CHR8T. 



Lung Fever. — Pneumonia. 

This diHeoHe, by common uoago, has beon called a fever ; but by 
physicians it is reckoned as one of the infiammationt. It is inflamma- 
tion of thti lungn or liijhU ; and whatever fever there may be results 
entirely from this local inflammation. 

Signs and Symptoms. — A patient suffering with lung fever is 
generally found lying upon his back, with some pain in the side ; 
more or less difficulty of breathing ; a cough, at first dry, but soon 
accompar.ied by raising a thick, sticky, rusty-colored matter, composed 
of a mixture of phlegm and blood. As the disease increases in 
severity, this matter will become more sticky and tenacious, so that 
it will adhere to a spit cup turned upside down. There will be more 
difficulty of breathing, greater prostration, and perhaps some delirium. 

For the purpose of more clearly describing this complaint, it is 
found convenient to divide it into three stages, or degrees of progress. 

First Stage. — This is called the stage of engorgement. The lungs 
during this stivge are engorged or crowded with blood. If we could 
inspect them, we should find the inflamed portion redder, thinker, and 
heavier than usual. We should find them weaker, that is, more 
easily torn than in the natural state ; with less air in them, and con- 
sequently crackling less upon pre.«jure, — yet not entirely destitute 
of air and crackling, and not so heavy as to sink in water. Rapping 
upon the chest at tliis period gives out a flatter, duller, or less hollow 
sound than usual. On applying the stethoscope, we hear less of the 
natural rustling sound of health ; and, either mingling with, or over- 
coming it, we hear a minute crackling sound, as the air passes in and 
out in breathing. 

This crackling has been compared to that produced by fine salt 
tluown upon red-hot coals ; or by that of rubbing a lock of fine hair 
between the thumb and finger near the ear. It is caused by small 
bubbles of air being forced along the moist and sticky sides of the 
small tubes and air-cells. It is heard only while the breath is being 
drawn in. 

Second Stage. — If the inflammation advances to the second stage, 
the swelling of the diseased lung increases so as to force out the air 
entirely, and it becomes solid, and wholly useless for the purpose of 
breathing. In solidity and general appearance, it resembles a piece 
of liver. Hence it is said to be hepatized, or liverized ; and this is 
called the stage of hepatization. 

I As the lung grows more solid, its vitality and strength diminish ; 
it is not near as strong as a piece of healthy liver, though it looks 
like it ; it is soft and easily broken ; indeed it seems to be in a state 
of commencing decay or rottenness. Hen je some writers, in order 
to be more precisely correct, call this the stage of red softening. 



frrrwapitti-.—je^.;^ 



■-s^-fsssmmm^ms^^sn^'- 



DIBBABr,S OF TIIR OIIEBT. 



267 



; but by 
nflamtna- 
te resiulUi 

fever is 
the Hide ; 
but soon 
!omp08ed 
reiVHes in 
I, HO that 
i be more 
delirium, 
lint, it Ls 
progress. 

rhe lungs 

we could 

taker, and 

is, more 

, and con- 

dec'citute 

Rapping 

iss hollow 

ess of the 

or over- 

les in and 

fine salt 
fine hair 
by small 
es of the 
is being 

>nd stage, 
at the air 
irpose of 
!S a piece 
this is 

iminish ; 

it looks 

n a state 

in order 

ling. 



With incrcouefl solidity, there is of course inoreasod dnllneM on 
porcuHsion. When the stethoscope is applied to the (;hest, we hoar 
no sound of air paHsing into and out of the diseased lung; no natural 
rustling, or minute crackling; but in their stead, we have a kind of 
whistling, produced by tlie air passing back and forth in the wind- 
pipe and ita branches, but finding no entrance into the solidified air- 
cells. The breathing sometimes sounds like a sort of puff, — owing 
to the column of air rebounding when refused admission to the 
closed-up cells. 

The general symptoms now increase in severity. There is greater 
difficulty of bFeathing ; the phlegm is more gluey ; perhaps some 
delirium phows itself ; and the patient grows weaker. 

Third S to *e. — At this period, the lung changes from red hepa- 
tization or red toftening to gray hepatization or gray softening, and 
matter is now found diffused through its whole substance. The 
percussion sounds are much the same as in the second stage. On 
listening, wc hear more of the rattling sound produced by disturbed 
phlegm. The matter raised is thinner, — more like liquid ; and 
looks like prune-juice. The symptoms generally indicate that the 
patient is sinking. Patients may recover from the first and second 
stages, but rarely from the third. 

Treatment. — Pneumonitis has been divided into three stages, 
corresponding to tlie inflammatory events of the disease: the first 
stage is that of active congestion, the second, that of solidification, 
and the tliird, that of t lution. The duration of the first stage is 
from twenty-four to forty-eight hours, of the second from two to 
four days, and the stage of resolution lasts from eight to ten days. 
Different cases vary, however, in these times. These different stages 
furnish different remedial indications. 

The objects of treatment in the fii-st stage are to arrest the disease, 
to lessen its intensity, to relieve pain, and to promote toleration of 
the disease. 

When high fever, a hard pulse, and extreme pain are present in a 
robust constitution, the abstraction of blood from the arm is indi- 
cated. These cases are not frequent, for lung fever mostly occurs 
in patients with feeble constitutions, but when practised in the 
proper cases, the relief to pain and embarrassment of breatldng is 
often immediate and marked. In those cases where blood-letting is 
contra-indicated, the same end can be secured, but more slowly, by 
saline cathartics and sedative remedies. After saline purgation, if 
the skin is hot and the pulse is frequent, tartar emetic may be given 
in small doses as a nauseant sedative ; but it must not be carried to 
the extent of distressing nausea. After this follows the use of vas- 
cular sedatives, such as the tincture of aconite and the tincture of 
veratrum viride, if not contra-indicated by the feebleness of the 
patient with a tendency to depression. 



268 



DISEAS7.S OF THE CHEST. 



• Sometimes the sulphate of quinine, in a full dose of from twenty 
to twenty-five grains at the onset, or within eight or ten hours, will 
arrest the disease. It may be well to try it, as it can be administered 
with perfect safety. Opium is of great importance also, to relieve 
pain and tranquillize the system. 

Cold or wai^n applications to the chest may be used according to 
the preferences of the patient. Warm applications act as revulsents ; 
the cold diminishes the determination of blood to the part, and re- 
lieves the pain by obtunding sensibility. Counter-irritants are not 
advisable in that stage. 

The treatment of the second stage aims at the promotion of reso- 
lution of the inflammation, the palliation of the symptoms, and the 
maintenance of the powers of Hfe. 

The tinctures of veratrum viride and aconite may be continued in 
this stage, if there is considemble fever and there is no tendency to 
asthenia ; but the leading measure is to support the system. 

The rational use of veratrum viride, than which there is no better 
drug in Pneumonia, consists in giving five-drop doses hourly till the 
pulse reaches jixty per mii .ute, then just often enough to keep the 
pulse in that neighborhood. 

This course embraces the use of tonics, stimulants, and nutritious 
diet. The use of alcohols is necessary in most cases, and sometimes 
very freely. The diet should consist of milk, farinaceous substances, 
and animal broths. Quinine in tonic doses is the best remedy in 
this stage. 

The preparations of opium are very useful, and only contra-indi- 
cated by the accumulation of mucus in the bronchial tubes. 

Digitalis is useful in five to ten grain doses three or four times a 
day, when it is necessary to increase the heart's action. 

The carbonat" of ammonia is necessary in cases of extreme pros- 
tration. 

The external application of the tincture of iodine is the best 
counter-irritant in this stage. 

During the third stage, all those hygienic measures which improve 
the general health are to be pursued. 

Typhoid Lung Fever. — Typhoid Pneumonia. 

This is an inflammation of the lungs, differing from the preceding 
only in the character of the fever attending it, which is of a low, 
typhoid character. The disease, like typhoid fever, is characterized 
by great debility and prostration. 

Symptoms. — These are a combinat-.on of the symptoms of pneu- 
monia and of typhoid fever. The disease begins mth great weari- 
ness, lassitude, dizziness, pain in the head, back, and limbs. Soon 
there is much difficulty of breathing, tightness across the chest, with 
a dry, short, hacking cough. 



Hmt aHJMMMM I IfcMMWBMi^ W 



DISEASES OF THE CHEST. 



269 



As the disease advances, the active syniptoms pass away ; there is 
a dull pain across the chest ; drowsiness is very apt to come on, with 
the various symptoms of sinking peculiar to typhoid fever. The 
skin is harsh end dry, the temperature uneven, the tip and edge of 
the tongue red, and the middle covered with ,i yellow or brown fur. 
The bowels are tender, swollen, and drum-head like ; while there is 
often a diarrhoja, — the discharges having a dirty-yellow color. 

Treatment. — This should be like the treatment of pneumonia 
and typhoid fever united. 

Great care must be taken not to use reduc' remedies. While 
active 'rging must not be used, yet, if there i*re symptoms of an 
inactive state of the bowels, podophyllin and leptandrin (34), (39), 
may be employed with advantage. 

When there are symptoms of great depression, use tonics (46), 
(48), (50), (63), (60), (64), (67), (73), taking care to keep the 
cough loose by flaxseed, slippery elm, and marshmallow tea, and by 
some external irritant. 



f pneu- 

it weari- 

Soon 

st, with 



Broncho-Pneumonia. 

This is an infectious inflammation, characterized by an exudation 
from the blood-vessels, the formation of new connective tissue, and 
the growth of bacteria. The disease involves the walls of the bronchi 
and the air-spaces surrounding t"he inflamed tubes. It is frequently 
called capillary bronchitis and catarrhal pneumonia. It is the ordi- 
nary pneumonia of children, and is frequently seen in young people. 

It comes on primarily, but is often secondary to measles, whooping- 
cough, etc. 

Symptoms. — In the very young, the only symptoms are fever, 
prostration, and rapid breathing. There is no cough, no physical 
signs, but the disease is, almost ^ ways, fatal within a few da,y%^ time. 

There is a great difference in the invasion of the disease in dif- 
ferent cases, the severer cases being ushered in by one or more con- 
vulsions, by rapid rise of temperature, vomiting, difficulty in breathing, 
and delirium; the milder cases beginning with lower temperature, 
moderate prostration and shortness of breath. 

The height of the temperature is, as a rule, in proportion to the 
severity of the disease. Temperatures of 106° and over are usually 
fatal. The pulse reaches 160 to 170 in adults, and even higher in 
children, — so high, in fact, that it cannot be taken. The respiration 
varies from 40 to 80. Sleeplessness, restlessness, and even delirium 
are frequently present. The face is flushed, the tongue coated, and 
oftentimes diarrhoea and vomiting occur. Cough is usually present, 
and in the ynng the sputum is swallowed. The urine is frequently 
albuminoua and contains casts. 

Between the second and fifth days the signs of consolidatioD and 



270 



DISEASES OF THE CHEST. 



pleurisy appear, i. e., dullness on percussion, bronchial breathing and 
bronchophony with crepitant rattles. 

The duration of the disease in children varies : of the fatal cases 
the majority die within the first fortnight. The cases which recover 
vary from one to chree weeks, though many persist for six and eight 
weeks. The softening and absorption whicii occurs in all pneumo- 
nias that recover occupy a much longer period in broncho-pneumo- 
nia than in lobar pneumonia. 

Many cases of broncho-pneumonia are complicated by cerebral 
svmptoms of convulsions, delirium, stupor, vomiting, etc., even before 
any marked lesions in the lungs appear; as these subside the lung 
symptoms appear. Many cases are protracted for a long time, and 
though they may terminate favorably at last, yet they are apt to run 
into a chronic hardening of the lung \>aich lasts for jears; or they 
recover with a permanent consolidation of the lung. Some die of 
exhaustion. 

Treatment. — The use of hot fomentations and poultices over the 
chest and the administration of small doses of ipecac and aconite at 
short intervals soothe the bronchitis and pain. 

For the cerebral symptoms, phenacetin and the bromides are very 
useful. Aconite and digitalis are usually employed when the pneu- 
monia stage comes on. As a rule stimulants are not required in 
children, in whom the disease most frequently occurs. 

In convaleaence, iron, q "nine, cod-liver oil, oxygen and a change 
of air apj to be recommenaod. 

Other Forms of Lung Inflammation. 

Op the various other forms of lung inflammation which occur, 
mention may be made of pneumonia dependent on Heart Disease ; 
Interstitial Pneumonia, or the formation of new connective tissue 
and obliteration of the air-spaces ; 1 abercular Pneumonia, which is 
caused by the presence of tubercle bacilli ; Acute and Chronic Mi- 
liary Tuberculosis, characterized by the presence of numerous minute 
nodules called miliary tubercles ; Acute and Chronic Tubercular 
Consumption^ Gangrene of the Lung, where a portion of the lung 
has lost its vitality and the germs of putrefaction have entered. 



Asthma. 

Asthma may be defined to be great difficulty of drawing in the 
breath, — coming on suddenly, sometimes gradually, -— accompanied 
with a sense of extreme suffocation, and a desire for fresh air ; con- 
tinuing for a longer or shorter period, and then passing away, and 
leaving the patient a period of comparatively easy respiration. 

Symptoms. — There are sometimes no premonitory symptoms, 
the attack coming on suddenly, and without warnings but more fre- 



DISEASES OF THE CHEST. 



271 



ling and 

»1 cases 
recover 
ad eight 
pneumo- 
pneumo- 

cerebral 
n before 
;he lung 
ime, and 
)t to run 

or they 
e die of 

over the 
conite at 

are very 
he pneu- 
[uired in 

i change 



ih occur, 
Disease ; 

e tissue 
[which is 
Ionic Mi- 
minute 

bercular 

;he lung 

■ed. 



in the 

ipanied 

|iir; con- 

(ray, and 



iptoms, 
Lore fre- 



quently there are, for some days before the onset, loss of appetite, 
flatulence, belching of wind, irritability, languor, chilliness, oppres- 
sion, and drowsiness. The hard breathing generally makes its 
appearance in the night, — quite often at three or four o'clock in 
the morning, when the nervous system is at its lowest ebb. There 
is first a sense of tightness, or stricture, across the chest, which 
seems to expand with difficulty. The patient can no longer remain 
lying down ; he rises up, draws up his kn<>.es, and, leaning forward, 
puts his elbows upon them, and his head upon his hands, and then 
struggles hard to di-aw in his ^-"ath ; which, passing in slowly and 
laboriously, produces a loud jzing sound. Sometimes he feels 
that he must have fresh air, a., rushing to a window, puts his head 
far out, to catch a stirring breeze. The hands and feet are cold, the 
face haggard and distressed, — sometimes a little red and swollen, 
but more generally pale and shrunk, — the body wet with perspira- 
tion, the pulse irregular, feeble, and small, though sometimes not 
disturbed. These symptoms continue for some hours, more or less, 
when the breathing becomes more easy, and there is a little phlegm 
raised, sometimes considerable. This cessation of difficult breathing 
may be complete, or only partial ; and lasts for a longer or shorter 
period, when the attack again recurs. 

Causes. — It is well known that Asthma has its cause mainly in 
the nervous system. The air-tubes are encircled with a series of 
little bundles of fibres, which are, in fact, muscles, and like all other 
muscles have the power of contracting or shortening themselves. 
These muscles, too, like all others, have nerves distributed to 
them ; and when these nerves become diseased or irritable, they will 
become disturbed on certain occasions, and cause these small, circu- 
lar puckering strings to contract and close up, the air-tubes near 
their terminations, very much as the puckerihg-string closes the 
mouth of the work-bag, so that very little air can pass into the air- 
cells, and that little with great difficulty and slowness. When these 
contractions take place, and the air is thus shut off, the result is a fit of 
asthma. This disease may be brought on by any of those states of 
the atmosphere which disturb or irritate the bronchial surfaces, or by 
any of the numerous causes which mysteriously unbalance the 
nervous system. A fit may be brought on by whatever disturbs the 
mind. 

Treatment. — The disease has been regarded as extremely diffi- 
cult of cure. There are certain remedies, however, which have a 
remarkable control over it, and, if skilfully used, will frequently 
bring it to a complete termination, and, even in the worst cases, to a 
state of very great mitigation and improvement. 

Inhalation. — The most important and certain remedy is the use 
of the Alterative Inhalant, described on page 243. 1! have with this 
article alone effected some surprising cures ; yet it is well to combine 



272 



DISEASES OF THE CHEST. 



other treatment with it. I have had several cases of a most distress- 
ing character, — the attacks continuing night and day, — in which 
the inhalation, judiciously administered, has caused the disappearance 
of the complaint within twenty-four hours, and in which no return of 
suffering has occurred for several weeks, and then only in a modified 
form. This remedy should be used four or five times a day. 

Iodide of potassium is a most valuable internal remedy in this 
complaint; indeed, in a certain sense, it is silniost a specific. It 
should be used (prescriptions 101, 138, 140, 151) at the same time 
with the inhalation. The following preparation is a very good 
remedy for this disease : Ethereal tincture of lobelia, two ounces ; 
tincture of asafoetida, one ounce; grindelia, one ounce; iodide of 
potassium, two ounces; simple syrup, four ounces. Mix. Dose, 
from a teaspoonful to a tablespoonful, every hour or two. 

Several other remedies are used for asthma, with more or less 
success, such as electro-magnetism, smoking stramonium leaves, 
burning paper dipped in a strong solution of nitrate of potash, and 
inhaling the smoke, etc., — but none of these have as much value as 
the tTTo remedies first named. 

In as grave a complaint as a severe case of asthma, it is always 
well to seek the aid of a physician. 

Hay-Asthma. — Hay-Fever. 

This is a very troublesome complaint, which seems to combine 
the peculiarities both of asthma and of influenza. Fortunately, it 
ftttacks but few persons, and those only at particular seasons of the 
year, — namely, while hay is in blossom, and during hay-making. 

Symptoms. — These are a combination of the symptoms of the 
two diseases above named. There is great irritation of the eyes, 
with sneezing, and a free discharge from the nose. There is 
tightness across the chest, diflSculty of breathing, and a pricking 
sensation in the throat These symptoms often appear in great 
severity, making the complaint a really distressing one. 

Cause. — This disorder appears to have but one cause, — namely, 
some sort of emanations from the grasses, flowers, etc., while in 
blossom ; which emanations come in contact with the mucous lining 
of the eyes, nose, and throat, producing very great and teasing irri- 
tation. 

Treatment. — One of the best remedies for this troublesome com- 
plaint is to avoid the cause, by removing, during the flowering and 
haying seasor, to some large city, or, still better, close down to the 
seashore, where flowers and hay do not grow. 

Of medicines, the tincture of lobelia, taken in moderate doses, is 
a very good remedy. Quinine and iron, given in combination (75), 
are valuable preparations. Strychnine and nux vomica, in connec- 



W;^Si,^I^S!iS. 



lost distress- 
— in which 
sappearaiice 
110 return of 
1 a modified 
day. 

ledy in this 
speoific. It 
I same time 
very good 
wo ounces; 
i; iodide of 
Aix. Dose, 

lore or less 
um leaves, 
potash, and 
oh value aa 

t is always 



to combine 
•tunately, it 
sons of the 
making. 

oms of the 
i the eyes. 
There is 
a pricking 
.r in gre&t 

— namely, 
1., while in 
sous lining 
easing irri- 

esome com- 
R'ering and 
)wn to the 

be doses, is 
ation (75), 
in connec- 



DISEA8E8 OF THE CHEST. 273 

t V^ .'l'.'" "'"^ "^'° ^ '^Wed in one of thesf solutions, and 

hung about the apartments of the house. The hands and face may 

likewise be washed, once or twice a day, in a weak solution. ^ 

Ihe oxide of zinc and the extract of nux vomica, made into pills, 

ornTtT '^'' ""' '" \^^^ " ^"^ °^ '^' extract to each pill,Cd 
one pill taken morning and evening, should not be forgotten 

m.?oi!^ '"T""' ^T^^ ^y "^^^'^^ °^ '' «^"^«1'« hair brush on the 

aTd'^m-^igr t^lt^ ^°^^' '- ^- "-^ '^ «^-^ ^ P— y^- 

rpJif;/°"T'i!^ formula is the most efficacious of this class of 
reraediBs and should be painted onto the nasal mucous membrane as 
high HP as possible ; its use maybe repeated several times till the 
membrane becomes numb. 

Cocaine 19 

Antifebrin ok 5!* 

Alcohol ... i^f- 

Simple Elixir ...!.' ' tZ' 

Mix and shake before using. 






.W.|!l»^*,.^Jn^^■* 



HEART DISEASES. 



Life rests upon a tripod, — the brain, the lungs, and the heart. 
These are equally important to its we'1-being and continuance. 

In substance, tbe human heart is a bundle of muscles, so put to- 
gether as to bear the greatest possible amount of work. In size, 
shape, and look, it is much like the heart of the hog. I wish it 
never had a likeness to it in its moral nature. 

The heart is enclosed in a case or sac, called the pericardium. It 
lies between the two lungs, a little to the left side of the chest. Its 
point is under the sixth rib on the left Ride, and its lower surface 
rests on the diaphragm, — a horizontal partition between the chest 
and belly. 

The heart is double. It has four cavities, — two for receiving the 
blood, which are called auricles, and two for driving it out, called 
ventricles. 

The venous, or dark blood, is brought from all parts below, and 
emptied into the right auricle through the ascending vena cava, and 
from all parts from above, and pour into the same cavity through 
the descending vena cava. From this it passes into the right ventri- 
cle, which contracts, and forces it through the pulmonary artery into 
the lungs, where it becomes red, and passes into the left auricle 
through the pulmonary vein, thence into the left ventricle, which 
contracts, and throws it out through the great aorta to all parts of 
the body. Fig. 95 gives a good idea of Ijie circulation through the 
heart and lungs. 

The heart is divided into two sides, which are separated from each 
other by a muscular partition, — each side having an auricle and a 
ventricle. 

The auricles have comparatively thin walls, as they are only used 
for reservoirs. The walls of the ventricles are much thicker, being 
used, — particularly that of the left side, — for forcing the blood 
over a large surface. 

Between the auricle and ventricle on the right side, are three folds 
of triangular membrane, called the tricuspid valves. Between the 
auricle and ventricle on the left side, are three valves, called mitral. 

At the beginning of the pulmonary artery, and the aorta, are three 
half-moon shaped folds of membrane, called semilunar valves. 

274 



1 



l t i i i ai»ftii)iiM i wiiwiiiwu»« Mi8ia»teBHia 



B B W iis ^tsr!; 



HEART DISEASES. 



276 



The office of all these valves is, to close after the blood has gone 
through, and prevent its flowing back while the cavity is being again 
filled. They do the same duty, in fact, as the valves of a pump. 

Through this heart, thus constructed, all the blood in the body, — 
about twenty-eight pounds, — passes once in about one minute and a 
half. This is rapid work ; and when we consider that the heart 
works in this way through the whole life, resting not, day or night, 
we cannot wonder that it gets out of order. 



the heart, 
lance. 

so put to- 

t. In size, 

I wish it 



^m&^^ 



irdium. It 

chest. Its 

wer surface 

n the chest 

eceiving the 
; out, called 

below, and 

la cava, and 

ity through 

right ventri- 

artery into 

left auricle 

ricle, which 

all parts of 

;hrough the 

Id from each 
iricle and a 

16 only used 

jicker, being 

the blood 

le three folds 
between the 

ailed mitral, 
fta, are three 

tves. 



12 



FlO. 96.; 

The whole heart is seldom affectefi. The left side is more liable 
to disease than the right. 

Impulse of the Heart. 

The ear, when placed over the heart, feels, at each beat, a slight 
shock. This is felt at the same time the first sound is heard. This 
impulse is caused by the apex or point of the heart being thrown up 
against the ribs by the contraction of the ventricles. It is felt best 
between the cartilages of the fifth and sixth ribs on the left side. 

The Sounds of the Heart. 

On appljring the ear to the chest just over the heart, two sounds 
are heard. The first one is dull and slightly prolonged ; the second 
is a shorter and smarter sound, having a sort of clack. These occur 
in pretty rapid succession, and then comes a brief interval. And this 
round of action, first a long and dull sound, then a short and smart 
one, and then an interval, — called the heart's rhythm, — is repeated 
continually. If the space of time occupied by the rhythm be divided 



276 



HRART DISKA8EB. 



into five parts, the first sound will take about two parts, the second 
one, and the interval of repose, the remaining two, The first sound 
is heard about the time of the contraction of the ventricles, and Ik 
therefore called the 8i/»tolic sound ; the second is synchronous with 
the opening of the ventricles, and is called the diantolic sound. The 
syllables too-to — too-to, very fairly represent the two sounds of the 
heart. These sounds are heard over the largest space in lean 
persons. 

Percussion Sounds. 

If the ends of the fingers be struck upon the cheat over the heart, 
a dull sound will be heard over a space from one and a half to two 
inches square, — beginning at the fourth rib on the left side, and ex- 
tending down nearly to the sixth. The dullness is diminished by 
lying upon the back, and increased by leaning forward, and by taking 
a full breath. The deadness of sound is caused by the heart being 
a partially solid body. The lungs which surround it yield a clear 
sound. 

If a solid substance, as large as the heart, were placed on the in- 
side of a drum, against the head, only a dead sound would be ob- 
tained by striking on that spot ; everywhere else, the sound would 
be louder. • 

Altered Sounds of the Heart. 

These sounds are changed by disease in a variety of ways, both as 
to their character and duration. One or both sounds may be turned 
into a noise like the blowing of a pair of bellows. This is called the 
bellows sound. When this sound is very harsh, it may become like 
the noise of a rasp, or file, or saw. These altered sounds are all pro- 
duced by an altered condition of the valvular passages throucrh 
which the blood passes. If you build an aqueduct of equal dim^;.;- 
sions tliroughout, and smooth on the inside, you may send a certain 
volume of water through, at a given speed, without noise. But if 
you make sudden contractions in the aqueduct, or allow large stones 
to project into it, and then attempt tc send through the same body 
of water, at the same rate of speed, you will hear all sorts of noises. 

Enlargement or Hypertrophy of the Ventricles. 

This is simply a thickening, or an increase of bulk, in the walls 
of the ventricles. The muscles composing the walls of one or both 
of these cavities grow thick and large. 

Physical Signs. — Impulse stronger than natural. When consid- 
erable, it is accompanied with a lifting and heaving of the parts. 
Dull sound on percussion over a larger space. First sound of heart 
prolonged; second sound feeble. The interval of silence, shorter 
than natural. In bad cases, the second sound is nearly extinguished. 



^m^ 



^^^ 



--^^^^' 



HBART DISEASES. 



277 



he secoml 
iret sound 
les, and is 
incus with 
und. Tlic 
ids of the 
B in lean 



■ the heart, 
ilf to two 
de, and ex- 
inished by 
. by taking 
eart being 
Id a clear 

on the in- 
ald be ob- 
iind would 



lys, both as 

be turned 

called the 

icome like 

ire all pvo- 

throuerh 

lal dinivii- 

a certain 

But if 

rge stones 

ame body 

of noises. 

Tides. 

the walls 
ae or both 

en consid- 
the parts, 
of heart 
e, shorter 
inguished. 



Qeneral Symptoms. — Hypertrophy of left ventricle gives a strong, 
prolonged, and tense pulse. I'alpitation more constant than in any 
other disease of the heart. In advanced stivges, the patient is easily 
out of breath. There is a rush of blood to the head on making exer- 
tion or stooping, with more or less throbbing and lancinating head- 
aches, which are aggravated by suddenly lying down or rising up. 
There are vertigo, ringing in the ears, sparks of light and other illu- 
sions before the eyes ; also a purplish, violet or livid color upon the 
cheeks, nose, and lips. In many cases there is a dull, severe aching 
pain in the region of the heart, and extending towards the shoulder 
and the inside of the arm. 

When the riffht ventricle is enlarged, there is a swelling of the ex- 
ternal jugular veins. 

Ca'ises. — The walls of the heart are thickened by overwork, in the 
same way that the blacksmith's arm is made muscular and large. All 
muscles gi'ow in the same way. More action sends more blood to 
them, and this causes an increase of nutrition. 

Whatever interposes an obstacle to the passage of the blood through 
tlie valviilar openings, will cause the ventricles which force it through 
to work harder. Hence, obstructions in the semilunar valves cause 
hypertrophy of the ventricles. 

Any excitement of the mind, or any great exertion, which causes 
the heart to beat harder and faater^ if it be often repeated, will induce 
a thickening of the ventricles. 

Treatment. — First, remove, as far as possible, all causes of excite- 
ment which produce palpitation. If the head is much affected, apply 
wet cups to the back of the neck. The same may be applied over 
the heart. This will generally improve the symptoms at once. A 
blister placed over the heart will likewise make a favorable impres- 
sion. 

The meals should be taken at regular intervals, and should be very 
light The food should be plain and simple, and composed much 
more of vegetable than of animal food. In fact, the diet should be 
80 spare as slightly to reduce the strength. 

The patient should be careful never to take violent exercise, or, 
indeed to be in a hurry about anything. In bad cases, walking up 
hill, or against a strong wind, is often out of the question, and must 
in any case be attempted with great caution. Staircases are to be 
shunned as enemies. An attempt to run, even to avoid being left by 
the cars, might, in some cases, prove immediately fatal. Carriage- 
riding is not objectionable. 

The passions must be held in the most thorough subjection. Ex- 
citements of all sorts are dangerous, and must be avoided. 

For the first week or two of treatment, active purgatives will be 
useful. For this purpose, epsom salts and senna will answer a good 
purpose, and should be used so as to procure two or three watery 
stools a day. 






278 



HEART DIHRASKS. 



Ill addition to this, Homo sedative to lesson the force of the heart's 
action is genemlly needed, especially when there is consideraltle 
palpitation. For this purpose, tincture of black cohosh, and tiiuturc 
of scuUcap, or the former with tincture of digitalis (285), (9-4), arc 
quite useful. Three to ten drops of tincture of the American hel' j- 
bore (venitruni viride) will reduce tlie action of the heart perhaps 
more effectually than any other inodicine, for a. few days or weeks. 

Dilatation of the Ventricles. 

The several cavities of the heart hold about one and a half ounces 
each. Dilatation is simply an enlaryement of these cavities, so that 
they will hold more. And this increase in the size of the cavity in 
simple dilatation is generally at the cost of the walls, which are made 
thinner and weaker, — just as the walls of a bladder are made thinner 
by blowing into it and increasing ita internal dimensions. 

