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A COMPENDIUM

LECTURES

THEORY AND PRACTICE
OF MEDICINE,

DELIVERED BY,

PROFESSORCHAPMAN,

-i\

UNIVERSITY OF PENNSYLVANIA.

PREPARED WITH PERMISSION, FROM DR. CHAPMAN's MANUSCRIPTS,
AND PUBLISHED WITH HIS APPROBATION.

BY N. D. BENEDICT, M.D.,

FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; PHYSICIAN TO THE
LYING-IN DEPARTMENT OF THE PHILADELPHIA HOSPITAL.

IBRARY OF THE

ffifg Acadeniy of Medicine,

X TO BE EEMOYED.

h^^ 1^

PHILADELPHIA:

LEA AND BLANCHARD.

1846.

0

^^-^

Entered, according to Act of Congress, in the year 1846,

By Lea and Blanchahd,

In the Clerk's Office of the District Court for the Eastern District of

Pennsylvania.

GERMAN, PRINTER,

19 St. James Street.

TO DE. CHAPMAN.

Dear Sir, —

As a testimonial of my gratitude for many acts of kindness,
and in view of the assistance you have so generously rendered
me in the execution of this work, I feel pleasure as well as
pride, in inscribing the book with your distinguished name.

N. D. BENEDICT.

\'^

PREFACE,

In presenting this work to the public, the author expects it to
stand chiefly upon the merits of the great man, in whose volu-
minous writings it is founded. Elevated on account of extra-
ordinary talent and learning, at the youthful age of twenty-six,
to the adjunct professorship of Obstetrics, in the University of
Pennsylvania, he was, seven years afterwards, elected to the
professorship of Materia Medica, and, in the thirty-sixth year
of his age, was transferred to the Chair most congenial to his
tastes and acquisitions — that of the Institutes and Practice of
Physic, and Clinical Medicine.

For many years past, with few living competitors, he has
stood, confessedly, at the summit of his profession. Distinguish-
ed for his acquaintance with the opinions of others, he is per-
haps unsurpassed for originality.

In all his investigations and speculations, he has shown an
eminent regard to the practical. Cautious in the reception of
new observations, or doctrines, he has been remarkably suc-
cessful in extracting their truths from their errors. The sound-
ness of every theory and precept, he has tested by a most ex-
tensive application ; and if the value of a medical writer's
instructions may be measured by his success in practice, then,
for the Lectures of Dr. Chapman, from his almost unrivalled
reputation as a practitioner, is claimed the highest merit.

VJ PREFACE.

These Lectures, annually delivered to classes averaging four
hundred members, must be familiar to a large part of the pro-
fession in the United States ; and we only repeat the " general
opinion, in pronouncing them, erudite, elaborate, and highly
finished compositions, enriched with the stores of the most
varied reading and of ample personal experience." To point
out another course of medical lectures, at once so profound, so
practical, and so much to be confided in, would perhaps be
impossible. The Lectures on Eruptive Fevers, Hoemorrhages,
Dropsies, Gout, and a part of the diseases of the Thoracic and
Abdominal Viscera, &c., &c. — having been published complete
in two volumes, are necessarily omitted in this compendium.

In making this Analysis, distinctness of division, perspicuity
in expression, emphasis of General Principles and other im-
portant parts, as well as the closest accuracy, have been care-
fully studied.

CONTENTS.

PAGE.

REMARKS ON THE CLASSIFICATION OF DISEASES 17

FEVER IN GENERAL 19

INTERMITTENT FEVER 30

REMITTENT FEVER 42

CONTINUED FEVER (MILD, INTERMEDIATE, AND EXTREME FORMS) 49

YELLOW FEVER 71

EPIDEMIC PNEUMONIC, OR SPOTTED, FEVER 84

DISEASES OF THE HEART AND BLOOD-VESSELS (INFLAMMATORY,

ORGANIC, AND NERVOUS) 87

ACUTE CARDITIS, PERICARDITIS, AND ENDOC A RDITIS 91

CHRONIC CARDITIS, PERICARDITIS, AND ENDOCARDITIS 96

HYPERTROPHY OF THE HEART 99

DILATATION OF THE HEART I03

ATROPHY OF THE HEART 106

RUPTURE OF THE HEART IO7

AFFECTIONS OF THE VALVES OF THE HEART 108

PALPITATIONS HO

ACUTE ARTERITIS 112

DEGENERATIONS OF ARTERIES II4

ANEURISM OF ARTERIES 116

PHLEBITIS 119

ACUTE INFLAMMATION OF THE THROAT 122

CHRONIC INFLAMMATION OF THE THROAT I05

DYSPHAGIA 126

PAROTITIS 127

^— CONTENTS.

PAGE.

DYSENTERY (INFLAMMATORY) 129

DYSENTERY (CONGESTIVE) 136

DIARRHOEA.-, 139

CHOLERA MORBUS 142

CHOLERA INFANTUM 147

FLATULENT COLIC 153

BILIOUS COLIC 157

COLICA PICTONUM 160

ACUTE PERITONITIS 164

CHRONIC PERITONITIS 168

ACUTE CATARRH 170

CATARRHUS .ESTIVUS 175

CHRONIC CATARRH 176

ACUTE BRONCHITIS 179

CHRONIC BRONCHITIS 182

CATARRHUS SENILIS 184

ACUTE INFANTILE BRONCHITIS 185

CHRONIC INFANTILE BRONCHITIS 187

CROUP. 188

ACUTE INFANTILE ASTHMA 194

WHOOPING COUGH 197

ACUTE LARYNGITIS 201

CHRONIC LARYNGITIS 205

PLEUROPNEUMONIA 209

CONGESTIVE PNEUMONIA 217

CHRONIC PLEURISY AND PNEUMONIA 220

APOPLEXY 223

PALSY 232

EPILEPSY 235

HYSTERIA 242

CHOREA 245

NEURALGIA 248

DIABETES 255

COMPENDIUM

DE. CHAPMAN'S LECTURES.

CLASSIFICATION OF DISEASES.

Diseases were first classified by Celsus, who associated those
bearing to each other a general resennblance. A second classi-
fication was by Ccelius Aurelianus, by whom they were divided
into the acute and chronic. A third was founded on the locality
of the disease, beginning with the head, and proceeding to the
chest, &c. A fourth, adopted by Boerhaave, was founded on
the supposed causes of diseases.

The plan of a Nosology, or arranging diseases into classes,
orders, genera, &c., according to their symptoms, was sug-
gested by Sydenham, and speedily acted on by Sauvages.
Since have been elaborated the nosologies of Linnaeus, Vogel,
Sagur, Cullen, McBride, Darwin, Pinel, Young, and Good.
These are all marked by great defects ; though the best is that
of Cullen, improved by the late Professor Hosack of New York.

Nosology was first attacked by Brown, who supposed all
morbid states were either sthenic, or asthenic, when compared
with the standard of health, which he arbitrarily fixed at forty
degrees. Those, however, loudest in their condemnation of
nosology, adopt its distinctions. An example is seen in Dr.
Rush, who held the doctrine of the unity of diseases; and then
2

18 CLASSIFICATION OF DISEASES.

in the division of his subject calls that by a phrase, which had,
before, been designated by a word.

Notwithstanding the features of a disease are modified much
by circumstances, yet there are leading characteristics which
still remain to isolate it. In order, however, to attain to a proper
arrangement, our views require great improvement, since the
arrangement ought to be based upon pathological conditions.
Nosology has greatly declined.

Dr. Chapman assorts diseases, as they are presented in the
different systems of the body. Yet, he confesses that this too
has its defects, among which is, chiefly, that each system is
composed of heterogeneous elements, each of which may be
separately affected, and require a peculiar treatment. Yet, on
the whole, he considers his plan the best ; and it has been fol-
lowed by many distinguished writers.

Limiting the term system to a part, or combination of parts,
having a similarity of structure, or which concur in the same
uses, the following may be stated :

1. The Circulatory, consisting of the heart and blood-vessels.

2. The Alimentary, of the stomach and bowels.

3. The Secretory, of the glandular apparatus.

4. The Absorbent, of the lacteals and lymphatics.

5. The Respiratory, of the pulmonary organs and their im-
mediate extensions.

6. The Perspiratory, of the external covering of the body.

7. The Sensitive, of the brain, spinal marrow, nerves, and
organs of sense.

8. The Muscular, of the muscles, and their appendages.

9. The Osseous, of the bones and their connexions.

10. The Generative and Urinary, of the organs subser-
vient to these processes in both sexes.

A part of what is embraced in this Physiological Division,
will be resigned to the departments of surgery and midwifery.
As much regard as possible will be paid to the distinctions
arising from the peculiar tissue in which the disease may be
located. The best classification would be that founded upon
the tissues of the body, but it is impracticable from the usual
engagement of several tissues in the same affection.

FEVERS.

It has been estimated that one-half, and by Sydenham that
one-tliird of mankind die from fever.

What is Fever? Cullen, who on this point has been chiefly
followed, defines it to consist in preternatural heat, and frequency
of pulse, after a shivering, accompanied with a disturbance in
many of the functions, and diminution of strength, especially in
the limbs. Of the constituents of this definition the first three,
viz., preternatural heat, and frequency of pulse, and antecedent
shivering, are not uniform attributes of fever. The last two,
disturbance of the functions, and debility, belong equally to other
aflfections. So exceedingly diversified are the manifestations of
fever, that though it may be easily recognised, yet an adequate
idea of it can only be conveyed by a description, such as shall
embrace the entire assemblage of appearances from its com-
mencement to its final termination, and in all the varieties of
which it is susceptible. This will be the proper substitute for a
definition, and will be executed in the special consideration of
fevers. At present will be given a mere summary.

SYMPTOMS OF INFLAMMATORY FEVERS.

PREMONITOR Y. — Nearly always, languor, listlessness, disin-
clination to motion, and some feebleness. Concomitantly, or soon
after, anorexia, nausea, eructations, or other disturbance of the
stomach, — irregularity of bowels, which are usually costive,
with uneasiness in them, furred tongue, — pains in the back and
extremities, with slight tremulousness, — skin harsh and unper-
spirable, pale and shrivelled, — countenance sunken, or otherwise
changed, — headache, or giddiness, — the mind perhaps dull and
confused, and the temper petulant and fretful.

20

DISEASES OF THE CIRCULATORY SYSTEM.

OF THE CHILLY ST A GE.— The case is gradually evolved
by an increase of the foregoing symptoms, and especially by the
sense of chilliness. Cold is felt in the back, as if a stream of water
were trickling down it, quickly followed by shiverings, or even
convulsive rigors. Respiration short and hurried, — vomiting, —
mouth dry and clammy, — thirst considerable, — circulation quick
and feeble, — and the muscular pains exasperated. This stage
continuing an indefinite period, is succeeded by the

STAGE OF REACTION.— Pulse vigorous, tense, and acce-
lerated, — extreme vessels full, — temperature restored, — respira-
tion somewhat freer, — countenance florid and tumid, — severe
headache, — and great depravation of the secretions.

Thence, the progress and eventuation are determined by the
type.

Such are the leading symptoms of inflammatory fevers, which
are, however, greatly diversified in degree of violence and com-
plication.

SYMPTOMS OF FEVERS OF A TYPHOID KIND.

In such fevers from the primary action of the cerebral and
nervous systems, or from improper management, reaction is
withheld, and hence appears the aspect of extreme prostration,
and of slow and imperfect developement.

THE A C C E S S 1 0 N.— This is very sudden. There is felt a sense
of coldness, or a decided chill. Skin pallid, or mottled, and
collapsed, often dripping with a dewy perspiration, — pulse small
and feeble, or full, irregular, and easily compressible, — strug-
gling of the heart, respiration slow and heaving, — muscular
power exceedingly impaired, — and intellectual powers dull or
confused.

Should the system emerge from this state, then is developed
the stage of

PARTIAL REACTIO N.— This state marked by hot head and
cold feet, and great cerebral and nervous distress.

FEVER IN GENERAL. 21

IRRITATIVE FEVER.

In this, the original impression is made on the nervous sys-
tem, and to it subsequently is the impression chiefly confined.
The case having begun with feelings of intense wretchedness,
which may last many days, a fever ensues of a diminutive
kind, exceedingly lingeriqg, marked by extreme debility, and
presenting the appearance of nervous irritation.

The congestive and irritative forms of fever, like the inflam-
matory, occur in the intermittent, remittent, and continued types.

CAUSES OF FEVER.

PREDISPOSING.— Excessive heat or cold; sudden varia-
tion of temperature ; humidity, or dryness of atmosphere ;
extreme rarity or density of air; calms or tempests; the steady
prevalence of certain winds ; and marsh miasmata or impreg-
nations received by the air from marshes. Emanations from
animal putrefaction, and mineral fumes are excluded by Dr.
Chapman, from this category. Crowding people in ill-venti-
lated apartments, which may act either through contagion
arising from disordered secretion, or as Dr. Chapman thinks,
from excess of oxygen, or carbonic acid, or both. At all
events, to this vitiation belongs properly the term Malaria, and
not Miasma, which relates only to vegetable emanations. Con-
tagion, as in eruptive fevers, acting either by contact, or through
the atmosphere. Corrupted or penurious food. Mental emo-
tions, sometimes of an exalting though more usually of a de-
pressing kind. An inexplicable epidemic influence.

EXCITING. — In a number of individuals exposed equally to
the predisposing causes, we see a great difference in the suscep-
tibility to impression- The agencies promotive of this suscep-
tibility are called exciting causes. These are : 1. A peculiar
organization. 2. The irritation of one or more organs, which
according to the ancient maxim, ubi irritatio, ibi affluxus, solicits
and directs the aggression of disease. This action is well shown

22 DISEASES OF THE CIRCULATORY SYSTEM.

in revulsives, when used to invite disease from one part to an-
other. But the doctrine here advanced is very contrary to that
which was promulged by Brown, supported by Rush, and which,
although it has lost caste with tiie profession, is still employed
in the common parlance of both physicians and the vulgar. The
other theory ascribes the increased susceptibility to debility.
It maintains that disease will fall upon a iceali organ. But it is
contradicted by the fact, that it is the robust who are usu-
ally the subjects of the attack ; that in seasons of widespread
danger, the protective measures employed are of a lowering
character, as they are also when used as precautionary to the
fever which it is apprehended will follow a wound.

Under this second head, then, all irritating and perturbating
agencies are included. — Indiscretions in diet, or clothing; ex-
posures to heat or cold, violent exercise, mental emotions, con-
stipation, acrid secretions retained in the body, &c.

D I A G N 0 S I S. — It will be here only stated that the diagnosis
is easily made. The farther consideration is pretermitted until
the fevers are taken up in detail.

PROGNOSIS.

The discussion of this will also be brief in this place. The
more a febrile attack is diffused over the system, the less dan-
gerous it is. The nriost tractable of fevers, are intermittents ;
the least so, are the continued, and especially those of a con-
gestive or typhoid character. By some indeed it is maintained
that the latter class cannot be cured by art, but only mitigated.
Proof is drawn from the eruptive fevers. But it is unfair to
draw such a general inference from fevers so peculiar in na-
ture. This theory is directly disproved by facts. Still there is
a disposition in fevers to a spontaneous crisis on certain days,
and the difficulty of arresting them on intermediate days is
great.

CRITICAL DAYS, or those in which a fever always has a
tendency either to abate or become exacerbated, were first ob-

FEVER IN GENERAL. 23

served by Hippocrates, and since liave been fully shown to
exist. According to Hippocrates, the critical days are the 3d,
5th, 7th, 9th. 11th, 14th, 17th, and 20th, or as some commenta-
tors declare, the 21st; and since have been added the 27th, 35th,
and 42d days. The vigour of our practice is rather unfavour-
able to the clear manifestation of these crises.

The occurrence of critical days has been explained on the
supposition that continued fevers are really disguised intcrmit-
tents, which, commencing as quotidian, or tertian, become
quartan on the 11th day. Crises are denoted by hasmorrhages,
especially from the nostrils, and hsemorrhoidal vessels, im-
proved and augmented secretion, and subsidence of the febrile
movement ; and these changes act, like our artificial evacua-
tions, rather as causes than effects merely of an ameliorated
condition. Fevers, however, sometimes subside gradually.

AUTOPSIC APPEARANCES.

The phenomena exhibited are mainly seated in the alimen-
tary canal, and collatitious viscera, brain, and spinal marrow.
Lesions also probably exist in the nerves, particularly the gan-
glionic centres, though seldom demonstrable. The upper por-
tion of the alimentary canal, with the liver, pancreas, and spleen,
are most apt to be implicated ; and next, the brain and its de-
pendencies, Phlogosis and congestion, with their varied results,
constitute the morbid conditions presented.

PATHOLOGY.

The question now agitated is, whether fever is the conse-
quence of some primary local irritation, followed by a series of
morbid associations, to a greater or less extent, — or, is the
original impulse of a general nature, giving a shock to the
entire frame, and the topical irritation, or inflammation, secon-
dary and dependent? This is only the revival of the old discus-
sion ending partly by common consent, in the division of fever
into symptomatic and idiopathic. Dr. Chapman regards all
fevers as sijmpatlietic of a primordial local disturbance. The

24 DISEASES OF THE CIRCULATORY SYSTEM.

settlement of this subject he deems of much practical impor-
tance.