Physical Signs. — Impulse more abrupt, and less marked than natr 
ural. Dull sound on percussion commensurate in extent with the 
dilatation. The first l)eat of the heart, clearer, louder, and shorter 
tiian natural, and more nearly resembling the second. 

Qeneral Symptoms. — Difficulty of breathing; terrific dreams; 
starting from sleep ; swelling of the feet and legs ; purple, violet, or 
blue color of the cheeks, nose, lips, and especially around the eyes ; 
feeble and oppressed palpitation ; various disturbances in the head ; 
bleeding from the nose, stomach, bowels, and womb ; and frequently 
eiUargement of the liver. 

Explanations. — The first sound of the heart is short and not well 
marked, in consequence of the muscular walls of the ventricles in 
this disease being thin and in a weakened condition, so that every 
stroke they make is short, quick, and spasmodic, instead of stron^ 
and lifting, as in hypertrophy. For the same reason, the impulse is 
a brief blow dealt the walls of the chest, which gives a slight shock, 
but has not power enough to lift the chest up. The blow is quick, 
because the muscle is thin and can contrect quicker than a thick one. 

Dilatation, by thinning the walls of the cavities, enfeebles the heart, 
and shows us an obstructed circulation. Accordingly the blood is 
not transmitted by the left ventricle, and being retained in the lungs, 
it causes a crowded state of the vessels, and difficulty of breathing ; 
also congestion of the brain, with terrific dreams, etc. And. this en- 
gorgement of the lungs, being propagated backwards to the right 
heart, great vein j, and all their ramifications, produces dropsy of the 
feet and legs, discoloration of the face, passive hemorrhages, and con- 
gfestion of the brain, liver and membranes. Fig. 95 gfives an idea of 
how all this happens. 

Treatment. — As in many other diseases, search out the causes, and 
remove them. If it be obs^uction of the circulation in the lungs by 



HEART DISEASES. 



279 



the heart's 
iiHidemUe 
id tiiK.tuie 
, (94), aro 
icim hel'a- 
rt peilmpn 
r weeks. 



lalf ounces 
as, 8o that 
) cavity in 
1 are made 
.de thinner 

d than nat- 
t with the 
,nd shorter 

c dreams; 
, violet, or 
the eyes; 
the head; 
frequently 

d not well 
ntricles in 
that every 

of strong 
impulse is 
ght shock, 
V is quick, 

thick one. 

the heart, 
3 blood is 

the lungs, 

jreathing ; 

id. this en- 
the righi 

jsy of the 
and con- 

an idea of 



auses, and 
lungs by 



bronchitis or other complaint, that needs tho first attention. If it Im- 
caused by violent exercise, by sti-ong enrntions of the mind habitually 
indulged, or by drunkenness, or any other irregularity of lift), these 
iiabita must be corrected without delay. 

If it be caused by organic disease of the valves of the heart, relief 
cannot be so readily obtained ; but even in these cases, it is to be 
sought and expected. 

The circulation is to be kept as tranquil as possible by a strictly 
([uiet and orderly life, and a plain, moderate, unstimulating diet. In 
this disease, however, it should be more nutritious, and composed to 
a larger extent of meats, than in hypertrophy. 

In some cases the general health and tone of the system will need 
to be improved by bitters (60), (67), (64), (69), (79), mineral acids 
(60), iron (269), (61), and aromatics (115). The compound mix- 
ture of iron is a good preparation when this mineral is called for by 
a low state of the blood. 

The stomach should be kept in the best possible condition, as a 
very small disturbance of it, even from acidity, will set the heart to 
l)eating very violently. 

If hysterical symptoms are present, tho compound galbanum pill, 
and valerian (97), and other nervines will be called for. 

In attacks of great difficulty in breathing, immerse all the extremi- 
ties in warm water, and throw a blanket around the patient to pro- 
mote sweating, — at the same time admitting fresh air to satisfy the 
desire for breath. Give a draught, composed of ether, camphor, 
ammonia, etc. (1S5). This may be repeated two or three times, at 
intervals of Iialf an hour, or an hour, according to the urgency of the 
case. 

Hypertrophy with Slight Dilatation. 

This is one of the most common complications of heart disease. 
It consists both in a thickening of t le walls of the he-.rt, and an en- 
largement of the cavities, — the f '.rmer being more marked than the 
latter. 

Physical Signs. — Both sounds are louder than in any other dis- 
ease of the heart, and are heard sometimes over the whole chest. 
The impulse is strong and heaving, with an abrupt back-stroke. In 
bad cases, the whole person, and even the bed, is shaken by it. The 
dull sound on percussion covers a large space. 

General Symptoms. — The same as those of the two diseases of 
which it is composed, slightly modified by the action of each upon 
the other. 

Dilatation with Slight Hypertrophy. 

This is an enlargement of the cavities of tne heart, with a slight 
thickening of its walls ; the dilatation being the predominant disease, 
or greater than hypertrophy. 






280 



HIART DIBRA8ES. 



Physical Slffns< — PorcuBHion giveH a dull Hound in the region nf 
the heart, in proportion to it« nize. The first l)eat reHemblcr, the sec- 
ond. The Houond Ixsat is loiidor than natural. 

The impulHe i8 a short, quick stroke, which contrasts strongly with 
the slower and heavior one of hypertrophy and dilat^ition. 

The general Hynijjtoms and the treatment are a modification of 
those of the two disease united in it. It is, however, to be kept in 
mind that the dilatation takes the lead ; and, furnishing the predomi- 
nant symptoms, is specially to l)e regarded in the treatment. 

Aneurismal Tumors of the Heart. 

When, from some obstruction in the valves, the blood cannot easily 
pass out of an auricle or a ventricle, its inner walls may become 
unable to bear the distending force, and giving way, let the blood 
through against the outer coats, which stretch, and swell out into the 
shape of a tumor, — the inside of the tumor becoming a regular sac. 
Such a state of things constitutes an aneurism of the heart. Of 
course it is a very grave disease. 

Softening rf the Heart. 

In this disease the substance of the heart becomes soft, and easily 
broken. It is genemlly the result of some form of inflammation. 

Physical Signs. — The contractions of the heart being weakened 
by softening, the impulse is reduced in force, and both beats are 
weaker, and often they are intermittent. The first beat becomes 
short and flapping, like the second. 

Qeneral Symptoms. — A quick, feeble, small, and faltering pulse, 
great anxiety, and a disposition to faint. General languor ; a sallow, 
bloodless, withered complexion, with a purple, livid tint of the lips 
and cheeks, and frequently, general dropsy, from the inability of the 
heart to propel its contents. 

Treatment. — When accompanied by acute inflammation, softening 
is to be treated on the same principles as inflammation of the heart- 
case. 

If it be a result of chronic inflammation, it calls for iron, bitters, 
nutritious animal food, and good air. 

Induration of the Heart. 

The muscular substance of the heart sometimes undergoes a hard- 
ening process. It is occasionally so much hardened as to sound, 
when struck, like a hollow horn vessel. The disease is rare. 

It increases the heart's impulse, like hypertrophy ; and it requires 
about the same treatment as that disease. 



i!c4*!:'.\V.av 



HBART DI8EA8IS. 



28t 



region of 
:5 the sec- 

mgly witli 

ication of 
le kept in 
3 predomi- 
t. 



mot easily 
ly become 
the blood 
it into the 
jgular sac. 
leart. Of 



and easily 
oatioD. 

weakened 

beats are 

: becomes 

ing pulse, 
a sallow, 

if the lips 
ty of the 



Hoftening 
16 heart- 

n, bitters. 



38 a hard- 
to sound, 

3. 

; requires 



Fatty Degeneration of the Heart. 

The heart HometinicH Iwconies overloaded with fiit, which in depos- 
ited between the hearUcuse and the mu8(;iihtr Huljotiince, — covering 
the organ all over externally, and in some cases penetrating to some 
depth into its sulmtance. The muscular walls themselves become 
thin and flabby. 

Symptom*. — The sounds of the heart are diminished, — especially 
the first. The pulse is irregular. Pain, and a feeling of oppression 
in the region of the heart, with general signs of retarded circulation, 
such as congestion of the bnvin and liver. There is occasiouall} "d- 
diness, loss of meuiory, and i iilpitation. 

Treatment. — Exercise, mental excitement, and stimulating drinks 
must be avoided ; and the patient must live for one or two yeare on 
a very light diet, takiug but very little auimal food. 

Bony and Cartilaginous Productions in the Heart. 

Tfiese productions in the heart are fortunately rare. Yet they 
occur; and the point of the heart, in its whole thickness, is some- 
times changed to cartilage. The ventricles are sometimes so ossified 
as to resemble the bones of the head. 

The symptoms of these degenerations are . obscure ; and as such 
cases are not curable, it is ol less consequence that we should Ikj able 
to know their precise nature during the life of the patient. The 
treatment can only afford temporary rel' ', and should be such us is 
prescribed in other heart-diseases with similar symptoms. 

Shrinking of the Heart. — Atrophy. 

The heart, liko any other muscle, is liable to defective nutrition, 
and in consequence of it may become Rmall. It shrinks, in some 
cases, to the size of an infant's heart. 

The complaint is generally caused by whatever reduces the general 
flesh, as consumption, diabetes, chronic dysentery, cancer, and exces- 
sive loss of blood. 

It can hardly be called a disease. Persons who have it are less 
subject to inflammatory diseases than others, though they faint from 
slight causes, &n<} have nervous affections. 

Treatment. — If its causes can be discovered, treait them; if not 
the treatment should be the same as for dilatation. 

Acute Inflammation of the Heart-Case. — Pericarditis. 

The pericardium, or heart-case, is a membranous sac, in which 
the heart is contained. It is composed of two layers. The outside 



••■ , 



282 



HEART DISEASES. 



m 



m 



one is fibrotis, dense and white ; the inside one is serous. The serous 
liiyer forms the lining of the fibrous one, and then is reflected over 
the heart and the roots of the large blood-vessels. 

When the pericardium becomes acutely inflamed, it thi-ows out 
both lymph and serum or water. The lymph often causes the two 
layers of the sac to grow together. 

Physical Signs. — The impulse is strong when the effusion of water 
is small, — feeble and unequal when it is large. Percussion yields a 
dull sound in proportion to the amount of fluid in the sac. 

When listening with the stethoscope, a rough noise is heard, resem- 
bling either the rasping of wood, the grating of a nutmeg, the rustling 
of silk, or the crackling- of parchment. Sometimes it is softer, like 
the blowing of a pair of bellows. Occasionally it resembles the 
creaking of a new shoe-sole, or has a low creaking, like the tearing 
of linen cloth. 

When there is effusion, the ordinary beats of the heart sound dull 
and distant. 

General Symptoms. — Acute inflammatory fever, generally pre- 
ceded by chills, with pungent pain in the region of the heart, shooting 
to the left shoulder-blade, shoulder, and up: -^r arm. 

Pain increased by taking a full breath, by stretching the left side, 
by percussion, and by pressure between the ribs over the heart. 
Sometimes the pain is in the epigastrium, or left hypochondrium. 
Inability to lie on the left side. 

Explanation. — The noises mentioned above are produced by the 
rubbing together of opposite surfaces of the heart-case, made rough 
by the exudation of lymph. The rasping is supposed to be caused 
by firm and rugged lymph ; th« rustling and creaking, by soft and wet 
lymph; the bellows muiinur, by soft and dry lymph; the creaking, 
croaking, and crackling, by drg, tough lymph. These sounds may all 
be imitated by rubbing a damp finger upon the back of the band, 
while listening with the stethoscope applied to the palm. 

Chronic Inflammation of the Heart-Case. 

When acute pericarditis runs for more than ten days or a fortnight, 
it becomes chronic. It is chronic from the beginning, when it runs a 
slow, insidious course, without marked or violent symptoms. 

The symptoms are much the same in kind with those of the. acute 
form, only less in degree. This low grade of the sjmaptoms of the 
disease renders it more obscure than the acute. 

Treatment. — In the acute form of the disease, apply wet cups 
over the region of the heart, or apply from a dozen to forty leeches 
to the same parts. 

At the same time, move the bowels freely by an injection (247), 
or by a purgative pill (31). 



HEART DISEASES. 



283 



The strength and amount of the remedies employed in each case 
must be in proportion to the vigor of the patient's constitution. 

It is of great importance that the treatment should be active and 
prompt, and that the disease should be broken down early. 

Diluent, cooling drinks (112), (129), (298), (299), should be al- 
lowed as freely as the patient desires, in order to dilute the blood, 
and render it less stimulating to the heart. 

At the same time, five to fifteen-drop doses of tincture of veratrum 
viride should be given every hour, to bring down the action of the 
heart. Ten-drop doses of tincture of digitalis every four hours are 
good. 

Let the diet be wholly of barley-water, thin gruel, weak tea, or 
arrow-root. 

During recovery, the diet must be spare, and the greatest tranquil- 
lity of mind and body be preserved. 

In the treatment of chronic cases, when the cavity appears to con- 
tain fluid, counter-irritation is suitable. Blisters, croton-oil, the com- 
pound tar-plaster, and especially the tincture of iodine. The diet 
may be a little more nutritious than in the acute form of the disease, 
— embracing light animal food and broths. 



(247), 



Inflammation of the Heart. — Carditis. 

This is an infl> mmation of the muscular substance of the heart. 
When existing alone, it is a very rare disease. Being mixed up with 
other forms of heart disease, it does not require any separate account 
of ite symptoms or treatment. 

Acute Inflammation of the Lining of the Heart. 

Bhdocarditis. 

The heart is one of the citadels of life. Disease attacks it on all 
sides. In this complaint, it has entered the fort and taken possession. 
The inflammation is on the lining membrane. 

Physical Signs. — The impulse is violent, abrupt and regular, as 
long as the circulation through the heart is free, but when this is im- 
peded, it is at first a confused tumult (which generally happens when 
a fort is first taken), and gradually sinks to a feeble flutter. 

The dull sound upon percussion covers a space of from three to 
seven square inches. 

The beats of the heart are generally accompanied or marked by a 
bellows murmur, the loudness of which depends on the strength 
of the heart's action. 

General Symptoms. — Inflammatory fever. The action of the 
heart being generally violent and abrupt, the pulse corresponds with 
it, and is strong, full and hard. 



284 



HEART DISEASES. 



Explanation. — The bellows sound is supposed to depend on the 
inflamed and swollen condition of the valves. 

The dullness on percussion will be slight when the circulation 
through the heart is free ; — more distinct and marked when it is 
obstructed. 

Dr. Hope says the disease may be anticipated, if a person be »M(/- 
denly attacked with these three signs : namely, fever, violent action 
of the heart, and a murmur which did not exist before. 

This disease, like inflammation of the hearlrcase, is often produced 
by, and is intimately connected with, acute rheumatism, and is then 
to be treated on same principles as rheumatic disorders. 

Chronic Inflammation of the Heart's Lining:. 

Physical Signs. — The impulse more perceptible and diffused than 
natural. 

The dull sound upon percussion covers a .space of from four to 
eight square inches. 

There is a sawing, rasping, or filing sound. This sound may cover 
one or both beats of the heart. Sometimes these unnatural sounds 
are double ; in which case, the first is caused by an obstruction to the 
natural flow of the blood forward ; the second, by the regurgitation 
or retrograde flow of the blood from some defect in the valve, — just 
as a pump-valve may get out of order, and allow the water which 
has gone through to flow back. 

Explanation. — A variety of organic changes occur in the valves, 
which give rise to the murmurs. Inflammation of the lining mem- 
brane of the heart reaches the valves, causing puckering, thickening, 
vegetative, cartilaginous, bony and ft,t-like degenerations, which oh- 
ttruet the blood in its onward flow, or prevent a closure of the valves, 
and allow it to flow back ; the former causing the first sound, the 
latter the second. If the unnatural noise be synchronous with the 
first beat of the heart, it implies disease in either set of the semilunar 
valyes, or an impossibility of closing the auriculo-ventricular open- 
ings ; if it accompany the second beat, it signifies that either set of 
the semilunar valves may be open. 

A murmur attending the first beat of the heait must be caused by 
a current of blood from a ventricle ; one attending a second sound, 
by a like necessity, is produced by a current into a ventricle. • 

Treatment. — The same as that for pericarditis. It should be 
equally prompt and vigorous. It must not be forgotten that this dis- 
ease leads to various organic diseases of the valves of a very grave 
character, and that such mischiefs can only be escaped by cutting the 
disease short in the very beg^inning. 



HEART DISEASES. 



285 



id on the 

irculation 
rhen it is 

n be gud- 
int action 

produced 
.d is then 



ning. 

'used than 

n four to 

may cover 
al sounds 
tion to the 
urgitation 
ve, — just 
,ter which 

be valves, 
ling mem- 
xickening, 
which 0^ 
he valves, 
ound, tlie 

with the 
iemilunar 

ar open- 
ler set of 

laused by 
sound, 

lould be 
this dis- 
sry grave 
tting the 



Disease of the Semilunar Valves. 

The inflammation of the lining of the heart makes sad work with 
the valves. The semilunars are subject to various changes in their 
structure. 

Physical Signs. — Obstructive Murmur. — In disease of the semi- 
lunars, the firat beat of the heart is accompanied or obscured either 
by the bellows murmur, or a sawing, rasping, or filing sound. The 
unnatural murmur, whatever it is, appears superficial or near. The 
second beat is natural. 

When the opening into the aorta is contracted, or in any way ob- 
structed by unhealthy growths, so that the blood is subjected to more 
than a natural degree of friction in passing, this sound will be heard. 
It is called obstructive, because it arises from the obstruction of the 
blood in its forward course. 

Regurgitant Murmurs. — First beat of heart natural. Second 
beat accompanied or replaced by bellows murmur. There is some- 
times a musical murmur. 

Explanation. — The regurgitant murmurs arise from the valves 
being too small, or defective in some way, and allowing the blood to 
flow back through the orifice. 

This murmur is loudest opposite the semilunar valves, and is more 
audible above these valves than below them. 

When the aortic valves are contracted or shortened, and the open- 
ings are not guarded by them, so as to prevent the backward passage 
of the blood, there is a double bell vs murmur, — one when it is 
driven through the orifice, and another when it flows back. 

Disease of the Mitral Valves. 

Physical Signs. — Obstructive Murmur. — First beat of heart 
natural. Second beat accompanied or replaced by bellows murmiir. 

Regurgitant Murmurs. — The first beat of the heart accompanied 
by a ioud and rough bellows murmur. This sound is like sawing or 
filing. It is loudest above or below the nipple, between the fourth 
and seventh ribs. There is occasionally a musical murmur. The 
second beat of the heart is natural. Sometimes there is a purring 
tremor. 

General Symptoms of Valvular Disease. — Cough, in many cases 
with watery expectoration ; difficulty of breathing ; frightful dreams 
and starting from sleep ; congestion of the lungs ; expectoration 
stained with dark and grumous blood ; swelling of the jugular veins ; 
a livid look of the face ; a feeling as if a cord were tied tight around 
the lower part of the chest ; general dropsy, of the legs and feet in 



286 



HEART DISEASES. 



particular; passive hemorrhages from the mucous membranes; en- 
gorgement of the liver and spleen ; congestion of the brain, with feel- 
ings of oppression. When the mitral valve is contracted, admitting 
regurgitation, the pulse is small, weak, irregular and intermittent. 
These are the worst symptoms of an advanced stage. 

Explanations. — The examiner will distinguish the various sounds 
thus: 

The murmurs generated at the origin of the arteries spread their 
sonorous currents upwards along these arteries' 

Those produced in the auriciilar orifices will be conducted into the 
auricles, and propagated downwards towards the apex of the heart. 

Which Set of Valves. — To learn in which set of valves it origi- 
nates, therefore, find its seat, and trace its direction. 

Finding the murmur to be in the aortic orifice, it is then known to 
be obstructive, if the first sound is morbid, and the second sound natu- 
ral ; and regurgitant, if the first sound is natural, and the second sound 
morbid. 

But if the murmur be in the mitral orifice, it is obstructive when the 
first beat of the heart is natural, and the second beat morbid ; and re- 
gurgitant when the first beat is morbid and the second beat natural. 

The Pitch or Key of a murmur depends on the distance of its seat 
from the ear of the listener, — nearness giving a high, and distance a 
low key. Thus, a murmur seated in the orifice of the pulmonaiy 
artery, being nearer the surface, has a higher pitch than any other. 
It is on about the same key with a whispered «, — sometimes a little 
lower, and depending somewhat on the strength of the current of 
blood, a strong current elevating, and a weak current depressing the 
tone. 

The mitral orifice is situated opposite the junction of the cartilage 
of the third rib with the left side of the breast-bone. The aortic 
orifice is about half an inch to the right of this, and the same dis- 
tance lower. It is known by the key being lower, — about like a 
whispered r, which is the ordinary type of thr .awing sound. 

Murmurs from pulmonic and aortic regurgitations are about two 
tones lower, in consequence of the currents of the blood being weaker. 
They are like whispering awe by inspiration and if the click of the 
valve be heard, the sound will be changed to paw. 

Murmurs in the mitral valve, being more deeply seated, are about 
four tones lower, and are like a whispered who. 

The tricuspid murmurs are higher than the mitral, because nearer 
the surface. 

The musical murmur has been compared to whistling, the cooing 
of a dove, and the mewing of a kitten. It generally results from re- 
gurgitation. 

The purring tremor is caused, generally, by regurgitation through 
the mitral valve. 



MMI 



mm 



HEAKT DISEASES. 



-> 287 



anes ; en- 
with feel- 
idmitting 
littent. 



U8 sounds 

•ead their 

d into the 
heart. 

i it origi- 

known to 
mnd natvr 
mid sound 

'e when the 
I; and re- 
itural. 

of its seat 
distance a 
julmonaiy 
any other, 
les a little 
jurrent of 
•essing the 

cartilage 
'he aortic 
same dis- 
tut like a 

4. 

tbout two 
g weaker, 
ik of the 

I are about 

Ise nearer 

|ie cooing 
from re- 
through 



Other Symptoms Explained. — The difficulty of breathing, fright- 
ful dieama, congestion of the lungs, hemorrhages, engorgements, etc., 
mentioned above, all proceed from such valvular stiffenings, pucker- 
ings, ossifications, enlargements, and contractions, as occasion a decid- 
edly obstructed circulation. 

The small, weak, irregular, and interrupted pulse, is caused by con- 
traction of the mitral valve, which occasions an insufficient or irregu- 
lar supply of blood to the ventricle, and causes the ventricle, by losing 
the resistance of the valve, to expend its force in a backward as well 
a forward direction, thus sending but little blood into the arteries. 

Treatment. — The tendency of valvular disease is to produce hyper- 
trophy and dilatation. The strong and ceaseless efforts of the ven- 
tricle to drive the blood through an orifice obstructed by valvular 
disease, will of course make the walls grow thick, which is hjrpertro- 
phy ; and at the same time, the accumulation of blood which cannot 
be driven forward fast enough, must tend to swell and enlarge the 
cavity, — which is dilatation. 

The great object of treatment, therefore, is to diminish the force 
and activity of the circulation, — to induce the heart to cease striving 
to do what cannot be done. 

To accomplish this, give sedatives (285), (94), (124). The helle- 
bore and cohosh will be found particularly serviceable. 

The tincture of the American hellebore is about the best of 
all. Purgatives may be given according to the strength of the 
patient. 

When there is dropsy, and a scanty secretion of high-colored urine, 
diuretics, or medicines to increase the action of the kidneys, are very 
important. For this purpose, digitalis and acetate of potash (130) 
are excellent. Should this not succeed in reducing the dropsy, an 
active purgative (31) may accompany it. 

Diaphoretics, or medicines which promote perspiration, are also 
useful. This opening of the skin, however, is generally brought 
about by the hellebore, etc. (124), (358). 

The diet should be unstimulating, and yet should be sufficiently 
nourishing to prevent the patient from running too low. Animal 
food of the most digestible kind may be taken once a day ; though 
there are many cases requiring its entire rejection. 

The passions should be kept in the most perfect subjection, and 
the life should be as tranquil is possible. Nothing must be done in a 
hurry. 

Water in the Heart-Case. — Hydropericardium. 

This disease is common as an attendant of general dropsy. 

Physical 5igns. — The impulse is undulatory, as if transmitted 
through a fluid, and it is not always of the same strength. 

The dullness extends upward in a conical form, in proportion to 






288 



HEART DISEASES. 



the amount of fluid, — sometimes rising as high as the second rib. 
The impulse does not coincide with the first beat of the heart. 

General Symptoms. — The patient has a sensation of tw- heart 
heintj in afioathuf state. The pulse is small, frequent, and intermit- 
tent. 

Explanation. — The reason that the impulse does not occur at 
the same time with the first beat of the heart is, that the apex does 
not immediately strike the walls of the chest, — some time being re- 
quired to push it up through the fluid. 

The l)eat8 of the heart sound more distant than natural in conse- 
quence of the organ being pushed away from the walls of the chest 
by the fluid. 

Palpitation. — Nervous Palpitation. — Ansmic 

Palpitation. 

There is a great deal of palpitation of the heart dependent on 
dyspepsia, hypochondria, hysterics, mental agitation, excessive study 
with deficient sleep, venereal excesses, and masturbation. 

Palpitations likewise occur from what is called anaemia, or a low 
and deficient state of the blood. 

Physical Signs. — The impulse is weak, fluttering, or tumultuous, 

— generally increased by trifles. 

The beats of the heart are increased in frequency, and sometimes 
marked by intermission. Now and then they are accompanied by a 
bellows murmur. There are musical murmurs in the jugular veins, 

— loudest a little above the collar-bones. 

General Symptoms. — The complexion is generally pallid and 
bloodless ; the li[>s and the inside of the mouth partaking of the 
same paleness; the pulse quick, small, weak, and jerking; and during 
palpitation it sometimes has a thrill. Slight causes produce breath- 
lessness and faintness. A dislike of animal food, and a fondness for 
acids. The monthly discharge in females is deficient, and the whites 
take its place. Sometimes the menses are too profuse, lasting for 
several days, and consisting only of blood. In this state of things 
there is great feebleness both of mind and body, with rushing noises 
in the ears. 

Explanations. — The murmurs depend on a lack of blood. The 
conditions of their existence are, thinness of blood, a swift and spas- 
modic circulation, and particularly an unfilled condition of the blood- 
vessels. A brook is the more babbling in proportion as its water is 
more shallow. It is a law in physics, that heaviness of freight gives 
steadiness of motion ; and lightness of freight gives unsteady motion. 
The fireman's hose trembles and vibrates when only half full of 
water. In like manner the blood-vessels are agitated when imper- 
IVctly filled. 



II 



HEART DISEASES. 



289 



jond rib. 
rt. 

tw. heart 
intermitr 

occur at 
pex does 
being re- 
in conse- 
the chest 



emic 

ndent on 
ive study 

or a low 

oaultuous, 

jometimes 
nied by a 
liar veins, 

)allid and 
ng of the 
nd during 
ce breath- 
ndness for 
the whites 
asting for 
of things 
ling noises 

ood. The 
t and spas- 
the blood- 
ts water is 
eight gives 
tdy motion, 
alf full of 
[ie» imper- 



Treatment: — This is to be governed altogether by the cause of 
the trouble. If it be dyspepsia, hypochondria, hysterics, etc., these 
several diseases require their usual treatment ; when they are cured, 
the palpitation will stop. 

But when it is caused by alow state of the blood, then give for 
several weeks, iron, the compound mixture, and (316), (310). 

The food must likewise be nourishing, — tender meat, beef and 
mutton, with broths, etc. 

Gentle exercise will be required, and much exposure to a bracing 
out-door air. 

Neuralgia of the Heart. — Mgina Pectoris. 

This is a strictly nervous disease. It begins with a sensation of 
pain and constriction in the region of the heart. This pain is accom- 
])iinied with more or less pain and numbness in the left arm. In 
females it is not uncommon for it to be attended by great sensitive- 
ness and pain of the breasts. When the attack is violent, the pain 
in the heart is excruciating, and even terrific. There is attending 
this a feeling of great oppression in the chest, amounting, in the 
worst cases, to a seiise of suffocation. The heart palpitates violently, 
the brain is oppressed, and f^rinting sometimes occurs. 

The disease is brought on, in nervous subjects, by over-excitement 
of the heart. Walking up hill, against a strong wind, may bring it 
(in. If walking at the time of the attack, the patient is compelled to 
stop, and stand still till the pain subsides. 

The disease is often connected with organic changes in the heart's 
structure, such as ossifications and other alterations. 

Treatment. — When the complaint depends on organic disease 
of the heart, the treatment must be directed to the cure of these 
diseases. 

To relieve a severe attack, the patient should be instantly placed 
in a quiet position ; wind in the stomach, if present, should be ex- 
pelled by peppermint or anise water, or ether, or (115), or some other 
aromatic. If there is acidity or sourness of the stomach, it must be 
corrected by a teaspoonful of soda in half a tumbler of water ; and 
if the stomach be full of undigested food, let the patient take a table- 
spoonful of ground mustard, stirred up with a teacupful of warm 
water. This will cause almost instant vomiting. 

These things being done, give some quieting or antispasmodic 
medicines, or one of the following prescriptions : (285), (97), (136), 
(124). Inhale 5 drops of nitrite of amyl on a cloth frequently. 

Greav relief is often obtained by sending a current of magnetism 
through the region of the heart, by applying one pole of the machine 
in front, and the other upon the back. 

During the intervals, the general health is to be improved by a 
wholesome, nourishing diet, gentle outrdoor exercise, and a careful 



^m^' 



290 



HBAllT DISEASES. 



control of all the passions. ,U of a grain of nitro-glycerine every 
hour, while in pain, steadies and slows the heart. 

Polypus of the Heart. 

A PORTION of the fibrin sometimes separates from the blood in 
the heart and large vesaels, and becoming more or less organized, 
forms polypuses, which fill the cavities to which they are attached, 
and seriously obstruct the circulation. 

Physical Signs. — When the pulsations of the heart, previously 
regular, become suddenly anomalous, confused, and obscure, so that 
they cannot be analyzed, we may suspect a polypus. 

aeneral Symptoms. —A sudden and great aggravation of the bad 
breathing, without any visible cause, — the patient being in agony 
from a sense of impending suffocation, and tossing about from side 
to side, struggling for breath. The pulse small, weak, irregular, in- 
termittent, and unequal; the surface and extremities cold; the face, 
livid, — to which there is generally added nausea and vomiting. 

Treatment. — When the polypus is once formed, the case is hope- 
less. The treatment, therefore, can only be preventive. 

The chief things to be done are, to keep the patient in a state . t 
entire tranquillity, and to bring the circulation to the surface, by keep- 
ing the skin warm, and excited by friction. This will call the blood 
away f.ora the heart and great vessels, and lessen the chances of the 
polypus. 

Displacements of the Heart. 

The heart may be misplaced from birth. I have seen a case in 
which it lay upon the right side, and had always been in that posi- 
tion. Its action was natural. 

A variety of causes may tend to push it out of its place, as water 
in the cavity of the pleura. In such cases, it will return to its place 
when the water is drawn off or absorbed. 



m ' ' ! S^,r ^^' :\'m^J ' ^^^^^IMl>^!i^LS ' -&'^ S!r£^ 



wsmr^ 



ne every 



blood in 
n'ganized, 
attaciied, 

)reviou8ly 
e, so that 



of the bad 
in agony 
from side 
egular, in- 
; the face, 
liting. 

Be is hope- 

a state «f 
ic, by keep- 
. the blood 
ices of the 



•c :! 



a case in 
that posi- 

e, as water 
bo its place 



m-^ 



PI 7 




THE INTERNAL ORGANS OF THE HUMAN BODY. 



PI 7 



DISEASES OP THE ABDOMINAL CAVITY. 



Undkb the above head I shall consider most of the diseases which 
occur in the great cavity below the diaphmgm, called the abdomen 
or belly. These affections are quite important, and make up a con- 
Hiderable part of the ills we suffer from disease. 

Before speaking of these diseases, however, I will call the reader's 
attention to a profile view of the 
relative position of the several or- 
gans lodged in this cavity. 

In Fig, 9G, L is the liver, S the 
Htomach, C the colon, R the rectum 
l\ the bladder, P D the pancreas, 
and I the intestines. The double 
lines, folded back upon each other, 
and surrounding most of the or- 
gans, represent the peritoneum^ a 
membrane which lines the g^at 
cavity of which I am speaking. 

It will be well, too, before pro- 
ceeding further, to make the reader 
acquainted witli the names of cer- 
tain regions of the abdomen which 
he will find constantly spoken of 
in medical books. I have not 
used these terms much in my 
Ixjok ; but it will be convenient 
to be acquainted with them. Phy- 
sicians who are careless in their 
readings are not always familiar 
with their exact locality. 

In Pig. 97, the abdomen is di- 
vided into nine different regions 
by the drawing of two parallel lines up and down, 2, 2, and 8, 8, 
and two lines across, 4, 4, and 1, 1. This gives three regions above, 
three in the middle, and three below. 

In the upper row, 6 is the epigastrium or epigastric region, in which 
are the left lobe of the liver, and a portion of the stomach ; 6, on the 

291 




FlO. 96. 



r 



202 



niSFARKS OK TIIR AnDOMINAI. CAVITY. 



1 




FlO 97. 



right side, is the right hi/poi'liondrium, in which is Um rijjlij, |oIh> of ilm 

livor ; iiiul f), mi tho h-t't Hidt;, is the lejt 
hjipochondriumy which coiitniiis tho sphuMi, 
and 11 portion of this Htomach and liver. 

In the nii(Ullo row, 7 is tlio umbilical 
m/ion, which contains tho small intestines. 
On the right side, H is the rif/ht lumlxv 
reyion, which holds tho right kidney and 
tho ascending colon ; and 8, on tho left, is 
the left liimliar re/jion, whi(!h contains the 
left kidney and the descending colon. 

In tho lower row, 9 is tho hi/pot/agt n'tim 
or hi/pof/astrio rej/ion, which contains h 
portion of the small intestines and hladdci . 
On the right, 10 is the riffht iliac fima, 
containing tho cceeiim or caput coli ; iiiul 
10, on the left, is the left iliac fossa, con- 
taining the sigmoid flexure. 
And now I may as 

well present, in Fig. 98, 

a front view of many of 

the organs, both in the 

chest and abdomen: 1, 1, 

1, 1, are the muscles of 

the chest ; 2, 2, 2, 2, the 

ribs; 3, 8, 8, the upper,/ 

middle, and lower lobes] 

of the right lung; 4, 4,1 

the lobes of the left lung;1 

6, the right ventricle of| 

the heart; 6, the left ven- 
tricle ; 7, the right auricle 

of the heart; 8, the left 

auricle; 9, the pulmonary 

artery; 10, the aorta ; 11, 

the vp "^^'a descendens ; 

12, indpipe ; 18, 

.*; 14, 14, 14, 

.<3 pleura; 15, 16, 

cho diaphragm; 16,16, 

tne right and left lobes of 

the liver; 17, the gall- 
bladder ; 18, stomach; 26, 

the spleen; 19, 19, the 

duodenum ; 20, the as- 
cending colon ; 24, the 

transverse colon ; 25, the 

descending colon; 22, 22, 22, 22, the small intestines; 28, 23, the 




rio. 98. 



I*. 



niBKAflFft np THK AHHOMINAI, riAVITY. 



203 



■•14. 



26 



walls of till) Iwlly turned down; 24, the thorarir, diict, <>[)eiiing intr) 
tho left Hnl)clavi>in vein (27). 

Acute Inflammation of the LWer. — I Icpai His. 

The liver is the largost gland in the l)ody. (See Fig. 81.) It lies 
in the right side, and iit the top of the great ulxloniinal cavity, di- 
rectly under the midriff, tnd lapping upon the stoniaoh. Fig, 90 
showH itH relative position. Its otHuu woh HUppcsed to Iw to take tiiv 
superabundant carbon out of the blood. TIuh carbon it unites vitii 
other elements and forms bile, the peculiar bitter sul)8tance which is 
poured into the upper bowel, and greatly aids digestion. 

The liver is liable to become inflamed from several causes, such 
as gravel-stones, external violence, suppressed secretions, hot climates, 
intlammation of the duodenum, etc. 

Symptoms. — These are sympathetic fever, with pain, and a sense 
of tension in the right side, inability to lie on the left side, difficulty 
of breathing, a dry cough, vomiting, and hiccup. 

The pain is acute and lancinating generally, though sometimes 
dull and tensive. When sharp, it is like the stitch of pleurisy, and 
it indicates that the peritoneum which covers the liver is inflamed. 
When dull, it is the body of the organ which is suffering. When 
the convex surface of the liver is the se.\t of the disease, the pain is 
apt to run up to the right collar-bone, and to the top of the right 
shoulder. Breatlung, coughing, and lying on the left side, increase 
the pain. A soreness is felt by pressing over the liver. The pulse 
is full, hard, and strong, tho bowels are costive, and the stools are 
clay-colored, owing to not being tinged with bile, — this having 
stopped flowing. The tongue is covered with a yellow, dark brown, 
or even black coat, and there is a bitter taste in the mouth. 

Explanation. — The bile, secreted by the liver, is poured into the 
upper bowel, and gives the brown or yellow color to the contents 
of the bowels. When the liver is inflamed, it cannot work, — it se- 
cretes little or no bile, and the discharges from the bowels lose their 
color. The bile is slightly laxative, and when it ceases to flow into 
the bowels, they become bound or costive. When the liver does not 
work, the bile has to be taken out of the blood by the kidneys, and 
the urine becomes of a deep yellow color. Much of it goes out 
through the skin, too, which is likewise yellow, and the sweat be- 
comes so yellow as to stain the linen. 

Treatment. — Flax-seed poultices applied over the liver are veiy 
good. Purgatives will also need to be used pretty freely at iiiyt. 
Those which produce watery stools (31), (247), (34), will be of the 
greatest service. 

After the cups and purgatives have been thoroughly used, blisters 
will be useful, and it will be better to apply several in succession, 



I 



294 



DISEASES OF THE ABDOMINAL CAVITY. 



rather than to keep the first one open. Or, in the milder cases, ;i 
mustard poultice may be applied over tli ^ whole side, and even along 
the dpine. 

Frictions over the stomach and liver with dilute nitro-muriatic 
acid, and a foot-bath of the same, will sometimes do well. The acid 
should be reduced with water to about the strength of sharp vinegar. 
Water a little soured with this same acid makes an excellent drink 
for the patient. 

Perepiration should be induced by the spirit vapor-bath, and kept 
up ger " by the tincture of the American hellebore, from three to 
ten divtps ?very hour. Or, the same thing may be done by prescrip- 
tions (12fi;, (358). 

When tb urine is small in quantity and red, ^,ive some diuretic, 
as iafusioK ^^ marshmallow-root, pumpkin-seeds, or trailing arbutus. 

The diet should be rice-water, gruel, and toast-water. While 
getting up, it may gradually be improved, and some light tonics 
(49), (58), (64) be added to it. 



Chronic Inflammation of tlie Liver. 

Hepatitis. 



Chronic 



There are few chronic diseases for which the physician is more 
often consulted than this. In the warm climate of the South, in 
the bilious districts of the West, and indeed even in the Middle and 
Eastern States, it meets us continually, and demands our attention. 
That it is difficult to cure must be admitted; but a constant famil- 
iarity with chronic diseases, for several years, has convinced me that 
it is generally curable. 

Symptoms A sense of fulness and weight in thp right side 

with some enlargement, and shooting pains felt in the same region, 
particularly when it is pressed, with pains in one or both shouldei-s, 
and under the shoulder-blades ; uncomfortable sensations when lying 
on the left side; yellowness of the skin, eyes, and urine; bowels 
irregular, loose, or costive; appetite disturbed; sometimes a dry, 
hacking cough; shortness of breath; tongue whitish, and brown or 
yellow towards the root ; a bitter and bad taste in the mouth in the 
morning. The urine deposits a sediment on standing. There is 
generally a low and desponding state of mind, with irritability and 
peevishness of temper. 

The skin is often covered with yellow spots and with a branny 
substance. The various symptoms of dyspepsia are often present. 
The nervous system is generally much disturbed, and there is a dis- 
inclination to apply the mind. There is frequently a great dread of 
imagined evil, supposed to be impending. 

Treatment. — This does not require *:o be as active as that for the 
acute form of the disease. 



""steiHB 



DISEASES OP THE ABDOMINAL CAVITY. 



295 



If there l)e much tenderness of the liver, begin with mustai-d 
poultices, and the compound pills of podophyllin, or the compound 
pills of leptandrin, or (36). 

I have abandoned the use of mercury in this disease, as in most 
others; but if any prefer to use it, the blue pill (52) will be found 
the most useful form. 

The compound tar-plaster placed over the liver, in bad cases, is 
often very serviceable. 

An alterative (138), (146) will be found useful. 

The daily alkaline sponge-bath must on no account be omitted. 
Vigorous friction must follow it. Vigorous constitutions will bear 
the shower-bath; in such cases it may, occasionally, take the place 
of the sponge-bath. 

The diet must be simple, yet nourishing and wholesome, and 
embracing but a small amount of fat, as this is composed largely of 
carbon, and the liver is unable to remove what i^ already in the blood. 

Especially and above all, out-door exc-cide must be taken to the 
full amount of the strength, and the thoughts be occupied with 
cheerful subjects. Let the hot sun be avoided, and the summer 
exercise be taken in the cool hours of the day. 

The recovery from this, as from all other chronic diseases, must 
necessarily be slow. 

Congestion of the Liver. 

This is not strictly a disease, but the result of gastro-intestinal 
disorders. There is an enlarged, congested liver, with a sense of 
fulness and weight in the right side under the ribs. 

The application of heat, and even leeches, to the side, and the ad- 
ministration of saline laxatives, afford relief. The diet must be light 
and farinaeeous. 

Passive Congestion of tlie Liver 

Results from mechanical obtruction to the outflow of blood from 
the liver. When this condition has existed some time, there is a 
sense of weight and fullness in the liver region when sitting up or 
lying on the left side. The liver is enlarged and tender; the breath 
is shortened, and pain may be present, extending to the shoulder. 

Jaundice is usually preseno, but only to a slight degree. When 
the heart is the cause of the obstruction to the outflow of blood, 
there is often present an associa id gsistro-duodenal catarrh, in which 
case loss of appetite, nausea, vomiting, belching of gas, and pain, 
are also present. In the later stages of a ] rolonged case, ascites, or 
dropsy of the peritoneal cavity, is present. 

Prognosis. — The outcome of passive congestion of the liver is 
usually grave, since it is the result of some structural disease else- 
where, as of the heart, asthma, chronic pleurisy, tumors, etc. 







296 



DISEASKS OF THK ABltOMINAL CAVITY. 



I 



Treatment. — The indications for treatment are to strengthen the 
lieait wilh digitalis, strophanthus, etc., increase the strength of tht; 
patient with strong, stimulating food, and to deplete the portal circu- 
lation by vegetable laxatives like podophyllin, rhubarb, aloes, etc.; 
the salines also furnish an agreeable method of depletion, as for 
instance, Crab-orchard water, Hunjadi, etc. It occurs usually after 
middle life, and is more common in women than men. It is usually 
secondary to cancer elsewhere, as in the bowels or stomach, rectum 
and womb. The liver is increased in size, and is frequently studded 
with cancerous nodules, which in well-marked cases may be felt 
through the abdominal wall. 

The disease usually gives rise to loss of appetite, nausea, vomiting, 
constipation, emaciation and weakness. Pain over the liver is gen- 
erally present, while jaundice exists in about fifty per cent of cases 
Dropsy of the bowels exists likewise in about the same proportion of 
cases. Hemorrhages from the nose, stomach and bowels occur in 
the later stages of the disease. The temperature is usually lowef 
than normal, and the pulse slow, especially if jaundice be present ; 
the urine is diminished in amount and high colored. The disease 
progressively advances to a fatal termination inside of a year. No 
kuowu treatment is of avail in arresting the terrible malady. 

Cirrhosis of the Liver. 

This is a disease characterized by an excessive increase of the 
fibrous tissue in the liver, whose later function is to contract and 
squeeze out, so to speak, the softer, glandular structure of the liver 
proper, thus causing its atrophy and diminution in size. The dis- 
ease is caused mainly by the introduction into the portal system of 
some irritant like alcohol. It is generally known as the gin-drinker's 
liver, but it does not result especially from gin any more than from 
any other spirit. It is, at all events, essentially a disease due to pro- 
longed though moderate use of spirits of one sort or another, and 
occurs between the ages of thirty and sixty, mostly in men. 

The symptoms of this disease are at first those of gastric and intes- 
tinal disorders due to alcohol, as nausea, flatulence, constipation and 
looseness, etc. 

Dropsy is finally the most pronounced symptom of the diseiise, but 
hemorrhages from the bowels not infrequently occur. The disten- 
sion of the abdomen by dropsy is sometimes enormous ; finally the 
feet and legs become swollen, emaciation and weakness progress, and 
the patient may finally die in coma or convulsions. The disease, when 
suffisiently advanced to be recognized, is incurable. 

Treatment. — The treatment is to be directed toward the removal 
of all irritating food and alcohol. The diet should consist largely of 
milk; green vegetables and fruit, beans, peas, eggs, lean meat, etc., 
may be taken if well borne. 



DISEASES OF THE ABDOMINAL CAVITY. 



297 



The stomach and bowels .are to be kept in good condition, th«> 
dropsy drawn off or removed by means of loose evacuations from the 
bowels. 

Hydrochloric acid in three-drop doses, well diluted, after meals, 
may be of service, while bitter stomach-tonics are to be given before ' 
eatiug. 

Acute Inflammation of the Spleen. ~ Splenitis. 

Thk spleen is in the upper part of the belly, on the left side, 
opposite the liver. It is subject to acute inflammation, which is 
known by a pain just under the short ribs on the left side, also by 
swelling, soreness to the touch, and by more or less fever. The pain 
often shoots ui) through the midriff and to the left shoulder. There 
18 a short, di-y cough ; a feeling of tightness about the heart ; a sick- 
ness at the stomach, and vomiting ; and a discharge frequently of 
black blood from the bowels. The urine is scanty, is passed with 
some difficulty, and is high-colored. 

This disease appears most frequently in hot climates, and is often 
connected with intermittent fevers. 

Chronic Inflammation of the Spleen. 

This prevails most in fever-and-ague districts, and is a frequent 
result of chills and fever. It is generally very stubborn, often lasting 
many years. 

Symptoms — A feeling of weight, tightness, and sometimes pain 
in the left side, the pain being increased by pressure, or an attempt 
to lie on the left side. The organ sometimes enlarges very much, so 
that it can be felt by the hand. This enlarged mass passes under 
the common name of " ague cake." There are sometimes numbness, 
weakness of the legs, difficulty of breathing, palpitation of the heart, 
inability to exercise much, otetinate constipation, vomiting of food, 
piles, diy skin, tongue coated white or red, low spirits, and occasion- 
ally dropsical affections. 

During the chill in fever and ague, the spleen becomes enormously 
loaded with blood. Surfeited and stretched in this way again and 
again, it is not strange that the organ should become diseased. 

Treatment. — This should be about the same as the treatment for 
acute and chronic inflammation of the livei-. 

After the active symptoms of inflammation are subdued, the warm 
bath may be used one or twice a week. 

In the chronic form of the disease, counter-irritation with the 
compound tar-plaster, with mustard poultices, croton-oil, or tincture 
of iodine, will be particularly needed. 

Among medicines, muriate of ammonia (53"), has a high reputation. 




^^"WIIM 



298 



DISEASES OF THE ABDOMINAL CAVITY. 



To keep the lx)wel8 open, [)odophyllin, quinine, and mix vomica 
(46), liave a fine effect. Iron may be given (73) when the patient 
is bloodless and pale. 

Jaundice. — Icterus. 

The jaundice is a very common disease, and to be known needs 
only to be seen ; but inasmuch as it may be but a symptom rather 
than a disease per se, it behooves one to be careful that some hidden 
disorder be not preying upon the system. Among the more common 
affections which give rise to jaundice are gastro-duodenal catarrh, 
frequently affecting children, obstruction of the gall-ducts by thick 
bile or mucus, or by gallnstones ; cancer, chronic forms of liver com- 
plaints, and some forms of blood diseases. 

Symptoms. — The most prominent symptoms are, yellowness of 
the skin and whites of the eyes, saffron-colored urine, and whitish or 
clay-colored stools. So full is the urine of bile, that a piece of white 
linen dropped into it receives a bright yellow tinge. 

Besides these symptoms, there are impaired appetite, a loathing 
of food, the sense of a load at the pit of the stomach, sourness of 
stomach, sometimes sickness and vomiting, a bitter taste in the moutli, 
disinclination to move about, sleepiness, a dull pain in the right side, 
which is increased by pressure. 

The entire body of a person who has died of jaundice, including 
bones, muscles, and membranes, are found to be full of bile, and col- 
ored yellow. 

Explanation. — The bile flows into the upper bowel, a little below 
the stomach, through a duct or tube about as large as a goose-quill. 
This little tube or vessel receives the bile from a smaller tube, called 
the hepatic duct, and from another which goes to the gall-bladder, 
called the cystic duct. 

These little tubes sometimes get obstructed or plugged up by 
sticky, thickened, or hardened bile, or by gall-stones, formed in the 
liver ; and the bile, finding no outlet through its natural channels, is 
taken up by the absorbents, distributed over the system, and produces 
the yellowness we witness. When these ducts and the gall-bladder 
are filled and stretched by this thickened and hardened bile, they be- 
come tender and sore. Hence the sore feeling in the side when 
pressure is made. 

There is another explanation of the way in which the yellowness 
of jaundice is produced, and it mattei-s not whether it or the one just 
given be adopted. It is this : The bile is formed by the blood, and 
not by the liver. The office of the liver is to draw or strain off the 
bile from the blood. And when this organ is inflamed, or irets slug- 
gish and will not work, the blood is not relieved of its yellow freight. 
The bile accumulates, and in attempting to escape through other 
channels, it lodges in the various tissues, particularly in the skin. 



vomica 
patient 



n needs 
(1 rather 

hidden 
common 

catarrh, 
by thick 
ver com- 

mmess of 
hitish or 
of white 

loathing 
irness of 
le moutli, 
ight side, 

ncluding 
, and col- 



,le below 
ose-quill. 
be, called 
l-bladder, 

id up by 
d in the 

annels, is 
produces 
l-bladder 
they be- 
de when 

llowness 
one just 
lood, and 
off the 
rets slug- 
freight, 
gh other 
skin. 



V 



DISKA8E8 OF THE ABDOMINAL CAVITY. 



JM9 



Treatment. — An infusion of thoroughwort, drunk freely every 
day, is a valuable remedy. The inner bark of the barberry steeped 
in cider, or this article compounded with others (286), (287), will 
be found excellent. 

The diet should be plain, wholesome, and nourishing, but com- 
posed mostly of vegetable articles, particularly green vegetables and 
berries when they are to be had. 

Cold water should be the principal drink ; or drink and medicine 
may be combined in the shape of three drops of murisvtic acid, and 
two drops of nitric acid, dissolved in a tumbler of water slightly 
sweetened. This is generally a pleasant drink, and will assist very 
much in the cure. 

The warm bath once or twice a week, and the alkaline sponge-bath 
every day, with smart friction, must not be omitted. 

When jaundice is caused by the passage of gall-stones through the 
bile-duct, there is sometimes terrible pain and suffering, — the stone, 
occasionally, being as large as a nutmeg, and forcing its way through 
a quill-sized tube. So great is the distress that the patient sometimes 
rolls upon the floor in agony. To alleviate this pain, large doses of 
opium, laudanum, or morphine, are required. A large teaspoonful of 
bicarbonate of soda dissolved in a tumblerful of hot water is an ex- 
cellent remedy if drunk at a single draught. It relieves the acidity 
of the stomach, and acts as a fomentation to the internal seat of the 
pain. MusUvrd poultices, or warm fomentations, over the seat of the 
pain, are required. The warm bath is excellent. 

The acid bath, made by mixing three parts of muriatic acid with 
two parts of nitric acid, and adding as much of this mixture to water 
as will make it about as sour as weak vinegar, is valuable in jaundice. 
Only a quart of water need be taken ; and the solution should be 
applied with a sponge. It is of the right strength, if it produce a 
slight tingling of the skin. 

Qall-Stones. — Biliary Calculi. 

These are brownish, ohocola -colored concretions which form 
either in the gall-bladder itself, in the duct leading from the gall- 
bladder, or in the common duct which is formed by the 
union of the gall-duct and the hepatic duct which leads 
from the liver. They are solid, generally have bodies of 
irregular shape and size, and have facets cavised by the 
stones being impacted ag^ainst one another. Fig. 99 
shows their appearance. These concretions are formed 
of inspissated bile and organic salts. When they settle into the ducts 
their natural course is downward through the duct into the bowel, 
where they are naturally carried off with the faeces. Their passage 
through these ducts is accompanied often with extreme pain and 
colic, the pain being the severest of any to which the system is sub- 
jected, and generally requires an opiate. When once an attack of 



^ 



a. 



^ 



FlO. 99. 



800 



PI8EASKS OF THE ABDOMINAI, CAVITY. 




gall-fitones has occurred, the patient is liable to more, as they seldom 
exist singly in the gall-bladder. These repeated attacks have lieen 
the subject of a great deal of thought among surgeons. 

Symptoms. — An almost constant uneasiness in the right hypo- 
chondriac region, with spasms of pain, coming on suddenly, and last- 
ing for a time with gi'eat severity, and then subsiding. The pain is 
caused by a stono being suddenly forced into tlie duct and moving 
forward in it, and it sulfides when the stone either stops, or gets 
through the duct. When the stone reaches the bowels, it passes off 
with the stools. 

The patient generally has a pale, sallow complexion, a small, feeble 
pulse, and often suffers from nausea and vomiting, and from restless- 
ness and hurried breathing. 

Treatment. — To reduce the spasm, give svapnia powder in full 
doses, or chlorodine. Also, apply mustard over the right hypochon- 
drium and stomach, and fellow it with hot fomentations with hops, 
or use wet cups. 

If the stomach is irritable, give the neutralizing mixture until it 
moves the bowels. To relieve the intense pain, morphine should be 
administered, together with hot baths and hot cloths over the abdo- 
men. 

Sweet oil was at one time advocated as a solvent of these bodies, 
but experience has not proven the validity of the claim. Many 
practitioners, however, still insist that oil in large doses hastens the 
passage of the stones. 

To remove the acidity on which the foi-mation of these stones so 
often depends, a neutralizing preparation (338) may be given for a 
long time, the diet, in the mean time, being well regulated. The 
sponge-bath with saleratus and water, should be taken daily, followed 
by brisk rubbing ; and free exercise in the open air should on no 
account be omitted. 

Of late years it is customaiy to treat this complaint surgically, 
operating directly on the gall-bladder by incising it and removing 
the stones. If the ducts become obstructed, they too are incised and 
the stones dislodged, either by pushing them down into the bowel, 
or otherwise, as maj' be most convenient. The gall-bladder is either 
sutured to the abdominal wall, and a biliary fistula forms, discharg- 
ing the bile upon the abdominal wall; or it may be drained off into 
a bottle; or, as has been recently advocated, the bladder may be 
sewn up tightly and replaced. Sometimes communication is estab- 
lished between the gall-bladder, or the duct, and the duoden m, by 
means of an ingenious device called " Murphy's Button." This 
button, invented by Dr. Murphy of Chicago, is intended to di-aw to- 
gether the parts to he connected, retaining them in that position. 
A fter some days the walls slough away, and the button passes into 
the bowel, and is thus removed from the system. By this means 



DISEASES OF THE ABDOMINAL CAVITY 



301 



jy seldom 
lave been 



rlit hypo- 
, and last- 
le pain is 
1 moving 
8, or gets 
passes off 

all, feeble 
n restless- 

er in full 
hypochon- 
/ith hops, 

e until it 
should be 
the abdo- 

se bodies, 
11. Many 
astens the 

I stones so 
iven for a 
bed. The 
', followed 
lid on no 

surgically, 
removing 
icised and 
he bowel, 
r is either 
discharg- 
d off into 
r may be 
I is ostab- 
len m, by 
n." This 
3 di-aw to- 
t position, 
asses into 
lis means 



many stubborn cases of impacted gall-stone have been permanently 
cured. 

Abscess of the gall-bladder, inflammation of the surrounding 
tissue, and even death are not infrequent results of the presence of 
these foreign bodies. 

For preventing the formation of gall-stones, see the articles on 
Biliousness, Diet, etc. 

Acute Inflammation of the Stomach. — Gastritis. 

This is a rare disease. It is generally induced by irritating and 
corrosive substances taken into the stomach. Poisons, as ai-senic, 
aquafortis, corrosive sublimate, and the like, are the most common 
causes of it. Blows, sudden stoppage of sweat, and excessive use of 
ardent spirits, may also excite it. 

Symptoms. — It is marked by burning pain in the stomach, thirst, 
restlessness, anxiety, constant vomiting, prostration of strength, a 
quick, hard, and small pulse, incessant retching, a sunken counte- 
nance, hiccough, cold hands and feet, and a damp skin. 

Treatment. — If the inflammation be excited by poison, the reme- 
dies named under antidotes for poisons must be first employed. 

The poison being neutralized or thrown off, the inflammatory con- 
dition must be combatted with the remedies usual for such states. 
Mustard poultices to the feet, along the spine, and particularly over 
the pit of the stomach, will be among the first things to be employed, 
and should be followed by hot fomentations of stramonium leaves or 
hops, — both the fomentations and the poultices to be repeated as 
occasion may require. Dry cupping over the region of the stomach 
is useful. Small and repeated doses of bismuth, or |-grain doses of 
cocaine, are generally very soothing to the stomach, and relieve the 
terrible vomiting. 

Drinks. — Cold water, bread-water, rice-water, arrow-root gruel, 
infusion of slippery-elm bark, and of mai-shmallow. These should 
be taken in very small qaantities, — say a teaspoonful at a time, — 
about twenty drops of tincture of aconite-root being added to a half 
tumblerful. Lumps of ice may be held in the mouth, and occasion- 
ally swallowed. 

Injections. — Emetics and physic are not proper, but injections 
(248), (263), or simply soap-suds, will be required. 

The remedies must be pursued until all tenderness has disappeared 
from the pit of the stomach. 

While the patient is recovering, great care must be taken not to 
overload the stomach with food. Arrow-root, sago, and milk are 
among the first articles to be allowed. After these, will come gnid- 
ually beef-tea, chicken-broth, soft-boiled eggs, and beef-steak, until 
the whole diet can be restored. 









302 



DISEASES OP THE ABDOMINAL CAVITY. 



Chronic Inflammation of the Stomach. 

This is a much more common disease that the preceding ; indeed 
it is very common. Though it does not put life in immediate danger, 
it perverts the feelings of the stomach, and causes many of the symp- 
toms of indigestion. Dyspepsia, however, is a different complaint, 
and not iiecessarily connected with inflammation. 

Symptoms. — There is generally pain in the stomach, which is in- 
creased by the presence of food, and by external pressure. The pain 
is sometimes felt only during digestion. The fermentation of tlie 
food in the stomach generates a gas, which is frequently belched up. 
This is what is meant in common language by having " wind in the 
stomach," and " belching wind." The meals are frequently vomited 
up ; the appetite is lickle, sometimes voracious, and again nearly ab- 
sent ; the thirst is likewise variant ; the tongue is white in the centre, 
and red at the sides and tip, — sometimes smooth and red all over, 
like a slice of raw beef. The urine is scanty and high-colored. 

The disease is very liable, if badly managed, to lead to ulceration 
of the coats of the stomach, and thence to a fatal end ; for an ulcer 
may penetrate the walls of the stomach, and let its contents into the 
abdominal cavity, which would excite an immediately fatal inflam- 
mation. 

Treatment. — If there be much tenderness, we may apply leeches 
over the stomach. With less tenderness, counter-irritation will an- 
swer,* — as blisters, croton-oil, mustard poultices, the compound tar- 
plasters, or dry cups. 

The skin of the whole surface should receive special attention. 
The warm or the cold bath should be used often, according to the 
strength of the patient. When the reaction ;is good, a cold compress 
bound upon the stomach every night, will do much to bring relief. 