ILLUSTRATION AND PROOF OF THE PROPOSITION.

— In the phlegmasiee, — in fever following injuries, and the recep-
tion of poison, — in fever produced by irritants, as worms, — and
in the eruptive fevers, it is undisputed that the febrile action is
merely sympathetic of the local disturbance. Tracing out the
evidence, we may also be persuaded that the same holds true in
its application to the so-called idiopathic fevers. These fevers
are caused mainly by contagion, or other effluvia, as marsh
exhalations, or by excesses of temperature, or sudden transitions
of weather, or some general, or epidemic agency.

Now it is plain that such atmospheric impregnations are only
admitted by being entangled in the saliva and swallowed. The
truth of this is evinced by the 'protection afforded against such
impregnations, and the poisonous fumes of certain metals, by
taking food or oil into the stomach previously to exposure.
These act either by sheathing the sentient surface, or by bring-
ing on digestion, in which process the deleterious properties of
the morbid agents are destroyed. The early phenomena, also,
are decidedly gastric. Still, supposing the lungs to be the
avenue of admission, the general proposition respecting a local
origin of fever, is not invalidated ; in that case, the lungs, instead
of the stomach, would be the primary seat of morbid action.

Cold, also, by inducing torpor of the skin, drives in the blood
and concentrates the sensibility upon internal parts, from the
disturbance of which radiates disorder to every part of the
economy. Heat, having first stimulated the cutaneous surface
beyond measure, when withdrawn, leaves it in a torpid condi-
tion, which acts in the production of visceral disease, in the same
manner as when proceeding from cold. This will suffice for an
illustration of the modus operandi of the causes in the production
of fever.

From the greater exposure and the more widely spread sym-
pathies of the stomach, we might a priori apprehend its irrita-
tions to be a common source of fever. And, in fact, they are
the source of nearly the whole of the idiopathic or essential

FEVER IN GENERAL. 25

fevers of writers, and certainly of our autumnal fevers. For
proof, look at the principal phenomena of their developcment,
which are eminently gastric. The same may be said of the
origin of the eruptive fevers ; and their early phenomena may
be pointed to as evidence of their ventricular origin. From
dissection, too, do we derive impressive proof of the same thing.

But though the primary impression be seated in the stomach,
yet this may be superseded altogether by the prepotency of a
sympathetic impression on some other vi-scus, as the liver, or,
in typhoid or congestive fevers, the brain.

Dr. Chapman believes that no unnatural substance enters the
blood in a healthy state, unless by injection. Yet he believes
the blood in fevers does occasionally become much changed, and
reacts on the solids, in the production of an increased degree of
the typhoid or congestive tendency. But the deterioration of
blood is eflected through the mediation of a nervous system
which is antecedently deranged. The blood in the commence-
ment of fever, if examined, will be found little, or not at all altered.

It has been inculcated by some that the primary impression
in fever is seated in the circulatory machinery. But the red
discoloration of phlogosis, reported as such by Bouillaud, has
been proved to be merely the infiltration of blood into the texture
after death. Indeed, the phenomena of inflammation of these
parts are very different from those of fever.

We have seen how fever is effected by a sympathy radiated
from the part or parts on which the morbid impression has been
made. But ivhat is the essential nature of fever? Of this, or,
in other words, of the intimate changes in the organization
wliich constitute it, we may expect to know nothing. We
must be content with tracing its well-ascertained phenomena.

The primary irritation (which is a disturbance of the normal
functions of the nerves) gives rise to symptoms declaratory of
sympathetic nervous and cerebral aflection. These constitute
the premonitory symptoms of fever. The internal irritation
inviting an afilux of blood from the cutaneous surface, occa-
sions the symptoms already described as those belonging to the

26 DISEASES OF THE CIRCULATORY SYSTEM.

stage of the chill The stale of irritation and congestion in the
viscera is followed by inflammation. In case the system, how-
ever, be overwhelmed by the force of the remote cause, reac-
tion may be refused, and the turgid condition, characterized by
the features formerly described, continues. Should inflamma-
tion be set up, there result the phenomena of fully developed
inflammatory fever.

The conversion of congestion into inflammation appears to be
effected thus. In order to overcome the impediment to the
capillary circulation, the heart and great vessels are additionally
excited. Should the obstruction be removed by the vis a tergo,
all does well. But the obstruction remaining, inflammation
results, which, from an extensive play of sympathies, induces
the commotion of system described by the term, a perfect
fever. That the febrile movement is primarily caused by the
topical lesion, is proved by the fact that where such lesion does
not exist, whatever may be the violence of the circulation, there
is no fever. It is only the extension of irritation from the local
lesion to the capillaries throughout the system, which can give
rise to the various functional derangements, such as vitiated
secretion, increased or diminished evolution of animal heat, and
other derangements depending on a disordered condition of the
capillaries.

Dr. Chapman does not, like Broussais, confine the primary
seat of irritation to the upper portion of the alimentary canal,
but maintains that any susceptible surface may become the seat
of the first attack, or by metastasis, or otherwise, may assume,
in the progress of the case, the most prominent position.

That the stomach suffers in every case of continued fever, is
contradicted by the observations of Andral, Louis, and others.
Broussais's idea, that every impression is transn)itted to the
brain, and thence reflected to the stomach, is gratuitous,

Louis located the origin of fever in the glands of Peyer and
Brunner; Clutterbuck in the brain; others have located it in
the spinal marrow, the liver, the skin, blood-vessels, or some
other part.

Dr. Chapman regards fever as being the product not only of

FEVER IN GENERAL. 37-

inflammation, but also of irritation simply, or of congestion. If
fever depend wholly on inflammation, it ought to vary in inten-
sity with the intensity of the inflammation, which is by no means
the fact, as is shown in the case of corrosive poisons.

Genuine fever is an aflection of the whole economy, though
rarely aficcting two parts in equal proportion.

The only true test of theory is practical experience. Do the
theory of fevers as just advanced, and the best practice in their
management, correspond 1 They will be shown to do so entirely.
This will prove confirmatory of the theory; and ev^en should the
theory be really false, it will entitle it to regard, since the great
end of a correct theory would still be fully attained, namely,
clear indications to good practice.

Being called to a case, which we are convinced depends on
some gastric irritation, whether arising from miasma, conta-
gion, accumulation of acrid bile, or some of the other causes we
have previously detailed, is not the first suggestion of reason to
remove the irritating agent by an emetic or purgative? And
is it not well known that an emetic or purgative, given in the
early stage of miasmatic fevers, typhus, and especially the exan-
themata, sometimes completely arrests their progress 1 which it
must do by removing the offending matter, or by breaking the
links of the forming chain of association, and in either case
coinciding with the theory.

But as in the phlegmasia3, which if early treated can be cured
by topical means, but which having involved the system in a
febrile movement, must be treated by general measures, so in
the fevers called idiopathic; since in an advanced stage the
morbid action throughout the organization, has become nearly
independent of its source.

Lest these views of pathology should be thought to have
been taken from Broussais, it may be stated that they were
announced by Dr. Chapman, long anterior to any of Broussais's
writings.

28 DISEASES OF THE CIRCULATORY SYSTEM.

TREATMENT.

1. Ascertain whether the fever be intermittent, remittent, or
continued ; — whether it be irritative, congestive, or inflamma-
tory,— simple, or compUcated, — and to w^hat stage it has ad-
vanced.

2. Inquire the age, previous heaUh, constitutional vigour,
habits of the patient, and his capacity to bear the operation of
remedies. The sex is also to be regarded.

3. Consider the nature of the prevailing epidemic, and calcu-
late the modifications it will be likely to impart to the fever.
This modifying influence of epidemics is often of very great im-
portance.

The fever being Inflammatory, the chief indication is, com-
monly, to reduce the excess of reaction.

For this purpose, we resort to the following remedies.

Venesection, then cups or leeches to the local affection.
Emetics, purges, cold applications to the surface, antimonials,
and other febrifugic articles. Should, however, the febrile
action, in a mitigated state, persist, as it does sometimes, we
must resort to blisters, or other revellents, to mercury as an
alterative, and sometimes to a more powerful mercurial im-
pression.

The case being congestive, we must determine whether this con-
dition be active or passive. In the former instance its manage-
ment should be nearly the same with that of inflammatory fever.
But the vital powers being evidently depressed, we must at once
invigorate them by internal stimuH, frictions, sinapisms, and
other exciting applications externally. Adequate reaction having
been attained, these measures may be relinquished for the
evacuant means already mentioned, though very cautiously,
lest by the supervention of exhaustion, the system relapse into
prostration.

FEVERS OP IRRITATION are to be treated by gentle
evacuations from the alimentary canal, and small local bleed-
ings; active measures being avoided.

FEVER IN GENERAL. 29

REMITTENTSANDINTERMITTENTSaretobe treated
during their periods of exacerbation on the principles of more
continued fever; but during the remissions, and especially the
intermissions, a class of articles, such as Peruvian bark, are to be
used for the prevention of the paroxysm.

The diet and regimen should be accommodated to the state
of the system.

Though the so-called idiopathic, or essential fevers as more
recently entitled, differ not in principle from the phlegmasias,
yet in conformity with custom, Dr. Chapman deems it advisa-
ble to treat of them separately. They have been divided into
synocha, or purely inflammatory, — sj/nochus, of the same condi-
tion, though of less degree in the commencement, with a ten-
dency to degeneration as it advances, — and typhus, when this
low state of the vital powers prevail from the inception to the
end.

FEBRIS INTERMITTENS, OR
INTERMITTENT FEVER.

This fever consists of a succession of paroxysms, between
each of which there is a distinct internnission, or subsidence of
the febrile state, called apyrexia. The period from the be-
ginning of one paroxysm to the beginning of another, is callea
the interval; and that from the end of one to the beginning of
another, the intermission. The paroxysm recurring daily, the
intermittent is entitled quotidian ; every other day, tertian ; and
when the attack reverts only once in three days, it is called
quartan. The attacks are said to recur sometimes much more
seldom, e. g., once a year. Dr. Chapman is convinced that the
disease having ceased, has a tendency to reappear on the 8th,
15th, and 22d days of its cessation, as well as semi-annually,
or annually. The types are sometimes complicated. There
may be, for instance, the double tertian, with two paroxysms
every other day ; or with a paroxysm every day, the alternate
paroxysms corresponding. These complications are rare. Of
all the types, the tertian is most frequent, and the quotidian next.
The quartan most frequently arises from neglect or ill manage-
ment of the other varieties. Commonly the quotidian occurs in
the morning, the tertian at noon, and the quartan in the evening.

Each paroxysm is divided into the cold, hot, and sweating
stages.

SYMPTOMS OF THE INFLAMMATORY FORM.

COLD STAG E. — Languor, chilliness, nausea, pallor ; soon after,
shiverings, or even violent rigors, with increased pain in the

INTERMITTENT FEVER. 31

head, loins, and cxtrennities. Sometimes vomiting, with urgent
thirst, and frequently copious discharges of pellucid urine.

The mind also is irritable and childish. When the natural
powers are feeble, or the force of the attack is overwhelming,
the blood determined upon the internal organs, remains.

The cold stage having continued from half an hour to an houi;
or sometimes longer, reaction succeeds, inducing the

HOT STAG E. — Hot surface, flushed face, violent headache,
anxiety, stomach generally disordered, bowels unmoved, urine
red. Pulse slowly becomes voluminous and vehement. This
state continuing from i/iree to iirelve hours, the

SWEATING STAGE supervenes with great relief. The func-
tions are restored to a state comparatively healthy. The urine,
in the former stage clear and red, is now a little turbid, and
deposits a whitish sediment ; unless a crisis is about to take
place, when the sediment is lateritious, or brick-dust-like.

DURATION^ — Twelve hours are given as the ordinary dura-
tion of a tertian, though it may extend to eighteen. Each of
the stages has sometimes been absent. Sweating has been
substituted by discharge from the kidneys.

All the stages of a tertian are more severe than those of a
quotidian. The quartan is in severity like the tertian, but is
distinguished for slightness of perspiration.

The case has sometimes been restricted to one part of the
system, — the limbs, for instance. Intermittents are sometimes
masked by other diseases, which fact it is of importance to
detect.

SYMPTOiMS OF THE CONGESTIVE FORM.

Coming on with debility, the chill is either violent for a short
time, or is very slight, or is alternated with feverish flushes, or
very speedily heavy congestion supervenes in one or more vis-
cera. Such an attack is rarely followed spontaneously by a
normal hot or febrile stasc. Continuing^ from six to eigrhteen

32 DISEASES OF THE CIRCULATORY SYSTEM.

hours, the coldness is succeeded by clammy or dewy perspira-
tion. The intermission is imperfect, and the succeeding parox-
ysm appears at an earlier hour. The pulse is nearly extinct, or
low, hobbling, full and compressible, — the tongue moist and
milky, — skin cold and damp, with, sometimes, a very unequal
temperature. The engorgement of the brain and lungs occa-
sionally amounts to apoplexy.

Cases occur in which there is little consciousness of danger
and little apparent suffering, and in which the patient may con-
tinue to walk about the house, that are prone to terminate sud-
denly in a swoon. Reaction, however, does sometimes take
place, in force sufficient to accomplish a recovery.

In other instances the force of the disease seems to be ex-
pended on the primse vias. Here there is great gastric disorder,
jactitation, a moist tongue, with a disposition to syncope. At
times, without any chill, fever, or prominent symptom, the
patient is seized with meteorism, copious discharges from the
bowels, sometimes emesis of a thin turbid fluid, and occasion-
ally cramps of the muscles. Coming on in the same way, but
without disturbance of the alimentary canal, there may take
place an excessive and debilitating cold sweat.

In all these cases, reaction is rare ; but taking place, if
moderate, it produces a low congestive fever. If it be forcible,
the fever is of a higher grade, and there is a peculiar determi-
nation to the brain.

A PYRE XI A. — During the apyrexia the pulse is not right,
and there is disorder of the alimentary canal. Indeed, all
the secretions and excretions are vitiated. Mind and body
are both deficient in tone. The apyrexia is marked also by
sallowness of complexion, uncomfortable feelings in the hy-
pochondria, or head, with an increased sensibility to cold.
In the graver varieties the apyrexial disorders are still greater,
and the tendency of one paroxysm to encroach on another,
leads to the formation of remittent, or of low continued fever.

INTERMITTENT FEVER.

CAUSES.

R E M 0 T E.— 7l/ars/i Miasmata. Dr. Chapman thinks he has
elsewhere (in his treatise on Epidemics), shown that these mias-
mata proceed from soils (particularly the argillaceous), and not
from the decomposition of organic matter. They are commonly
ascribed to vegetable decomposition.

EXCITING causes, and not, as has been supposed, predispos-
ing causes also, are extreme heat of the atmosphere, indiscretions
in diet, accumulations of bile, &lc. Confounding intermittent
with hectic, some of the late writers attribute it to a variety of
local irritations. It occurs at times as an epidemic ; and so
occurring, is apt to be more malignant, or mixed and ambiguous
in character, requiring, therefore, a close diagnosis. No age is
exempt.

DIAGNOSIS.

The intermission is the most distinctive trait. The time of
year, exposure of the individual to miasma, and the symp-
toms of a developed attack will assist in the diagnosis. In pa-
thology it most resembles remittent, but in external physiognomy,
hectic fever. Intermittent and hectic thus differ :

1st. The paroxysms of hectic want that agony in the spine
and limbs, so characteristic of intermittent.

2dly. The paroxysms of hectic are seldom uniform for any
number of days in succession, and after a short time, may come
on at any hour of the day or night. Two paroxysms occur
mostly in the twenty-four hours.

3dly. The paroxysm of hectic is often destitute of the chilly,
and sometimes of the other stages.

4thly. The sweating stage of hectic does not always afford
relief; on the contrary, chills and flushes may come and go at
the same time.

Sthly. The flush of the cheek in the hot stage of hectic, is cir-
cumscribed and peculiar. There is no headache ; but the joints
3

34 DISEASES OF THE CIRCULATORY SYSTEM.

of the lower extremities, apt after a time to be swollen, become
in the hot stage extremely painful.

6thly. The pulse in hectic does not subside with the parox-
ysm, and in every respect is the apyrexia less complete.

7thly. The tongue in hectic is clean, florid and polished ; in
intermittents, is covered with a whitish or yellowish fur.

8lhly. The alimentary canal is healthy in hectic, but the re-
verse in intermittent.

9thly. The urine in hectic is usually turbid during the parox-
ysm, and clear in the intermission, but reversely in intermittent.

lOthly. The mind in hectic is cheerful, while it is the opposite
in intermittent.

PROGNOSIS.

Tertian is the most manageable type, the quotidian being apt
to degenerate into remittent or continued fever. Favourable
signs, are a complete chill, which foretells an efficient reaction;
the retardation of the paroxysm ; cleaning of the tongue ; bilious,
or dark, tarry and offensive stools; lateritious sediment in
the urine ; and scabby eruptions about the mouth. The unfa-
vourable signs, are the premature appearance of the paroxysms,
and complication with other disease. The case will be more
intractable also in proportion to its duration, which results as
well from the force of habit, as from the disorders of the chylo-
poietic and other viscera. A violent paroxysm, when simple,
is not the most dangerous, but frequently proves the final
attack.