The diet cannot be too carefully managed. While there is consid- 
erable tenderness, the nourishment must be of the most simple and 
unirritating kind, — consisting of little more than the most bland 
nutritive drinks ; and even these should be taken in small quantities 
at a time. Gum arable water, rice-water, barley-water, arrow-root, 
gruel, tea, and toast without butter, will be amply sufficient to keep 
soul and body together, and will, in two or three weeks, generally 
starve the enemy out of his quarters. After this, a more nourishing 
diet may gradually be resumed. Many of the recent proprietary 
foods serve an admirable purpose in furnishing a large amount of 
nutriment in small bulk, which is easily digested. Among these 
may be mentioned proteinol, in teaspoonful to biblespoonful doses, 
liquid peptonoids, malted milk, koumiss, matzoon,, etc. These latter 
are milk preparations with the cooling and refreshing taste of soda. 



DISEA8KS OF THE ABDOMINAL UAVITY. 



303 



IndSgestion. — Dyspepsia. 

Dyspepsia is a disease of civilization. Savages know nothing of 
it. It is the costly price we pay for luxuries. All civilized nations 
suffer from it, more or leas, but none so much as the people of the 
United States. It is here, in the new world, that the disease has 
become domesticated, and we, as a people, who have threatened to 
monopolize its miseries. 

Few disordere inflict upon their victims greater suffering; yet it is 
not particularly dangerous, and it is even loubtful whether it tends 
very much to shorten life, unless the lengv . of life be judged to con- 
sist in the sum of happiness enjoyed, — in which case few complaints 
shorten it more. 

Symptoms. — These vary very much in different stages of the dis- 
ease, and in different persons. In general the complaint begins with 
a sense of fullness, tightness, and weight in the stomach, sooner or 
later, after meals, and a changeable, diminished, or lost appetite. 
Cooasionally, the app-tite is craving, and when, in obedience to its 
promptings, a large meal is taken, there is pain in the stomach, with 
general distress and nervousness, and sometimes vomiting. Flatu- 
lency and acidity are common, with sour and offensive belching of 
wind ; and very often there is a water-brash, or vomiting of a clear, 
glairy fluid when the stomach is empty. Dizziness is a prominent 
symptom. There is a great deal of what patients call an " all-gone " 
feeling at the pit of the stomach, — a weakness so great at that par- 
ticular spot, that it is very hard to sit up straight. There is a bad 
taste in the mouth ; the tongue is covered with a whitish fur ; there 
is headache, heartburn, palpitation at times, high-colored urine, and 
tenderness, now and then, at the pit of the stomach. The bowels 
are generally irregular, sometimes very costive, at other times loose, 
when portions of food a^e passed off undigested. 

Nervous Complication. — Such are the symptoms in a case of 
simple disorder of the stomach, when no other part of the system is 
materially involved. This is indigestion, well-marked, and distressing 
enough ; but it is only a part of what is understood by a case of 
modern dyapepna. In thia^ either the indigestion, in its course, dis- 
turbs and involves the nervous system, or the nerves become them- 
selves disordered, and produce the indigestic Sometimes one hap- 
pens, sometimes the other, it matters not which ; both are present — 
the affec :ion of the stomach and of the nerves — in a case of thorough 
dyspepsia. To make out a full case, in its tormenting completeness, 
we mast add to the above symptoms, great depression of spirits, 
amounting at times to complete hopelessness and despondency; a 
dread and fear of some impending evil ; a lack of interest in passing 
events ; unwillingness to see company or to move about ; an irritable 
iind fretful temper ; a desi.e to talk of one's troubles, and nothing 



m 



304 



DI8KA8KS OK THE ABDOMINAL CAVITY. 



else ; a sallow, haggard, sunken, and sometimes wild expression of 
countenance ; a dry, wrinkled, and harsh skin, with unreireshinp 
sleep, disturbed by all sorts of annoyances and difficulties, such m 
shipwrecks, falls down precipicps, and nightmare. 

The man who bus all these symptoms, or any considerable portion 
of tht'in, lias dyspepsia, and is about as miserable as if all the sorrows 
of life were electrical currents, and were running through him con- 
tinually. 

Causes of Dyspepsia. — To healthy digestion, three conditions are 
especially necessary, — that the footl should be well chewed and 
mixed with saliva before it is swallowed ; that the stomach should 
pour out and mix with it the right amount of healthy gastric juice ; 
and that it should be well churned wliile in the stomach. 

It is well known that tiie firat of these conditions, a thorough chew- 
ing of food, is rare in this country. We eat too fast ; we do not 
masticate our food ; we bolt it whole. 

This Ls the first cause of dyspepsia, and it is tlie fruitful mother of 
causes. It furnishes the occasion for eating too much ; for when the 
food is swallowed with such rapidity, the stomach is taken by sur- 
prise, as it were ; it cannot secrete gastric juice fast enough to bo 
diffused through the fast-growing mass ; and the appetite does not 
decline until a great deal too much is taken. The coats of the 
stomach, lx;ing stretched unnaturally, do not pour out the gastric 
juice at the right time, or as much of it as is wanted, and what there 
is, is altered in quality. 

Moreover, the stomach being overburdened, cannot tuni over and 
e'liurn it contents properly. 

To fast eating, we may add, high-seasoned dishes, too stimulating 
fur the stomach ; eating between meals, and at unseasonable houre, 
— particularly at bed-time ; excessive use of strong drinks and 
tobacco ; habitually sitting up late at night : inactive habits of body ; 
and excessive use of the mind. 

No causes of dyspepsia are more active chan those which disturb 
and fret the mind. It is surprising how suddenly any mental ag'ta- 
tion will put an end to the appetite, and suspend digestion. And 
when these mental disturbances are protracted, when care becomes a 
daily and hourly companion, dyspepsia is almost sure to show itself. 
Considering the numerous causes of unpleasant mental excitement 
which we have in the politics, the business, the ambition, the family 
jars, etc., of this country, it is a wonder that dyspepsia is hot even 
more prevalent. It is hard for the sensitive to escape. 

These causes may seem too simple to be the frequent origin of so 
much misery, and yet whole volumes might be written on this one 
subject. One cannot too forcibly nor too frequently remind the 
reader of the importance of these simple and brief remarks. No 
treatment will avail if they are not heeded. 



UI8RASKP OF THK ADDOMINAL CAVITY. 



806 



tBion of 
I'reHhiiij^ 
such aH 

I portion 
) sorrows 
liim con- 

itions are 
wed and 
h should 
ric juice ; 

igh chew- 
'^e do not 

mother of 
when the 
3n by 8ur- 
ugh to Ix! 
does not 
its of the 
;he gastric 
what there 

1 over and 

timulating 
,ble hours, 
rinks and 
of body ; 

[ch disturb 

sntal ag'*^a- 

;ion. And 

becomes a 

[how itself. 

ixcitement 

the family 

hot even 

rigin of 80 
In this one 
}emind the 

larks. No 



Urinary DeposiU. — Before speaking of the treatment of dyspep- 
sia, it will bo proper to take notice of certain deposits in the urine, 
to which persons suffering from this complaint are liable, and the 
discovery of wliioh will, in many cases, indicate the treatment. 

Many dyspeptics have acid urine, which is loaded with cry»tah of 
oxalate of lime. These persons are much depressed in spirit, and 
look upon the dark side of everything. They are painfully disturbed 
by small annoyances, are imtablo in temper, incapable of exerting 
themselves, look with dread upon tlio future, and generally have the 
(lark and dingy look of the face whioh indicates functional derange- 
ment of the liver. 

The most of these crystals are octahedral in form, and in the field 
of a good microscope are beautiful objects for inspection. (Figs. 100 
and 101.) To o'-tain them, take a portion of urine passed in the 
morning (urina sanguinis}, and let it stand till a deposit takes place. 
Pour off the upper portion of the urine ; put a part of the remainder 
in a watc'ij-glass, and gently lieat it over a lamp. The heat will 
cause a deposit of the crystals. 




no. 100. 



Fro. 101. 



no. 103. 



The oxalate of lime is frequently found in urine, the crystals hav- 
ing the form of dumbells. When examined by polarized light, they 
appear beautifully colored and striated. (Fig. 102.) 

The urate of ammonia, and uric acid gravel, are likewise found in 
large quantities in the urine of many dyspeptics. Some are ex- 
hausted by them, and reduced almost to skeletons, and to a wretched 
state of health, — having boils, eruptions, etc. 

To find the urates, put a little of the urine containing the deposit 
in a test-tube, and warm it gently over a lamp. If the deposit readily 
dissolve, it is probably urate of ammonia (Figs. 103 and 104), and 
may then be examined under the microscope, to make the matter 



sure. 



To find uric or lithic acid, let morning urine stand until a solid 
deposit has sunk to the bottom ; then pour off the liquid, and place 
some of the solid portion upon .. glass, and examine it with a micro- 
scope, and if this acid be present, its peculiar crystalline forms 
(Fig. 105) will he discovered, either alone, or mixed with urate of 
ammonia. 



806 



mSRASKS OF THR ABDOMINAL CAVITY. 



In thofle cases in which there is a great prostration of the nervous 
system, with ii Iokh of sexual power, ImuI feelings in the head, perhaps 
pain and weakness across the loin:'*, and a tendency to consiuuption, 




rio. 108. 




FlO. KM. 






we may suspect the presence of the triple phosphates in the urine. 
Phosphorus m one of the elements of the hrain and nerves, and when 

there is a constiint drain of this element 
through the kidneys, the nervous system 
is gradually exhausted. To find the triple 
phosphatt^s, put some morning urine in a 
glaiis vessel, and let it stand till a sedi- 
ment has gone to the bottom. Put some 
of the sediment in a test-tube, and warm 
it gently over a lamp. If the warmth 
do not dissolve the deposit, add to it a 
little acetic acid; if the deposit dissolve in 
the acetic acid, it probably consists of earthy 
phosphates. This is then to be exam- 
ined under the microscope to ascertain 
whether it is the plio8{)hate of lime, the 
triple phosphate, or a mixture of both. 

Fig. 106 shows us the prismatic crys- 
tals of the triple phosphate. In a few 
rare cases, these are penniform (Fig. 107). Fig. 108 gives us an- 
other specimen of the crystals of the triple phosphates, as they 



7^ Ay^- 




FlO. lOS. 





FlU. 106. 



FIO. 107. 



-i^,v\ 



FlO. 108. 



appear under the microscope, mixed with amorphous particles of 
phosphate of lime. If an excess of ammonia be added to the urine, 
the crystals become star-like and foliaceous, as in Fig. 109. 



mSKASES OK TIIF AHPOMINAI, CAVITY. 



307 



the nervom 
jad, perhaps 
^iwumption, 



I the urine. 
8, and when 
ihis element 
/OU8 system 
lul the triple 
^ urine in a 
I till a sedi- 

Put some 
5, and warm 
the warmth 
add to it a 
it dissolve in 
Ists of earthy 
3 be exam- 
to ascertain 
of lime, the 
e of both, 
smatic crys- 

In a few 
fives us an- 
;e8, as they 




lO. 108. 




particles of 
» the urine, 
9. 



Treatment of Dyspepsia. — Ah there are few cnmplaintH whicli 
(listreHH the i Lient morn thiiii dyspepsi.., so tluiro are few which jjive 
till! physioiai. lUore trouble, (it^norally our 
art has failed upon it t)e(;ause too much ha.s 
liet'ii required of us. We have not merely 
been asked to euro the disease, but to do it 
while the patient eontiuu(!s the indulgenec 
(if his appetite, or his exces-sivo application 
to business or study. It luislMsen ex[)ected 
of us, that wii-ii medicine we should contra- 
vene the laws of nature, and restore health 
while the causes of the disease are in full ac- 
tivity. 

This complaint is often brought on by 
not keeping the l:Kiwels open. To euro it, therefore, one of the first 
things to })e done is to remove costiveness and regulate the bowels. 

One of the very best articles I know of to remove constipation is 
Mettauer's Aperient. I have placed it in the departmei ', of Phar- 
macy ; it ought to be in the United States Dispensatory. Taken 
immediately after meals, in doses of a teaspoonful, it corrects a(;idity 
of the stomach, it gently opens the bowels, and when its action is 
over, will be found to have diminished the costiveness, rather than 
increased it, as most kinds of physic do. It is excellent in the bil- 
ious forms of dyspepsia, — acting fiiiely upon the liver, — particularly 
if a few drops of aqua rcgia in water be taken before meals, — the 
iiperient being taken after. 

If piles exist, this mixture will he objectionable on account of the 
aloes, and the fluid neutiulizing extract may take its place. Sweet 
tincture of rhubarb and soda (37), is sometimes preferable to the 
aperient. 

Several other preparations (38), (289), (39), (290), will be found 
useful to remove costiveness and debility of the stomach. 

For acidity, besides the remedies already mentioned, prepared char- 
coal may be used, in teaspoonful doses, or carbonate of magnesia, or 
fluid magnesia, or trisnitrate of bismuth. A good remedy is pulver- 
ized gufaiacum, rhubarb, prepared charcoal, and carbonate of mag- 
nesia, equal parts; also (28), (37), (38), (42). If crystals of oxa- 
latb of lime be found in the urine, give a few drops of aqua regia, in 
water, thrje times a day. 

Hygienic Treatment. — The didt must be managed with great pru- 
dence. Food must be taken in such quantities only as the stomach 
can digest, however small that quantity may be ; and it must be taken 
slowly, and well chewed. No article should be touched, or thought 
of, which disagrees with the stomach. Costiveness may frequently 
I* entirely removed by eating no bread except that made from un- 
bolted wheat-flour, commonly called Graham bread (that made from 
Franklin Mills flour), or by making one of the three daily meals of 



308 



DISEASES OF THE ABDOMINAL CAVITY. 



boiled cracked wheat, with milk or molasses. If the triple phosphates 
be found in the urine, there is a special reason why the unbolted 
flour, or the cracked wheat should be used. The wheat-grain abounds 
in phosphorus, the largest portion of which is in the bran, and this 
is much needed when the kidneys are robbing the brain of its phos- 
phoric element. 

Not too much Brain-work. — It is important that the brain and 
nervous system should be relieved of the burden of too much work, 
and that the thoughts should be turned into the most agreeable chan- 
nels. If the patient would get well, the disinclination to move about 
and see company must be resisted. In many cases, dyspeptics are 
like sea-sick persons, — feeling as though they would rather go over- 
board than move. In such instances, friends must not be harsh with 
them, and frown upon their listlessness as if it were a fault ; but 
rather treat them affectionately, and beguile them out by all sorts of 
pleasing enticements. Exercise must be had, every day, and be con- 
nected, if possible, with an object, so that it may be performed cheer- 
fully. It is important to engage the mind in the exercise; and for this 
purpose, some contested game is very useful, as playing at billiards, 
rolling nine-pins, pitching quoits, or, where the strength will permit, 
playing ball or riding the bicycle. 

Cheerfulness. — Nothing does more to drive away dyspepsia than a 
cheerful, lively, and even mirthful state of mind. All the nervous 
influences sent from the brain to the stomach should be of the most 
agreeable kind. Some people think it vulgar to laugh. Let such 
stand with long faces in life's shadows, if they choose. As a general 
loile, the best men and women laugh the most. Good, round, hearty, 
side-shaking laughter, is health for everybody ; for the dyspeptic, it 
is life. 

Dyspeptics who have a taste for it, and can endure the expense, 
should travel. A voyage to Europe, and a year spent in seeing the 
wonders of the old world, will generally cure the most stubborn case 
of indigestion. This, however, depends upon circumstances. For 
those having the finer organizations and the higher natures, extensive 
travelling is sometimes indispensable. The narrow circle of thoughts, 
associations and things in tho:r own neighborhood, do not fill the 
compass of their wants ; their many-sided faculties need to be drawn 
on by the large variety to be found only in travel. Their large and 
impressible natures want to be filled full in order to drive outdisease, 
and it takes a world, or a considerable part of it, to fill them. The 
dyspepsia of such natures is not comprehended by the multitude, and 
even physicians are often amazed that their narrow prescriptions do 
not reach it. 

Heartburn. — Cardialgia. 

This is a gnawing and burning pain in the stomach, attended by 
disturbed appetite. It is generally caused by great acidity of the 



~ 



DISEASES OP THE ABDOMINAL CAVITY. 



309 



)ho8phates 

unbolted 

n abounds 

I, and this 

its phos- 

brain and 
uch work, 
lable chan- 
love about 
eptics are 
r go over- 
harsh with 
fault; but 
dl sorts of 
nd be con- 
ned cheer- 
nd for this 
b billiards, 
ill permit, 

)sia than a 

e nervous 

the most 

Let such 

a general 

id, hearty, 

speptic, it 

! expense, 

seeing the 

aborn case 

ices. For 

extensive 

thoughts, 

ot fill the 

be drawn 

large and 

ut disease, 

em. The 

itude, and 

iptions do 



bended by 
ity of the 



stomach, and is a symptom of dyspepsia, and often afliicts pregnant 
women. Whenever too much food is taken, it is liable to ferment, 
and become extremely sour, — causing heartburn. In such cases, 
vomiting often occurs ; and what is thrown up is sour, and some- 
times bitter. 

Treatment. — Immediate temporary relief may be obtained by 
swallowing a teaspoonful of soda, magnesia, or chalk, in a tumbler of 
cold or warm water. Fluid magnesia, or lime-water, will answer the 
same purpose. If there is wind in the stomach, as well as acidity, a 
teaspoonful of the aromatic spirit of ammonia, or (135), will often 
still the uneasiness in a moment. 

To cure the complaint, the stomach must be strer Jiened by the 
remedies directed for dyspepsia. 

Spasm or Cramp in the Stomach. — Gastrodynia. 

Though generally of shorter duration, this is more violent than 
heartburn. It is attended by a sense of fullness, by anxiety, and by 
great restlessness. In females, hysterical symptoms are often coupled 
with it. Great quantities of air or gas are generally expelled, and 
the pain shoots through to the back and shoulders. 

Treatment. — A strong purg^ative injection (248) will often bring 
immediate relief. The sweet tincture of rhubarb and soda (37), with 
a few drops of tincture of cayenne mixed with it, will often bring 
speedy relief. So will a mustard poultice laid upon the stomach. 
The mustard poultice is a remedy of great excellence, in many cases. 
It deserves to be called the poor man's friend. 

Water-Brash. — Pyrosis. 

This consists in a discharge from the stomach, generally in the 
morning, of a thin, glairy, watery fluid, sometimes insipid, at other 
times sweetish, and at still others sour. A burning heat or pain in 
the stomach attends, and seems to be the immediate cause of the 
discharge. The discharge appears to be the natural mucus of the 
stomach, which is poured out in large quantities in consequence of a 
kind of catarrh of its mucous lining. The amount thrown up varies 
from a spoonful to a pint or more. 

The complaint is caused by a poor, innutritious diet, or by what- 
ever causes the blood to become thin and watery. 

Treatment. — Ten or fifteen drops of water of ammonia, in half a 
tumbler of water, will quiet tlie distress, and check the discharge. 
The most effectual remedy I am acquainted with for breaking up the 
discharge, is the trisnitrate of bismuth, taken at meal-times, in from 
twenty to thirty-grain doses, three times a day. The compound pow- 
der of kino is a valuable remedy. The compound tincture of senna 
and the tincture of balsaiu ^i tolu, in equal parts, and administered 






310 



DISKASES OF THE ABDOMINAL CAVITY. 



in tablespoonful doses, are sometimes useful. The tincture of nux 
vomica is a good remedy. 

To restore the blood, some of the various preparations of iron (74), 
(80), (78), (316), will be required. 

The diet should consist of easily-digested, nutritious food, 
soupsv broths, fresh meat, and unbolted wheat-bread. 



aa 



Vomiting*. 

This occurs under a great variety of circumstances. It may be 
induced by acidity of the stomach, by irritability of the stomach, by 
distress of mind, by injury of the brain, by offensive odors, and by all 
organic diseases of the stomach. 

Treatment. — Generally, it is cured by treating the disease which 
induces it. But in many cases it persists very obstinately, and may 
become the chief thing to be attended to. In such cases, it may re- 
quire a careful investigation of the cause to check it. But generally 
some aromatic, as ginger, spearmint, peppermint, or spice-tea, will 
put an end to it. Some cordial or stimulant, as brandy, champagne, 
tincture of ginger, paregoric, elixir solutis, or cherry brandy, will 
answer well. Strong coffee, without sugar or milk, will, in some 
cases, act like a charm. If it is dependent on acidity, the remedies 
are given under " dyspepsia." If caused by irritixbility of stomach, 
a pill of extract of belladonna and ipecac (339) will do well. 

While vomiting, the patient should lie still in bed, and in bad 
cases, a mustard poultice should be placed upon the stomach. 

The vomiting of children may sometimes be stopped by wetting a 
piece of cloth with laudanum, and laying it upon the "t of the 
stomach. 

Seasickness. 

This is the great terror of persons who, for the first time, croRs the 
ocean. • It is said that dark-complexioned persons suffer more from 
it than other;. 

If it cannot be entirely prevented, it may be mitigated by lying 
flat upon the back. To lie on deck, in the open air, is much better 
than lying in the close air of tie cabin or stateroom. A wineglass 
of brandy, or iced champagne, sipped now and then, will relieve the 
sickness very much. For a child, it is sometimes sufficient to wet a 
cloth with mustard, and lay it upon i\e pit of the stomach. Creo- 
sote, one drop at a dose, made into a p;!1 h excellent. Ten drops 
of hartshorn, in half a tumbler of water, is good for some. But the 
best known i-emedy is chloroform, taken in doses of from forty to 
eighty drops, suspended in water by means of a little gum-arabic. 
Bromide of soda in large doses, daily, prevents it, or bromo-caffein 
when it first comes on. Cocaine in one-eighth grain doses every 
twenty minutes is usually very helpful. A spinal ice-bag placed 



n^- ^j - wiw f ^ n ^ 'iyw 



mnm^mimmmm 






DISEASES OF THE ABDOMINAL CAVITY. 



311 



opposite the stomach while the sufferer lies upon the back will do 
more toward curing sea-sickness than any other single remedy. 
These bags are about eight inches long, made of thin rubber, and are 
to be filled with small pieces of cracked ice. When the ice melts 
refill the bag. 

Milk Sickness. 

This disease prevails in the West, chiefly in the neighborhood of 
level, heavily-timbered, rather wet oak-land. 

The cattle, horses, and sheep, which range in this land, are fre- 
quently attacked by a disease which the people call the trembles. It 
is supposed to be produced by eating some plant growing upon those 
lands, 88 cattle which feed in the neighboring regions are free from 
it until they find their way into these low grounds. It has been sug- 
gested that the offending plant may be the poison ivy (rhus toxicoden- 
dron) . Be this as it may, the calves, soon after sucking cows which 
have run in these grounds, are seized with trembling, and frequently 
die of the disease. Dogs which lap the milk are affected in a similar 
manner. Children drinking it leave the table and vomit. Upon 
grown persons the effects are more severe, but not so sudden. The 
eating of the beef, mutton, or veal, of affected animals, brings on the 
same disease. 

Symptoms. — The disease sets 'in with sickness at the stomach, 
which is preceded by general debility, more particularly of the legs. 
There is nausea, vomiting, and the breath is so offensive and peculiar 
that those acquainted with the complaint immediately recognize it 
from this smell. 

These existing for weeks, constitute, in some cases, the whole of 
the symptoms. In other cases they are more severe, being attended 
by chills and flushes, great oppression about the heart, anxiety, deep 
breathing, heat in the stomach compared to fire and boiling water, 
violent retching and vomiting, alarming beatings of the heart, and 
throbbings of the large vessels, and cold extremities, — producing, 
all together, extreme distress. 

In most cases, the vomiting returns eVery hour or two, attended 
by great burning at the pit of the stomach, the substance thrown up 
having a peculiar bluish-green color, and a sour smell. As soon as 
this discharge takes place, the patient falls back upon the pillow, and 
lies easy until another turn comes round. . The tongue is covered 
with a whitish coat, the bowels are obstinately costive, and the pulse 
is small and quick. 

Treatment. — It is believed that the neutralizing mixture, given 
in tablespoonful doses every time the nausea and burning ciensation 
are felt, is the most effectual remedy yet used. It relieves the 
acidity, and seems well adapted to allay the irritation. Some anti- 
bilious physic (40) to move the bowels should also be given. 



MillJi 



HMMMHBt^. 



312 



DISEASES OP THE CHEST. 



Besides these remedies, a mustard poultice should be put upon the 
stomach, and hot bricks to the feet, and the patient be kept still for 
some hours. The diet should be very mild, — only toast-water, rice- 
water, or thin gruel. 

Acute Inflammation of the Peritoneum. — Peritonitis. 

This disease affects the extensive membrane which lines the whole 
inside of the belly, an extenpion of which forms the omentum or 
apron. It is an inflammation to which women are much exposed 
after confinement, and is known, in such cases, as child-bed or puer- 
pral fever. It is common among men also, and is a grave disease. 

The accepted notions of no disease have undergone so much of a 
revolution of late years as those relating to peritonitis. It was formerly 
considered to be generally of spontaneous or idiopathic origin, whereas 
now we know it to be the outcome of some one of se . o^al diseases, 
but lately understood, as for instance, appendicitis, septicaemia or 
blood-poisoning, inflammation of the fallopian tubes and ovaries, 
tuberculosis, abscess of gall-bladder, strangulated hernia, etc. 

Symptoms. — Like other forms of fever and inflammation, it is 
preceded by chills, with increased heat of surface, thirst, full, strong, 
and frequent pulse, flushed face, and red eyes, dry tongue with red 
edges, dry skin, restlessness, short, quick breathing, nausea and 
vomiting. 

The pain is increased by the patient sitting or standing up, — the 
bowels being thus pressed against the inflamed membrane. Lying 
upon either side is painful for the same reason. To lie flat upon the 
back, with the feet drawn up, is the only endurable position. The 
patient lies still, for all movements give pain. 

The pain in this disease is generally sharp, cutting, and pricking, 
but is not always equally intense. It is aggravated by the passage 
of wind along the bowel, by which the inflamed membrane is slightly 
stretched. 

When the disease is advancing towards a fatal termination, the 
belly becomes greatly swollen and tense, — having to the hand a 
peculiarly tight, drum-head feeling ; the pulse is rapid and feeble ; 
the countenance is full of anxiety, and is pinched and ghastly ; and 
a cold sweat breaks out. 

Treatment. — Small doses of antimony, lobelia, or ipecac, to pro- 
duce nausea and a moisture upon the skin, are generally among the 
first things given. The tincture of veratrum viride, in five to ten- 
drop doses, repeated every hour, will accomplish the same thing more 
effectually than any other known article. For such purposes, I give 
it the first place among medicines. A large poultice of white bread, 
rye-meal, or flax-seed, may be spread over the belly ; or cloths wet 
with cold water will be still better, if the patient be full-blooded, 
and naturally strong. The bowels should be moved at once by some 



T)I8EASE8 OF THE ABDOMINAL CAVITY. 



313 



active physic, as Dutteriuit, salts, magnesia, castor-oil, or cream of 
tartar (20), (17), (18), (27),or by podophyllin, etc. (40), (41), (31). 

The two main indications in the treatment of peritonitis after having 
discovered and treated the causes, are the thorough draining of the 
bowels of their watery secretions by some gentle saline which will 
not stir them up ; and secondly to maintain them in a state of quiet and 
rest. The first is met by magnesia in the form of the solution of the 
citrate, say one-half bottle every four hours till copious watery move- 
ments occur. Tliis drains the glands and causes a flow of the poi- 
sonous effete material into the bowels and rids the system of so much 
poison. The second indication is met by opium in some of its many 
forms. It is often, however, a serious problem for even the physician 
to decide, and should only be undertaken with his advice. 

The drinks should be lemonade, soda-water, tamarind-water, cur- 
rant-jelly dissolved in water, and preparations (298) and (299). 
Indian-meal gruel, toast-water, barley-gruel, and the like, are the 
only allowable diet. 

Chronic Inflammation of the Peritoneum. 

When the acute inflammation of the peritoneal membrane is not 
successfully treated, it may run on for a time, and then subsid" into a 
lower grade of inflammation, called chronic, and in this state remain 
for an indefinite time. But it often arises independently of the acute 
disease, and attacks persons of both sexes, and of all classes and ages. 
Scrofulous children have it, and, wasting away under it to mere skel 
etons, are said to have consumpdon of the bowels. 

Symptoms. — These are sometimes very obscure, and the advances 
of the disease stealthy. At first there may be only a little soreness 
of the belly, so slight, as not to be noticed except after hard work, or 
upon some wrenching motion. Generally, there is a sense of fullness 
and tension of the belly, although it may not be increased in size. 
After a time, it enlarges a little, and its tension or tightness increases, 
especially towards evening. By pressing carefully with the hand, a 
deep-feeling tension may be detected, giving to the hand a sensa- 
tion as of a tight bandage underneath, with the skin and integu- 
ments sliding loosely over it. If water has been poured out into the 
abdominal cavity, its fluctuation may be frequently detected by press- 
ing upon one side of the belly with the palm of one hand, and strik- 
ing the other side with the ends of the fingers. 

As the disease goes on, the features become sharp and contracted, 
and the countenance grows pale and sallow. Costiveness comes on, 
sometimes chills and fever, with debility, loss of flesh, cough, difficult 
breathing, hectic, and swelling of the legs. 

Treatment. — Costiveness, if present, may be relieved by Mettauer's 
aperient, or the neutralizing mixture, assisted by coarse bread, and 
boiled cracked wheat. 




314 



DISEASES OF THE ABDOMINAL CAVITY. 



Daily bathing is especially necessary, particularly the alkaline 
sponge bath, with vigorous friction over the bowels. The warm bith 
once or twice a week will be useful. In some cases, a wet towel 
laid upon the bowels over night, and well covered by flannels, will 
afford relief ; or the compound tar-plaster may occasionally be used. 

If there be dropsy of the belly, iodide of potassium (138) should 
be taken freely, and the skin made sore over the inflamed part, by 
tincture of iodine, well rubbed in, once a day. 

If the patient be pale and bloodless, give iron, quinine, etc. (74) 
(76), and let the diet be nourishing ; and if nervous symptoms be 
connected with the debility and paleness, add some nerve-tonic (93), 
(81), (316). When the disease is known to be the outcome of a 
deposit of tubercles on the peritoneum, it is now customary to open 
the abdomen under antiseptic methods and wash out the cavity. The 
effect of a mild sallrsolution and the light and air oftentimes arrests 
the disease. 

Acute Inflammation of the Bowels. — Enteritis. 

By inflammation of the bowels is generally understood an inflamed 
condition of the muc&us membrane which lines them ; but tliis, most 
commonly, is only a part of the disease ; it involves more or less, 
besides this mucous lining, the whole substance of the bowel. After 
an inflammation has existed some time, and even, in severe cases, at the 
start, certain poisonous substances are formed as the result of germ 
invasion, called toxines. These are genuine poisons, and often 
spread rapidly through the walls of the bowels by means of the 
numerous lymphatic vessels to the peritoneum itself, — that delicate 
membrane which we have seen covers all organs within the abdomi- 
nal cavity. When this membrane once becomes poisoned, an acute 
inflammation sets up, which masks all other symptoms, and is indeed a 
veritable blood-poison. We have then to deal with peritonitis. 

Symptoms. — The disease begins with a chill, and with uneasiness 
and slight griping pains, which increase in severity until they are in- 
tense and burning. Pressure aggravates the pain, which is most 
intense about the navel, but extends more or less over the whole- 
bowels. 

From the beginning there is sickness at the stomach, and some- 
times vomiting ; there is loss of strength, costiveness, great anxietfy, 
thirst, heat and fever, dry, furred, and red tongue, and but little urine, 
with pain in passing it. The matters passed from the bowels are 
dark and fetid ; and the whole belly is tender and sore to the touch. 
The pulse is quick, hard, and small. 

The stomach will be but little affected, comparatively, when the 
disease is at some distance from it in the lower portion of the bowels. 
Indeed, the nearness of the inflammation to the stomach, or its re- 
moteness from it, may be judged pretty correctly by the degree of 



DISEASES OF THE ABDOMINAL CAVITY. 



315 



disturbance in that organ. The length of time after drink and medi- 
cines are swallowed, before they are vomited up, is a pretty good 
measure, likewise of the distance of the disease from the stomach. 

How to Discriminate This disease is liable to be confounded 

with colic, and with inflammation of the peritoneum. It is impoitant 
to distinguish it from colic, particularly, because the treatment for that 
would aggravate this. In this disease the pain is increased by pres- 
sure; in colic, it is not, but is rather relieved. In enteritis, the pain 
remits, but never ceaaes wholly, as it does in colic. In enteritis, 
the knees are drawn up, and the breathing is short; in colic it some- 
times gives relief to stretch the feet down, and the breathing is not 
altered. 

To distinguish it from inflammation of the peritoneum, take notice 
that diarrhoea is much more common than in this latter complaint, 
while the pulse is not as quick, nor the pain as severe. 

Treatment. — This should be very much the same as that recom- 
mended for peritonitis. Perhaps in both diseases it might be veil 
to begin with covering the belly all over with leeches. 

The tincture of veratrum viride, in full doses, so as to keep up a 
free perapiration, cold compresses, mustard poultices, hot fomentations, 
poultices, blisters, soothing and quieting injections, and demulcent 
drinks, as slippery elm, marshmallow, flax-seed, etc., if judiciously ap- 
plied, will do about all that we have it in our power to accomplish. 

In this disease it is well to inquire if the patient has a hernia, for 
if so, it is liable to become strangulated without his knowledge. A 
strangulation of the gut may be the cause of the disease. When this 
happens, the complaint is very unmanageable. The bowel may pos- 
sibly, in such case, be disentangled by applying a large dry cup ; or, 
what is better, a number of small ones ; but the tenderness of the 
belly makes the use of this remedy difficult. Here again magnesia 
may be of signal benefit unless the movements are already too copious 
and exhausting, in which case disinfectants or astringents must be re- 
sorted to. The possibility of tuberculosis must not be ignored. 

Chronic Inflammation of tlie Bowels. 

Like other chronic inflammations, this may follow the acute torm, 
but it also results from various other causes, as unripe fruit, taking 
cold, drastic physic, and improper treatment of other diseases. 

Symptoms. — Red end and borders of the tongue, dull pain in 
belly, increased by pressure and rough motion, abdomen either swelled 
or flat, skin dry and husky, feet and hands cold, small frequent pulse, 
thirst, loss of flesh, low spirits, urine scanty and high-colored, and 
dirty, slimy discharges from the bowels, from one to four times a 
day. 

Treatment. — To begin with, blisters, or croton-oil, or mustard 



_ll 



316 



DISEASES OF THE ABDOMINAL CAVITY. 



poultices, or dry cups, if the tenderness is not great, or leeclies if it is. 
If the bowels are hot and feverish, bind a cold compress upon the 
belly over night, covering it well with flannel. The warm bath 
should be used twice a week. Salol, ten grains every three hours, 
bismuth and opium, are in this case very valuable. Wasliing out the 
lower bowel with hot water by means of a syringe often soothes and 
heals. 

The diet must be of the most simple, unirritating kind, beginning 
with a solution of gum-arabic, rice-water, barley-water, arrow-root or 
sago-gruel, and gradually rising, as the symptoms improve, to beef- 
tea, mutton and chicken broth, tender beefsteak, etc. 

When the strength will permit, gentle exercise must be taken in 
the open air, but not on horseback, or in hard, jolting carriages. 

As soon as the inflammation is subdued, some mild laxative (35) 
may be given, in connection with an infusion of wild-cherry bark, 
geranium, and Solomon's seal, equal parts. 



Appendicitis. 

This is one of the so-called modern diseases, — not that it has not 
existed for a long time, but that not till lately has it been recognized 
as a distinct ailment. Formerly it fell under the general category 
of peritonitis or inflammation of the bowels. American physicians 
have done more toward discovering its characteristics than others. 
It is an inflammation of the appendix vermiformis, which is situated 
at the end of the large bowel, in the right flank, close to the junction 
of the colon witli the small bowel (see Fig. 60). This organ is a 
small, round, tail-like body, about the size of a slate-pencil, and aver- 
ages some three inches in length. It is hollow, lined with mucous 
membrane, and covered like the bowel proper with a peritoneal mem- 
brane. It secretes mucus. Its use is as yet unknown, being thought 
by many to be a rudimentary organ like the uvula, without function, 
and possibly analogous to the herbivorous stomach. Whenever small 
seeds enter the cavity of this organ (which is in reality a rare occur- 
rence) or whenever, from any cause, a catarrhal inflammation is de- 
veloped in it, the secretion increases, and being confined, aggravates 
the trouble. This catarrhal inflammation is generally mild and the 
trouble often subsides either for good or to start up again sooner or 
later. 

The inflammation may, however, become purulent, the germs pen- 
etrating the walls of the appendix and causing a general inflammation 
of the peritoneal coat of the bowel. In these cases nature fights 
hard to resist the invasion of the germ and throws out a large amount 
of lymph and serum, which, when it hardens, often acts as a barrier 
to the furtl ,.' progress of the peritonitis which has begun about the 
appendix. These cases are characterized by a hard lump in the ap- 
pendicular region, the inside of which contains pus as a rule, which 



T>W l )^i i| »l » l il .,-V. i | | i,H,|ij.> ■ 



DISEASES OF THE ABDOMINAL CAVITY 



317 



lies if it is. 
upon the 
i^arm bath 
ree hours, 
ig out the 
jothes and 

beginning 
ow-root or 
B, to beef- 

i taken in 
iages. 
ative (35) 
erry bark, 



it has not 
'ecognized 
I category 
physicians 
an others. 
is situated 
e junction 
)rgan is a 

and aver- 
;h mucous 
neal mem- 
ig thought 
, function, 
ever small 
are occur- 
ion is de- 
tggravates 
i and the 
sooner or 

erms pen- 
ammation 
ure fights 
je amount 
} a barrier 
about the 
in the ap- 
ile, wliich 



has escaped from the bursting appendix. Cases of this class are ex- 
tremely dangerou < and require the immediate aid of a surgeon, as 
they are bound to give trouble sooner or later, even if the first attack 
does not prove fatal. 

There is still a third class of cases, called fulminating, because 
from the very first they seem to be purulent, and spread lapidly into 
a general peritonitis, death occurring within a few days from the ap- 
pearance of the fiiBt symptoms. These cases are the most hopeless 
of all, and must be operated on without the slightest delay, since im- 
mediate evacuation of the pus, before a general infection of the ab- 
dominal cavity supervenes, is the only possible hope of saving the 
patient. 

Symptoms. — The disease, as generally observed, begins with lan- 
guor and pain in the abdomen, with special soreness on the right 
side, oftentimes nausea and vomiting, constipation, a slight rise of 
temperature, and headache. As the disease progresses the tenderness 
amounts to pain, a bunch may be felt by the medical attendant : the 
temperature gets a little higher and symptoms of pus formation set 
in. The case may hang in this initial stage (up to the point of pus 
formation) for several days and finally subside, ^t being a more or 
less catarrhal inflammation; but when pus has nice formed the pa- 
tient cannot escape without an operation for the removal of the of- 
fending body. Many surgeons at the present day even take the 
ground that every inflamed appendix should be removed. 

Treatment. — The medical treatment consists in giving magnesia 
in form of the solution of the citrate, with a light diet, and keeping 
the patient in bed. Poultices may be of some benefit. Opium should 
not be used unless pain is extreme. 

The operation for appendicitis, when performed between the attacks, 
is a comparatively safe one in competent hands ; but it becomes a very 
grave one if pus forms rapidly and invades the general abdominal 
cavity. Between these two classes of cases there are all grades of 
difiiculty and danger. 

Cancer of Intestine. 

This disease is much less frequent than cancer of the stomach, 
constituting about five per cent of all cases of cancer. It occurs 
usually about the middle period of life. We are in absolute igno- 
rance of its causation in this region. The rectum is the most favor- 
able part of the bowel for its development, the large intestine next, 
and then the small intestine. 

Symptoms. — Intestinal hemorrhage, pain ; emaciation, irregular 
movements of the bowels, pain in the sacral region, radiating to the 
genitals and down the course of the sciatic nerves (in case of rectal 
cancer), are among some of the indefinite symptoms of cancer of the 













f 



818 



DIBKA8E8 OF THK ABDOMINAL CAVITY. 



bowels. When well marked and when located favorably, a tumor 
may he discovered by palpation, but often this cannot be felt and tlie 
masses which at lirst seem to indicate cancer may afterward prove 
to be merely fajcal accumulations. When the mass can be felt in 
the rectum the diagnosis becomes clearer. The prognosis of the 
disease is extremely unfavorable. 

Treatment. — As for treatment, only in rare cases is much aid 
ever procured. The formation of an artificial anus in the left flank 
may avert for a while the final end. The injection of the new cancor- 
serum is still of doubtful success. 

Opiates to relieve pain, nourishing food frequently repeated, and 
the use of antiseptic enemas, are, for the most jmrt, the chief meas- 
ures that afford relief. 

Intestinal Obstruction. 

This is a mechanical interference with the movements of the fce- 
ces, and is caused either by intussusception or invagination, con- 
striction, twists, stricture or hernia. These conditions are frequently 
produced by irregular movements of the bowels as a whole, and by 
irregular movements in various parts of the same, there being an 
increased peristalsis in one part and constipation in an adjacent part. 
Many cases of intussuception occur at the ileo-ctecal valve, the small 
bowel entering the large lx)wel and being driven downward. The 
circulation of the bowels is naturally interfered with, and intense 
congestion occurs, with swelling and final obstruction of the calibre 
of the gut. Pain becomes paroxysmal and peritonitis ensues. Pain 
increases, with vomiting and the discharge of mucoid stools ; finally 
the patient dies of exhaustion. 

Constriction of the bowel forms the larger proportion of cases and 
is not infrequently caused bj' fibrous bands which are the result of 
inflammation. Strangulation may be produced by a loop being held 
down by such bands or by being twisted about it. Intestinal ob- 
struction, ulceration, and even perforation are common results. 

A twist or volvultis is also a cause of obstruction, though less com- 
mon than the two causes just mentioned, and occurs generally near 
the sigmoid flexure. 

Stricture of the bowel usually occurs at the sigmoid flexure, or in 
the rectum, and is not usually complete, some small amount of fiecal 
matter still escaping. Tumors, like cancer, not infrequently cause 
stricture by their compression. 

Functional obstruction occurs chiefly in hysterical females, but also 
in disease of the brain and spinal cord, as well as from peritonitis 
and blows on the abdomen. It is the result of a paralysis of the 
bowel. 

Impaction of fauces is still another frequent cause of obstruction. 
The contents of the bowels, especially in the rectum, become hard, 



"" • 'mmMtt^Km . i i mm 



Bi.mi i uAjn^j giftjt i w i j *» i i .^. ' i.u. i iu)mw!'. i ;.'Miu^ -— - — *-^r^ 



mSEASKS OF THK ABDOMINAL CAVITY. 



319 



iy, a tumor 
felt and the 
»rard prove 
be felt in 
osis of the 

I much aid 
le left flniik 
uew cancor- 

peated, ami 
chief meati- 



of the fee- 
lation, con- 
frequently 
3le, and by 
e being an 
jacent part. 
3, the small 
vard. The 
md intense 
the calibre 
ues. Pain 
ols; finally 

F cases and 
e result of 
being held 
testinal ob- 
sults. 
h less com- 
lerally near 

ixure, or in 
.nt of fiecal 
ently cause 

Bs, but also 
peritonitis 
ysis of the 

ibstruction. 
3ome hard, 



blocking the passage till quite a perceptible bunch may be felt ex- 
ternally. The channel is notalways blocked completely. Gall-stones 
may become impacted near the ileo-cascal valve in their pasaage 
downward, and form the starting point of the faecal accumulation. 
These various causes produce either acute or chronic obstruction. 

SymptomA. — In the acute variety, pain, vomiting and constipa- 
tion are the prominent symptoms. There are at first some digestional 
disturbances, with moderate pain. Afterwards the pain becomes 
severe, even intense, and is usually located near the seat of the ob- 
struction. It is at first colicky and intermittent, but finally becomes 
continuous and severe over the whole abdomen. Vomiting sets in, 
first of food, then later of bile, and finally stercoraceous if the ob- 
struction becomes complete. Vomiting occurs whether the obstruc- 
tion is in the large or small bowel. Before the close of the soenr 
this vomiting a«sumes a ricewater-like character, perhaps attended 
with hiccough. 

There is an absence of the passage of wind, although at fii-st some 
small amount of faecal matter may pass. In intussusception there 
are usually bloody discharges in addition to constipation. The ab- 
domen of course soon becomes tympanitic or swollen, and sounds of 
water and gas may be heard very distinctly. 

The general symptoms are those of a very grave disease, — restless- 
ness, cold extremities, pinched features, and cold, clammy skin. The 
pulse is small, the temperature generally subnormal, tongue dry, and 
thirst very pronounced. 

In the event of chronic obstruction, all these symptoms appear very 
much more gradually. Pain is less severe, vomiting often absent tiU 
the obstruction becomes complete. The faecal matter may often be 
several feet long before the obstruction becomes severe. Long-stand- 
ing constipation which does not respond to proper laxatives should 
arouse suspicion. The stools themselves are often ribbon-like in 
shape and very small, not infrequently resembling the faeces of sheep. 

The prognosis of obstruction of the bowels is usually very grave, 
and the duration of life varies from a few hours to ten or twelve days. 
The higher up the obstruction, the worse the prognosis. Simple 
faecal impaction perhaps offers the most hope; next those cases 
amenable to surgical interference. 

Treatment. — Opium to relieve pain and to stop the exaggerated 
peristaltic movement in parts of the bowel above the obstruction is 
surely indicated ; it also relieves the vomiting. Continued, large 
enemas of suds and oil, and even the addition of turpentine, should be 
resorted to at once as soon as the trouble has been made out. These 
are best given with the hips elevated, and should consist of four to 
six quarts of water ; they are to be given slowly and without much 
force. Oftentimes an anaesthetic is needed. 

If the obstruction is from fsecal impaction, small, repeated doses 



320 



DI8EARK8 OF THK ABDOMINAL CAVITY. 



of Bomo fliUine should bo used ; say two ouncos of tho solutir n of tho 
citmtu of magnesiu every two hours. Castor-oil in teaApoonful (loses 
hourly till movement occurs is also good. But if the olwtructioii is 
from intussusception, twist, stricture, etc., all laxatives must Ikj 
strictly interdicted. Finally, these simple means failing and the case 
lie suspected to be due to impaction by foreign bodies, fibrous bauds, 
etc., the abdomen must Imj opened and the seat of the obstruction 
found and if possible removed. The operation in this class of cases 
is not attended with a great percentage of recoveries, and yet the 
fatal termination is much surer if left alone ; in many cases it is 
brilliantly successful. 

External methods of treatment by hot fomentations of turpentine, 
and even of massage, often add greatly to a favorable termination. 

The diet must be very light and nutritious, and in case of vomiting 
must be given by the rectum. After Liie obstruction has been re- 
lieved, one must be very careful about the diet and see that the bow- 
els are open daily. 

Wind Colic. — Platulent Colic. — Interalgia. 

This is a severe and distressing pain in the bowels, — sometimes a 
stoppage, and a swelling about the pit of the stomach and the navel. 
What children call belly-ache is a mild form of it. The wind passing 
from one portion of the bowel to another causes a rumbling noise. 
The pain is not increased by pressure ; and this distinguishes it from 
the pain of inflammation. It moves about, too, from place to place, 
and is much relieved by the escape of wind up or down. 

The complaint may be caused by a weakness in the digestive or- 
gans, by eating indigestible food or unripe fruit, by costiveness, and 
by taking cold. Some persons always have the colic excited by eat- 
ing certain kinds of fruit. 

Treatment. — When the complaint is caused by an indigestible sul)- 
stance taken into the stomach, the offending matter should be thrown 
off by an emetic as yoon as possible. If this does not bring relief, 
let it be followed by a dose of salts, salts and senna, compound infu- 
sion of senna, elixir salutis, elixir pro., or sweet tincture of rhubarb. 
If there is no sickness of the stomach, a little essence of peppermint 
or spearmint in hot water, or brandy, gin, or whisky, in hot water, 
may prove sufficient to expel the wind, and relieve the pain. Ginger 
and hot water does well with some. If there be costiveness, and the 
pain is obstinate, let the bowels be unloaded by a stimulating injec- 
tion (248), (249), (250). Inject one dram of ether in a little starch- 
water into the bowels, and relief will often be instant. It can be 
repeated every half-hour. The injection of a table-spoonful of tur- 
pentine in suds can also be tried and repeated eveiy two hours. 



■ iW i ii wa »i| »M.W l t i VMI jrjmTJIIiMiflU tWKI 



W»! l ' ' I ._WJJ,. J»-WJ ' >W-W ' !X». 



iticn of tlu! 

on fill (loHCK 

Htructioii JH 
iH must be 
nd the ca8(! 
roiiH haiulH, 
obstruction 

188 of caBOS 

md yet tlie 
ca«es it is 

turpentine, 
nination. 
)f vomiting 
IS lieon re- 
at the bow- 



Igia. 

ometimes a 
1 the navel, 
ind passing 
iling noise, 
hes it from 
e to place, 

gestive or- 
■"eness, and 
ted by eat- 

Bstible sul)- 
'. be thrown 
ring relief, 
ound infu- 
if rhubarb. 
)eppennint 
hot water, 
in. Ginger 
ss, and the 
ting injec- 
btle starch- 
It can be 
:ul of tur- 
ours. 



DI8KA8K8 OF Tl« ABDOMINAL CAVITY. 321 



Air-Swelllngs. — Ti/mpaniteB. 

It is quite common for persons in delicate health — particularly 
females — to have their stomach and bowels swell up, sometimes 
slowly, sometimes suddenly, so that they cannot bring their clothes 
together. They do not know what to make of it; it sometimes 
(ilarins them ; and they ask their medical adviser what it means. 

These swellings may occur from an accumulation of air within 
the bowels, and also within the abdominal cavity. This latter gives 
the belly a peculiarly hard feel, like the head of a drum, and when it 
is pressed upon with the finger no indentation remains. It usually 
is the result of a weakened sympathetic nervous system, brought 
about by some one of the many abdominal diseases. 

Treatment. — If the air be in the intestinal tube, a stimulating in- 
jection may bring away the wind. It may be composed of one pint 
of infusion of peppermint, one gill of tincture of prickly-ash berries, 
half a gill of tincture of castor, and a teaspoonful of ginger. The 
l)owels of the patient should be rubbed for a long time ; and in all 
forms of the complaint, it would be well to do this every day. Some- 
times the wind may be drawn off by inserting into the rectum a long 
rubber tube. Treatment often resolves itself into a cure of some 
existing uterine or ovarian diseaae and the various phases of peri- 
tonitis, in which latter case there is fever and other well marked 
symptoms. 

The best constitutional remedies are tonics, — iron, quinine, mineral 
acids, and bitters, (48), (65), (59), (60), (62), (63), (64), (71), 
(73). 

Exercise in the open air, and a careful regulation of the diet, will 
do much towards removing these troubles. Costiveness must be care- 
fully guarded against. 

Bilious Colic. 

This is a dangerous disease. There is pain of a griping, twisting, 
tearing kind, — what the ancients called atrocious pain. It is chiefly 
about the navel, but sometimes tortures the whole bellv. It comes 
and goes in paroxysms. Sometimes the abdomen is drawn in, at 
other times it is swelled out, and stretched like a drum-head. At 
first the pain is relieved by pressure ; after a time the belly is tender to 
the touch. There is thirst and heat, and a discharge of bilious mat- 
ter from the stomach. In the worst cases, the pulse is small, the face 
pale, the features shrunk, and the whole body covered with cold 
sweat. While the head is hot the feet are cold. In advanced stages 
of the disease, the action of the bowels is sometimes reversed, and 
the fecal matter forced up through the mouth, owing to impaction of 
fteces or other obstructions of the bowel. 



822 



DISEASES OF THE ABDOMINAL CAVITY. 



Causes. — Costiveness, irritating substances in the bowels, thick, 
vitiated bile, long exposure to cold, torpidity of the liver and skin, 
great unnatural heat, with dampness, obstruc' )d gall-duct, etc. 

These attacks are usually the result of indigestion in the upper 
bowel, near the bile-ducts, creating a thick mucus which obstructs 
the passage of bile from the ducts into the bowels. A regulation of 
the duct, small doses of podophyllin or the acids, with daily doses of 
some mild bilious laxative, will prevent their return. Crab-orchard 
water, sal-muscatelle, and other simple medicines answer every pur- 
pose. 

Treatment. — Administer an active purgative injection immediately 
(251),(252). Internally, dioscorin, camphor, etc. (340), every fifteen 
minutes until relief is obtained, at the same time 'covering the whole 
belly with a large mustard-poultice. A strong decoction of the wild- 
yam root, drunk freely, is a medicine of some value, — so is a decoc- 
tion of scullcap and high-cranberry bark, eoual pai-ts. This latter 
article is excellent in spasmodic affections, ou .vhich account it has 
gained the name of cramp-bark. The sickness at the stomach may 
frequently be allayed by effervescing drafts, to which twenty-five or 
thirty drops of lavender are added. Croton-oil, given in one-drop 
doses, done up with crumb of bread, will sometimes succeed well as 
a purgative medicine ; or castor-oil and spirits of turpentine, equal 
parts, in two great spoonful doses, may be tried before the croton 
oil. 

The warm bath is worth remembering, and trying, too, if the 
means are at hand. Hot fomentations of the bowels with a decoc- 
tion of poppy-leaves, stramonium-leaves, hops, wormwood, boneset, 
or peppermint leaves, should not be overlooked. Bottles filled with 
hot water, or hot bricks rolled in flannel, should be placed at the back 
and feet to promote perspiration. 

Persons subject to this complaint may derive advantage from one 
pill composed of extract of high-cranberry bark, etc. (100), taken after 
each meal for some months. At the same time a reasonable amount 
of exercise should be taken out of doore, and a sponge bath, with 
friction, be employed daily. Care should be taken not to be often 
exposed to the hot sun. 

Painters' Colic. — CoUca Pictorum. 

This form of colic is caused by the slow introduction of lead into 
the system, — generally the carbonate of lead. It passes under the 
different English names of painters' colic, Devonshire 3olic, and dry 
belly-ache. The first of these is the name by which it is most com- 
monl}' known, f-om its frequent occurrence among painters, who use 
white lead (carbonate of lead) a great deal in the preparation of their 
colors. 

Symptoms. — The disease generally comes on in a very gradual 



,< i iW<l)ip, m i »,||l|i<HBIH Ii|ii| . ril lHH| i JI!ai i l l i l », i TO»Wl ' JUI ' HM«u i u > .,L. I - 



l ' >"i!l,£ 



DISEASES OP THE ABDOMINAL CAVITY. 



823 



)wel8, thick, 
sr and skin, 
st, etc. 

1 the upper 
jh obstructs 
egulation of 
lily doses of 
yiab-orchard 
' every pur- 

imraediately 
ivery fifteen 
g the whole 
of the wild- 
[) is a decoc- 

This latter 
ount it has 
omach may 
enty-five or 
in one-drop 
;eed well as 
titine, equal 

the croton 

too, if the 
th a decoc- 
)d, boneset, 
1 filled with 
[ at the back 

e from one 
I taken after 
ble amount 
bath, with 
to be often 



)f lead into 
I under the 

lie, and dry 

most ccm- 

rs, who use 

ion of their 

3ry gradual 



way. At first, the appetite is impaired, there is a slight nausea, 
belching of wind, languor, very obstinate costiveness, transient pains, 
with a feeling of weight and tightness in the belly, and a disinclina- 
tion to make any exertion. 

By degrees, the pain in the bowels, and particularly about the na- 
vel, becomes more severe, and has a twisting character. The belly 
becomes hard, drawn in, and a little tender to pressure, and the stom- 
ach very irritable. The pain occasionally slacks off a little; but 
never, even in mild cases, entirely stops, as in other kinds of colic. 

In some severe cases, the pain runs up to the chest, and down the 
arms ; also down to the bladder, causing the urine to be passed with 
pain and difficulty, and giving a sense of weight and liem ing down 
a the lower belly. During the severest pains, the countt'nance is 
pale, conti-acted, and full of suffering ; cold sweats break out upon 
the face and limbs, and anxiety and agitation seize the patient. 

When the disease is not seasonably removed, it degenerates into 
the chronic form, the mental and physical energies become torpid, 
the circulation in the small vessels inactive, the skin dry, harsh, shriv- 
elled, pale, sallow, or of a leaden hue, the temper irritable, despond- 
ing and gloomy, and the body wasted. Besides all this, the muscles 
which lift up the lower arm become palsied, so that, when the aims 
are niised, the hands hang down in a helpless condition. In some 
cases, there is a blue line along the edges of the gums. 

Treatment. — For relieving the pain and opening the bowels, the 
treatment should be very much the same as that for bilious colic. 
There is one article, however, which is thought to have some special 
influence in cu' ^ng this disease, after it has become chronic ; it is 
alum. Fifteen grains of alum, two of aloes, two of jalap, and four 
of ipecac powder, may be mixed, and taken for a dose two or three 
times a day. If the muscles of the arm be palsied, one thirtieth of 
a grain of strychnine may be added to the above. The aromatic sul- 
phuric acid, taken as a drink, fifteen drops to the tumblerful of water, 
is always worthy of trial. 

The use of the electromagnetic machine maybe tried for the palsy; 
or a splint applied to the arm and hand, with vigorous friction once or 
twice a day, will sometimes do much for recovering the use of the 
muscles. 

But the best remedy for the palsied muscles is iodide of potassium 
(146), taken freely. The P'llphuret of potassa, one ounce dissolved 
in a quart of water, au^ taken in teaspoonful doses, three times a day, 
is also worth a trial. The affected arm should be soaked an hour, 
once or twice a day, in the same amount of this latter salt, dissolved 
in a gallon of water. 

Means of Prevention. — The numei-ous persons wl 3 work in lead 
should comb their hair with a fine comb, wash their hunds and face, 
and rinse their mo^'th s dveral times a day, and also wash the whole 



824 



DISEASES OF THE ABDOMINAL CAVITY. 



person with soai) once or twice a week, and with clear water, or sal- 
eratus and water, once a da3\ Their working clothes should be of a 
kind to admit of being washed once or twice a week, and they should 
be put off for others when out of the workshop. A paper cap should 
be worn while at work. The food of the workmen should not be ex- 
posed to the vapoi-s or floating particles of lead, and consequently 
should not be carried into the shop ; and when much of the poison is 
floating in the air of the workroom, it is a good plan to wear a mask 
to prevent its being drawn with the breath into the throat and lungs. 
It has been said that those who eat freely of fat meats, butter, and 
other oily substances, are not attacked by the disease, though exposed 
to the poisoA. I know not what protection this can give, unless the 
skfn is in this way kept more oily, which prevents the absorption of 
the poison. This would seem to afford a hint in favor of anointing 
the whole person once or twice a week with sweet-oil. 

Costiveness. — Constipation. 

T?EW disorders are more common than costiveness. By this term 
I mean a sluggish state of the bowels, which causes them to retain 
the faeces longer than is warranted by health. In this complaint, the 
discharges from the bowels are not always less frequent than they 
should be, but they are less in quantity, are compacted and hard, and 
are passed bj hard straining, and sometimes with considerable pain. 

Symptoms. — Headache, dizziness, feverishnesa, bad feelings in the 
head not easily described, loss of appetite, sometimes nausea, but 
little desire to go to stool, a weight and heaviness about the lower 
part of the belly, and a sense of confinement over the whole body. 

Causes. — Sedentary habits, particularly when connected with close 
application of the mind ; astringent articles of medicine ; stimulating 
diet, composed chiefly of animal food ; various diseases, particularly 
those of a nervous character, and especially, a neglect to evacuate 
the bowels at proper periods. All these causes tend to weaken the 
bowels, and gradually to arrest that peculiar undulatory movement, 
or worm-like action, called the peristaltic motion of x,ne bowels. It 
is this continual contraction of the muscular fibres of the intestines 
from above downward, which pushes the contents steadily along; and 
whatever weakens the force of this vermicular play of the intestinal 
walls, brings on constipation. . 