The disease is dangerous to the infirm. Children are easily
cured. The intermittent may terminate by a conversion into
remittent or continued fever, or it may run into a chronic state,
and by long protraction, derange the organs. In this latter way
it lays the foundation of other diseases — as certain affections of
the heart or lungs, or inflammation, or congestion of the abdo-
minal viscera, with jaundice, and especially dropsy.

The nervous system may also becoino deranged, and parti-
cularly with neuralgia. This last, supposed by some to be a

INTERMITTENT FEVER.

35

late disease, was formerly designated by difPerent terms, such
as rheumatalgia, lumbago, gastralgia, &c.

Death occurring suddenly during the cold stage of a pa-
roxysm, it is usually from engorgement of the viscera of the
great cavities; occurring during the hot stage, it is from con-
vulsions arising from excitement of the brain, or spinal marrow.
The sweating stage is scarcely ever fatal, except in malignant
and congestive cases.

AUTOPSIC APPEARANCES.

Death happening in acute cases in the cold stage, the chief,
if not only appearance, is that of engorgement in one or more
viscera. Death happening in the hot stage of an inflammatory
attack, or after a series of paroxysms, phlogosis is displayed in
the brain, its meninges, or those of the spinal marrow, in the
pulmonary apparatus, or in the abdominal viscera. Congestive
cases, death occurring at any stage, display immense engorge-
ments and traces of weak inflammation. Tn chronic cases are
revealed all kinds of organic depravation of the abdominal vis-
cera, with frequent hydropic effusion.

PATHOLOGY.

Many attempts have been made to account for the periodical
nature of intermittents, but they have all, so far, been unsatis-
factory. It has been alleged, in solution of the difficulty, that
the paroxysm ceases in consequence of the excitability of the
system being exhausted, and when this is recruited, the pa-
roxysm is renewed. But among other objections, it may be
asked: — Why, then, are not all diseases periodical?

Another question is, What is the nature of the action ? It is
commonly asserted to be that of irritation, congestion, or in-
flammation. That these latter slates should come and go so
rapidly, may seem strange; yet post mortem examination re-,
veals such phenomena, and the sudden accession and departure
of inflammation in rheumatism and in gout, furnish a confir-
matory analogy.

36 DISEASES OF THE CIRCULATORY SYSTEM.

Again, What is the seat of this action ? It is generally alleged
to be seated in the stomach and intestines. Chronic cases are
undoubtedly kept up by disease in other viscera. But in view
of the great similarity to remittent and continued autumnal
fevers, in causes, symptoms, and treatment, and the converti-
bility of intermittent into them. Dr. Chapman regards the ac-
tion as essentially gastro-enteric, and the other viscera as af-
fected sympathetically.

In recent and in mild cases, there is probably irritation only,
with temporary congestion, while in confirmed ones there ex-
ists inflammation with its organic derangements.

In congestive and malignant cases, either from a primary
want of constitutional vigour, or from the overwhelming action
of the remote cause upon the brain and nervous system, the
blood recedes from the skin to the deeply-seated organs, pro-
ducing the heaviest engorgements, and this without the power
of due reaction.

TREATMENT OF THE PAROXYSM.

INFLAMMATORY FORM.

COLD STAG E. — To overcome the chill, we place the patient
in bed, cover him well, make hot applications to the lower ex-
tremities, and administer warm beverages. The mischief, how-
ever, taking place principally in the cold stage, should it be
protracted, or the prostration be considerable, we resort to
more efficient measures. For this purpose have been used,
ether, carbonate of ammonia, camphor, &c. But the best is
opium, or its preparations. The application of the tourniquet
to an upper and lower extremity, is not deserving of much con-
fidence. More may be expected from friction along the spine,
or a sinapism to the epigastrium.

Venesection, useful in many cases of heavy engorgement,
is unnecessary in ordinary cases. It is a practice introduced
and recommended by Macintosh, but is adapted only to some
cases, and is pernicious in others.

The substitution of cold for hot applications, has sometimes
succeeded, by reviving, probably, cerebral and nervous energy.

INTERMITTENT FEVER. 37

HOT STAGE. — The indication here is, to promote sweating.

Emetics. — These may be premised when the stomach is
irritated by bile or other matter.

Diaphoretics. — Acetate of ammonia, or sweet spirits of
nitre, with landanum ; or, better, especially where there is much
gastric disorder, the effervescing draught, or neutral mixture.
But with such a view, the following is incomparable.* Opium
may be used very advantageously in patients who are not
plethoric.

Intense fever arising, as it sometimes does, with strong and
dangerous local determination, it becomes us to use the lancet,
local bleeding, purging, and other auxiliary measures. When
the constitution is vigorous, and the fever well established,
enemata of cold water may be advantageously employed.

SWEATING STAG E— Here, nothing more is needed than
to wipe the patient dry, and give him dry clothes, to check the
discharge, when excessive.

CONGESTIVE FORM,

Here the system may pertinaciously refuse to react, while the
most important organs suffer from venous congestion. In con-
sequence of such congestion of the brain, may be induced
apoplexy, or coma.

Venesection, which may seem to be indicated, will perhaps
be inconsistent with the exhaustion of the vital functions.

Topical B 1 e e d i n g, must therefore be substituted.

Emetics. — Especially of salt and mustard, which do not
leave behind them protracted nausea and gastric debility.

Sinapisms to the stomach, neck, and extremities.

Opiates, eminently useful in the chill of common inter-
mittents, are here both safe and efficacious. Indeed, in inost

* R. — Acac. Gum. ;

Potass, carb., aa. 3j. ;
01. menth., gtts. vi. ;
Tinct. opii, gtts. xxx. ;
Aq. font. f3iv.
A tablespoon fill every half hour, to be followed with a small portion of lemonade.

38 DISEASES OF THE CIRCULATORY SYSTEM.

disturbances of the brain connected with jniasmatic fevers of any
type and any stage, opiates are far more serviceable than is
generally supposed.

Cases occur, also, where there is dangerous collapse, without
extreme concentrations of blood. These cases are to be
managed by external warmth, sinapisms, cordial stimulants,
carbonate of ammonia, camphor, and opiates.\ . . , ^<^^^a

Examples, moreover, of the disease are met with, where the
whole force seems to be expended on the alimentary canal, pro-
motive of incessant puking and purging. Here, use opiate
enemata and external irritants.

The sweating being excessive, the most effectual treatment
will be a sinapism, and next a vesicatory to the epigastrium,
with dry frictions, and a lotion to the surface of strong solution
of alum in brandy, or the liot air-bath.

As the system emerges from these states of prostration, fever
may ensue, which is to be treated according to its character.

TREATMENT OF THE A P Y R E X I A.

INFLAMMATORY FORM.

Diversified as are anti-intermittent medicines in other respects,
they all concur in deriving their curative power in this disease,
from their adaptedness to subvert the disposition to a renewal of
that gastric irritation, which usually constitutes its inceptive
movement.

Before the commencement of tonic remedies, the system should
be prepared for their use. In consequence of a neglect of this
preparation, the dilEculty of cure is enhanced, the intermittent
is in danger of being converted into a remittent or continued
fever, relapses are common, with serious organic derangements.
These preliminary measures are emetic and cathartic evacua-
tions. The former seem, by breaking up trains of morbid asso-
ciation, to possess in themselves an anti-periodic power. These
measures should be avoided, however, in case of inflam-
mation.

Venesection. — Should tlie condition be inflammatory or
febrile.

INTERMITTENT FEVER. 39

Topical Bleeding at the epigastrium, should the stomach
show symptoms of phlogosis, or whenever tonics are not well
borne. These topical means are of themselves enough, some-
times, to efiect a cure. Phlogosis being manifested, evacuants
of the alimentary canal should be anticipated by bloodletting.

Cinchona. — The preparatory means having been taken, the
most useful of all means is cinchona, or its preparations. With
the Peruvian bark, it is very advantageous to combine the ad-
ministration of certain other articles — as cloves, tartrate of pot-
ash, muriate of ammonia, or carbonate of potash or soda, in
the proportion of a drachm to the ounce.

R. — Pulv. cort. Peruv. 3ss.
J*,, Rad. serpent. 5].

Sod. carb., vel potass, carb. 9iJ4||^(5^ '
Div. in pulv. iv. The whole to be taken in the course of the day.

R. — Pulv. cinchon. 2j.
Confect, opii 3j.
Succ. limon. 3ss., vel
Acid, sulph. aromat. 3j.
V^Vin. Lusitan. rub. 3viij. ^/ v 4.1^% Lu^^^l
Given in the dose of a wineglassful, three times a day.

Sulphate of (Quinine. — Recommended as a substitute for
the bark, from its being more tolerable to the stomach. Its
cures, however, Dr. Chapman thinks, though rapid, are not the
most radical. Bad effects follow its exorbitant use. It is best
given in the dose of a grain every hour, commencing early in
the morning, fasting, and ending at the time of the expected pa-
roxysm. Most efficacious is it in solution, combined with the
sweet spirits of nitre, or opium. When necessary, from phlo-
gosis of the stomach, or other cause, it may be applied endermi-
cally. Five or six grains of the sulphate applied once in twenty-
four hours, are alleged to be sufficient. It should be mixed with
cerate. The acetate is less irritating. Quinine and the bark
failing,

Arscuious Acid, or Fowler's solution, may be tried.

Snlphate of Copper, excellent in inveterate cases, espe-
cially of quartan type.

40 DISEASES OF THE CIRCULATORY SYSTEM.

Dr. Chapman regards the last two articles as superior to
quinine in chronic cases, and also as respects completeness and
permanency of cure.

A vast number of other remedies have been recommended,
stimulant, tonic, or astringent.

Indeed, whatever powerfully affects the physical or mental
constitution, has a tendency to destroy the intermittent.

CONGESTIVEFORM.

The Bark, or Quinine, is to be largely given in conjunc-
tion with tonics, or even diffusible stimulants.

The tonics may, in these pernicious intermittents, be employed
in the paroxysm, according to circumstances. The indications
for their use are the same with those belonging to the same con-
ditions of remittent and continued fevers.

TREATMENT OF ANORMAL MANIFESTATIONS.

In intermittent developing itself merely on some organ, the
eye for instance, or as a nervous disease, the treatment will be
the same as in a normal presentation.

Intermittents being blended with a more serious disease, as
dysentery, should be disregarded till the more urgent affections
be cured.

TREATMENT OF CHRONIC INTERMITTENT.

This, if dependent on visceral phlogosis, must be subverted
by remedies adapted to the reduction of the phlogosis. Should
there be also obstruction, some alterative, especially mercury,
should be employed. Kept up by habit, a blister on the epigas-
trium, may be used. Emetics may be employed for the same
purpose, when there is certainly no inflammation. The bark
may be well employed, when there is no phlogosis, but when
there is, it is highly pernicious. Arsenic and copper are some-
times better, however, than bark.

When an intermittent has been long dormant, and is re-deve-
loped in the winter, for instance, by the supervention of one of

INTERMITTENT FEVER. 41

the phlegmasise, the primary treatment should be addressed to
the phlegmasia. But this being cured, and the intermittent re-
maining, recourse may be had to bark, or other tonics.

D I E T. — This should co-operate with the treatment, and be
more or less nutritious, accordingly.

Intermittents, though some have attempted to prove them to
be salutary, should be cured as soon as possible. It is not true,
moreover, that they have much tendency to cease spontaneously.
The earlier, too, we commence with tonics, after the evacuant
preparation, the better.

Intermittents have a tendency to be revived every seven days.
In anticipation of this, therefore, we should administer our tonics,
for three different periods.

In consideration of the great disposition of the disease to re-
turn, even when seemingly eradicated, all exciting causes ought
to be avoided. If the patient do not emigrate from the miasma-
tic district, he should be particularly careful not to go out in the
morning without having first eaten, and should take daily doses
of quinine alone, or with iron. The cold bath or travelling often
succeed in preventing relapses. An attack being threatened,
the patient should go instantly to bed, cover himself warmly, and
take an opiate. But as a preventive of a paroxysm of the perni-
cious congestive intermittent, so much dreaded, the most effica-
cious apphance is a blister to the epigastrium, so as to be fully
drawing at the time of the expected accession. At this juncture,
also, is to be given the following mixture:

R. — Sulph. Quinice gr. viij.
Sp. iEther. Nitr. 3j.
Tinct. Opii gtts. xxv.
Aq. Font. 3j.

PEBRIS EEMITTENS OR REMITTENT EEVER.

This is a fever, which, though observant of somewhat regu-
lar exacerbations and abatements, never wholly subsides like an
intermittent.

Remittence is common to many febrile conditions ; but in the
one now in view, commonly called the autumnal bilious remit-
tent, it forms a striking characteristic. Endemic to hot countries,
it is seldom met with even in temperate regions.

It will be here described as it occurs in our own country. It
is more pervading and severe in the southern and southwestern
portions, in miasmatic districts, and particularly when Intense
heats succeed heavy rains. By no length of residence, in some
places at least, is the protection of acclimation acquired, except
by the negro, on whom it seems to be partially conferred.

It appears in the South as early as the first of June, though
it seldom shows itself with us before the close of August. It
is rarely seen in large cities, except on their confines.

SYMPTOMS OF THE INFLAMMATORY FORM.

FORMING STAGE. — Anorexia, languor, heaviness, and
anxiety, alternate sense of heat and cold, obtuse pain in the
head, back, and limbs.

CHILL. — This is sometimes absent. It is generally slight,
though it may be otherwise.

F E V E R. — Increased pain in the head and back ; swimming,
inebriated-looking eyes; precordial tightness; heat, general or
partial; vomiting of bilious or other matters; a white slimy or

REMITTENT FEVER. 43

yellowish furred tongue; thirst, bitter taste, a feeling of burn-
ing, distension, or pain in the stomach ; tender epigastrium ;
torpid bowels, unless they be involved in the affection ; some-
times sallowness of the skin and eyes, and a strong, rapid,
tense, and voluminous pulse. During the twenty-four hours,
and especially in the morning, a remission is observed. The
renewed attack is rarely preceded by a chill. As the case
proceeds, if the attack be severe, the type changes from quoti-
dian to the tertian.

The fever having progressed uninterruptedly beyond the
fifth, and sometimes the third day, we shall find the vital powers
depressed, and augmented cerebral and nervous affection.

Dr. Chapman believes there is a disposition in the disease to
observe in its solution the septennary period.

CAUSES.

R E HI 0 T E. — Genuine remittents arise only from miasmata.

E X C I T I N G. — Indiscretions in diet, exposures to the heat of
the sun, or to night air, indulgence of perturbating passions, &c.

DIAGNOSIS.

Remittent is distinguished by the season of the year, the
locality, the force of the attack, the distress of the stomach, the
state of the tongue, sallowness of the skin and eyes, and, above
all, by the tendency to remission.

PROGNOSIS.

FAVOURABLE SYMPTOM S.— Remissions regular, and in-
creasing in length; soft and slow pulse; skin moist, relaxed,
temperate, and of a natural colour; stomach quiet; the tongue
cleaning and a cessation of thirst ; the alvine discharges being
of bile, or dark, tarry, and fetid ; urine lateritious or turbid, with
copious precipitates ; scabby eruptions about the mouth ; ra-
tional mind, with a firm and steady state of the nervous system.

44 DISEASES OF THE CIRCULATORY SYSTEM.

UNFAVOURABIE SYMPTOM S.— Tendency to a typhoid
state ; delirium, or otiier cerebral or nervous affection ; cold
wrists and warm hands ; gastric distress, watery alvine dis-
charges, having a cadaverous odour; diminished secretion, or
suppression of urine ; dark and incrusted or flabby tongue ; un-
natural skin, and fetid breath.

AUTOPSIC APPEARANCES.

Mucous coat of stomach, duodenum, ileum, and sometimes
of colon, is found inflamed. The liver is inflamed and bloated by
congestion, and generally the gall-bladder is filled with vitiated
bile. The spleen is disordered chiefly by ramoUescence. The
peritoneum, with the mesenteric glands, is involved. No organ
suffers more than the brain and its arachnoid membrane. The
spinal marrow is also affected. The blood, at first presenting a
dense inflammatory cake, afterwards loses its inflammatory
appearance, and is nearly destitute of cohesion.

PATHOLOGY.

This fever is synochus, with a tendency to typhoid degene-
ration. Commencing in gastro-enteric irritation, soon converted
into inflammation, the liver, then commonly the brain, and finally
the circulatory apparatus, become affected. Connected as the
stomach and liver are, by functional and other ties, the latter is
involved in the disease of the former, particularly in warm wea-
ther, when there is a predisposition to hepatic disorder. The
liver at first being merely irritated, an excessive biliary secretion
takes place. From over-stimulation, it afterwards becomes
torpid, congested, inflamed, and secretes not at all, or very im-
perfectly. Now the skin and adnata become icterose, which
denotes not the exuberance, but the want of bile. The change
of colour is shown, under the head of Jaundice, to result from
a peculiar condition of the capillaries, sympathetic of gastro-
hepatic irritation. Sometimes the heart and blood-vessels sym-
pathize with the stomach, inducing fever, before the implication
of other structures. So much do the affections of the various

REMITTENT FEVER. 45

organs fluctuate in intensity, that in different stages of the dis-
ease tiie most opposite titles are conferred upon it — that being
called cerebral fever, which before was hepatic, and was pri-
marily gastro-enteric fever.

TREATMENT.