Treatment.- — One of the first things to be done is to establish the 
habit of attemptinq to evacuate the bowels at a particular hour every 
day. The best time for most persons is -soon after breakfast in the 
morning. Whether successful or not, the attempt to procure an evac- 
uation should on no account be omitted. This regularity will often 
do much to break up the costive habit. 

Diet. — To this should be added a careful regulation of the diet. 



DISEASES OP THE ABDOMINAL CAVITY. 



325 



iter, or sal- 
)uld be of a 
they should 

cap should 
1 not be ex- 
)n8equently 
he poison is 
rear a mask 
t and lungs. 

butter, and 
igh exposed 
, unless the 
sorption of 
f anointing 



y this term 
n to retain 
nplaint, the 
. than they 
d hard, and 
rable pain. 

dings in the 
musea, but 
i the lower 
ole body. 

i with close 
stimulating 
particularly 
» evacuate 
weaken the 
movement, 
bowels. It 
) intestines 
along; and 
e intestinal 

stablish the 
hour every 
fast in the 
lire an evac- 
will often 



if the diet. 



The quantity of food taken should be no greater than can be easily 
digested. Full meals which distend the stomach and cause it to press 
upon the bowels embarrass their movements. Bread made from fine 
wheat flour is an abomination in this disorder. Eat only that from 
unbolted flour. Cracked or rolled wheat, prepared as directed among 
dietetic preparations, is excellent for the cure of costiveness. Fresh 
vegetables, as peas, beans, potatoes, squashes, and ripe fruits, in their 
season, are all wholesome, and help to relieve costiveness. But rich 
pies, puddings, cakes, doughnuts, and all that sort of trash, increase 
the disorder. 

Water Injections, etc. — One of the best remedies is water, cold 
or tepid, according to the condition of the patient, injected into the 
bowels with the fountain syringe. Syringes for this purpose may be 
obtained in any drug-store, and one should be in every family. 
Water used externally, in the form of the sponge-bath, is also useful. 

Medicines. — All the above measures having failed to give relief, 
take Mettauer's aperient, or the neutralizing mixture. If these fail, 
podophyllin, etc. (36), may have a trial. A cold decoction of thorough- 
wort, drunk daily, sometimes has an excellent effect. It must be re- 
membered that medicines may make mattere worse, and they should 
be used cautiously. Cascara Sagrada taken in small, repeated doses, 
say, half a grain once, twice or more times daily till the bowels move, 
for some weeks, then gradually decreased, often yields excellent re- 
sults. A glass of some aperient like Hunyadi Janos water, one-third 
glass with one-half glass of plain water on rising, will then take the 
place of the cascara ; and finally a glass of plain water will accom- 
plish all that previously required the use of the cascara. Daily knead- 
ing of the bowels, following the course of the large bowel, will add 
greatly to break up the sluggishness of the muscular atony of the 
bowel-walls. 

Piles. — Hemorrhoids. 

There are few complaints more common than the piles, and 
scarcely any which cause more trouble and misery. They consist in 
a fullness of blood, and languid circulation in the lower portion of the 
lower bowel or rectum. In consequence of this congestion, either the 
veins of the gut become enlarged or varicose, or the blood gets infil- 
trated into the cells beneath the mucous membrane, and collects, so 
as to form bloody tumora. 

These tumors, which are seldom absent, are the leading features of 
the piles. They sometimes appear externally, around the anus ; this 
is external piles. At other times they are within the bowel ; the com- 
plaint is then called internal piles. They are called bleeding piles 
when blood is discharged, and blind piles when it is not. 

Symptoms. — Usually there is a sense of weight and weakness in 
the lower part of the back and lions, with a painful itching alxjut the 



../ 



326 



DISEASES OF THE ABDOMINAL CAVITY. 



-•a I 

■ il 



I 






anus. On going to stool, there is a burning, cutting pain experienced, 
which is followed by bearing down and tenesmus. If it be bleeding 
piles, the little tumors will bleed at every motion of the bowels. 
There are frequently disagreeable sensations in the head, general las- 
situde, an irritable state of mind, and a sense of fullness and anxiety 
in the stomach. The pains experienced range all the way from the 
slightest twinges up to the most terrible sufferings, which appear like 
tearing the body asunder. 

Causes^ — Everything that irritates the lower bowel, and causes a 
determination of blood to the part. All drastic physic has this effect, 

— particularly aloes, which acts especially upon the rectum. Habit- 
ual costiveness, straining at stools, riding much on horseback, sitting 
a great deal, tight-lacing, high-seasoned food, and stimulation gener- 
ally, lifting and carrying heavy weights, and indurations of the liver, 
as well as a bilious indigestion. "^ 

Females during pregnancy are much affected with piles, which are 
induced by the costiveness so peculiar to their condition, and by the 
pressure of the enlarged womb upon the veins of the pelvis. 

Treatment. — This should be medicinal and dietetic. 

Great care must be observed not to push medication too far. Ac- 
tive purging will do great mischief. Yet costiveness must in some 
way be corrected. For this purpose, no remedy that I have ever 
tried has done better in this complaint than an electuary composed 
of confection of senna, flowers of sulphur and cream of tartar (6), 
taken in doses just sufficient to procure one natural motion of the 
bowels each day. Pills made of extract of thoroughwort are said to 
do well. If the liver be in a congested state, take some of the arti- 
cles recommended in the chronic inflammation of that organ. 

For the local treatment, nothing is better than two ounces of lard 
and one dram of the flowers of sulphur mixed, and rubbed between 
two plates of lead until they are well blackened. This ointment is 
not only soothing but curative, both in the bleeding and blind piles. 
An ointment of almost equal excellence may be made from one hand- 
ful each of witch-hazel bark, white-oak bark, and sweet-appletree , 
bark, boiled together in one pint of water down to one-third of a pint. 
Then strain, and add two ounces of lard and simmer away the water, 

— stining continually before and after removing from the fire, till it 
cools. Witch-hazel suppositories are excellent, as is also an oint- 
ment composed of 1 ounce stramonium ointment, 6 grains pulverized 
opium, and 6 grains tannin. 

If there is much inflammation and distress, an emollient and 
soothing poultice should be applied, composed of slippery-elm 
bark and stramonium or poke leaves. Steaming the parts is some- 
times useful, by sitting over a hot decoction of hops, stramonium, 
and poke. 

Piles may often be cured by the use of the domestic syiinge. Daily 



11 
^1 



sem 



mt 



fffm$^^ 



DISEASES OP THE ABDOMINAL CAVITY. 



327 



Jxperienced, 
be bleeding 
the bowels, 
general las- 
and anxiety 
ay from the 
appear like 

ind causes a 
i this effect, 
im. Habit- 
)ack, sitting 
ition gener- 
of the liver, 

s, which are 
and by the 
vis. 



10 far. Ac- 
ist in some 
' have ever 
y composed 

tartar (6), 
tion of the 

are said to 
jf the arti- 
^n. 

ices of lard 
jd between 
ointment is 
blind piles. 
a one hand- 
5t-appletree , 
I of a pint. 
r the water, 
3 fire, till it 
lo an oint- 
pulverized 

)llient and 
iippery-elm 
18 is some- 
lamonium, 

ige. Daily 



injections of cool or cold water will do much to strengthen the bowel, 
and restore the dilated veins to their natural condition. 

The food should be of a laxative nature, corn-bread, rye-pudding, 
bread of unbolted wheat flour, mealy potatoes, ripe fruit, pudding 
and milk, buckwheat cakes, broths, and a little tender meat once a 
day. 

When the piles are very painful an ointment of cocaine, ten 
grains, vaseline, one-half ounce, smeared well over them, is exceed- 
ingly grateful. Five-grain iodoform suppositories are very effective 
in reducing piles ; its odor, however, is quite objectionable to many. 
Surgical treatment is often the only resource left for their cure. 

Looseness of the Bowels. ^Diarrhoea. 

Looseness, or relax of the bowels, is manifested by frequent, copi- 
ous, and thin or unusually liquid discharges. The excessive dis- 
charge may be caused either by irritating and unwholesome food, by 
inflammation and ulceration of some portion of the bowels, or by de- 
bility. 

5yniptoins. — Rumbling noise in the bowels, with more or less 
weight and bearing down and uneasiness in the lower part of the 
bowels. This pressing down and uneasiness are relieved as soon as 
the evacuation takes place, but returns when another is near at hand. 
Griping is generally present, the strength is reduced, and the skin is 
pale, dry, and, after a time, sallow. 

Treatment.- — When the complaint is caused by irritating food, it 
will generally stup as soon as the offending substance is removed, and 
not much medicine will be required. 

To neutralize any acidity, to remove wind, allay irritation, and 
strengthen the stomach, the compound syrup of rhubarb and potassa 
is well adapted, given in teaspoonful doses, every hour, till it oper- 
ates. A little paragoric added to it occasionally, or essence of pep- 
permint, or spearmint, may aid its good effects. 

If nausea and vomiting are present, put a mustard poultice of one- 
third strength upon the stomach, and give one-tenth grain of cocaine in 
a teaspoonful of water every fifteen minutes. If there is much grip- 
ing' give an injection (248), with twenty drops of camphor in it. 
A common diarrhoea may generally be arrested at once by prescrip- 
tions 159 or 162, in teaspoonful doses, after each discharge. 

When there is inflammation and ulceration of the bowel, the treat- 
ment must be similar to that for dysentery, — fomentations exter- 
nally, and the occasional i se of starch injections, mild cathartics (9), 
(10), and poultices externally. 

Chronic Diarrhoea. 

The acute form of diarrhoea, not being properly managed, oft«n 
runs on, and becomes chronic, aiid is at times exceedingly difficult 
to cure. 






13 1 



«1L 



328 



niSKASES OF THE ABDOMINAL CAVITY. 



Symptoms. — Frequent discharges, generally with some pain and 
griping, restlessness, thirst, poor appetite, debility, loss of flesh, dry, 
rough, and somewhat sallow skin, and tongue dry and dark-colored. 
The food often passes through the bowels pretty much in the condi- 
tion in which it was swallowed. The liver is generally out of order, 
and the bowels are frequently afflicted with a low grade of inflam- 
mation. 

Treatment. — In this form of the disease, astringents and tonics 
will generally be required. Sometimes a teaspoonful of brandy, in a 
little sweetened water, or in clear water, several times a day, will 
effect a cure. Good cherry brandy is a valuable remedy ; so is black- 
berry brandy. Many of the worst cases have been cured by taking 
no nourishment, for a long time, except milk, with a little lime-water 
in it. 

When the liver is involved in the complaint, as evinced by light- 
colored stools, leptandrin, geranium, etc. (341), may be given with 
advantage. 

In some instances, when there is considerable debility, pills of 
quinine, catechu, etc. (342), will do well. 

A sponge-bath must be taken daily, and the skin be well rubbed 
after it. 

Cholera Morbus. 

The above name is given to a disease common in warm weather, 
and characterized by sudden attacks of bilious vomiting and purging, 
with severe pain in the belly, cramps, and general fever and sul)se- 
quent prostration. The great amount of bile secreted and discharged 
has given it the name cholera, from choloa, bile. 

Symptoms. — The disease begins by sickness and distress at the 
stomach, which is succeeded by violent gripings, with vomiting of 
thin, dirty-yellowish, whitish, or greenish fluid, with discharges from 
the bowels similar to that vomited. The nausea and distress, with 
some few exceptions, continue between the vomiting and purging, 
and the pain, at times, is intense. The pulse is rapid, soon becoming 
small and feeble, the tongue dry, the urine high-colored, and there is 
much thirst, though no drink can be retained on the stomach. It is 
to be distinguished from diarrhoea by the bilious discharges. 

Treatment. — Apply a large mustard poultice over the stomach and 
liver, and give tablespoonful doses of compound powder of rhubarb 
and potassa, every half hour, until the vomiting and nausea are 
checked, adding to each dose five to ten drops of camphor, if neces- 
sary. Perhaps it would generally be best, however, to give liberal 
draughts of warm water, at first, or flax-seed tea, that all the solid 
contents of the stomach and bowels may be washed out. 

A teaspoonful of laudanum in a wine-glass of flax-seed tea, given 
ns an injection, every two hours, will sometimes do excellently well; 



DISEASES OF THE ABDOMINAL CAVITY. 



329 



le pain and 
flesh, dry, 

irk-colored. 
the condi- 

at of order, 
of inflam- 

and tonics 
irandy, in a 
a day, will 
so is black- 
l by taking 
lime-water 

d by light- 
Sfiven with 

y, pills of 

ell rubbed 



n weather, 
d purging, 
and subse- 
discharged 

ess at the 
jmiting of 
arges from 
tress, with 
1 purging, 
L becoming 
id there is 
ich. It is 
i. 

omach and 
•f rhubarb 
lausea are 
, if neces- 
ve liberal 
the solid 

tea, given 
ntly well; 



or a tea made of ohamoniile flowers, or Colombo, and made sour by a 
few drops of nitric or sulphuric acid, and given internally, will some- 
times succeed better than most other things. One grain of svapnia 
and thirty grains of bicarbonate of soda dissolved in an ounce of sweet 
tincture of rhubarb, and given in teaspoonful doses, every half hour 
will often have a fine effect. The prescription 162 is also valuable. 
Hot-water bags should be applied to the feet, and warm flannels, 
or other kinds of dry heat, to the whole body. 

Asiatic Cholera. 

Besides the above name, this fearfnl disease has been called epi- 
demic cholera, malignant cholera, spasmodic cholera, and cholera 
asphyxia. It first attracted notice in Bengal in 1817, whence it 
spread westward through Europe, and in 1832 it reached Quebec, on 
this continent. It has since then visited Asia and Europe several 
times with great severity, and has even been present on our shores. 
But at the present day the strict vigilance of sanitary boards has 
done much to prevent its spread and mitigate its terrors. Through 
the investigations of Koch and other.-; it is now known to be propa- 
gated by a microbe, called the comma bacillus, and the efforts of 
investigators is now being directed to the discovery of an agent that 
will destroy this germ and thus control the disease. 

Symptoms ^ First Stag^e. — The first, premonitory stage, is 

mirked by derangement of the digestive organs, rumbling in the 
bowels, pain in the loins or knees, twitching of the calves of the legs, 
impaired appetite, thirst, and especially, a slight diarrhoea ; and these 
symptoms continue from a few hours to several days. I should add 
to these symptoms what is said to have been recently discovered, 
namely, that for several days before the attack, the pulse is down to 
forty or fifty heats in a minute. This, if it prove to be reliable, is a 
veiy valuable symptom. 

Second Stage. — This stage is marked by vomiting and purging a 
thin, colorless fluid, looking almost exactly like rice-water ; by severe 
cramps in the calves of tho legs, which soon attack the bowels and 
stomach. These cmmpi are excessively painful, and draw the mus- 
cles into knots. The tongue is pale and moist; the pulse feeble, 
though sometimes full and firm ; the breathing hurried, with distress 
about the heart ; great thii-st ; a feeling of internal warmth, and the 
secretion of urine entirely stopped. 

These thin, colorless discharges by vomiting and purging, are the 
serum or watery portion of the blood, which oozes through the sides 
of the blood-vessels, and runs off rapidly, leaving the crassamentum, 
or red, solid part of the blood, stranded upon the inner surfaces of the 
arteries and veins. When so much of this is discharged that the 
blood cannot circulate freely, the patient sinks into the 




830 



DI8EA8E8 OF THE ABDOMINAL CAVITY. 



4' 



Third Stage, which is characterized by great prostration ; pulse 
hardly perceptible ; akin cold and clammy ; face blue or [)urple, and 
eyes mnrh Huuken ; liandH dark-colored and sodden, looking like a 
washerwoman's ; breathing short and laborious ; a sense of great heat 
ill the stomach ; and intense thirst. Recoveries from this stage sel- 
dom take place. 

Treatment. — In the first stage, the diarrhoea should receive the 
most prompt attention. From five to ten drops of laudanum, re- 
peated a few times, every three hours, will generally put a stop to it. 
Catechu (162) is also a suitable remedy. The compound syrup of 
rhubarb and potassa, with some other articles (843), in tablespoonful 
(loses, every hour, till it opei-ates gently, is worth a trial. The diet 
should of course be very carefully regulated at such a time, though 
not particularly changed, except to leave off any indigestible article 
which is known to be injurious, and to be made a little more sparing 
than in time of perfect health. 

When the second stage has set in, or the stage of vomiting, purg- 
ing, and cramps, the treatment must be energetic. The sinking pow- 
ers must be sustained by chloroform, opium, and ammonia (119), or 
by camphor, opium, and cayenne (344), giving one pill every hour. 
Brandy may also be given freely. 

The warmth o* the surface must be promoted by all possible means, 
hot bricks and bottles, tincture of cayenne, friction, etc. 

In the third stage, the remedies recommended above are to be pur- 
sued with increased energy, particularly the stimulants, and the efforts 
to promote the warmth of the surface. 



f ( 



Dysentery. — Bloody Flux. — Colitis. 

This is an inflammation of the mucous membrane lining the lower 
or large bowels. The small bowels begin at the stomach, and are 
eight or ten yards long ; being largest near the stomach, and dimin- 
ishing in size as they approach their termination in the caecum. The 
lower or large bowels are two or three times as large as the small 
ones, and from their junction with the latter, they extend about six 
feet to the outlet, or anus. The large bowels are composed of the 
caecum, the colon, and the rectum. The rectum is about one foot in 
length. 

In most cases of dysentery, the rectum, and about half the adjoin- 
ing portion of the colon, experience the chief force of the inflamma- 
tion. Sometimes the whole of the colon and caecum are affected. 
Sometimes the mucous membrane lining these is ulcerated, and, be- 
coming wholly disorganized, passes off in shreds. 

Symptoms. — The disease comes on with loss of appetite, costive- 
ness, lassitude, shivering, heat of skin, and quick pulse. These are 
followed by griping pains in the bowels, and a constant desire to pass 




DISEASES OF THE ABDOMINAL CAVITY. 



881 



ion; pulse 
uiplt', and 
ng like a 
great heat 
stage sel- 

3ceive the 
!anum, re- 
stop to it. 

syrup of 
lespoonful 

The diet 
le, though 
ale article 
re sparing 

ing, purg- 
king pow- 
(119), or 
^ery hour. 

)le means, 

to be pur- 
ihe efforts 



the lower 
, and are 
id dimin- 
um. The 
the small 
ibout six 
id of the 
le foot in 

le adjoin- 

nflamma- 

affected. 

, and, be- 



I, costive- 
rhese are 
■e to pass 



their contents. In general the passages are small, composed of mucus 
mixed with blood. These passages are attended and followed by 
severe gripings and inclination to strain, learnedly called tormina, and 
tenesmus. They are sometimes, in the early stages, attended by nau- 
sea and vomiting. The natural feces, which do not pass off much, 
are small in quantity, and formed into round, campact balls, or irreg- 
ular, hardened lumps. This tenesmus, or great desire to strain, will 
continue, perhaps increase, for several days — the discharges being 
mostly blood in some cases, and chiefly mucus in others. Having 
generally but little odor at fii-st, these discharges become, as the dis- 
ease advances, exceedingly offensive. 

Causes. — Dysen tery is very frequently caused by sudden changes 
from hot to cold, by which sweating is suddenly checked, and the 
blood repelled from the surface. Hot climates, and dry, hot weather 
are predisposing causes. All green, unripe, and unwholesome food, 
and indigestible food of every sort, may induce it. 

Treatment. — In mild cases give a tablespoonful of castor-oil and 
two teaspoonfuls of paregoric, mixed, once a day. Sometimes, in 
place of the above, a dose of rochelle powder, dissolved in water, and 
eleven or twelve drops of camphor, may be taken. A moderate quan- 
tity of flax-seed or slippery-elm tea, may be taken as a drink, and the 
bowels be well emptied by an injection of starch. 

When there is much pain in- the bowels a mustard poultice laid 
upon them will have a good effect. The starch injections should, in 
such case, have half a teaspoonful of laudanum mixed with it. The 
compound syrup of rhubarb and pdtassa will often act favorably, 
given in tablespoonful doses. 

If there is reason to suppose the liver is affected, give podophyllin, 
etc. (46). 

The patient should not be allowed to sit up, and must be kept very 
still, and be allowed only a very scant diet, as flour porridge, well 
boiled, rice water, etc. 

Chronic Dysentery. 

When dysentery " runs on " for some time, it is liable to become 
chronic. 

Symptoms. — Looseness of bowels, — the discharges being un- 
healthy, more or less bloody, attended by bearing down, or a desire 
to strain, and being in number from two to forty a day. There is 
great debility, the pulse is weak and quick, the tongue slightly furred, 
the appetite lost, the face pale and sallow, the skin dry and parched. 
Sometimes the relpx alternates with costiveness. 

Treatment. — In this form of the complaint, astringents will be 
necessary (169), (161), (162), (345), (346), (347). 

Injections may be used, if necessary, composed of nitrate of sil- 





m 



(I 

4 






382 



DISEASES OF THE ABDOMINAL CAVITY. 



ver, fifteen grains to the ounce of water, or an infusion of golden seal, 
with a little tincture of prickly-ash berries added to it. 

The diet must be very light, easy of digestion, and nutritious. In 
Home cases, it should be composed chiefly of wheat porridge, or boiled 
milk and boiled rice. In other cases, a little tender beef-eteak should 
be taken once a day. 

Worms. — Vermes. 

The intestinal canal is subject to various disturbances from the 
presence of worms. Of these troublesome tenants, there are three 
principal varieties. 

The Ascaris, or pin-worm, called also maw or thread worm, is a 
small, wliite, thread-like worm from half an inch to an inch in length. 
These worms live, in great number, in the rectum, where they excite 
great irritation and itching. 

The Lutnbricus, or atcaria lumbricoideg, is a round worm, about an 
eighth of an inch in thickness, and from an eighth to a quarter of a 
yard in length. Its color varies from a milky whiteness to a deep 
red. It generally occupies the small bowels. 

The Tenia Solanum, or tape-worm, is a flat worm, with four suck- 
ers at the head, is from a few feet to some hundreds in length, and 
full of joints. It dwells in the small bowels, and feeds on the chyle 
as it comes along, before it is absorbed by the lacteals. In this way, 
it robs the body of nourishment, and produces great loss of flesh, and 
an enormous appetite. 

Symptoms. — In the grown person the symptoms of worms are 
qiiite obscure, except an intolerable itching within the anus, which 
generally indicates pin-worms. 

In children worms are indicated by paleness, itching of the nose, 
grinding of the teeth and starting in sleep, irregular appetite, bad 
breath, swelled upper lip, picking of the nose, hard swelled belly, and 
one cheek constantly flushed. 

Treatment. — For expelling worms various articles have been used. 
Among these spirits of turpentine (165) has a high reputation. The 
following preparation does well : Spirits of turpentine, half an ounce ; 
essence of anise, half an ounce ; castor-oil, one ounce ; worm-seed 
oil, one ounce. Mix. The dose for a child one or two years old is 
ten to twenty drops, eveiy two or three hours. In two or three days, 
a brisk physic should be given. The worm-powder is quite success- 
ful. 

One of the most popular remedies is the pink-root. It should be 
united with a purgative. The following is a good preparation: Pink- 
root and senna, each half an ounce ; bitartrate o^ potassa, one dram ; 
pulverized jalap, half a dram ; cardamom seeds, half a dram ; extract 
of liquorice, two drams. Mix, and add half a pint of boiling water, 
liet the whole steep an hour. Give a tablespoonful or two, occasion- 
ally, till the worms are expelled. • 



DISEASES OF THE ABDOMINAL CAVITY. 



388 



An injoction composed of quassia (66), or aloes (22), or of simple 
sweet-oil, is very effectual *in removing pin- worms from the lower 
bowel. So is an injection composed of the red iodide of mercury, 
one grain; iodide of potassium, half a grain; and two pints of 
water. 

Most of the above preparations are thought to be successful in ex- 
pelling all kinds of worms ; but for the tape-worn .o other remedy 
has yet shown itself as effectual as pumpkinrseeda. The seeds should 
be well bruised, and steeped in water. This should be drunk freely 
for several days, if need be. It is believed to be a sure remedy, oven 
in cases of several years' standing. 

In all cases of worms, the diet should be carefully chosen, and be 
connected with proper exercise, pure air, frequent bathing, and all 
those measures which tend to improve the general health. 

After the expulsion of the worms, tonics should always be taken 
to strengthen the bowels, that the same evil may not return. 

Acute Inflammation of the Kidneys, — Nephritis. 

Before speaking of this disease, I wish to give the reader a general 
idea of a kidney, and shall do so by the use of two cuts. 

Fig. 110 presents the external surface of the right kidney, with its 
renal capsule mounted on top ; i, being its upper edge ; /, h, superior 
and inferior branches of the emplgent artery ; c, d, e, three branches 
of the emulgent vein ; a, the pelvis of the ureter ; b, the ureter. 

Fig. Ill is the same kidney laid open ; 1, being the super-renal 
capsule ; 2, the vascular portion ; 3, 3, the tubercular portion, consisting 





FlO. 110. 



Fio. 111. 



of cones ; 4, 4, two of the calices receiving the apex of their corres- 
ponding cones; 5, 5, 5, the three infundibula; 6, the pelvis; and 7, 
the ureter. 
The kidneys are glands, and their office is to draw or strain off 



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884 



DIBRABRS OP THE ABDOMINAL CAVITT. 



from Lho l)ody those effete or worn-out particloH, or product* of deenif 
which corUain nitroi/en, while the liver tukes away thoHO carhoiMceoum 
matters whieh have no nitrot/en. These UHeless HulwtiinceH which jro 
out tlirougit tiie kidneys are genenvUy in tlio form of urea. In citrry- 
iiig off these matters, the kidneys may have more to do than properly 
belongs to them; and may be so stimulated, or irritated, or injured 
in some way, as to become inflamed. 

Symptoms.— Like most other inflummatory disesBes, it iHjgins with 
cold chills and rigoiv, especially in the back and loins, followed by 
fever and pain. The pain frequently extends to the bladder, the loins, 
and the thighs, and is of a severe, lancinating kind — though some- 
times obtuse. Pressure, motion, straining, or ttvking a full breath, add 
to its pungency. The urine is scanty, high-colored, sometimes bloody, 
and can only be passed drop by droj). In the loins theie is a sense 
of heat, gnawing, and constriction ; the bowels are either constipated, 
or relaxed by diarrhoja. A numbness of the thigh, and drawing up 
of the testicle on the affected side, are marked and peculiar symptoms. 
In some cases, there are nausea, vomiting, oppression of the stomach, 
faintness, hiccough, drum-head distention, and rumbling of the bowels. 
The skin is hot and dry, the pulse hard and frequent. 

Causes. — The use of cantharides, oil of turpentine, and other di- 
uretics, taking cold, violent exercise, mechanical injuries, the transla- 
tion of rheumatism or gout, the striking in of skin eruptions, and 
gravelly formations in the kidneys or ureters. 

Distinctions This disease is to be distinguished from colic by 

the pain being increaeed by pressure, and by the frequent but difficult 
discharge of red urine ; from lumbago^ from its being confined fre- 
quently to one side, and also by the urinary troubles, and by the 
nausea and vomiting; and from all other diseases, by the numbness 
)f the thigh, and the drawing up of the testicles. 

Terminations of the Disease. — It runs a rapid course, and may 
terminate by resolution, or by suppuration. When the latter happens, 
it is indicated by the decline of the more violent symptoms, a throb- 
bing and a sense of weight, with chills, followed by flushes of heat, 
and sweating. The matter formed, generally small in quantity, may 
pass into the cavity of the kidney, and thence through the bladder to 
a natural outlet with the urine. 

Treatment. — Either put the feet into a hot mustaid-bath, or put 
mustard drafts upon them. At the same time apply a large mustard 
poultice upon the small of the back, and follow it up with hot fomen- 
tations of stramonium leaves and hops, or stramonium and wormwood 
or tansy. 

Let perspiration be induced as soon as possible by five to ten- 
drop doses of tincture of veratrum viride, repeated every hour, or by 
teaspoonful doses of the compound tincture of Virginia snake-root, 
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DISEASES OP THK ABDOMINAL CAVITY, 



If costiveness exist, the bowels must be opened by epsom salts, 
cream of tartar, or salts of tartar ; or by copious injections of warm 
water, containing a few drops of the tincture of arnica-leaves. Such 
injections not only unload the bowels, but act as a local bath, by lying 
in the bowel near the inflamed kidneys. 

The drinks must be mucilaginous and diuretic. The marshmal- 
low root and peach-leaves, slippeiy-elm bark, flax-seed, mullein, elder 
blows, hair-cap moss, and cleavers, are all valuable. If the disease is 
caused by gravel, twenty drops of liquor potassse, largely diluted 
with flax-seed and upland-cranberry tea, and taken freely as a drink, 
is excellent. We recommend Poland water in large quantities. 

Chronic Inflammation of the Kidneys. 

This is frequently the result of the acute form of the disease, but is 
also produced by injuries and other causes. 

Symptoms. — A weakness in the small of the back, and a dull, 
heavy pain in the kidneys. The urine is passed often and in small 
quantities. It is alkaline — sometimes white and milky — and has 
in it deposits of phosphate of lime, and triple phosphates. 

Treatment. — Infusions of pipsissewa, uva ursi, trailing arbutus, 
wild carrot, queen of the meadow, buchu-leaves, or foxglove aie use- 
ful diuretics, and may be taken with advantage. 

The bowels must be kept open with some gentle physic (18), if 
they are costive ; and the alkaline sponge bath, with friction, be used 
daily. 

An eruption may be brought out upon the small of the back by 
rubbing on a few drops of croton-oil ; or, if the patient prefer it, a 
mustard poultice may be applied two or three times a week. 

The food should be nutritious, and easily digested, and a little ex- 
ercise be t<aken daily in the open air. 

Acute Inflammation of the Bladder. — Cystitis. 

This disease affects the lining membrane of the bladder, — some- 
times its muscular substance. It may attack the upper portion, the 
middle, or the neck of this organ. It runs a rapid course. 