First discover to what height the fever has progressed, and
what is the principal seat of the affection.

FORMING STAGE OF THE FEVER.— Here we have gastric
irritation, headache, and slight disorder of circulation. The
remedies are, gentle evacuation of the primse vise, leeches to the
epigastrium, cold to the head, a stimulating pediluvium, cold
demulcent drinks, tepid or cold sponging, mild diaphoretics, as
the neutral mixture, with rest and extreme abstinence.

FEVER FULLY FORMED. Venesection.— When there is
a strong, full, or active pulse, a hot skin, or determination to
the brain, or other important organs, this is unrivalled. With
such indications, bleeding will never be amiss. In these fevers,
with a vigorous constitution, bleeding should be rapid and
carried to the verge of syncope, or to syncope itself Small
bleedings merely moderate the disease ; large ones make such
an impression upon the capillaries as to subvert it. The force
of general vascular action having been reduced, venesection
need hardly be repeated.

Local Bloodletting, especially to the head and epigas-
trium.

Cold Applications to the head. Sometimes they are
well applied to the epigastrium. But to the latter region,
fomentations are generally preferable.

Stimulating Pcdiluvia occasionally, as revulsives. The
extremities are always to be kept warm.

Purgatives. — The case having been thus prepared, the
bowels are to be cleansed of the morbid secretions of their
mucous coat and the liver. Thus a great source of irritation is

46 DISEASES OF THE CIRCULATORY SYSTEM.

removed. Dr. Chapman employs calomel, followed by castor
oil, or Epsom salts.

Emetics. — Very salutary, as well from their tendency to
equalize the circulation and restore healthy secretion, as from
the evacuation of the stomach. But they must be used only
before the accession of gastritis, or after its reduction. Gastritis
is to be determined by the tongue, which is either milky white,
or dark in the centre, with florid edges; by tenderness of epi-
gastrium on pressure ; sense of heat in the stomach ; violent
retchings, with the evacuation of a glairy fluid ; and above all
by extreme jactitation. It is best, however, for the inexperienced
practitioner to forbear emetics, unless clearly demanded, and
to substitute purging, which acts on nearly the same principles.
Evacuants should, if possible, be given only during a remission
of the fever.

laxatives. — A recurrence to cathartics, will seldom be de-
manded ; but moderate doses of calomel, or the blue pill, to
promote or correct secretion, and remove undue accumulations,
or an occasional dose of castor oil, will prove useful. We may
also co-operate with enemata.

By the evacuants above-mentioned, will we succeed in pro-
ducing dark, tarry, fetid, acrid stools, glutinous in character,
which had formed on the bowels like an adventitious membrane.
Their removal is both beneficial in itself, and indicative of a
prior improvement.

Mercury, when given moderately, purges ; given very largely,
it creates torpor by excess of stimulation; given minutely, it
acts specifically in the revival or correction of secretory power.
We see, then, how it may be abused in the administration of
excessive doses. If in such doses it should purge, it purges only
by watery stools with great irritation. But such stools are of
no value here.

But evacuations may be carried too far. By undue irritation
of the bowels, in this way, an artificial dysentery is effected,
with tender, tympanitic abdomen, florid, or heavily furred
tongue, and much cerebral disturbance. Whenever watery
discharges succeed dark, tarry ones, we should desist from

REMITTENT FEVER. 47

purgatives, and give only emollient enemata, or use other mea-
sures to allay intestinal irritation.

SUBSIDIARY MEASURES.

Cold Sponging. — V'ery soothing and useful, when the
skin is steadily hot and dry, and the pulse vigorous.

Enemata of Cold Water, often repeated, under like cir-
cumstances, are, perhaps, still more serviceable. They should
not be used in loaded bowels.

A n t i m 0 n i a 1 s. — The best of these is tartar emetic. It should
be given so as not to produce nausea. Where the tartar emetic
is not borne by the stomach, we may substitute the effervescing
draught.

Blisters. — Applied when vascular action is high, they
aggravate the fever and inflammation; but the action having
been reduced, they contribute much to the complete destruction
of inflammation. They also alter the condition of the capilla-
ries, so as to effect a perspiration which had been obstinately
refused before. They should be retained so as merely to pro-
duce redness, the part being then dressed with a poultice, or
simple cerate.

Bar k. — This may be given when the case is lingering, feeble,
and endued with decided paroxysmal manifestations. The
tongue, too, must be moist, the surface cool, relaxed, and per-
spirable, and there must be no marked local affection. Given
otherwise, it is apt to cause a typhoid degeneration. Sulphate
of quinine, however, is by high authority said to answer when
the bark will not — as, where the skin is dry.

But when the disease has taken a decidedly intermittent type,
then the quinine is, undoubtedly, of prime value.

The mercurial impression cannot be produced in the height of
the fever, and is not needed when it has subsided. The mer-
curial action is the effect, and not the cause of the improvement.

Dr. Chapman limits the use of mercury, as has been seen, to
a purge at first, and to small doses subsequently, designed to act
upon the secretions.

In southern remittents, where the hepatic congestion is
greater, somewhat larger doses may be required for the relief

48 DISEASES OF THE CIRCULATORY SYSTEM.

of the liver. Yet he deprecates the absurd and injurious ex-
cesses so much practised. Such exhibitions of mercury can
be vindicated by no circumstances, and they frequently entail
the most deplorable results.

The condition which is liable to supervene in the advanced
stages, by the giving way of the vital powers, being the same,
essentially, with a certain phase of typhus fever, will be treated
of under that head.

CONTINUED FEVEES.

This term is applied to fevers, which have a slight daily re-
mission. Dr. Chapman is persuaded, that, excepting the brief
febrile irritations denominated ephemera, and perhaps the yellow
fever, either of which is scarcely a genuine form of pyrexia,
every fever, for a certain period at least, is made up of parox-
ysms. Continued fevers arising from marsh miasmata, show
an inclination to observe some one of the various primitive
intermittent types, — some inclining to the quotidian, others to
the tertian, and others to the quartan.

The term, continued, is used, therefore, in a qualified sense.

Of these fevers, the most common is a congestive and more
continued state of the autumnal remittent which has been just
disposed of.

TYPHUS, derived from the Greek ru^oj (tuphos), signifying
stupor, is the old and familiar title of such fevers. But from
the disease being thus designated by a symptom not always
present, and from the very ominous import of the term, it would
be well, if by general consent it could be abandoned.

Congestive is used here in a sense contradistinguished to in-
Jlammatory, or rather as the antecedent stage of the latter in a
weakened form. These terms applied to the doctrine of fever,
are not very significant ; but in the present state of our know-
ledge, what better can be substituted ? There exists, often, con-
gestion in one organ, cotemporaneously with inflammation in
another.

Typhus is commonly divided into the typhus niitior, and
gravior, corresponding respectively to the old terms, nervous,
and putrid fevers, and with the French ataxic, and adynamic.
4

50 DISEASES OF THE CIRCULATORY SYSTEM.

Dr. Chapman divides the fever, according to its degree of
severity, into three grades, — the mild, the intermediate, and the
severe. It is considered essentially congestive.

SYMPTOMS OF THE MILD FORM.

PREMONITORY— The approach is often very mild and in-
sidious. A mere feeling of uneasiness, for days ; or languor
with low spirits, hebetude of mind, and giddiness. Next, in-
creased weakness ; anorexia, or sickness of stomach ; costive-
ness, or diarrhoea ; furred tongue, which is flat and flabby ;
soreness of the muscles ; uneasiness, or pain in the head, neck,
or back, or in all these parts ; with an alternation of chills and
flushes, the pulse being rather irritated.

FEVER DEVELOPE D— Augmentation of cerebral disorder,
evinced by vertigo, or headache, or delirium ; dulness of hear-
ing, and general insensibility to impressions; the voice falter-
ing ; the eye inexpressive ; subsultus tendinum, and muscular
tremors.

THE CASE EXASPERATED— Tongue florid and polished,
or, perhaps oftener, partially coated or darkly encrusted, tre-
mulous and not always easy of protrusion ; torpor of bowels,
or excessive purging of thin, acrid fluids ; meteorism, with
tenderness of the abdomen ; urine scanty and highly coloured ;
in cold weather, (and rarely at other times,) some acute
affection of the lungs; skin usually dry and hot, or the tem-
perature unequally diffused ; an occasional eruption on portions
of the body, either miliary or of larger vesicles, with inter-
vening redness, and technically called sudamina. Conjointly
or separately, with the sudamina, are sometimes found rose-
coloured spots. Pulse variable. Mostly it is full and soft, be-
coming small, weak, and exceedingly accelerated — though Dr.
Chapman has seen it throughout slow and hobbling, indicative
of a very obstructed circulation. In this way, especially under
bad practice, does the fever run on for several weeks, or
degenerates into a more violent form.

CONTINUED FEVERS. 51

SYMPTOMS OF THE INTERMEDIATE
FORM.

PREMONITOR Y.— Much the same as in the mild form. May
simulate at first an intermittent.

FEVER BEING FULLY DEVELOPED— Well-defined py-
rexia ; heat of surface ; considerable determination of blood to
the head, with a tendency to delirium ; heaviness, or stupor ;
tongue thickly furred, or covered with a white slime, or more
or less dry ; peculiar countenance, the eyes being suffused and
dull, or swimming and fatuous, as in incipient inebriety, or the
aspect being scowling and malignant, or expressive of distress ;
pulse generally full and slow, though very compressible, denoting
much disturbance of the animal economy; breathing irregular,
with deep sighing, and the breath sometimes very offensive ;
bowels costive ; heat, oppression, and tenderness of the stomach,
with occasional vomitings of bile, or glairy, viscid matter, and
often unquenchable thirst. Sometimes purging early com-
mences.

SYMPTOMS OF THE EXTREME FORM.

THE CASE ADVANCING, these symptoms are aggravated.
The aspect livid, bloated, smooth and polished, or pale and col-
lapsed, with the eyes sunken and heavy, covered, as it were,
with a film. Coma, with low delirium; inarticulate utterance,
or vehement ravings, or typhomania, or distraction of the senses
denoted by floccitation or picking at the bed-clothes, or catch-
ing at illusory objects (called musca) volitantes), or pouting of
the lips. The fever continues, though the pulse is smaller, and
so quick as scarcely to be counted, or, where the brain is deeply
implicated, preternaturally slow. Tongue is now usually dry,
dark, encrusted and chapped, tremulous, and hardly capable of
protrusion, and the gums and teeth covered with the same tena-
cious sordes ; temperature unequally distributed, the extremities

52 DISEASES OF THE CIRCULATORY SYSTEM.

being cold ; nervous trennors, a prominent synnptom from the
beginning, increased so as to constitute subsultus tendinum.
The tendon may be thrown by the spasm over the radial artery.
Convulsions may occur, or oftener rigidity of the extremities of
one side. Abdomen commonly tympanitic, and the bowels,
though previously torpid, discharge involuntarily large quanti-
ties of sooty fluid. Urine is deeply coloured and offensive, or
pellucid, or its secretion is entirely suspended.

In the highest degree of malignity, w-e have glandular ab-
scesses, haemorrhages of black dissolved blood from the various
mucous membranes, with vibices and petechioe, and purpura or
large livid spots. The pulse sinks, skin is universally cold, with
a clammy sweat, singultus occurs with vomiting of a dark fluid,
and death closes the scene.

This description characterizes a case of extraordinary malig-
nity. Yet the fever may present great variety in intensity and
complication.

This form of fever may terminate in two or three days by
convulsions, from congestion of the brain, or may run on for
two or three weeks or longer. Average duration from eight
to ten days.

The severe form just described, is rarely seen in this country.

Fevers, however, usually sporadic or endemic, though some-
times epidemic, occur among us of an infinitely more congestive
character. They occur generally in the autumn. The system
may sink at once into a collapse from which it never emerges.

More frequently commencing with extreme muscular debility,
the disease is displayed in a rapid succession of chills and
flushes, the skin soon becoming permanently cold, pallid, or
mottled and shrivelled. The fiice, in a violent attack, quickly
becomes dusky red, leaden, or bronzed; the forehead smooth
and polished, the eyes wild, s;lassy, and vacant; the aspect ex-
pressive of great distress; the brain always much affected. The
alimentary canal and liver suffer, especially in warm weather,
or where the foundation of the disease has been laid in mias-
matic influence. In \\ inter the lungs are more apt to be involved,

CONTINUED FEVERS. 53

the cases then, from the livid patches on the skin, being called
the spoiled fever, or, from the lowness of animal temperature,
the cold plague.

CAUSES.

PREDISPOSING. — Is the fever generated by contagion?
Dr. (/hapman is much inclined to doubt it, but thinks it safest to
consider the subject as still sub judice. Let it be understood, that
by contagion is meant a virus secreted by the capillaries, which
is capable of reproducing the same disease. The advocates of
contagion adduce many instances of typhus fever attacking a
great number of individuals collected in the same building, and
instances to show that the disease is carried by fomites, many
of which citations are indisputably authentic. It appears that
the fomites are sometimes very retentive ; retaining, in a case
adduced by M'Cormac, the semina of the fever, for a space of
two years. But generally their influence is very much confined.
Dirty clothes seem to be better vehicles for this infection, than
clean ones. The disease arising from fomites is said to be the
most malignant. Of this infection the incubative period is gene-
rally eight or ten days, though the fever is sometimes manifested
almost immediately, and at others, not for seventy days. The
facts to prove these statements are multiplied and conclusive.

But, after all, what is there in facts of this kind to demon-
strate that the agency employed in the propagation of the fever,
is an animal secretion ? They may all be otherwise explained.
The fever seems to have been always generated primarily in
close, crowded quarters, where are evidently means enough for
its origination. And if it be possible that virus sufficient for the
infection of one individual should be thus spontaneously gene-
rated, why should not all be deemed to be affected from the same
source? And why, again, may not this virus be carried by fo-
mites as readily as that which is supposed to be contagion? The
doctrine of contagion, then, must fall before a simpler explana-
tion of facts, not from positive disproof, nor from a want of ana-
logies, bui from the want of positive proof

Conceding, however, every thing to the contagionists, which

54 DISEASES OF THE CIRCULATORY SYSTEM.

is claimed by them, it must be confessed that congestive or
typhus fevers do also arise from other causes. Among these,
may be a want of oxygen, or excess of carbonic acid, or other
vitiation of atmosphere effected in crowded assemblies. The
bad cerebral and nervous effects of such assemblies are directly
evinced by headache, tremulousness, nausea, embarrassed respi-
ration, muscular relaxation, and loss of strength. The disease
is owing, also, to penurious diet, miasmata, to extreme heat, or
extreme cold. It is found, therefore, in reference to the last two
causes, most in Winter in the North, and most in Summer in the
South. Typhus is attributable, also, Dr. Chapman thinks, to in-
adequate evacuations, or a too early resort to stimulants in other
fevers.

E X C I T I N G. — Anxiety or grief, especially nostalgia or home-
sickness. In fine, whatever greatly depresses the mental or
physical system.

DIAGNOSIS.

Pre-eminently discriminative, is sensorial and nervous disturb-
ance, with simultaneous loss of muscular strength, epigastric
and precordial discomfort. From the beginning, prevail despon-
dency and listlessness of mind and body. The dulness of appre-
hension, thickness of speech, tottering gait, and pallid or mottled,
or dusky red hue, are also diagnostic symptoms. As the fever
developes itself, however, all obscurity must cease.

Being caused by contagion, or malaria, the cerebral and
nervous symptoms are exceedingly prominent, the pulse is
rather irritated than oppressed, the fever is less congestive in
character, slower, and seldom or never appears in warm
weather. Being caused by continued heat and miasmata, it
begins with a chill, and is of paroxysmal tendency, with pre-
dominant implication of the chylopoietic apparatus. Occa-
sioned by cold, it is sudden in accession, with a protracted
collapse, and on reaction there is especial implication of the
pulmonary organs and nervous system, with sometimes an
affection of the liver or spleen. There is nothing distinctive of

CONTINUED FEVERS. 55

dothinenteritis, — the alleged marks of that affection being com-
mon to other forms of disease.

PROGNOSIS.

The fever being brought on by contagion, or foul air, runs a
protracted and obstinate course, and our chief merit consists in
merely rescuing important organs from serious lesion, until the
fever spontaneously subsides. Should the patient be retained in
a foul atmosphere, the chance of cure is diminished. In the
typhus fever of the United States there is nearly alvi^ays the
critical tendency, with a disposition to subside spontaneously
at an early period, and to submit to remedial impressions,
unless there be extreme congestion, with little capacity of reac-
tion ; which condition proves very difficult of removal. Epi-
demic typhus is very aggravated and fatal.

Hhe favourable symptoms are, abatement of the cerebral and
nervous affection, cheerfulness, a subsidence of the engorge-
ments, soft clean tongue, temperate surface, tarry alvine dis-
charges, heavy depositions in the urine, glandular swellings,
and scabby eruptions about the mouth.

The adverse signs are, a sense of internal heat with cold skin,
or the peculiar heat called calor mordax; petechia, ecchy-
moses, &c. ; great irritability, or preternatural composure of
the stomach, with a good appetite ; a polished, or dark-coated
tongue, or one perfectly natural ; pain in the head, nape of
neck, or lower part of spine; haemorrhages; retention, or
suspended secretion of urine ; the various cerebral and nervous
affections; distorted countenance; insensibility to vesicatories
or sinapisms, or the spots of their application becoming gan-
grenous; cadaverous odour; a trembling or hobbling pulse;
and a disposition to slide down in the bed.