Symptoms. — Burning, piercing, and throbbing pain in the region 
of the bladder. The pain extends to the perineum, and in some 
cases, to the testicles and thighs, and is much increased by pressure. 
The perineum, the space between the fundament and testicles, feels 
sore to the touch. The desire to pass urine is incessant, but the 
effort to do so is mainly ineffectual. The water passes off drop by 
tlrop, with great pain, or is entirely stopped, causing enlargement 
of the bladder, and great distress. Mucus from the inflamed lining 
of the bladder passes off with the water. Nausea, vomiting, and 




886 



DISEASES OF THE ABDOMINAL CAVITY. 



great anxiety are common. The bowels are bound, and when the 
disease is on the side next the lower bowel, there is a desire to empty 
the bowels ; and if the inflammation be in the neck, there is great 
pain in the perineum, and frequently an entire retention of the water. 
The pulse is full, hard, and frequent, the skin hot and dry, the thirst 
urgent, and the patient restless and dejected. 

Causes. — This disease may be produced by taking cantharides and 
turpentine ; by irritating sutetances forced into the bladder with a 
syringe, or by pushing bougies or catheters into it ; by gravel-stones 
in the bladder ; by retained urine ; by external injuries ; by gonor- 
rhoea ; and by cold applied to the feet, or to the lower portion of the 
abdomen. 

Treatment. — If the urine be rettiined, it is of the utmost impor- 
tance that it be early drawn off with the catheter, lest a distention of 
the bladder bring on mortification. Great care is required not to pro- 
duce irritation by any roughness in introducing the instrument. 

Leeches should be applied upon the lower part of the bowels, the 
perineum, and around the anus. When these are removed, warm 
poultices should be applied. Cold compresses will often do as well. 
The bowels must be opened with epsom salts. Injections of warm 
water, with a few drops of tincture of arnica-leaves, will act finely as 
a local bath, — the water being retained as long as possible. 

The tincture of veratrum viride will be required in five to ten-drop 
doses, or the compound tincture of Virginia snake-root, to induce 
perspiration. Ex. jaborandi may sometimes be used for the same 
purpose. 

Drinks must be taken very sparingly. A small amouint of cold in- 
fusion of slippery-elm bark, or marshmallow and peach-leaves, or 
cleavers. This mucilaginous drink must be the beginning and the 
end of the diet during the active stage of the disease. Alkalis are 
exceedingly useful in allaying the pain and smarting of urination, 
perhaps the bestremedybeingliq. potass, citratis, in tablespoonful doses 
every two hours. Suppositories of opium and belladonna in one-fourth 
grain doses by the rectum every two to four hours allay the frequent 
urination and pain and quiet the spasm of the neck of the bladder. 



Chronic Inflammation of the Bladder.— Cystirrhoea. 

This is much more common than the active form of the disease. 
It often arises from the same causes which produce acute inflamma- 
tion of the bladder. 

It often passes under the title of "catarrh of the bladder." It is 
a chronic inflammation of the mucous lining of that organ, and is a 
very common and troublesome affection among old people. 

Symptoms. — Slight lancinating pains, with a feeling of heat in tlu; 
region of the bladder, and a sense of weight and tenderness in the 



DISEASES OF THE ABDOMINAL CAVIIV. 



837 



when the 
to empty 
B is great 
the water. 
, the thirst 

arides and 
ier with a 
ivel-s tones 
by gonor- 
tior of the 

lost impor- 
stention of 
. not to pro- 
iment. 
bowels, the 
3ved, warm 
do as well. 
ns of warm 
Lct finely as 
le. 

'. to ten-drop 
I, to induce 
ir the same 

t of cold in- 
leaves, or 

ig and the 

Alkalis are 
urination, 

jonful doses 

one-fourth 

le frequent 

6 bladder. 

hfstirrhcea. 

the disease, 
inflamma- 

ier." It is 
an, and is a 

heat in tlx' 
Iness in the 



perineum ; frequent and tormenting desire to pass water, with occa- 
sional spasmodic action of the bladder. The urine is loaded with 
tenacious mucus, just as the expectoration has large quantities of 
mucus in it when there is inflammation of the membrane lining the 
windpipe and bronchial tubes. When the water has stood a while, 
this mucus settles at the bottom of the vessel, leaving the fluid clear 
above. Great quantities of this are son^etimes passed, — amounting 
even to pints in a day. The triple phosphates of magnesia and am- 
monia are often found in the water. 

Frequently there are demngements of the appetite and digestive 
functions, a white or brown fur upon the tongue, a harsh, dry skin, 
with thirst and general debility, — especially in the back and loins. 
Sometimes there id a little fever. 

Treatment. — To reduce the inflammation, apply leeches, or mus- 
tard, or croton-oil, or a cold compress every night. 

As a diuretic, give an infusion of buchu, uva urei, trailing arbutus, 
queen of the meadow, etc. Tincture of veratrum viride and sweet 
spirits of nitre (125) is a good remedy. The compound infusion of 
trailing arbutus is well recommended. So is the compound balsam 
of sulphur. An infusion of the pods of beans has been well spoken 
of. 

An injection into the bladder, once a day, of a tepid infusion of 
golden-seal root, with much care, may be of great service; or an 
infusion of equal parts of golden-seal, witch-hazel, and stramonium. 
It may be done with a gum-elastic catheter and a small syringe. 

The bowels must be kept open with the neutralizing mixture, or 
some other mild physic ; and the skin bathed with saleratus and 
water once a day, and rubbed well with a coarse towel. 

Should there be any scrofulous, or gouty, or rheumatic condition of 
the system, the remedies for those complaints may be used in addition 
to the above. 

Disease of the Supra-Renal Capsules. 

The supra-renal capsules are sm^ll bodies situated above the kid- 
neys. (Fig. Ill, i.) Their office is not well understood. It has 
been found of late that they are subject to a disorder having peculiar 
symptoms. Tliis is a comparatively new disease. 

Symptoms. — The most marked symptom is a peculiar change in 
the color of the skin, called " bronzing." This bronzing process lo- 
gins in patches on those parts exposed to the sun, and to friction, 
as the neck, the bsicks of the hands, the fronts of the thighs, and the 
arms. These patches look, in color, like spots upon a bronze statue, 
deprived of their gloss. 

Another marked symptom Ls a general debility, which comes on 
witliout any apparent cause, — there being, generally, no evidence of 
niganic disesise, and no loss of flesh, — and is attended with faint- 



838 



DTSKASRS OF THK ABDOMINAL CAVITY. 



ings, loss of energy both of body and mind, a peculiar flabbiness of 
flesh, and an early death, apparently from sheer weakness. 

The blood becomes depraved, and loses its coloring matter, as 
shown by the paleness of the skin where there is no bronzing. 

The pulse is generally very soft and compressible. The stomach is 
irritable, the appetite is gone ; there is nausea and sometimes vomiting, 
with pain and a sense of sinking at the pit of the stomach. Fre- 
quently there is costiveness, sometimes diarrhoea, and pains in the 
back and loins. In some cases there are epileptic fits, failure of 
memory, change of temper, or a numbness of the fingers, legt, etc. 

Treatment This disease is a peculiarly fatal one. As no mode 

of treatment has yet proved successful, it is well to observe caution 
in prescribing. 

The treatment prescribed for chronic inflammation of the kidneys, 
would perhaps be as safe as any that could at present be proposed. 

Bright's Disease of the Kidneys. — Albuminuria. 

This peculiar disease was first explained to the profession in 1837, 
by Dr. Bright, of England, whose name it took. It consists of a dis- 
order of the kidneys, — probably a congestion and an obstructed cir- 
culation in them, from which arise two most important effects ; first, 
albumen, an essential alimentary constituent of the blood, is secreted 
and passed off, in larger or smaller quantities, in the urine ; and sec- 
ondly, urea, the worn-out matters of the blood which the kidneys are 
made expressly to carry off, is permitted to remain. If the urine of 
a person having Bright's disease be examined, therefore, albumen, 
which should not be there, will be found, and urea, a natural constitu- 
ent, will be absent. The presence of albumen, however, while ab- 
normal, is not necessarily indicative of Bright's disease, as it may 
proceed from indigestion and blood disorders. 

Method of Examination To discover albumen in urine suspected 

to contain it, place a little in a test tube, and boil it over a spirit- 
lamp. If albumen be present only in minute quantity, it may caupe 
only a delicate opalescence ; if in larger quan- 
tity, it may separate in curdy flakes, and fall to 
the bottom as a more or less abundant white 
precipitate. If very abundant, the liquid may 
become nearly solid. 

The albumen is the same as the white of an 
egg, and the boiling has the same effect in 
whitening and hardening it, as upon that sub- 
stance. 

no. 112. Albumen is sometimes found in the urine in 

a coagulated state, and having the shape of tubes or worms (Fig. 
112). This is quite common in Bright's disease. The deposit seems 
to be made up of fibrous casts of the uriniferous tubes of the kid- 
neys. 




»;a:«sa 






abbiness of 

matter, as 
izing. 

9 stomach is 
J8 vomiting, 
lach. Fre- 
ains in the 

failure of 
legi, etc. 

\8 no mode 
rve caution 

he kidneys, 
proposed. 

ninuria. 

ion in 1837, 
ists of a dis- 
itructed cir- 
fects ; first, 
, is secreted 
le ; and sec- 
kidneys are 
;he urine of 
re, albumen, 
ral constitu- 
sr, while ab- 
3, afi it may 

ae suspected 
/er a spirit- 
t may cause 
arger quan- 
, and fall to 
idant white 
liquid may 

white of an 
le effect in 
jn that sub- 
he urine in 
i^orms (Fig. 
sposit seems 
of the kid- 



DI8EA8E8 OF THE ABDOMINAL CAVITY. 



339 



Symptoms. — The two unnatural conditions mentioned above 
give rise to the symptoms of Bright's disease. One of them, how- 
ever, is itself the most constant and characteristic symptom of the 
disease, namely, the presence of albumen. This, too, being one of 
the nutritive constituents of the blood, its abstraction thins the 
serous portion of the blood, and causes it to filter out of its vessels 
into the cells, — causing dropsy of the cells, usually called cellular 
dropsy, or anasarca. This general dropsy begins frequently in the 
face, and spreads rapidly over the whole body and limbs. In addi- 
tion to this, there are pains in the back and loins, a gradual failing of 
strength, and a derangement of digestion. The skin becc mes drj, 
with a pale and bloodless appearance, and theie are frequently thirst, 
nausea and vomiting. The urine frequently has fat, blood, epithelial 
scales, mucus, blood-discs, fibrous casts of the uriniferous tubes, and 
saline sediments ; and is genenally lighter l)y weight than in health, 
and less in quantity, and is apt to be red, brown, or dingy in color. 

The retention of urea in the blood acts as a poison, and causes, 
toward the latter end of the disease, when accumulated in large quan- 
tity, drowsiness, convulsions, and apoplexy. 

A frequent desire to make water, with a shifting back and forth 
of the bowels between costiveness and diarrhaea, are common symp- 
toms. 

Treatment. — The results of treatment in this diseaso are often un- 
satisfactory. Yet if biken in season, investigated with proper care, 
and treated with due diligence, much mfiy be done for its cure. It is 
one of those harassing complaints, which physicians in family prac- 
tice seldom have the patience to investigate and manage with suffi- 
cient care. 

Let the healthy and active condition of all the vessels of the skin 
be the first object aimed at. Tliis will relieve the laboring and falter- 
ing kidneys of a portion of their burden. The alkaline sponge-bath 
with vigorous friction every day will secure tiiis object. 

In the next place, the skin being put in a working condition, should 
be made to work by some internal diaphoretic, — as the tincture of 
veratrum viride, in doses of from five to ten drops, or the compound 
tincture of Virginia snake-root, in teaspoonfnl doses. 

The kidneys may be still further relieved, especially when there is 
considerable tenderness and other signs of inflammation, by cupping, 
leeching, mustard-poultices and croton-oil. 

The bowels should be regulated by some gentle physic, as cream of 
tarter dissolved in flax-seed tea, lochelle powders, epsom salts, etc. In 
some cases, podophyllin and leptandrin (40), or tho compound 
powdei of jalap (41), ai-e useful. 

When ithere is dropsy of the cells, elaterium may be used as physic 
(31), or the kidmys may ,be jogged by digitalis (130), (129), its effects 
being carefully watched. Cider, freely drunk, has been found useful 
in some cases. 




340 

To restore 
the essential 
the vegetable 
be used daily. 

Coffee, and 
bread, high-se 
nothing must 
cannot easily 



DISEASES OP THE ABDOMINAL CAVITY. 

the blood, iron (73), (93), (74), (75), (72). (71) is 
article. When there is considerable debility, some of 
bitters, as quinine, quassia, gentian, Colombo, etc., may 

ail indigestible articles of food, as rich pastries, new 
lujoned meat, and fats, must be avoided, — in a word, 

be taken, either in kind or quantity, wliich the stomach 
digest. 

Diabetes. 

This disease is a kind of diarrhoea of the kidneys. The amount 
of urine secreted and discharged is large, sometimes enormous in 
quantity, amounting even to seveial gallons in twenty-four houns. 
Everything taken into the stomach seems to run off by the kidneys. 
The food and drink being mostly converted into urine, do but little 
good. The kidneys having got into an exalted state of action, do 
too much, — just as the mucous membrane of the air-tubes does in 
bronchitis. 

Nature of the Urine — Not only is there too much urine discharged, 
but, instead of being lighter than healthy urine, as in Bright's disease, 
it is heavier, and instead of holding albumen in solution, it contains 
grape-mgar. 

To Detect Sugar. — Put a little of tlie suspected urin^ in a test- 
tube ; add to it a drop or two of solution of sulphate of copper, which 
will give the fluid a pale-blue tint. Now add liquor potassa in 
excess : if sugar be present, this will throw down a pale-blue precipi- 
tate (hydrated oxide of copper), which will immediately re-dissolve, 
forming a purplish-blue liquid. Boil this over a lamp ; if there be 
sugar, a reddish or yellowish-brown precipitate (sub-oxide of copper) 
will be thrown down ; if no sugar, a black precipitate (common oxide 
of copper) will fall to the bottom. 

Another 7fe««.— Place a little urine in a tesUube; add to it half 
its volume of liquid potassa, and boil five minutes. If there be sugar 
present, the liquid will take a brownish or bistre tint. 

Growth of Torula as a Teat. — Place a portion of saccharine mine 
in a warm place, and a scum will soon rise, as 
if a little flour had been dusted on it. This, 
when examined under the microscope, proves to 
be minute oval bodies. These expand and dilate 
I the vesicle containing them into the form of a 
' tube. They still continue to erdarge, and pro- 
ject from the parent bladder, like buds. The 
whole then resembles a jointed fungoid growth 
(Fig. 113), which finally breaks up, and falls to 
the bottom, as a copious deposit of oval vesicles 
or spores. 




FIO. 113. 



• 'iltTtitiiidinrriiifcTlir'"'"-'^"" ' 



DISEASES OF THE ABDOMINAL OAVITY. 



841 



)• (71) 18 

, some of 
may 



etc. 



tries, new 
II a word, 
a stomach 



18 amount 
)rmous in 
)ur horn's. 
8 kidneys. 
I but little 
action, do 
BS does in 

ischarged, 
t's disease, 
t contains 

I in a testr 
per, which 
potassa in 
le precipi- 
e-dissolve, 
: there be 
copper) 
laion oxide 

to it half 
be sugar 

rine urine 
)n rise, as 
it. This, 
proves to 
and dilate 
form of a 
and pro- 
lids. The 
id growth 
id falls to 
il vesicles 



Other 5ymptoms. — Great thirst, craving appetite, dry skin, a 
sense of weiglit and uMea.sine8s in the stomach after eating, dry and 
parched mouth, wliiU? and foul or clean and red tongue, wasting of 
llt'sli, languor and aversion to exercise, debility, pain and weakness 
ill the loins, co.>?tiveness, loss of the sexual feeling, and cold teet. 
As the disease di-aws towards a fatal end, the gums become spongy, 
the breath fetid, sometimes smelling like urine. 

Treatment. — The skin should have about the same treatment as 
that recommended in Bright's disease. Also, the same counter-irrita- 
tion over the kidneys. The bowels must be kept open by some 
gentle physic (13), (12), (15). 

Tonics. — These will be required to restore the tone of the system, 
particularly iron, — same preparations as recommended in Bright's 

disease. 

Astringents to check the flow of urine will be needed. Alum, in 
tliree-grain doses, three times a day, or sugar of lead, or white vitriol, 
or clear opium, will be serviceable. Creosote, in one or two-drop 
doses, and tincture of cantharides, have each cured cases. 

One scruple of Peruvian bark, one scruple of wild-cranberry leaves, 
powdered, and half a grain of opium, mixed and taken three times a 
day, is a good remedy. 

All articles which contain sugar and starch must be forbidden in 
the diet. Bread and potatoes contain a large amount of starch ; and 
beets, parsni^^s, and some other vegetables, have sugar. It is best 
to confine the patient almost entirely to tender, fresh meats ; and the 
drink, notwithstanding the great thirst, must be restricted to a very 
small quantity. Saccharin should be used to sweeten drinks instead 
of sugar. 

Bleeding from the Kidneys, etc. — Hcematuria. 

By this I mean a discharge of blood from the urinary passage. It 
may come from the kidneys, the ureters, the bladder, or the urethra. 

Symptoms. — The passage of the blood is preceded by pain in the 
region of the bladder or kidneys, and accom- 
panied by faintness. There is generally heat 
and distress in the loins, and tenderness upon 
pressure in the region of the bladder or kid- 
neys, according to the place from which the 
blood comes. 

It is sometimes difficult to decide whether 
the coloring matter in the urine is really blood. 
In such cases, the microscope will generally 
detect the blood corpuscles, if present. They 
commonly appear as in Fig. 114, having a yellow color, and being 
pretty uniform in sxze. 



op 
o P 



\o o 

o \ o 



O 



Fl». 114. 



342 



DISEASES OF THR ABDOMINAL CAVITY. 



Treatment. — This must of course vary according to the nature of 
the case, and the immediate cause producing it. Where active bleed- 
ing exists, the patient must have absolute rest in bed, with applica- 
tions of cold to the hips and loins. If the patient l)e strong and full 
of blood, w^et cups or leeches may be applied over the kidneys, or the 
bladder. In such cases, too, the bowels must be freely moved with 
some preparation of salts (14), (18), (20), (25). 

Sugar of lead is a valuable remedy; but it should be given in large 
doses for a short time, rather than in small doses for a long time. It 
is best taken in form of solution (348), two great spoonfuls every 
two hours, until five or six doses are taken. 

But the best remedy is gallic acid. It seems to have extraordinary 
power in this complaint. It should be given in five-grain doses, 
mixed with a teaspoonful of mucilage of gum-arabic, and t'en drops 
of tincture of henbane. 



Suppression of Urine. — Ischuria Renalis. 

This disease is, in one respect, just the opposite of diabetes. 
While immense quantities of urine are secreted in that, none is se- 
creted in this. In that, the kidneys do too much ; in this, they do 
nothing. 

This complaint is sometimes called paralysis of the kidneys. It 
usually occurs in old persons, and those inclined to corpulency. 

Symptoms. — The patient makes no water; and if the catheter be 
applied, none will be found in the bladder. The patient feels unwell, 
restless, anxious, with a slight pain in the loins and bowels, perhaps ; 
but on the whole not illness enough to give any very good account 
of it. After a little time, nausea comes on, and perhaps vomiting, 
and soon drowsiness, wanderings of mind, incoherent talk," hiccough, 
stupefaction, and death. These head symptoms are caused by the 
shutting up, in the kidneys, the natural outlet of urea, of an excre- 
mentitious matter, which acts as a poison to the nervous system. 
Before death, the perspiration has a strong smell of urine. 

Treatment. --The cause of this complaint not being known, the 
treatment must necessarily be a little uncertain. We cannot go 
amiss, however, in placing the patient immediately in a warm bath 
for fifteen or twenty minutes. Then apply wet cups over the kidneys, 
and follow these either by mustard poultices or by hot fomentations. 

Let the bowels be opened by the compound powder of jalap, or by 
elaterium (31). Epsom salts or cream of tartar might in some cases 
be substituted for the above. A stimulating injection is also desira- 
ble (246). 

Diuretics, as sweet spirits of nitre, digitalis, queen of the meadow 
and peach-leaves, equal parts, and marshmallow, are of course called 
for. 



le nature of 
ctive bleed- 
ith applica- 
ng and full 
neys, or the 
moved witli 

ven in large 
g time. It 
nfuls every 

traordinary 
[rain doses, 
1 t«u drops 



lis. 

)f diabetes. 

none is se- 

his, they do 

idneys. It 
idency. 

catheter be 
eels unwell, 
Is, perhaps ; 
jod account 
a vomiting, 

,* hiccough, 
ised by the 
an excre- 
3U8 system. 
I. 

known, the 
cannot go 
warm bath 

the kidneys, 

mentations. 

jalap, or by 
some cases 
also desira- 

he meadow 
)ur8e called 



DISEASES OF THE ABDOMINAL CAVITY. 



343 



Much of the poisonouM matter retained mayln^ got out througli the 
skin, by a free use of the compound tinclun; of Virginia Hiiake-root 
or tincture of vemtrum viride in full doses. 

Although the symptoms, in the earlier stages of this (;omplaint, 
may not attract much attention, or Iw thought worthy of notice, yet 
the treatment should be prompt and energetic, as a fatal termination 
is sometimes reached in the brief space of forty-eight hours. 

Retention of Urine. 

This disorder is often confounded with suppression of the urine, 
but it is different in eveiy respect. In suppression, the urine is not 
formed by the kidnej^ ; in retention, it is formed, and, in some cases, 
poured into the bladder, but is retaintd on account of some inability 
to pass it. 

Ischuria. — This is one of the forms of retention. In this com- 
plaint, the urine has passed from the kidneys to the bladder, but from 
some cause, generally palsy of the muscles of the bladder, it cannot 
be passed off. In this case, there is no pain, but the stream of water 
flows off with slower and slower pace, — the patient having to make 
tiresome efforts with the abdominal muscles to get the bladder 
emptied. As the quantity discharged diminishes, the f'abire to uri- 
nate grows more urgent. Pressure just above the pubes gives pain, 
and the bladder feels under the hand like a large, hard tumor. 

Dysuria. — In this form of the complaint, the water is passed to 
some extent, but with pain and heat along the water-pipe. This is 
generally caused by some inflammation along the urethra. 

Strangury. — In this the water is only passed drop by di-op, and 
with great burning, scalding, and tenesmus in the neck of the bladder. 
When there is considerable inflammation, the skin becomes hot, the 
pulse hard and quick, and the tongue covered with a white fur. 

Causes. — These several f oi-ms of the complaint are caused by palsy 
of the bladder, gonorrhoea, inflammation in the neck of the bladder 
or the water-pipe, mechanical injuries of the bladder in child-bearing 
or otherwise, by tumors pressing upon it, by irritation from gravel or 
stone within its cavity, by stricture or partial closing up of the ure- 
thra, by disease of the prostate gliind, by taking spirits of turpentine 
or cantharides, or by the absorption of this latter article when used 
as a blister. 

Treatment. — It is obviously necessary in this complaint, that 
treatment, in order to be of any avail, should be prompt ; for when 
the retention is complete, the bladder will burst in from two to five 
dayrs, and cause the death of the patient. 

The treatment must vaiy according to the cause of the retention. 

If it be caused by palsy of the bladder, the common flexible cathe- 




844 



DISEASES OF THE ABDOMINAL CAVITY. 



t«r miiHt b« 1186(1 daily until the muscular fibres recover their IohI 
power. When much irritation is caused by introducing it, it is better 
not to withdraw it, but to oIoho its oxtcrnal orifice with a Hinall i)luf,', 
which the patient vnu remove an often aH necessary to let off the 
urine. To remove the paralynis, the electro-magnetic machine is 
woith a trial, the current being passed through the bladder. At 
the Hame time let the patient bike stiychnia (Sh), (80), (83), (96). 
Cantharides, in the form of tincture, or in connection with strychnia 
(291), is ofter used. 

If the retention is caused by inflammation of the neck of the blad- 
der, leeches should l)e applied to the perineum, and three or four drops 
of croton-oil may 1k^ rubbed on just above the pubes to bring out an 
eruption. Warm fomentations will also be serviceable, and warm 
hip-baths. Cooling diuretics, as infusions of marahmallow, cleavers, 
pumpkin-seeds, buchu, sweet spirits of nitre, etc , must not b§ pmitted. 

Inability to Hold the Urine. — Enuresis. 

This complaint, generally called incontinence of the urine, is quite 
common among children. In some cases the child has no ability to 
hold it8 water at any time ; but generally it is only passed off invol- 
untarily at night while in bed. In adult life it m less frequently met 
with, except among the old. 

Causes. — Irritation of the roots of the spinal nerves which go to 
the bladder, mechanical injuries of the bladder, palsy of the bladder, 
particularly in old people, debility of the neck of the bladder, a gen- 
eral weakness of the nervous system, worms in the bowels, piles, 
whites, gravel or stones in the bladder, long prepuce in boys, etc. 

Treatment. — As a general rule, the change of constitution which 
occurs at puberty cures this complaint. But as this does not always 
happen, it is important that parents do everything in their power to 
break it up earl^ , lest it become an affliction for life. 

Children who suffer from this disorder are apt to drink largely. 
This habit should be restrained. But little drink should be allowed, 
whatever the desire for it. Care should be taken that the child make 
water before going to bed, — also that it be aroused at a late hour for 
the same purpose, and that the foot of the bed be elevated so as to 
draw the urine away from the neck of the bladder. 

The skin should be washed all over, every day, with cool, or cold 
water, and vigorously rubbed with a coarse towel. This will cause 
the excess of fluids to pass off thiough the skin, and lessen the action 
of the kidneys. 

In some instances children urinate in bed through carelessness, 
being half conscious of what is occurring, but not caring enough to 
rouse themselves. In such cases, they are often cured by some de- 
cided correction, — the impending act of passing water connecting 



DISEASES OF THE ABDOMINAL UAVITY. 



345 



their IohI 
b Ih Ixitter 
[null i>lug, 
3t off the 
mchinu Ih 
Ider. At 
53), (95). 
Htrychtiia 

■ the blad- 
four drops 
ing out an 
ivnd warm 
, cleavers, 
1^ gmitted. 

is. 

16, is quite 

) ability to 

off invol- 

uently met 

/hich go to 
le bladder, 
der, a gen- 
vels, piles, 
ys, etc. 

tion which 
lot always 
r power to 

k largely. 
)e allowed, 
lild make 
te hour for 
3d so as to 



ol 



or cold 
will cause 
the action 



lelessness, 

enough to 

some de- 

jonnecting 



itself in their mind with the corrootion, and recalling them inHtaiiUy 
to full coMsciouNucss. Of ('ourse this mode of relief should be resorted 
to with great judgment and caution. 

When the complaint proceeds from debility or rehxntioii of the 
neck of the bladder, the compound infusion of trailing arbutus and 
the isinglass custard found among dietetic preparations, may In; used 
freely. The tincture of cantharides, from ten to forty drofw to chil- 
dren, may be given, and increased gradually to a hundred, or until 
slight difficulty is felt in puasing the water. Then stop, and give 
the urticles mentioned al)<)ve. Spirits of turpentine is useful to some 
extent, given also in stnall doses, and (tontinued for some time. 

If the disorder be caused by irritation of the spinal nerves, cold 
water douched upon the back, or croton-oil rubbed along the spine, 
or a warm stimulating or irrittiting plaster upon the lower part of the 
back, /ill be required. The electro-magnetic machine may do well 
in some cases. Tincture of belladonna, given just as tincture of can- 
tharides above, afternoon and at Ixidtime, gives best results usually. 
Belladonna after a while troubles tlie eyes and must be stopped. 

Urinary Deposits. — Gravel. — Stone. 

Unnatural deposits in urine are to be regarded simply as evi- 
dences of changes which disease is making in the body. As such 
they are valuable, — more valuable, in many cases, than any or all 
other symptoms we can study, and most valuable from the ease with 
which they may be investigated. Yet but very few physicians, com- 
paratively, pay any special attention to them, or make any effort to 
acquire the small amount of knowledge needed for their detection. 

Sources of the Urine. — The urinary secretion has three ; irces. 
The largest bulk of it comes from the superabundance of drink taken 
into the stomach. This is shown from the free flow of pale urine 
after taking copious drafts of water or other fluids. Such quantities 
of water as are often drunk, would embarrass the functions of animal 
life, were it not pumped off by the kidneys. 

A second source of supply for the urinary secretion is to be found 
in the elements of imperfectly digested food, and also some abnormal 
elements arising from incomplete assimilation. Oxalic acid is a 
specimen of the latter, being sometimes largely excreted, in dyspep- 
sia, soon after a meal. 

The third source of urine is found in those old and worn-out atoms 
of the system, which can serve no further useful purpose in the ani- 
mal economy, and which cannot be got rid of by the lungs or skin. 
It is only, however, one portion of the dead tissue, namely, that which 
is rich in nitrogen, which goes out through the ♦• .1 strainer ; an- 
other portion, which has a preponderance of inflai. lable elements — 
carbon, hydrogen, and perhaps sulphur — takes the outward channel 
t)i rough the liver, as bile. 



I 




p5» 



346 



DISEASES OP THE ABDOMINAL CAVITY. 



^ 



Characteristics of Urine. — Healthy uiihe has a light amber color, 
is transparent, arul has different degrees of density, its specific gravity 
varying from 1.003 to 1.030. It has an aromatic, violet-like smell, 
and a bitter, disagreeble taste, like salts. 

That which is passed a little time after drinking largely, is pale, 
and has a low specific gravity, varying from 1.008 to 1.009, and is 
called urina potus. That passed soon after 'he digestion of a full 
meal, is called urina chyli, or urina cibi ; it has a specific gravity from 
1.020 to 1.030. That which is secreted from the blood, and is passed 
before eating or drinking iii ,.he morning, is called urina sanguinis; 
and has a specific gravity of from 1.015 to 1.026. This is the best 
specimen of the average density and nature of healthy urine. 

Healthy urine contains urea, uric acid, sulphuric acid, phosphoric 
acid, lime, magnesia, phosphate of soda, etc. It; is only when these 
are discovered in excess, that they indicate disease. 

Examination of Urine^ — Let a piece of blue litmus-paper be first 
dipped in the urine ; if it be acid, the color of the paper will be 
changed to red,OT reddish-brown. Should the blue color remain un- 
changed, then use 'yellow turmeric or reddened litmus paper ; 
if the urine is alkaline, the turmeric will become brown, and 
the reddened litmus will be changed to blue. If the color in 
both cases remains unaltered, the urine is neutral ; that is, 
neither acid nor alkaline. 