AUTOPSIC APPEARANCES.

In the mildest cases not very well known. May be conjec-
tured from the symptoms to consist in some congestion, with a
slight phlogosis or erethism of one or more tissues.

56 DISEASES OF THE CIRCULATORY SYSTEM.

In severer forms are found injected and thickened arachnoid,
vascular and turgescent brain, stomach and duodenum inflamed,
ulcerated, or ecchymosed, or softened ; and the ileum, and in
case of diarrhoea, the ccecum and colon, affected much in the
same way, even to ulceration.

According to the observations of Louis, Chomel, and Cru-
veilhier, ulcerations of the glands of Peyer and Brunner, with
lesions of the spleen, constitute the most uniform pathological
characteristic of this fever, so that it has received the title of
dothhienteritis. But their statements, however true in regard to
typhous cases in the Parisian hospitals, are not repeated by the
cultivators of morbid anatomy in Great Britain and Ireland,
who assert such lesions to be very rare. One of them, Ma-
crobin, affirms them to be confined to the large and foul
infirmaries of Paris and London. Dr. Chapman thinks very
few cases would be found in our own hospitals.

The glands both of Peyer and Brunner, or either set of them,
may be alone affected. Those of Peyer are more commonly
involved.

The glands enlarge so as to resemble a pimply, or even pus-
tular eruption. Not being resolved, this state is prone to dege-
nerate into ulceration. The ulceration may be deep, but is
commonly trivial The follicular affection may be inde-
pendent of inflammation of the mucous tissue, or combined
with it.

In cases arising from miasmata, or heat, the liver and spleen
are congested and softened, and the pancreas sometimes hard-
ened. The peritoneum and mesenteric glands are also gene-
rally implicated. The case proceeding from the action of cold,
lesions of the lungs in substance, and more commonly of the
pleura and bronchia, are to be found. Affection of the wind-
pipe sometimes occurs.

IN MALIGNANT TYPHUS.— The solids are flabby and
seemingly, though not actually, putrescent; and the blood de-
prived in a great measure of its solid materials, and with its
constituents commingled. The viscera are marked by heavy
congestion, and unless no reaction has taken place, with a weak

CONTINUED FEVERS. 57

grade pf inflammation, in vvhicli the spinal cord, ganglia, solar
plexus, and the nervous filaments derived from it, participate.

PATHOLOGY.

Are low fevers, engendered by various causes, identical in
nature 1 Bancroft endeavours to prove that there is a specific
typhus fever, which reproduces itself by contagion, and which
has existed from time immemorial ; and that all low fevers
generated by other agencies are entirely incapable of originating
a contagion, and are not specific. Dr. Chapman thinks that
Bancroft adduces much to sustain his proposition, and that it
may be hereafter verified. In such a case, other low fevers
should be called typhoid {typhiis-Uke).

Louis, and Bretonneau hold the existence of a distinct form of
low fever, different, however, from the regular typhus, and dis-
tinguished by follicular lesion. This is called typhoid fever by
Louis, and dothinenteritis by Bretonneau. That there is a
fever of a distinct nature, originating in, and kept up by folli-
cular lesion. Dr. Chapman deems preposterous in itself, and as
yet gratuitous. How, he asks, can a disease so singularly per-
vading receive its birth and be nurtured in a source so insig-
nificant?

Still more extravagant is the allegation of those who hold that
the disease itself consists in these lesions.

The early phenomena of the disease are not at all enteric.
They are gastric, nervous, and cerebral. Low fevers are
known to be nearly exempt from such lesions. These generally
occur in children, among whom low fevers are comparatively
rare. Conversely is it ascertained, also, that similar lesions
exist in scarlatina, cholera infantum, diarrhoea, dysentery, tabes
mesenterica, phthisis pulmonalis, strangulated hernia, and other
diseases, not of a low type, and not even accompanied with
fever. Were the fever a peculiar exanthematous one, as some
contend it is, then the follicular pustules would be a remote
eflfect merely.

Dr. Chapman, then, deems these lesions to be not the cause, but
the result of low fever ; and not a constant, but a casual result.

58 DISEASES OF THE CIRCULATORY SYSTEM.

Andral has seen well-marked cases of the fever where no
appreciable alteration of the alimentary canal existed.

Formerly fevers with petechias were held to be distinct in
nature. But subsequently were found to derive their petechise
from hot and badly ventilated apartments, or an alexipharmic
practice. The same, Dr. Chapman suspects to be predicable of
the sudamina and rose-coloured blotches, the pretended incidents
of this dothinenteritis. There is no doubt that neglect of purging
and other evacuations, has much to do with the production of
the follicular lesion.

Dr. Allison, of Edinburgh, treating of fevers, in " Tweedie's
Practice of Medicine," says that follicular lesion is an occasional
accompaniment of typhoid fever in Edinburgh, especially during
an epidemic tendency to diarrhoea or dysentery. That the
symptoms and local affection are the same with those which
have attracted so much attention in Paris, but that invariably,
the follicular lesion is " secondary in point of date," and its ap-
pearance and disappearance " exert no influence on the essential
features of the general febrile state."

The doctrine nowhere receives general adoption. Many of
its former adherents are giving it up. Louis now believes the
follicular disease to be merely an effect.

Dr. Chapman believes that the low fevers, like other diseases,
are different in nature, from, among other things, a difference in
the cause. Excepting, however, the typhus seemingly arising
from contagion, of v^hich he considers that imputed to follicular
irritation to be merely a modification, he does not think any of
these fevers acquire such a pathological difference as to mate-
rially determine the treatment.

From the external physiognomy of the anatomical characters
of low fevers, like the inflammatory remittent, we judge that
they commence in epigastric irritation, which by sympathetic ex-
tension involves first the brain, thence the nervous system at large,
and thence various tissues and organs, and the blood itself. But
the seat of primary irritation may not be always the stomach.
Dr. Chapman, in cases excited by contagion, or foul air, has
seen it to exist in the brain, and again in the lungs, &c.

Essential only to the constitution of the typhous state is a cer-

CONTINUED FEVERS. 59

tain kind and degree of sensorial and nervous disorder, which
may proceed directly from the brain itself, or may be derivative
from a reflection of an irritation of any one part of the great
nervous centres. In typhus mitior, the impression on the ner-
vous system is moderate, resembling narcotism, the vascular
system at an early period not being implicated.

Uniformly the result of an intense degree of such influence
upon the cerebral and nervous system, is congestion, and by
which well-marked typhus is characterized. Regarding the
nature of congestion, it may be stated, that the veins become
the principal receptacles of the blood, while the arteries are
comparatively empty. The principal symptoms of internal con-
gestion, are a cold, pallid, or mottled surface, an emptied pulse,
or from the struggles of the heart, a full and soft, or inflated
one, an indisposition of the blood to coagulate, and much op-
pression attended with debility.

The venous engorgement is attributable to the fact that the
arteries retain their vitality and energy longer than the veins,
and consequently the power of emptying themselves when such
a power is no longer imparted to the veins. So we see, in apo-
plexy of the brain, or spinal marrow, in the inefficieni state of
the brain and mucous centres just before death, in haemorrhages,
and in many other diseases, that heavy venous engorgements
occur. The innervation upon which the contractility of the vas-
cular system depends, is no longer adequate for the supply of
the veins. In typhus, this want of innervation results from ^he
impression on the brain and nervous system of the remote cause.

More frequently, however, there is sufficient energy left for
the institution of a partial reaction, which leads to the deve-
lopement, in certain parts, of a low form of inflammation. In
these cases the inflammation is generally found in the surface,
or investing membrane of a viscus, while congestion exists in
the interior of the viscus. This presents a mitigated form of
the fever.

The blood is discovered to have lost much of its fibrine and
its solids; and the blood globules are observed to have been
materially affected. But these changes, though they no doubt
operate mischievously on the solids, are secondary in their oc-

60 DISEASES OF THE CIRCULATORY SYSTEM.

currence to those main derangements of the solids, which we
have described.

TREATMENT.

MILD FOR M. — Of cardinal importance in the treatment of
typhus is it, that not the name, but the actual pathological con-
dition, should be prescribed for. What is this condition in
typhus mitiorl There is no great degree of active phlogosis,
nor weight of engorgement, nor vitiation of the secretory func-
tions.

Discarding then venesection, unless demanded by unusual
vascular force, and emetics and purgatives, and all other harsh
or vigorous measures, we resort to gentle laxatives and ene-
mata ; topical bleeding, repeated and diversified, as parts may
seem to suffer; with cold or tepid sponging of the surface,
according to the indications, next, to the mild diaphoretics with
stimulating pediluvia, particularly if the head or primoe via) be
affected, and to the bland mucilaginous beverages, acidulated
with lemon juice. Still, venesection may be necessary for the
prevention of a severe developement, and will be then indicated
by the intensity of the febrile symptoms, and the full and op-
pressed pulse.

SEVERER FOR M.— Here, to no inconsiderable extent, are
congestion and inflammation simultaneously manifested. This
state, in our country, is commonly connected with the inflam-
matory remittent fever ; — the early treatment being much the
same, but differing somewhat.

Emetic s. — Very useful at an early stage by relieving the
congestion of internal organs, determining to the surface, and
inducing reaction. Their employment in an advanced stage is
rather hazardous. They may then be useful, should there be
much irritation of the stomach from vitiated secretion or other
contents, but would be very injurious in a gastritis.

Purging. — Emetics being used or not, purging is early to
be attended to. Calomel is preferable from its more complete
evacuation of the bowels, from its superior power of arousing

CONTINUED FEVERS. gj

the recuperative energies, and counteracting the tendency to
congestion, or reh'eving its incipient formation, as well as from
its excellence in restoring, or rectifying secretory action, not to
mention other salutary effects.

Venesection. — Congestion still existing, or undue febrile
reaction occurring after the previous evacuations, venesection
should no longer be postponed. Nay, these conditions being
pre-eminently marked, it may accompany or precede such eva-
cuations.

The quantity of blood abstracted should be such as to over-
come, or sensibly relieve congestion, taking care not to trans-
cend the recuperative limit of the system.

Cups, or leeches. — Deeming it prudent not to employ ve-
nesection, we may substitute topical bloodletting, or this may
be used subsequently to phlebotomy. These applications should
be made to the seat of the most prominent local affection.
They are nearly always needed for the epigastrium and head,
and oftener than is supposed to the spine. Affiection of the
spinal marrow is denoted by pain in the part, and spasm. The
speedy relief afforded by these means is hardly to be conceived,
by those who have not witnessed it. They should be renewed
so long as the condition is unaltered. The point of determina-
tion is frequently changed, thus requiring of us great vigilance
to follow it up.

Subsequent Purgation relieves congestion by revulsion
to the whole tract of the bowels, removes offensive and de-
pressing secretions, and is promotive of healthy secretion. It
is especially useful in our southern fevers. It should not be
resorted to when activity of phlogosis exists in the bowels, and
the drastics should be avoided. Calomel, or blue pill, followed
by castor oil, is to be preferred. A contra-indication is the
occurrence of thin, watery stools, indicative of increased irrita-
tion from excessive purging.

A report upon the post mortem appearances of the bowels in
cases of this form of disease, by a disciple of Broussais, who
from theoretical notions was opposed to emesis and efficient
purgation, describes the alimentary canal as filled with bile
and other substances, in a state of extreme offensiveness and

62 DISEASES or THE CIRCULATORY SYSTEM.

putrefaction. These cases continued from three to four weeks,
and they eminently prove the wretchedness of the practice.

Even the natural contents of the bowels may become irritant,
as is seen in the occurrence of colic, and enteritis from consti-
pation. Dr. Chapman thinks it probable, that the dothinenteritis
is induced, or exasperated, by this want of proper evacuation.

Cold Applications to the S u r f a c e.— Very useful auxili-
aries when the skin is heated and unperspirable. It is gene-
rally safest to sponge.

With such treatment, the case will, at this time, usually wear
a favourable aspect. But, in case of increased vascular action,
or local determination, we should again resort to a general and
topical abstraction of blood. Now it is that the disease begins
to grasp important organs, and if its hold be not broken, de-
plorable derangements of structure will ensue. The disease,
however, having been mitigated, employment may be made
of the

Diaphoretics. — There being still some excitement, the mild
articles only should be used. Such are the neutral mixture,
the citrate, or acetate, of ammonia, and sweet spirits of nitre.
Opium, when admissible, may be added. These not sufficiently
answering, tartar emetic may be well substituted, in quantities
not so great as to harass the stomach. Dr. Chapman thinks,
of all this kind of remedies, the antimonials, perhaps, have the
greatest power to intercept the march of continued fever.
Better, however, when the pulmonary apparatus is chiefly con-
cerned, or when the secretions are defective, or very much
depraved, is the use of the combination of calomel, opium, and
ipecacuanha.

Thus we see that nearly all the remedies by which we
combat the early stage of this form of typhus, are of the
depleting or evacuant character, reductive in their tendency,
or calculated to equalize the circulation, and diminish the heat
and excitement of the system.

The mortality resulting from the imbecile treatment of the
French school has been frightful. Dr. Chapman has had good
opportunity of comparing the treatment here recommended with
that by tonics and stimulants, and is convinced of its superiority.

CONTINUED FEVERS.

63

Bloodletting is now sanctioned, in Europe, by the most autho-
ritative writers. Dr. Chapman makes statistical quotations to
prove the superiority of the plan. Few are the exceptions to
the rule, that in the early stage of all acute diseases wearing the
aspect of debility, this must be attributed rather to oppression
than exhaustion.

Still, cases there may be, in which, from the overwhelming
power of the remote cause, the capacity of reaction is but
SLIGHT, and bleeding should be very cautiously conducted, lest it
tend only to waste the remaining strength. In these cases the
pulse forms no guide as to the propriety of venesection. The
action of the heart, though perhaps more trustworthy, is also fal-
lacious. Acuteness of pain, warmth of skin, and integrity of
constitution, are the best indications for the practice. The con-
firmed drunkard in no disease bears depletion well. Considered
allowable, venesection is to be tried with the greatest care, and,
according to the effect, must we stop, or proceed to a further
abstraction. Even then, however, local bleeding may be safely
and efficaciously performed. Emetics are applicable, especially
salt or mustard, which do not weaken the tone of the stomach,
nor depress the vital energy, and are followed by prompt and
enduring reaction. Calomel, freely exhibited, and at short inter-
vals, is another important measure.

These measures failing, resort to sinapisms placed at various
points, and particularly over the epigastrium. Should so great
a delay be admissible, a blister to the epigastrium may be sub-
stituted. This application acts, not only by revulsion to the
surface, but by a direct relief afforded to the stomach, with
which, so greatly, the whole economy sympathizes. But still
more does Dr. Chapman imagine it to act by its influence upon
the solar plexus and ganglia behind the stomach. It is upon
the want of innervation, partly, from these centres, that the
congestion of the viscera depends. From the dependence, also,
of the respiratory function and the circulation upon the upper
portion of the spinal marrow, there is an indication for the
application of a sinapism or blister to the nape of the neck.

These not answering, bags of hot sand or hot oats, may be
laid along the bod}'.

64 DISEASES OF THE CIRCULATORY SYSTEM.

Concomitanily with these measures, should be administered
active diaphoretics and warm cordial beverages.

That powerful stimulants, at this conjuncture, may relieve
the congestion from torpor, is undeniable ; but, failing, by their
vis a iergo, they either increase the congestion, or superinduce
inflammation. The belter plan is to precede their use by deple-
tion, or stimulate and bleed simultaneously. But in cases of
absolute sinking, stimulation is unconditionally and immediately
required. Then may be given ether, carbonate of ammonia,
camphor, hot toddy ; or, should the disease have a miasmatic
origin, quinine and opium, combined, will be found singularly
adapted. Such urgent cases, however, seldom appear. The
system having recovered, under these external and internal
stimulants, the means formerly mentioned should then be tried,
namely, bloodletting, vesication, mercurial purging, «fec., and,
subsequently, calomel, opium, and ipecacuanha.

TREATMENT OF THE STAGE OF EXHAUSTION.

Little does it matter what may have been the incipient nature
of the fever, inflammatory or congestive; from the neglect of
proper evacuations, from the premature use of stimulants, and
from bad ventilation, the case may fall into a state of exhaus-
tion. A man in perfect health could, by the same means, be
reduced in a short time to the same condition. From the com-
parative inattention of nearly all authors to this subject, it is
dwelt upon by Dr. Chapman, the more minutely.

Nothing perhaps in the exercise of our profession is more
difficult than to discriminate the period at which, in an acute
disease, stimulants may be advantageously used. Judging from
the pulse, tongue, skin, topical pain, &c., we perhaps make up
our mind to try them. But their effect must be most closely
watched. Being ill-timed, they produce pain in the head,
morbid vigilance, or delirious wandering, or stricture of the
chest, jactitation, hot, dry skin, parched tongue, thirst, disor-
dered stomach, a quick, small, corded pulse, and vitiated secre-
tions. Unless they act upon one of the secretions, they gene-
rally raise a febrile commotion. As a common rule, stimulants

CONTINUED FEVERS.

65

are not to be given, when there is reason to believe in the
existence of inflammation, especially of the stomach or brain.

Deciding on the use of slinuilants, the following may be
resorted to. —

Carbonate of Ammonia.— No other stimulant will an-
swer so well, or is so generally approved of. From the
action upon the skin and other secretory organs, it may be used
with less dread in equivocal conditions. It should be given in
small quantities, and be frequently repeated. Over-stimulation is
much to be guarded against. Admirably co-operative with this
medicine is wine whey. They are generally prescribed together.
The efi'ect, however, of the carbonate of ammonia wearing off,
as is speedily the case, with all the diffusible stimuli, recourse
may be had to

Camphor. — Dr. Chapman has always used it in connexion
with opium and ipecacuanha, and rather doubts its utility when
used alone.

Vapour Bath. — To be used if the skin is cold or dry, or
the temperature unequally diffused. The production of a halitus
from the skin is preferable to a sweat, — the good effect resulting
from the change in the condition of the capillaries. Should
the vapour bath stimulate too highly, and create jactitation,
we should substitute sponging with tepid vinegar, or spirits and
water, which often has the best effects.

Epispastics. — Cotemporaneously, or antecedently to the
course just mentioned, should be used the epispastics, which not
being called for by local affection, should be applied to the
extremities. Dr. Chapman, by retaining them only to the pro-
duction of rubescence, avoids strangury, sloughing ulcers, and
other detriments.

The Sulphate of (I ui nine.— An excellent remedy, and
particularly useful, when the disease is of a miasmatic source,
or shows a tendency to remission.

A neiD stage of the disease now calls for a upao class of means.

Opium. — Used in small doses, it is a general stimulant, but

its chief value consists in the relief of low delirium, nervous

tremors, subsultus tendinum, mental and corporeal distress

induced by morbid vigilance, anxiety, and restlessness ; and

5

66 DISEASES OF THE CIRCULATORY SYSTEM.

the relief of diarrhoea. In these cases it may be more freely or
largely applied. For the soothing of sensorial and nervous
agitation the acetate of morphia, or acetous tincture of opium,
or camphor, is very well qualified.

Musk, AssafcEtida, Castor, — Not so good as opiates,
but may be substituted for a change. The musk, when pure,
which it hardly ever is, is excellent.

Wine, — As a cordial and nutritive stimulant, the best. When
pure, Madeira and Sherry are to be preferred. Claret may be
also used. The quantity should be small at first, to be increased
according to the diminution of susceptibility.

Carbonic Acid, — To this practitioners w^ere led by the
notion of its tending to counteract the tendency to putridity.
But in the living state, putridity never takes place, nor is there
any tendency to it. The putrefaction of bodies covered with
petechias, &c., is the slowest. The carbonic acid, however, is
a cordial and agreeable stimulant to the stomach. It may be
taken in porter, ale, cider, or champagne wine.

The mineral acids are remedies of moderate value, and best
suited to the haemorrhagic condition.

At this period some practitioners trust to the mere use of
mercury. This, Dr. Chapman regards as absurd. He uses it
only with opium and ipecacuanha.

Oil of Turpentine. — Excellent as a stimulant and as a
corrective of the secretions of the alimentary canal. It is well
suited to haemorrhagic cases.

Dr. Stephens has published accounts of the wonderful success
of the saline treatment. This he connects with the theory of
fever being essentially a humoral disease, in which the salts of
the blood are deficient. But his accounts bear the stamp of
enthusiasm and exaggeration. The saline treatment, on a simi-
lar theory, was tried unsuccessfully in the Asiatic cholera.

These remedies, which we have mentioned, having failed, they
must be repeated in augmented doses. Phosphorus, a potent
stimulant, might here be used. But great care in this, as in
other cases, is requisite, lest, in the enfeebled state of the sto-
mach, the medicine act upon it chemically.

Blisters here do no good, and may eventuate in gangrene.

CONTINUED FEVERS. 67

But friction over the whole surface with the oil of turpentine
and olive oil, or other stimulant, are sometimes serviceable.
Such also is the application of warmth.

The patient being unable to swallow, administer medicines
by the oesophagus tube, by the rectum, or by a new surface.
Dr. Chapman thinks in the advanced stages that it would be
always better to administer our medicines by injection, the
rectum then presenting a more susceptible surface than the
stomach.

Sometimes a cure is effected, when the case seems desperate.

TREATMENT OF INCIDENTAL AFFECTIONS.

1. Determination to the head, with delirium, or stupor, or a ten-
dency to it. Arising from inflammation, the hair should be cut
off, and cold applications made to the scalp. These failing,
resort to topical bleeding, stimulants to the lower extremities,
and a blister to the nape of the neck. Arising from congestion,
these remedies are equally applicable, excepting the cold. But
in an advanced stage, from whichever condition the affection
may proceed. Dr. Chapman relies most upon opiates, camphor,
musk and assafoetida, &c. These are as well suited to nervous
tremors, &c., and even to convulsions.

2. Restlessness and icant of sleep. — In the early stage, when
these affections are usually associated with increased heat of
skin, cold to the surface is most tranquillizing. After the force
of action is reduced, opiates may be properly prescribed.

3. Excessive nausea, or vomiting. Proceeding from ingesta
or accumulations of bile, or more offensive matter, which may
be known from the character of the ejections, it will be neces-
sary to repeat the emetic, to administer tepid water, or to purge
with calomel, Epsom salts, or magnesia. Proceeding from mere
irritability, use may be made of effervescent draughts; lime-
water and milk, or milk alone, or other alkalies; small portions
of calomel with a little morphia; mint tea; strong coffee, with-
out cream or sugar; acetate of lead, in small quantities; prussic
acid; the spices; the clove bag, wrung out of hot brandy, to
the epigastrium, or sinapism or blister to the same region, with

68 DISEASES OF THE CIRCULATORY SYSTEM.

Stimulant pediluvia. Before trying any of these, we should be
sure there is no gastritis. In this case, topical bleeding should
be repeatedly employed, with cold or warm applications, and
finally a blister.

4. Diarrhoea. — Supervening in an advanced stage, to be
treated by astringents, opiates, and the cretaceous preparations.

5. HcBmorrhage. — Sulphate of quinine largely given, the mine-
ral acids, oil of turpentine, and perhaps phosphorus.

6. Diminished urination, at an early stage. Topical bleeding,
counter-irritation, and the mild diuretics. Retained urine must
be drawn olf by the catheter. Contraction of the bladder may
be sometimes induced by cold or hot applications to the pubes
and perineum.

7. Meteorism. — Carminatives useless. Castor oil and oil of
turpentine, with injections of the latter, or of assafoetida, promise
most.

8. Singultus, or hiccup. — Being occasioned by irritation of
the phrenic nerve, at an early stage, it is relieved by cupping,
and a blister to the back of the neck. Occasioned by irritating
sordes in the stomach, it is palliated or removed by alkalies, or
acids, or by ether, Hoffman's anodyne, or other antispasmodics.

DRINK S. — A moderate quantity of liquid may be allowed.
Acidulated drinks, or barley water, rennet whey, &c. In active
phlogosis of the stomach, iced water, or ice itself, may be amply
given. The thirst may also be quenched by enemata of cold
water. The tastes of the patient may be much consulted. The
mouth should be cleaned with lemon juice, or yeast, or charcoal
and water.

FOOD. — The drinks will be sufficiently nourishing, except
when tonics and stimulants are indicated, and then the diet may
be changed to co-operate with those measures. The morbid
and ill-boding appetite, sometimes manifested, should not be
indulged.

LIGHT AND COMPANY, and whatever accelerates the pulse,
should be particularly excluded.

CONTINUED FEVER& 69

VENTIIATIO N.— Highly important in typhus. Cleanliness
equally so. The linen to be daily renewed. Unpleasant effluvia
to be avoided by sprinkling vinegar or cologne-water, or by
muriatic or chlorine fumigations. Dr. Chapman doubts the
anti-contagious power of such articles as the two last, but thinks
them, at all events, generally inapplicable from the oppression
they cause the patient.

The disposition of the patient to get up, should be opposed.
In an old case, however, and where the febrile action is much
reduced, much benefit may accrue from silting up, and from
passive exercise.

CONVALESCENCE.

In some fevers there is a great disposition to relapse.

In the first place, then, the patient should be removed into a
new room where every association with his sickness will be re-
moved. He is to be shaved and freshly dressed. His diet should
consist at first of the farinaceous articles. Next may be allowed,
chicken-water, essence of beef, soft boiled eggs, oysters, boiled
chicken, &c. To eat often, and but little at a time, is a golden
rule in convalescence.

Pure water is generally the best drink, though should the con-
dition require it, malt liquor is better than wine or ardent spirits.

Very slowly should the patient return to the usages of life.
Especially should much intellectual or physical exertion be
avoided.

After complete apparent recovery, the pulse will sometimes
retain a singular celerity. This, for the most part, subsiding
spontaneously, may yet be the consequence of some cardiac
lesion, perhaps of effusion, and require rest, low diet, and small
doses of digitalis and colchicum.

The patient, however, remaining feeble and without appetite,
resort should be made to the tonics, — elixir vitriol, bark, the pure
bitters, &c.

Excessive vigilance is incident to convalescence from this fever.
It may arise from cerebral excitement, original or reflected from
some abdominal viscus, or from what is called nervousness. In

70 DISEASES OF THE CIRCULATORY SYSTEM.

the last case, it may be treated by the acetous tincture of opium,
morphia, lupulin, henbane, Hoffman's anodyne hquor, or the
spider's web. Arising from an empty stomach, it may be obvi-
ated by a little food taken an hour before retiring.

DiarrhoEa is to be treated by laudanum ; costiveness by rhu-
barb, which laxative is not incompatible with the opiates that
may be required by other affections.

YELLOW FEYEE.

This disease, although expressed by many different names,
has never yet received a judicious one. It has been called
typhus ictorodes, typhus cum floridine cutis, maladie de Slam,
by the French, and voniito prieto, or chapetonado, by the
Spaniards. The yellow fever is an endemic of tropical cli-
mates, though occasionally incident to more temperate regions.

SYMPTOMS.

INTRODUCTOR Y.— Generally, lassitude, stiffness of limbs,
and uneasiness in the back, loins, and calves of the legs. Soon
after, a sense of coolness, which is succeeded after many hours,
or more speedily, by a dry, hot skin ; dull, or acute pain of the
head, darting through the eyeballs; injected eyes, and a coun-
tenance expressive either of fierceness or incipient drunkenness.
Sometimes, however, the countenance betrays no change, or
even a preternatural serenity, or a look of great distress, with
lachrymation, or a malignant frown, and the face is either
leadened or bronzed, with a marble-like expression. The mind
usually preserves a singular integrity throughout the disease,
though there may be from the beginning indications of its aber-
ration or weakening. Epigastrium tender, possessing often a
burning sensation, with anxiety and oppression at the praecordia.
The bowels usually maintain an obstinate torpor; the tongue
is little changed, or white and fuzzy.

AFTER THE FIRST TWELVE HOURS.— An exacerbation
of the fever. Evidence of undue accumulations of blood in one
or more of the viscera. Deep sighing, nausea, retchings •f

72 DISEASES OF THE CIRCULATORY SYSTEM.

mucus, or glairy albuminous matter. Vomiting seems to take
place by an irregular convulsive movement of the diaphragm.
Wretchedness; the tongue milky, broad and fuzzy, or florid, or
of a fiery redness, or perfectly natural.

NOT ARRESTED, the case now rapidly becomes worse.
The eyes assume a dirty yellow colour ; circulation more irre-
gular, the carotids, in particular, pulsating strongly ; the surface
damp or sweaty, with a state of skin approaching to oedema,
and of a yellow hue, though this last occurs only in cases of
extraordinary malignity. Frequently, sore throat ; difficult de-
glutition, and, sometimes, paralysis of the extremities.

TOWARDS THE CLOSE OF THE THIRD JiiY.— JVotnvf re-
quenthj an apparent abatement of most of the had symptoms.
Soon afterwards, however, supervene almost unquenchable
thirst, and discharges usually of the dark, flaky, granular
matter, called black vomit. Contemporaneously occur a reduc-
lion of temperature, and decrease of vascular action and mus-
cular power, though the last may be fully retained to the end.
Feeble pulse, cold colliquative sweats, involuntary diarrhoea of
matter like the black vomit, haemorrhages of dark blood, low
delirium, with coma; laborious respiration, singultus, collapsed
countenance, muddy eye, tumid abdomen, occasionally sallow
or livid skin.

Sometimes, however, there is an anomalous absence of many
of the derangements which we have just described. The pa-
tient is unconscious of disease, and, without manifest delirium,
insists upon going out and resuming his avocations. But even
here, i/ie peculiar countenance, the deep sighing, and tender epi-
gastrium, distinguish the disease. This serene state will in two
or three days terminate by a sort of swooning away, or will
become more developed by the supervention of black vomit and
other characteristics. In other cases, death takes place without
the slightest premonition, and with the suddenness of a blow.

Sometimes is the disease shown only by pain in the toe, or
some other anomalous part. Priapism has been also remarked
as the only manifest affection. Also, in the female is apt to

YELLOW FEVER. 73

occur pruriency of the pudenda. The epidemic seems to select
for the force of its attack, tiie part most predisposed. Displayed
generally in the epigastric region most forcibly, it may fall on
any of the lower viscera, or the lungs, or the cerebral, mus-
cular, or nervous system, the affection of which may be so
preponderant as to obscure the real disease.

CAUSES.

Dr. Chapman believes that the disease is of domestic origin.
He thinks, however, that it may be generated from the materials
which are contained in the holds of ships, and that it is never
carried by fomites. But the distempered atmosphere of a
port at which the fever is raging, may be confined in the hold
of a vessel which is hermetically sealed, until the hatches are
opened in another port. During this time the crew will not of
course be subject to the disease, though they may acquire it at
the opening of the hatches. Likewise when the miasm is
generated from a putrefying cargo, the crew may be exempt
until the hold is opened.

It is equally certain, however, that the same kind of miasm
may be evolved by the putrefaction of domestic filth in certain
positions, as was evinced by the fever in this city in 1805, and
in Baltimore and New York. Whether exhalations from filth,
local or imported, will be productive of this fever under all cir-
cumstances, remains to be determined. Reasons there are,
however, to suspect that the tendency to spread is enhanced by
high temperature steadily preserved. We may suppose, also,
that the generation of the miasm is dependent on a certain
constitution of atmosphere.

The fact that the miasm of yellow fever is never generated
beyond the watery margin of the city, was originally asserted
by Dr. Chapman ; and though the contrary has been affirmed, the
proofs alleged have not been conclusive. Could mere masses
of putrefaction produce the miasm, it would exist throughout
the country, where these are most abundant. The filth of our
cities proves inoperative to this effect, except in this particular
situation. The fever has invariably appeared along the wharves,

74 DISEASES OF THE CIRCULATORY SYSTEM.

and rarely extended itself far into the city, or beyond the influ-
ence of this position. In this city it was the opinion of the most
experienced of our practitioners, that Third Street, which was
little above a third of the city, constituted the limit of atmospheric
distemperature. The same thing has been reported of the yellow
fever, as it appears in South America and in the West Indies.
The only exception is in Spain, where it is represented occasion-
ally to have prevailed in some of the interior cities. But whether
such really be the fact, or the disease be the ordinary typhus of
Europe, our information at present is too indefinite to enable us
to determine positively. As to our own country, similar state-
ments have been made. They are, however, illy authenticated.
The fever is said to have occurred repeatedly at Natchez ; but
this fever has a much closer affinity to our ordinary bilious,
than to the yellow fever. Yet, in consistency with Dr. Chap-
man's principle, which claims the influence of water to be an
element necessary in the production of the yellow fever, it is
possible to suppose that the fever is occasionally generated along
our great lakes and rivers. That the fever should be generated
only in this watery position, may be attributed to the moistness
of the filth, though this is only conjectural. The materials from
which the exhalation proceeds, are in some cases doubtless
very small ; yet reflecting on the wide-spread diff'usion of the
odour thrown out by musk, it may be readily conceived that
the effluvium, arising from a source hardly visible, might still
be highly operative.

Fevers do arise in situations where none of the materials of
miasmata exist. The yellow fever here, as in other places,
avoiding, as it were, foul and dirty wharves, has broken out on
the neatest. But this may be perhaps explained on the suppo-
sition that where the surface is dry and clean, there are accu-
mulations below, from which, through the crevices, the poisonous
miasm escapes. It may be moreover affirmed, that the fever
has generally appeared and raged to the greatest extent on
wharves recently made, and filled up with the filth of the streets
and argillaceous soil of cellars.

Yet, contrary to all this, has it been affirmed that yellow fever
is of contagious origin. By contagion, it is presumed, is here

YELLOW FEVER. 75

meant what the word legitimately signifies, — a virus generated
in one individual, through vitiated vascular action, capable of
communicating the disease to a second, and so of muliiplying it
indefinitely. Opposed, however, to the doctrine of contagion,
are the following considerations : —

1. The fever is soinetimes an epidemic, in its nature, laws,
and eflects.

2. The disease has in no well-attested instance spread, when
removed from the infected districts. In our hospitals, was this
fact most conclusively exhibited. Here, the nurses, physicians,
and other attendants, though exposed as much as possible to
any contagion which might have existed, were exempt from
the disease. As an experimenUim crucis, the black vomit, the
saliva, and the serum of the blood, have been harmlessly
inoculated into the system. The vapour, also, from the black
vomit has been breathed, and two ounces of it have been swal-
lowed, with impunity.