This being done, let the specific gravity be taken. This is 
easily done by the urinometer (Fig. 116). This instrument 
is known also by the names hydrometer, and gravimeter. It 
is generally made of glass. When placed in distilled water, 
it will sink to a certain point; and as all bodies immersed in 
fluid displace a bulk equal to themselves, it follows that in 
a fluid denser than water, the instrument will not sink so 
deep. The Space above the large bulb is marked off into de- 
grees corresponding to different densities. When this instru- 
ment is immersed in urine, and has come to rest, the number on the 
graduated scale, which stands at the surface of the liquid, when 
added to 1.000, will represent the specific gravity of the fluid. If, for 
example, the surface of the liquid corresponds with 9 on the scale, 
the specific gravity of the urine will be 1.009 ; if at 26, it will be 
1.025. 

By attending to the specific gravity of the urine, the physician may 
often gain important information respecting his patient, as it may be 
made to show him how much solid matter is daily carried out of the 
body through the kidneys. This, at the bed-side, may often give 
useful hints in regard to treatment. 

The following table, constructed by Dr. Golding Bird, shows at a 
glance the amount of solid matter in 1000 grains of urine of different 
densities : — 



FIO. 118. 



i 1 1 ilnliiMiillilljWMlMliimHIMi 



^M^a^ 



m 



mber color, 
iific gravity 
rlike smell, 

ely, is pale, 
009, and is 
m of a full 
[ravity f lom 
1(1 is passed 

sanguinis; 
is the best 
ine. 

phosphoric 
when these 

iper be first 
per will be 
remain un- 
;mus paper; 
brown, and 
the color in 
al; that is, 

in. This is 

instrument 

dimeter. It 

;illed water, 

mmersed in 

ows that in 

not sink so 

off into de- 

this instru- 

mber on the 

quid, when 

aid. If, for 

a the scale, 

), it will be 

ysician may 

18 it may be 

I out of the 

often give 

shows at a 
of different 



DISEASES OF THE ABDOMINAL OAVITT. 



347 



Speoiflo 
Gravity. 


Solids. 


Water. 


Speciflc 
Gravity. 


SoUdi. 


Water. 


Speoiflo 
Gravity. 


SoUd(. 


Water. 


Specific 
Gravity. 


Solldi. 


Water. 


1001 


2.31'. 


997.67 


1011 


26.63 


974.37 


1021 


48.93 


951.07 


1031 


72.23 


927.77 


1002 


4.66 


905.34 


1012 


27.96 


972.04 


1022 


61.26 


948.74 


1032 


74.66 


926.44 


1003 


6.99 


993.01 


1013 


30.29 


969.71 


1023 


53.59 


946.41 


1033 


76.89 


923.11 


1004 


9.32 


990.68 


1014 


32.62 


9t)7.38 


1024 


55.92 


944.18 


1034 


79.22 


920.78 


1005 


11.6S 


998.35 


1016 


34.96 


!)65.05 


1026 


68.26 


941.75 


1036 


81.66 


'J18.46 


1006 


13.98 


986.02 


1016 


37.23 


962.72 


1026 


60.60 


939.42 


1036 


83.88 


916.12 


1007 


16.31 


683.69 


1017 


39.61 


960.39 


1027 


62.91 


937.09 


1037. 


86.21 


913.79 


1008 


18.64 


981.36 


1018 


41.94 


958.0(1 


1028 


65.24 


934.76 


1038 


88.54 


911.46 


1009 


20.97 


979.03 


1019 


44.27 


955.73 


1029 


67.67 


932.43 


1039 


91.87 


909.13 


1010 


23.30 


976.70 


1020 


46.60 


963.40 


1030 


89.90 


930.40 


1040 


93.20 


906.80 



The mode of using the above table is this. Having learned the 
density of the urine passed in twenty-four hours by means of the 
urinometer (Fig. 115), a glanc at the table will show the proportion 
of solid matter and water in 1000 grains of the urine. Then, by 
weighing the whole quantity of urine passed in twenty-four hours, 
the weight of solids drained off by the kidneys may be determined 
by the simple rule of proportion. 

Symptoms of Qravel. — A sudden attack of pain in the region of 
the kidneys, so acute and severe, frequently, as to cause fainting and 
even convulsions. The pain runs down to the groin and thigh, caus- 
ing a numbness on the affected side, and a drawing up of the testicle. 
The pain is excessive at times^, and then remits. Finally it stops 
suddenly. 

Leading from the kidneys to the bladder are two small tubes about 
the size of a goose-quill, called ureters, — being the appointed chan- 
nels of the urine. The pain, of which I have spoken, is caused, gen- 
erally, by the passage of a stone along one of these small tubes. If 
the stone happen to be a- little too large for the tube, or uneven or 
ragged upon its surface so as to bruise and tear the delicate lining 
of the ureter, severe pain is the result. The pain is intense when the 
stone moves along ; remits when it stops ; and suddenly ceases alto- 
gether, when it gets through, and drops into the bladder. 

Sometimes there is no pain, the gravel being so fine as to pass 
through the ureters very easily. It then passes through the urethra 
also, and is found as a sediment of the urine at the bottom of the 
vessel. 

These urinary deposits are various, and quite unlike each other in 
kind. They indicate different states of health, and require to be 
spoken of separately. 

Uric-Acid Qravel. 

This form of deposit passes indifferently under the name of uric 
acid gravel, or lithie acid gravel. The person who is in the habit of 
passing this kind of deposit largely, is said to have the lithie or uric 
acid diathesis or condition. 

The urine of persons in this state lets fall, after it has stood awhile, 



1 



84a 



DISEASES OF THE ABDOMINAL CAVITY. 



' 



a reddish sediment, like brickdust. This consists chiefly of urate of 
ammonia (Figs. 116 and 117), tinged with certain coloring matters. 
This coloring substance may be more or less abundant, anil give to 
the deposit various shades, as dirt;y-white, yellow, pink, and red. The 





FIO. 116. 



Fig. 117. 



pure uric acid sometimes appears as fine sand, or large crystals (Fig. 

118). The urine is of a dark copper-color, about like brown sherry^ 

and is more scanty than in health. It is 
also highly acid, giving to litmus paper 
a deeper shade of red. 

Persons who pass this kind of gravel 
largely are apt to be troubled with in- 
flammatory complaints; with acidity of 
the stomach and heartburn; and some 
of them with gout and rheumatism. 

Placed under a blowpipe, uric acid is 
decomposed, and gives out an odor like 
that of burnt feathers, combined with 
the oil of bitter almonds, it is dissolved 
by liquor potassa, from which muriatic 
and nitric acids precipitate it; and by 
sulphuric acid, from which it is precipi- 
tated by water. Acetic, nitric, and mu- 
FiG. 118. riatic acids, alcohol, ether, and water, do 

not dissolve it. 

Causes. — Uric acid is the form in which nitrogen and the effete 
compounds which contain it are got out of the body. It is the result 
of the decomposition of the tissues of the body. Its gravelly particles 
are the sands of life daily washed out of us, — reminding us always 
that we are wasting away. Whatever causes the body to waste 
rapidly, produces it in excess. We find it, therefore, in the urine of 
those who suffer from gout, rheumatism, dyspepsia, fevers, debility of 
the genital organs, straining of the loins, etc., which produce loss 
of flesh. 

Treatment. —The remedies for this uric-acid gravel are the alka- 
lies, bicarbonate of potash, bicarbonate of soda and magnesia. The 




ite 



■• « l» " 



DISEASES OF THE ABDOlfflNAL OAVITT. 



349 



:)f urate of 

g matters. 

1^. give to 

red. The 



■stals (Fig. 
iwn sherry, 
alth. It is 
tmus paper 

d of gravel 

ed with in- 

acidity of 

and some 

latism. 

uric acid is 

n odor like 

bined with 

dissolved 

muriatic 

; and by 

is precipi- 

and mu- 

water, do 

the effete 
the result 
y particles 
us always 
to waste 
\e urine of 
debility of 
oduce loss 

the alka- 
is'm. The 



first named is generally the best. It may be used in the form of the 
neutralizing extract, — especially if there be costiveness. If the bowels 
do not need physic, let the potash be taken in the shape of lye made 
from hard- wood ashes ^300). Fluid magnesia i& an excellent remedy ; 
so is liquor potassa, taken in twenty or thirty-drop doses. The urine 
must be w.itohed, and these remedies discontinued when it becomes 
alkaline. Black coffee drunk freely every day is an excellent remedy. 

At the same time the stomach should be. supported by some bitter 
tonic, as the infusion of quassia, gentian, oolumbo, Peruvian bark, etc. 

Iron is, in many cases, not to be ove: )ked. If the patient be 
nale and bloodless, some of the preparations of this metal will be 
needed (61), (73), (74). 

Acid must be carefully avoided, both in food and drink. 

The diet must be plain, digestible and nourishing, and quite mod- 
erate in amount. The quality is of less consequence than the quan- 
tity. 

Exercise is of great consequence, and must be regular, and, if pos- 
sible, in the open air. 

The skin must receive daily attention in the shape of an alkaline 
sponge-bath, with friction. This will throw upon the skin much of 
the labor done by the kidneys. Poland Spring water used in large 
quantities is good. 

Phosphatic Deposits. 

These deposits are indicated by a state of the urine just the oppo- 
site of that which contains the uric-acid gravel. They are contained 
in urine which is either alkaline when passed, or becomes so very soon 
by standing. 

As the urine cools, a white sand falls to the bottom, and frequently 
a film forms upon the surface of the water. Looking at this film in 
different lights, you may see in it the several colors of the rainbow. 
Skira off this pellicle, place it upon paper, and let it dry ; and you 
may then see the little shining crystals. This urine quickly grows 
putrid and offensive. Sometimes it smells strongly of ammonia. 
The more phosphates it contains, the sooner it becomes alkaline. 

These deposits are generally the triple phosphates. Healthy urine 
contains the phosphate of magnesia in a state of solution. Under 
some circumstances, the urea of the urine is decomposed in the kid- 
neys, anr^. ammonia is disengaged. This combines with the phosphate 
of magnesia, and forms the triple salt of the phosphate of ammonia 
and magnesia, which is not soluble. 

Symptoms. — A sallow complexion, a languid, spiritless state of 
mind, and an exhausted, debilitated condition of body. The urine is 
pale, rather copious, slightly turbid, has a low specific gravity, and 
smells unhealthy, having sometimes the faint odor of weak broth. 
There is generally derangement of the digestive organs, windy stom- 
ach and bowels, nausea, constipation, or diarrhoea, stools of various 



iir 




360 



DISEASES OF THE ABDOMINAL CAVITY. 



colors, and sometimes, in diarrhoea, resembling yeast, and an aching 
pain and weakness in the loins. 

Causes. — These deposits are produced by great debility of the 
constitution, by injuries of the spine, dyspepsia, defective assimila- 
tion of food, bad diet, irritation of the neck of the bladder, and or- 
ganic disease of the kidneys. But they are caused more especially 
hy whatever wears and exhausts the nervovs system^ as heavy cares, de- 
pression of spirits, sedentary habits, great; mental exertions, mastur- 
bation, and venereal excesses. 

Tre»tment. — These deposits being connected with great debility, 
care i-ust be t^ken not to make the matter worse by taking active 
purgatives, by extrexne fasting, or by any means which will incresise 
the weakness. 

On the contrary, the strength must be supported by all the means 
that can be commanded. With this ^ iew, the citrate of iron (75) 
may be taken. Arsenic combined with iron (80), to allay irritability, 
and impart strength at the same time, may be used. The valerianate 
of iron (93) is excellent for the same puipose. 

Connected with a state of urine just the opposite to that which 
holds the uric-acid deposits, this form of gravel calls for the opposite 
remedies. Instead of the alkalies, the acids are wanted. The nitric 
and muriatic acids, with a vegetable tonic (Tfi), may be used. Borax 
is spoken of in high terms, and is thourht by some to have great 
power in turning alkaline urine acid. T e compound balsam of sul- 
phur is highly spoken of, and the compouii infusion of trailing arbu- 
tus is also mentioned with approbation. 

It is all-important to throw off care, and to give the mind a chance 
to rise up with all the elasticity it has. To bring this about, journeys 
and amusements are useful. The society of lively, laughing, witty 
friends will do a great deal to give the spirits a lebound, and the 
whole health an upward movement. Such persons are a blessing to 
th^ world ; and he who reckons a few of them among his friends will 
live the longer for it. 

The skin should have the benefit of the daily tonic effect of a 
sponge-bath, with water at first tepid, and afterwards cool ; and exer- 
cise, out of doors, should be habitual, and connected, as much as pos- 
sible, with objects of pleasure. 

The drinking of hard water is highly injurious ; and if none other 
can be had, it should be distilled, and then spread out to the atmos- 
phere, in shallow vessels, that it may recover its pleasant taste by 
reabsorbing air and carbonic acid. 

Oxalic Deposits. 

. Oxalate of lime a\ the urine is the cause of this kind of gravel, 
It appears in the form of dumb-bells, and octahedral crystals. (Figs. 
119, 120, and 121.) 






1 an aching 

lility of the 
ve assimila- 
ier, and or- 
B especially 
f-y cares, de- 
3ns, mastui- 

eat debility, 
iking active 
irill increase 

LI the means 
f iron (75) 
r irritability, 
3 valerianate 

I that which 
the opposite 

The nitric 
sed. Borax 

have great 
[vlsam of sul- 
railing arbu- 

ind a chance 
)ut, journeys 
yhing, witty 
nd, and the 
blessing to 
friends will 

effect of a 
1; and exer- 
nuch as pos- 

E none other 
the atmos- 
i,nt taste by 



d of gravel. 
T.h. (Figs. 



DISEASES OF THE ABDOMINAL CAVITY. 



351 



The urine has a specific gravity of 1.015 to 1.025, and is genemlly 
of a dark amber-color, and clear and bright ; it is generally acid, 






Fio. iia 



Fio. lao. 



Fio. 121. 




though occasionally alkaline or neutral. Urea is generally found in 

it, and epithelial cells (Fig. 122). Unlike the 

uric and phosphatic urines, it is quite free 

from sediments, except, as often happens, there 

is a large amount of urea in it, in connection 

with the oxalate of lime. 

When the urate of ammonia is combined with 
the oxalate of lime, it often happens that the 
latter has to be dissolved with a little liquor 
potassa, before the former can be seen with the 
microscope. *''*'• *^- 

Symptoms. — Great depression of spirits, excitable state of the ner- 
vous system, painful susceptibility to external impressions, dyspeptic 
symptoms, and disturbances of the liver, a fear and dread of consump- 
tion, emaciation, inability to make exertion, — the' smallest exertion 
causing fatigue ; in men, a deficient sexual power, a pain and weight 
across the loins, and some irritability of the bladder. 

Causes. — These deposits are supposed to result, like most other 
derangements connected with loss of flesh, in too great a degree of 
oxidation. Vegetables produce oxalic acid by just the opposite pro- 
cess, namely, deoxidation. 

Whatever depresses the vital powers, may generate this deposit, 
as mental depression, overwork of the brain, burdensome cares, idle- 
ness of mind or body, masturbation, debaucheries, intemperance, vene- 
real excesses, and injuries of the spine. 

This deposit may also be produced by certain articles of diet, which 
contain the oxalic acid. Among these may be named the rhubarb 
plant, which in summer is largely used for tarts ; and sorrel. 

Treatment. — The treatment for these deposits should be very 
much like that for the phosphatic. The stomach and liver should 
receive some special attention. A pill of leptandrin, podophyllin, 
etc. (39), may be usvorl with advantage. The preparation of nitric 
and hydrochloric acids (76) mu-^it generally be taken for some time. 
In cases of great irr'tability, the sulphate of zinc (82) does well. 



i 



i 



II 



t 



352 



DISEASES OF THE ABDOMINAL CAVITY. 






The diet should be plain, digestible, and nourishing, — all articles 
containing oxalic aoid being rejected, as the rhubarb plant, sorrel, 
tomatoes, onions, etc. 

For the rest, folJow the directions for the treatment of phosphatic 
deposits. 

Urate of Ammonia Deposits. 

The urine which contains these deposits is generally pale, and of 
low specific gravity, about 1.012. It becomes opaque on cooling, 
from the deposition of a nearly white urate of ammonia. Instead of 
falling down readily, tliis forms ropy masses in the fluid, and looks 
like mucus or pus, or something between the two. Its real nature is 
discovered by applying a little heat, which quickly dissipates it. 

Microscopic Character. — Place a drop of this turbid urine te- 
tween two slips of glass, and examine it closely with a microscope ; 
you will see myriads of minute globules adhering together in lirear 
masses. Now place a drop of the turbid urine in a watch-glass, and 
gently warm it ; as soon as it has become clear, add a drop of hydro- 
chloric acid to it, and when it is cold, examine it with the microscope. 
The muddiness will be gone, and you will now see lozenges, or thick 
cohering prisms of uric acid (Fig. 123). The explanation of this is, 
that the hydrochloric acid combines with the ammonia, forming muri- 
ate of ammonia in solution, and liberating the uric-acid crystals. 





FiQ. 12a 



FIO. 124. 



Urate of soda (Fig. 124) is sometimes found in urine, which has 
similar chemical reactions with urate of ammonia. 

Causes. — These deposits are generally produced by some over- 
eating, or derangement of the skin. 

The treatment is the same as that for uric-acid gravel. 

Hippuric Acid Deposits. 

These deposits appear in the healthy urine of the cow and the 
horse ; and also in that of human beings, but in such small quanti- 
ties as to be scarcely appreciable. 

They sometimes, however, appear in unhealthy proportions ; but 
they never show themselves as a sediment, until after the addition 



-atasmaaCMMHaMH 



■ all articles 
>lant, Borrel, 

phosphatic 



pale, and of 
on cooling, 
Instead of 
1, and looks 
3al nature is 
pates it. 

id urine l)e- 
microscope ; 
er in lii;ear 
sh-glass, and 
op of hydro- 
micro3coi)e. 
ges, or thick 
on of this is, 
irming muri- 
jrystals. 



!, which has 
some over- 



ow and the 
mall quanti- 

)rtion8 ; but 
he addition 



DISEASES OF THE ABDOMINAL CAVITY. 



85S 



of a stronger acid. The urine containing them is generally slightly 
acid or neutral, — sometimes alkaline, — having a low specific gravity, 

from 1.006 to 1.008. The triple phosphates 
are often found in it. 

To detect these deposits, fill a large watch- 
glass with urine, and evaporate it over a lamp 
to a few drops. Then add to it about half 
its* bulk of hydrochloric acid, and set it aside. 
The addition of the acid produces a bright 
pink color, and an odor like new hay. After 
a few hours, if the hippuric acid be present, its 
'*»• "»• peculiar crystals will be seen. (Fig. 126.) 

Cause. — In man, this deposit is supposed to depend on the 
absence of food having a good share of nitrogen. The urine of 
vegetable-eaters contains it in largest quantities. 

Treatment. — The only treatment required is a diet composed in 
good proportion of animal food, a proper attention to the skin by 
bathing, etc., and when debility exists, tonic medicines, as iron and 
bittera, with out-aoor exercise enough to keep the muscles in working 
order. 

Cystine Deposits. 

These do not occur in healthy urine, and rarely as an element in 
diseased action. They contain twenty-six per cent of sulphur. 

Urine which contains cystine is of a pale yellow color, and has a 
low specific gravity. It frequently has an oily appearance, and its 
smell is peculiar, resembling that of sweet brier. Sometimes its odor 
is fetid, like putrid cabbage. On being kept for a short time, it has 
its surface covered with a pellicle which looks oily, and consists of a 
mixture of crystals of cystine and the phosphate of ammonia and 
magnesia. 

The cystine deposit appears to be diffused through the urine, which 
is always turbid when boiled. It is a white or fawn-colored powder, 
and falls to the bottom as a sediment. It undergoes no change by 
warming the urine, and this distinguishes it from white urate of 
ammonia. It is not soluble in diluted hydrochloric or strong acetic 
acid, which distinguishes it again from the earthy phosphates. 

To test this deposit, add liquor ammonia to a portion of it, and 
shake them. If the deposit be cystine, it will dissolve readily. Allow 
a few drops of the solution to evaporate on a slip of glass, and the 
six-sided tablets of cjrstine will remain, which may be examined under 
the microscope. (Fig. 126.) 

It is to be remembered that occasionally the chloride of sodium or 
common salt crystallizes in octahedral forms (Fig. 127), which, in 
some positions, may look very much like cystine. The r-^ady solu- 
bility of the chloride in water, and the absence of all color when they 
are examined by polarized light, will prevent mistaking these crystals 




I IH 



354 



DISEASES OF THE ABDOMINAL UAVITY. 



for cystine. If urine containing common salt Ix' quickly evap«»mtod 
on a slip of glacs, and be then examined, instead of the octahedrouH, 
we find crosslets and daggers. (Fig. 128.) 




no. 136. 



FlQ. 127. 



FlO. 128. 



Cause«. — i\.n excess of sulphur in the tissues, a scrofulous consti- 
tution, and hereditary predisposition, with defective oxidation, and 
torpidity of the liver. It is often found in the urine of girls who 
have the green sickness. 

Treatment. — The great object is to improve the general health, 
which is to be done by attending to the skin, and the administration 
of iron and bitters, and also alteratives. The syrup of iodide of ij-on 
is a valuable remedy. Podophyllin and leptandrin (34) are wanted 
to regulate the liver. The nitro-muriatic acid (76) should be tried. 

The daily sponge-bath, and daily exercise, as in most chronic com- 
plaints, must on no account be neglected.- 

Stone. — Calculus. 

It often happens that the proper treatment for removing urinary 
deposits is not adopted in season. In such cases, gravelly particles, 
finding a lodgment for a time, in the kidneys or bladder, are apt to 
draw other particles to themselves, which become fastened to them, 
and form a layer quite around them. Over this, other layers form in 
succession, until a stone is produced so large that it cannot pass off. 
These grow to various sizes, — being sometimes so large as to fill the 
bladder. 

Uric-Acid Calculus. — The most common of these formations is the 
uric-acid calculus. It is generally smooth or slightly tuberculated on 
the surface, and varies in color from a pale yellowish-fawn to a red- 
dish-brown. When sawn through the centre, its layers will be found 
tolerably regular, but of different thickness. (Fig. 129.) 

To test it, place a small fragment upon platinum foil under the 
blow-pipe. If uric acid, it blackens, and gives out an odor like burnt 
feathers mixed with the oil of bitter almonds. 

Mixed Calculus. — These calculi are frequently composed of two 
or more different kinds of matter arranged in irregular layers. Fig. 
180 is a mixed calculus, — the dark layers being oxalate of lime, the 
light ones uric acid. 



mum 



DI8KA8E8 OF THE ABDOMINAL CAVITY, 



855 



■ evapomtod 
)ctahedronH, 




•'la. 128. 

iilous consti- 
idation, and 
of girls who 

leral health, 
[ministration 
adide of ij-on 
I are wanted 
aid be tried, 
jhronic com- 



rmg urinary 
ly particles, 
, are apt to 
ed to them, 
yers form in 
lot pass off. 
as to iill the 



In testing such, fragments of each ingredient should be separately 
examined. 

Urate of Ammonia Calculus. — We occasionally meet with a cal- 
culus composed of the urate of ammonia. These calculi, whtn found, 
are generally small in size, smooth or slightly tuberculated upon the 
surface (Fig. 131), and of a pale slate or clay color. When heated 
before the blowpipe, it gradually disappears. 



FlQ. 129. 



KlU. 130. 



PlO. lUl. 



Phosphate of Lime Calculus. — This has a smooth polished s'm- 
face, and quite regular layers, which separate easily when the calculus 
is cut asunder. It has a pale fawn or stone color. (Fig. 182.) 

It chars before the blowpipe, and gradually becomes wliite as the 
carbon burns away. Diluted nitric or hydrochloric acid dissolves it 
without effervescence. 

Oxalate of Lime Calculus. — ^ This is frequently met with uncom- 
bined with others, but more generally its nucleus is uric acid or urate 
of lime. It commonly has a brown, dark-olive, or dirty-purple color. 
Its surface is irregular and somewhat rough. It looks like the fruit 
of the mulberry, and is known as the mvlbenry calculus. (Fig. 138.) 

It dissolves, without effervescence, in diluted nitric or hydrochloric 
acid. When thus dissolved, the addition of a little ammonia will 
cause it to fall to the bottom as a white precipitate. 



lations is the 
erculated on 
wn to a red- 
^ill be found 

) 

1 under the 

or like burnt 

osed of two 
ayers. Fig. 
of lime, the 



FlO. 132. 



FIO. 133. 



FIO. 1S«. 



Fusible Calculus. — This is a mixture of phosphate of lime and the 
phosphate of ammonia and magnesia. It is the most common of 
all the calculi, except the uric acid. It has an oval, irregular form 
(Fig. 134), and is white, soft, and friable, like chalk. Sometimes it 
is hard. ' 

It may be known by the readiness with which it melts down before 
the blowpipe, without being consumed. 

Causes. — The causes of the different kinds of gravel have been 
already explained. Generally atones of the bladder are formed in the 



366 



DIBBASES OF THE ABDOMINAL CAVITY. 



kidney, and descending through the uretere into the bladder, arc pr(>- 
vented fi-om passing out through the water-pipe by an enhirged proH- 
tate gland. Remaining in the bladder, they soon get encrusted over 
by other matters in the nrine, and grow by ciccrotion to be stones. 

Symptoms. — When a stone in the bladder reaches a certain size, 
especially if it is rough, it always produces suffering. A dull, annoy- 
ing pain is felt at the end of the penis. The desire to make water in 
frequent, and there is a sense of weight in the perineum. Sometimes 
the stream of urine is suddenly stopped by the stone falling on the 
orifice of the urethra. As the bladder becomes nearly emptied, it 
embraces the stone, and the pain is inci-eased. Jolting in a carriage 
causes great pain. Mucus passes off with the urine, and sometimes 
blood. After a time, the appetite fails, hectic sets in, albumen ap- 
pears in the urine, and the patient sinks under inflammation of the 
bladder. 

These symptoms being found in diseases of the kidneys and blad- 
der, no one is authorized to pronounce upon the existence of stone, 
until the stone has been touched by a metallic sound introduced into 
the bladder. 

Treatment. — The only effectual treatment is a choice between 
three operations, — lithotrity, lithotomy, litholopaxy. 

The first consists in introducing an instrument, a kind of forceps, 
into the bladder, through the urethra, taking hold of the stone, and 
crushing it. The preparatory treatment consists in correcting the 
unhealthy state of the urine, and the frequent introduction of bougies 
or sounds to enlarge the water-pipe for the easy entrance of the 
crushing forceps. The after treatment consists in diluent drinks to 
increase the urine, injections of warm water to wash out the frag- 
ments, with hip-baths, soothing injections, and leeches or cupping 
upon the perineum. 

Lithotomy consists in making an incision into the bladder through 
the perineum, and taking out the stone or stones whole. 

Litholopaxy consists in crushing the stone in ntu by means of the 
lithotrite and syphoning out the debris. 

Dropsy of the Belly. — Ascites. 

This is a collection of water in the cavity of the belly ; sometimes 
the fluid is outside of the peritoneum, and next to the muscles. 

Symptoms. — An enlargement of the belly, with a sense of disten- 
tion and weight, — particularly on the side on which the patient lies. 
When the collection of water is large, .the breathing becomes short 
and difficult, and the swelling is uniform over the whole abdomen. 

In some instances the fluctuation of the water may be distinctly 
heard when the patient moves about, — just as we may hear the 
water in a half-filled barrel when it is rolled over. This sound of 
the fluid, when heard, distinguishes the complaint from pregnancy. 



DIBEASES OF THK ABDOMINAL CAVITY. 



357 



iiiid Ifom the drum-head state of the bowels. This fluctuation nmy 
Hometimes be produced by pressing ujKjn one side of the belly while 
the patient is standing or sitting, and striking the other side with the 
ends of the fingers of the other hand. 

In some citses, there is loss of appetite, dry skin, eostiveness, scanty 
urine, oppression of tho chest, cough, colic pains, and variable pulse. 

Causes. — A frequent cause of this complaint is chronic inflamma- 
tion of the serous membrane which lines the abdomen, — I mean the 
peritoneum. It may also be produced by scarlet fever, fever and 
ague, disease of the heart, particularly dilation of the right cavities, 
and diseases of the liver, particularly the shrivelled, hobnail condition 
of the liver, — in short, whatever causes a pressure upon the portal 
veins, and obstructs the venous blood returning fi-om the intestines. 

Treatment. — The remedies for this disease are mainly diuretics 
and purgatives. The IwweLs may sometimes be reduced in a few 
days from an enormous size, by medicines which excite the action of 
the kidneys. Digitalis combined with acetate of potash, etc. (130), 
forms an excellent preparation. The patient should have as a con- 
stant drink, a strong infusion made from two parts of hair-cap moss, 
and one each of juniper berries and dwarf-elder bark ; also an infu- 
sion of queen of the meadow. 

The purgatives used in this complaint are those which produce 
watery stools. One of the best of these is elaterium. It will some- 
times carry off the water with great rapidity ; combined with some 
active catliartics (31), it will have all its good effects without the 
griping it is apt to occasion alone. 

Cream of tartar, taken in large doses, every day, will sometimes do 
wt 11. Epsom salts produces watery stools, and is a good remedy. 

For promoting absorption of the fluid, the iodide of potassium, 
taken in from three to ten-grain doses, three times a day, is a valua- 
ble medicine in many cases. The compound infusion of parsley is 
said to be still better. 

The skin must receive careful attention. The alkaline sponge 
bath, with friction, will increase the tianspiration of fluid through 
that organ. Exercise does much to keep up an active circulaticm, 
and to lessen dropsical effusions. 

The strictest temperance, both in eating and drinking, must be 
olwerved. A light and nourishing diet, with water, tea, and the 
diuretics named above for drinks ; beyond these the patient must 
not go. 

A kneading and shampooing of the bowels once a day has an 
excellent effect ; it gives activity to the circulation in obstructed 
veins. A bandage tied close ai'ound the bowels, and tightened as 
the water diminishes, has an effect upon the sluggish vessels similar 
to that of the laced stocking in varicose veins of the l