3. The disease has been invariably suppressed on the acces-
sion of cold weather, differing in this respect from contagious
diseases. These, from the free ventilation, or from the volatility
and difl^usion of the virus, are less prevalent in warm weather.

4. In contagion, the sphere of communication is very narrow.
But in numberless instances has yellow fever been taken by in-
dividuals, who had held not the slightest intercourse or proximity
with the sick, but who had merely passed through the street in
which the contagion was alleged to reside.

5. Even the line of demarcation may be drawn with tolerable
precision, indicating the limits of danger, excepting when the
poisoned air may be wafted over it by the force of winds. Dr.
Chapman has always found the spread of the fever to be in the
direction of the wind.

G. Unlike contagious diseases, which originating in a single
point, thence radiate, yellow fever simultaneously appears in
remotely separated positions.

7. In favour of the non-contagious character of the disease,
an appeal might confidently be made to probably nine-tenths of
the profession who have had opportunities of becoming con-
versant with it. This argument has some force, from the fact

76 DISEASES OF THE CIRCULATORY SYSTEM.

that the question is one so much dependent for its solution upon
the mere observation of simple phenomena.

But it has been alleged, that while the fever is not generally-
contagious, it does under certain circumstances prove so, —
as in crowded, ill-ventilated places. But this assertion, how-
ever plausible, is wanting in proof. The cases alleged in
support, are only five or six in number, which occurred in the
country, where the yellow fever seldom or never exists, and in
the practice of men who, from want of acquaintance with
yellow fever, would be unable to distinguish it from malignant
cases of ordinary autumnal fever. It is indeed to be recollected,
that according to the erroneous doctrine of the time, the only
difference in the two diseases, regarded their degree of violence.

In the immunity which is rendered by one attack of yellow
fever, this disease has been said to resemble contagious diseases.
But it is untrue, that in contagious diseases subsequent protection
is so generally afforded by one attack. No agreement exists
among the advocates of the hypothesis, as to the mode in which
this disease, acknowledged in its general character to be other-
wise, becomes contagious; or, in other words, how a vitiated
atmosphere operates in the case. Chisholm says, that it merely
increases susceptibility to the impression of the virus already
received into the system, and at the same time enhances the
action, giving the fever a more aggravated and malignant
shape.

Professor Hosack maintained some " chemical combination
with the virus already secreted from the diseased body, and
that thereby the contagion becomes more or less multiplied
according to the extent and virulence of such vitiated atmo-
sphere." Disclaiming, as he does, the notion of a tertium quid
being formed in the operation, such would nevertheless evidently
result. —

Professor Rush supposed the contagion to originate in an exha-
lation from the excretions of the patient : but were such the case,
the disease thus produced would be as diversified in its nature
as the effluvia from these various sources. Contaminated air,
however. Dr. Chapman does believe to influence yellow fever,
by the induction of a typhoid state. The typhoid impression

YELLOW FEVER. 77

may even be so strong as to supplant the primary nature of the
disease, but then the contagion would be of typhus, and not of
yellow fever.

By the researches of Webster, it has been demonstrated that
all climates are liable to the 'periodical visitation of epidemics, and
that they alternate as regards their general character, two of the
same nature never occurring in immediate succession. In our
own country the yellow fever was repeatedly alternated with
the spotted fever, a species of typhus.

It is to be lamented, however, that in all countries in which
legislation has attempted to put barriers to the progress of yellow
fever, the most harassing laws are founded upon the almost
exploded doctrine of contagion.

EXCITING CAUSES. — The ordinary exciting causes of
febrile affections. Sleep seems to have some tendency to its
production. In this state, the greatest proportion of attacks
takes place.

Period of Incubation. — The average period is from two to
three days in the commencement of the epidemic, becoming
greater towards its close, as the poison is, probably, more
diluted.

DIAGNOSIS.

Distinct from its exclusive prevalence in cities, and along the
wharves, there are peculiarities in itself, so striking, and par-
ticularly the countenance of the sick, that it has scarcely ever
been mistaken. It bears the closest resemblance, perhaps, to
aggravated autumnal fevers. They differ in the following re-
spects : —

1. Yellow fever originates in a miasm, which is generated
only in particular positions, and at certain times; while, to a
greater or less extent, common bilious fever is incident to many
climates and all seasons.

2. The diseases differ in type and in symptoms. The diffe-
rence is manifested in the pulse, tongue, respiration, discharges
from the stomach, condition of the secreting power of the liver.

78 DISEASES OF THE CIRCULATORY SYSTEM.

in the muscular and nervous systems, in the countenance, and
especially in the expression of the eye.

3. The yellow fever has its seat and throne in the stomach,
while the bilious, though of gastric origin, chiefly involves the
liver.

4. The convalescence from yellow fever, is rapid and com-
plete ; from bilious fever, slow and precarious. In yellow fever
the susceptibility to the disease is destroyed or diminished by an
attack ; in bilious fever it is increased.

5. The treatment adapted to bilious fever, totally fails in yel-
low fever.

6. The mildest case of yellow fever is as easily designated as
the most violent and malignant.

PROGNOSIS.

Like other malignant epidemics, the fatality is greatest at its
first appearance, and afterwards gradually declines.

Cases marked by forcible reaction and high fever, are most
favourable ; and the reverse are those connected with confirmed
relapse, extreme epigastric, or praecordial uneasiness, jactitation,
delirium, or coma, or vomitings of tenacious albuminous matter.
Still more desperate are the cases, which, with the peculiar
physiognomy, little or no affection is evinced. Especially
ominous is an eager desire for food, and, above all, solid animal
food, with the morbid venereal feelings, to which allusion has
been made. Of the worst import is that exquisite nervous sen-
sibility productive of tetanus or hydropliobia, or where the whole
suffering, to an excruciating degree, is concentrated in a part
(the pudenda, or testicles, more commonly), or the tongue in
an advanced stage, suddenly clearing, or the pulse, previously
bad, becoming, with a deterioration in other respects, conspi-
cuously better, or the occurrence of the black vomit. Cases thus
characterized do not recover.

The disease mostly terminating on the third or fifth day, may
do so in a few hours.

However severe the case, convalescence is almost incon-
ceivably rapid and complete.

YELLOW FEVER. 79

AUTOPSIC APPEARANCES.

The most prominent lesions are in the epigastric region. On
opening the stomach we discover, sometimes a dark fluid, here-
after to be described, and the food, drinks, and medicines taken,
in some instances, several days before, w^holly unaltered by the
digestive process. The mucous membrane presents the evi-
dences of phlogosis. These are also manifested by the duo-
denum. Nearly always, in Philadelphia, has the liver been
healthy, though the reverse has occurred elsewhere. Impli-
cated also, occasionally, are the spleen, kidneys, urinary
bladder, heart, and lungs. The brain is but little aflected, even
when cerebral disorder is strongly marked.

During the last years of its prevalence, instead of the in-
flammatory, the fever presented the congestive character.

In the year 1820, when the Philadelphia Yellow Fever Hospital
was under the charge of Drs. Chapman and Hewson, two im-
portant facts were there established. The hlack vomit was
determined to be only blood more or less altered : in proof of
which, it might be visibly pressed out of the vessels. It was
observed also, that whenever this fluid had been discharged in
great quantities, the mucous coat presented a pallid hue. The
general appearance of the fluid is that of coffee-grounds, or the
sediment of port wine, though it is sometimes sero-sanguineous,
and sometimes exactly like the menstrual fluid. The black
vomit, when fresh, was found to be replete with animalculae.
The blood was exhibited from the concrete mass, to absolute
fluidity. Dr. Chapman never saw it fully separated into its
constituents, crassamentum and serum.

Cases have been reported as being destitute of all lesion.

The black vomit is not pathognomonic of yellow fever.

PATHOLOGY.

The nature of this fever is still almost as much disputed as
other points in its history. Like other epidemics, influenced
by various agencies, it is sometimes inflammatory, and some-

80 DISKASES OF THE CIRCULATORY SYSTEM.

times congestive. Sometimes the two conditions are blended.
The disease originates in a peculiar irritation, or congestion,
or inflammation of the stomach ; which is proved as well by
the symptoms, as by dissection. This state involves the nervous
connexions of that organ.

Between yellow fever and the condition induced by certain
poisons, both in commencement and progress, has often been
observed the most striking parallel. This parallelism is most
remarkable, and may be traced by any one acquainted with the
action of poisons. Dr. Chapman, then, considers the disease
to consist in the action of an extremely virulent poison upon
the stomach, producing excessive disorder of that viscus, and
involving other parts sympathetically.

TREATMENT.

Dr. Chapman enters upon this subject with the confession
that he is aware of no kind of practice deserving of much con-
fidence. Mistaken in the year 1793 for a species of typhus, it
was treated, after moderate evacuations, by wine and bark-
Mistaken afterwards for a form of the ordinary autumnal
fever, it was treated by copious venesection, and subsequently
by brisk purgations, and sometimes by emetics.

While the last course was pursued, some French practitioners
from St. Domingo, instituted a new practice. Their remedies
were adapted to calm the irritation of the stomach. Having
checked vomiting by the ordinary means, their next object was
by diluent beverages to wash out the offending cause.

Of these kinds of practice, the last, if not the best, was at
least the most harmless.

Encouraged by reports from the West Indies, an essay was
early made of the mercurial plan. But on the whole, it appeared
that in violent cases the mercurial impression could not be pro-
duced, and that in milder forms it was unnecessary. Nor is a
salivation uniformly successful. The practice has lost ground
in the West Indies.

A more correct pathology having been developed by post
mortem dissection, remedies were employed suited to the reduc-

YELLOW FEVKR. 81

tion of a gastritis. These remedies consisted in the lancet,
leeches, fomentations and blisters, to the epigastrium, with
active purging by calomel, alone, or variously combined. Vas-
cular action being high, cold was applied to the surface, and
subsequently sweating was induced by the lenient diaphoretics
and the vapour bath. Vomiting was restrained by ten or
twelve drops of turpentine frequently repeated. In a sinking
condition, the system was upheld by the proper stimulants.
This practice was in the end very generally adopted.

In New York was adopted the practice of the French
physicians, combined with the more liberal employment of the
diaphoretic measures.

With these plans of treatment the mortality was dreadful.
In Philadelphia more than half the cases ended fatally ; seven-
tenths died at Cadiz; and four-fifths at Gibraltar.

Convinced of the inefficacy of all the existing modes of treat-
ment, Drs. Chapman and Hewson, during the last epidemic in
this city, instituted a new practice, founded upon the analogy
between this disease and poisoning from acrid substances.

Emetics. — These were limited to the earliest stage, when
the stomach was yet uninflamed. Their object was to remove
the offending cause, or to break up the primary morbid impres-
sion on the stomach.

lenient Purging, with calomel, or castor oil, &cc.

Next followed an exhibition of the

Oil of Turpentine, in doses commonly of a drachm, every
hour or two. This was taken alone, or combined with the car-
bonate of ammonia, or some essential oil, which latter rendered
it more retainable by the stomach. Further evacuations from
the bowels being demanded, a drachm of turpentine was com-
bined with an ounce of castor oil.

Unless it be applied very early, the turpentine, in common
with all other remedies, will be for the most part unavailing.
The vitality of the stomach, after ten or twelve hours, is nearly
destroyed, and remedies then applied to it are inert. Applica-
tions to the skin will be found equally ineffectual.

Although many patients were brought into the hospital lutein
the disease, yet out of sixteen thus managed, twelve recovered.
6

82 DISEASES OF THE CIRCULATORY SYSTEM.

The principle on which the turpentine was enaployed in the
early stage of the disease may be vindicated. —

Of the counter-agency of turpentine in scalds and burns, we
are aware. The stomach in yellow fever is in a state probably
similar. We know also that in many instances the turpentine
is soothing in its effects on the stomach, removing the sense of
heat and irritation in that viscus, and subduing the force of vas-
cular action and general excitement. The turpentine, much
about the same time, was prescribed in the plague of Malta,
and it is strenuously recommended as the best corrective of the
gastritis from acrid poisons. Dr. Chapman has for a number
of years used turpentine in peritonitis, already partly subdued
by depletion. In dysentery, at that point when gangrene is
menaced, turpentine is more useful than any thing else. It is
excellent also in cholera infantum, in a somewhat earlier stage ;
and in chronic diarrhcea, in which the mucous coat of the in-
testines is chiefly affected, it is an incomparable remedy.

But suppose, what is perhaps most frequent, that a state of
feeble congestion should prevail. All are agreed to the superior
efficacy of the medicine in other low fevers so circumstanced,
and not less so in hasmatemesis of like character.

With similar views, and somewhat successfully, was pre-
scribed the acetate of lead.

Yet, in conclusion, it must be acknowledged, that the turpen-
tine will not always answer, and sometimes aggravates the
disease.

The fever was treated by Dr. Stephens by certain neutral
salts, to replenish the blood with its saline ingredients. Dr.
Chapman's unfavourable remarks on this treatment are con-
tained in his lectures on typhus.

Again, in the extreme southern portion of our country, has
the disease been met in its inchoative stage, by immense doses
of quinine. This plan Dr. Chapman has never seen tried ; yet
he cannot help regarding it as a pernicious extravagancy.

Dr. Chapman professes to have no great confidence in any
scheme of treatment hitherto proposed.

PREVENTIVE RE GUL ATIONS.— The quarantine laws

YELLOW FEVER. 93

should be restricted exclusively to foul vessels. The cargoes
of all suspicious vessels should be discharged at a distance
from the city, nor should an entrance be allowed, until all such
vessels be thoroughly purified.

In the construction of wharves, Dr. Chapman proposes to
substitute stone for wood, and to fill up the interior with stone,
instead of earth or the rubbish of the city.

Should the locality, from which the miasm proceeds, be
densely built, a freer ventilation should be afforded by the open-
ing of new streets.

The ordinary filih of the city should be removed ; for though
it cannot originate, it may aggravate the disease.

When the disease breaks out, the infected spot and its imme-
diate vicinity should be evacuated, and all intercourse with
them carefully avoided. It is, however, better to avoid dis-
turbing the sick.

The stomach should be supplied frequently with food, which
acts either by shielding the susceptible surface of that organ,
or by calling into action the digestive process, by which the
poison is destroyed or neutralized. The diet, clothing, state of
mind, &c., should be properly regulated.

Thinking it probable that the miasm ascends to no great
height, Dr. Chapman advises persons who are obliged to remain
in the infected district, to retire at sunset to the upper part of
the house.

The efficacy of fumigations of chlorine, or of sprinkling the
distempered district with the carbonate of lime, is to be decided
by future experience.

PNEUMONIA TYPHODES.

Synonymes, spotted fever, cold plague, &c.

First attracting notice in New Hannpshire and Massachusetts,
in 1806, it afterwards swept gradually through the whole
United States, It appeared for the first time in Philadelphia in
1813, but reappeared the next winter in more fearful strength.

SYMPTOMS.

The disease was Protean ; but generally the patient was sud-
denly and unexpectedly attacked with great prostration. An
alternation of chills and heats; skin becoming dry, pale, and
mottled, face bronzed, physiognomy exceedingly anxious ; de-
lirium, followed by stupor. In some instances so rapid was
the onset, that persons were cloven down as by a stroke of
lightning. On other occasions, the disorder was ushered in by
all the circumstances of pneumonic inflammation, or congestion.
In the south, there was uniformly some gastric distress.

So far, in many cases, the affection may have been mistaken
for bilious pleurisy ; but the extreme atony, together with
pneumonic disease and mental disorder which certainly suc-
ceeded, dissipated all doubt. The tongue became a dark brown,
like that of the black iovgue fever of the west.

In Virginia, the throat was generally the most prominent
point of invasion.

CAUSES.

Its origin is involved in doubt. From its prevalence in the
winter, and disappearance on the approach of warm weather,

PNEUMONIA TYPHODES. 35

it would seem to be in some way dependent on cold. To this
supposition, also, the similarity of fevers which are certainly
thus produced, lends support.

But from the universality of its prevalence, as well as its obe-
dience to the laws of epidemics, we must refer it to a distem-
perature of the atmosphere — vague as this explanation is. Like
other epidemics, it gave a complexion to all other diseases. So
much was this the case, that throughout the country the lancet
was generally abandoned — a revolution in practice, from whose
effects we have not yet wholly recovered.

The exciting causes are not peculiar.

The disease has occurred at various times, both in this
country and Europe; and in a mitigated form, it occurs among
the poor every winter.

PROGNOSIS.

When the countenance would assume a placid, inanimate ex-
pression, with the skin polished, and of a leaden or bronzed
complexion, hope was diminished. But the most alarming cases
were those in which the patient seemed to be little affected by
his disease, could not be persuaded of his danger, and would
persist in being up. These much resembled the ivalking cases,
in yellow fever. But on the whole, the epidemic was more
manageable than the last-named disease.

Its duration varied from a few hours to several days. It
commonly terminated, however, on the third or fifth day. Con-
valescence was rapid and complete.

AUTOPSY.

Engorgement, usually of the brain, lungs, heart, and spleen.
The throat tumefied and purplish, spotted with fragments of
lymph, or covered with a pellicular coating of it. Livid
patches, limited to the upper portion of the alimentary canal,
or extending to the bowels. The blood was like that in other
maliofnant fevers.

86 DISEASES OF THE CIRCULATORY SYSTEM.

PATHOLOGY.

A state of congestion, produced in a way already fully de-
tailed under other heads.

TREATMENT.

As soon as the alimentary canal had been evacuated, it was
found best, in this city, to make an active employment of

Diaphoretics. In urgent cases, they anticipated purgatives.
The best were those into which

Opium entered, particularly when there was pain. Dr.
Chapman preferred the

Dover's Powder; with which were combined the free use
of strong

Wine Whey, the Tapoar Bath, and Hot Fomenta-
tions, to the lower extremities, the trunk, and armpits.

As the disease advanced, with diaphoretics were united the

Cordial Stimulants, of which the best was the carbonate
of ammonia. Here, too, the

Oil of Turpentine may be of use. The vital powers still
sinking.

Stimulating Frictions became necessary.

There being, however, determinations to the throat, chest, or
liver,

Emetics of salt and mustard were preliminary measures.
Then a mercurial purgative was directed. Local congestions
were afterwards managed by

local Bleeding and Blisters.

Venesection would not answer in this city.

DISEASES OP THE HEART AND
BLOOD-VESSELS.

These, until the commencement of the present century, re-
ceived but little inrestigation. .

Dr. Chapman arranges them as follows :
IJiFLAMMATORY.

Acute and Chronic.
ORGANIC.
NERVOUS.

Real and Sympathetic.
The diagnosis of inflammation of the heart or its tissues, from
that of the lungs, is confessedly difficult.

In the former, however, we have the pain more severe, and
seated in the region of the heart; greater deviations in the cir-
culation, and the respiration and the sputa are less affected.

Disorganization of the heart may be suspected from the fol-
lowing

SYMPTOMS.

Bloated face ; tumid lips ; the complexion and lips purplish,
though sometimes florid, or of a waxy pallor, with edematous
swellings, particularly about the eyelids; countenance thin and
sharp, eyes prominent and staring, and the face haggard ; respi-
ration short and difficult, with the difficulty greatly increased
on exertion or mental emotion; in bad cases, an inability to
maintain the recumbent posture, and sleep disturbed by fright-
ful dreams ; frequently dyspepsia, and, as a consequence, per-
haps, of the gastric irritation, petulance and melancholy.

88 DISEASES OF THE CIRCULATORY SYSTEM.

But more is to be learned from the circulation. Heart's action
commonly, though not always, irregular, as is betrayed by pal-
pitations and great variations in the force of the pulse. Engorge-
ment of the superficial veins, a tumultuous circulation, or a pul-
sation in the larger veins, especially the jugular. Hence occur
venous congestions, hsemorrhages, and dropsies.

PRIMARY IRRITATION of the heart may be either spas-
modic or neuralgic. The former is denoted by the peculiar
nature of its pain, sudden remission, and the extraordinary irre-
gularity of the heart's action. The neuralgic affection is denoted
by a pain singularly sharp and darting, with less disturbance of
the heart and pulse.

SYMPATHETIC IRRITATIO N.— Great disorder of circu-
lation, and almost invariably dyspepsia.

As CONSEfiUENT upon cardiac disease, are the various
forms of cerebral disorder — particularly apoplexy— besides, in-
flammation or congestion of the pleuras, lungs, liver, kidneys,
uterus; thickening, or other changes in the alimentary canal,
and haemorrhoids.

CAUSES.

As is predicable from the peculiar exposure of the heart to
corporeal and moral influences, diseases of this organ are quite
numerous.

Hereditary disposition, connected or not connected with
malconformation. There is a greater inclination in the male
than in the female. Cold, damp, austere iveailier, seems to
act as the most prolific cause. Rheumatism and gout, mis'
placed, or metastatic. Excessive labour in doors, and in dis-
torted positions of body. The consumption of ardent spirits.
A stimulating, or, what Dr. Chapman believes was first indi-
cated by himself, a penurious diet. Inordinate venerial indul-
gence, or masturbation. Recession of cutaneous eruptions — of

DISEASES OF THE HEART AND BLOOD-VESSELS. QQ

the exanthematous, and still more, of the chronic. The strumous
diathesis, and the syphilitic taint, are alleged causes.

Affections of other organs, such as various pulmonary dis-
eases, chronic irritations of the prima: vias, enlargement of any
of the abdominal viscera, pregnancy.

Moral Emotions. — Cardiac diseases wonderfully increase dur-
ing times of public terror. So violent is the action of the heart
when sympathetic of the emotions, that it sometimes literally
hursts.

Besides this, the heart may be affected by whatever acts
noxiously on the system. Hence it is, that the pulse is so often
appealed to, as affording the must faithful criterion of morbid
conditions.

DIAGNOSIS.

Very obscure.

Bi/ Physical Signs. From percussion little aid will be de-
rived. This deficiency is in part obviated by auscultation;
though Dr. Chapman concurs with Andral, when he says that
auscultation may indicate lesions of the heart, where none ex-
ists; and, conversely, furnish no signs of such, when actually
prevailing to a considerable extent. And again, after stating
that it often gives very useful and necessary information, An-
dral adds, — though alone, and without the aid of other signs, it
cannot, except in some rare instances, show certainly the exis-
tence of these affections.

To acquire the arts of percussion and auscultation, requires
an ear and training, which few practitioners can command.
There are many false pretenders to proficiency.

Instruction in this branch is resigned by Dr. Chapman to the
anatomist and the clinical teacher.

PROGNOSIS.

From the importance of the heart, and the inferior opportu-
nity afforded for recovery by its ceaseless motion, cardiac
diseases are invested with extraordinarv danger. Yet some

90 DISEASES OF THE CIRCULATORY SYSTEM,

cases may be cured, and others so palliated, that life may be
prolonged with considerable comfort.

AUTOPSIC APPEARANCES.

The appearances of the heart are detailed in the consideration
of its specific diseases. But whatever the affection may be,
provided it has been long continued and severe, a sensible in-
crease takes place in the size, and w^eight, and of the viscera of
the three great cavities.

PATHOLOGY.

Dr. Chapman reserves what concerns the pathology of the
special lesions.

Though organic changes are chiejiy referable to inflammatory
action, yet some of them occur independently of it, or, at least,
without its ordinary manifestations.

Of organic affections there are three varieties : hypertrophy,
caused by an excessive supply of blood ; atrophy, caused by an
inadequate supply ; and alterations of structure, or new forma-
tions, caused by a vitiation of the nutritive functions.

TREATMENT

Should be most prompt. Of the first importance is it, to dis-
tinguish the inflammatory from the purely nervous. The reme-
dies in the former, are depletory and evacuant, and subsequently,
sedative; in the latter, or nervous, they are, in most respects,
the reverse.

CARDITIS, PERICARDITIS, AND
ENDOCARDITIS.

Inflammation of the muscular substance of the heart itself,
has been said to be extremely rare. This Dr. Chapman doubts;
and he refers the absence of inflammatory appearances in post
moi'iem examinations, to the well-known indisposition of the
muscular tissue to disclose the usual demonstration of phlogosis.
Still, it is much less common than pericarditis. But believing
that the heart and its membranes may be simultaneously in-
flamed, and that when any one is exclusively so, we have no
means of ascertaining the fact with certainty; and above all,
that could it be done, the treatment would be the same. Dr.
Chapman prefers embracing the three phlegmasiae under one
head.

SYMPTOMS.

Vary much, according to the violence of the attack.

I N C I P I E N T.— Commonly like those of pleuritis, or pneu-
monitis.

MORE ADVANCE D. — An acute lancinating pain, sense of
heat and constriction in the pra3Cordial region, extending to the
scapula or shoulder, and arm, down to the elbow, increased by
pressure between the ribs, and by a deep inspiration. Some-
times, however, pain is absent; or it is trivial, or dull, and
fixed ; and may be felt, in all its states, most in the epigastrium,
or left hypochondrium.

Inability to change the position, particularly to the left side,
or to straighten, or lie on it; restlessness, anxiety, anguish;

92 DISEASES OF THE CIRCULATORY SYSTEM.

face pale, or occasionally flushed in the left cheek, or tumid,
and sometimes leaden, at times bedewed with perspiration; a
disposition to syncope.

Very characteristic is the inability to assume the recumbent
posture, relief being afforded by the trunk being ben-t, and the
arms resting on some support in front. Heart usually bound-
ing and forcible; pulse strong, full, and tense; though the former
may be feeble and irregular, and the latter small, corded, inter-
mittent, and jerking, or thrilling. The pulses of the two arms
may vary. Urine high-coloured and scanty; bowels consti-
pated, or healthy.

Headache, distraction of the senses, jactitation, delirium, dis-
tortion of countenance, which may assume the expression of
terror or despair.

Complications, with inflammation of the lungs, or their con-
nexions, or with other affections.

Cases resulting from sudden metastasis of articular gout, or
rheumatism, are marked by sharp, spasmodic pain, and labo-
rious action of the heart, with great irregularity of circulation,
and pulsation in the veins of the neck.

CAUSES.

Already detailed in the general discussion of cardiac diseases.
In this city, this disease prevails most in winter, and among
those under the age of puberty.

DIAGNOSIS.

This, Corvisant thinks difficult, from the frequent complica-
tion of other phlegmasia of the chest. But in its simple form,
Dr. Chapman has easily recognised the disease. The peculiar
countenance is very distinctive.

Endocarditis and phlogosis of the lining membrane of the
pericardium are marked, like inflammation in other serous tis-
sues, with acute, lancinating pain ; but occurring in the fibrous
portion of the pericardium, or the heart itself, the pain is more
like spasm, or it is rheumatic, or neuralgic.

ACUTE CARDITIS. 93

But endocarditis is said to be attended with little pain — with
only a feeling of prascordial oppression. At the same time that
the heart's action is tumultuously violent, the pulse is feeble and
intermittent ; and thence rapidly follow extreme debility, great
dyspnoea, tendency to syncope, &c. Dr. Chapman, however,
believes the simple and early character of the disease to be
highly phlogistic, and the state just described to result from the
mechanical obstruction of the valves, which may, from various
causes supervene; or sometimes, perhaps, from the mixture of
secreted pus with the blood.

By Physical Signs. 1. PERICARDITI S.— When the effusion
has become considerable, dulness of percussion. The contrac-
tions of the ventricles, give a stronger impulse, and a sound
more marked than in a natural state. At intervals of various
duration, more feeble and shorter pulsations, corresponding to
intermissions of the pulse. Exceedingly characteristic of peri-
carditis, is commonly held to be the b?'uit de frottement — a sort
of rubbing, or rustling up and down, compared to the friction
of silk or parchment. This, at first heard faintly, near the
centre of the sternum, gradually becomes more wide-spread
and louder, and is then imitative of the creaking of the sole of
a new shoe. From the last circumstance it is called the cri de
cuir, or leather creak. It is produced by the opposing surfaces
of extravasated lymph. But the value of this sign is much
diminished by its frequent absence, its being inaudible, or by its
being confounded with what closely resembles it, the sound
emitted in valvular disease. The indications of serous effusions,
are deferred by Dr. Chapman to the consideration of dropsy of
the pericardium.

2. ENDOCARDITIS.— Dulness of sound on percussion over
the precordial region, or still greater space. Uniformly pre-
sent is the bellows sound.

What applies to valvular degenerations, is postponed.

94 DISEASES OF THE CIRCULATORY SYSTEM.

PROGNOSIS.

All cardiac inflammations are alarming ; of which, however,
endocarditis is more so than pericarditis. Life may terminate
very suddenly and unexpectedly.

Commonly, such diseases, after running a course of several
days, provided the brain and lungs escape, submit to our reme-
dies entirely, or degenerate into some of those chronic states,
hereafter to be noticed.

AUTOPSIC APPEARANCES.

The pericardium exhibits redness — arborescent, punctated,
in patches, or diffused. A concrete exudation on its surface,
like that in pleurisy, though thicker, more consistent, and rougher.
Effusions of serum in the sac, amounting often to a pint. Some-
times, though rarely, effusions of pus.

In endocarditis, the lining membrane exhibits various colours,
from a light rose tint to a bright red, or a purple or brownish
hue, local or diffused. The inflammation is highest about the
valves; and the tumidity there is such as must have interrupted
the circulation. Discoloration alone is not decisive of inflam-
mation ; there must be coincident vascularity, or tumefaction,
or change of structure, or effusions of lymph, or pus. Co-
agula of blood are sometimes met with, which, when organized,
are called polypi.

The heart itself is generally somewhat tumid, vascular, and
changed in colour. Its surface is often coated with lymph, or
spread with a collection of purulent matter. The interior of the
heart is seldom much affected.

Pulmonary lesions are, according to Louis, discoverable in
two-thirds of the cases.

TREATMENT

Is simple, but should be highly prompt. *

Venesection,— Except in the aged, the inebriate, or other-

ACUTE CARDITIS. 95

wise infirm, or in the advanced stage, this measure should be
freely employed, until evidence of relief is afforded. It is a
remedy of primary importance.

Topical Bleedin g. — To be repeated until the force of the
attack is overcome, when we may resort to

A Blister.

A Purgative in the beginning, and subsequently,

laxatives.

Tartar Emetic, and Nitre.— Dr. Chapman is opposed to
the use of immense doses of these articles.

D i g i t a 1 i s. — On the whole, more to be depended on, than the
articles just mentioned.

C a 1 0 m e 1. — Used by Dr. Chapman in combination with opium
and ipecacuanha. It is detrimental in leucophlegmatic or
depraved constitutions, but is well adapted to the sanguineous
or inflammatory, in which we suspect a disposition to the secre-
tion of fibrine.

Dover's Powder. — Useful in quieting spasmodic action of
the heart. Dr. Chapman believes that diaphoresis has been too
much neglected in carditis. He has found the Dover's powder
particularly useful in arthritic and rheumatic cases.

Colcllicum seems, in the states just alluded to, to exercise
a sort of specific influence.

Stimulating Revulsives to the extremities, in order to
invite a return of the rheumatic affection.

CHEONIC CARDITIS, PEHICARDITIS,
AND ENDOCARDITIS.

SYMPTOMS.

Cases sometimes progress to a considerable extent, without
attracting any notice. Generally, however, there is some febrile
movement, from the first, or at least a hectic pulse. A jarring
sensation given to the hand, when placed over the heart ; though
there is seldom palpitation.

Little or no pain in the prsecordial region, and when it does
occur, it is obtuse and fugitive. But a sharp and permanent
pain is sometimes felt in the epigastrium, hypogastrium, or
between the shoulders. The stomach is sometimes irritable, and
the head aching and giddy.

Continuing for months or years, the case grows worse, and
henceforward displays no material distinction from the second-
ary form of the disease.

The above is a portraiture of the ordinary form ; but arthri-
tic and rheumatic cases vary considerably. In these is pain
more acute and gnawing ; greater anxiety and oppression in the
prascordia ; most violent palpitations, with a more disturbed
pulse ; excessive dyspnoea upon physical or mental excitement,
or the recumbent posture; the disease at first distinctly parox-
ysmal, and, when rheumatic, dependent on the states of weather;
peculiar petulance.

CAUSES.

Like those of the acute variety ; or the disease may be a de-
generation of an acute attack. It is oftener attributable to
rheumatism than is ihc acute form.

CHRONIC CARDITIS. 97

DIAGNOSIS.

Still more obscure than in acute carditis. Dr. Chapman,
however, believes that in a large proportion of cases, a careful
investigation will lead to a correct inference.

PROGNOSIS.

Of very difficult cure, yet not so intractable as to discourage
our efforts.

AUTOPSIC APPEARANCES.

1. A firm adhesion is sometiines found between the pericar-
dium and heart. The former is usually thicker and more
opaque than is natural.

2. The endocardium is thicker, more condensed, opaque, and
rough, owing either to real hypertrophy, or to an adventitious
membrane. This condition exists in an exaggerated degree
about the valvular openings. The valves are rendered more
or less adherent by lymph. But the valves, in addition, present
divers structural alterations, which will be pointed out subse-
quently.

3. The heart itself betrays the evidence of inflammation,
chiefly restricted to the superficial layer of muscular fibres.
Abscesses and ulcers are occasionally found in the substance of
the organ. But it is sometimes, after the long existence of effu-
sion in the pericardial sac, discovered to be in an atrophied
condition.

P A Til OLOGY.— Essentially the same with that of acute
carditis.

TREATMENT.

When the case is recent, and we have an expectation of
effecting a cure, we may resort to the following expedients : —

7

98 DISEASES OF THE CIRCULATORY SYSTEM.

Topical Bleeding, sometimes may be anticipated by vene-
section.

Counter-irritation.

Tartar Emetic, Digitalis, or Col chi en m.— According
to the remarks made on their use, in the treatment of the acute
disease.

Calomel, Opium, and Ipecacnanh a. — It is only by an
alterative mercurial impression, that any very material anormal
condition of the heart can be rectified. Dr. Chapman's trials of
the iodine as a substitute, have not proved very favourable to
that medicine. But he does not discourage a fairer trial.

A Purgative at first ; subsequently laxatives, to keep the
bowels soluble. The drastics are only of service for the re-
moval of pericardial effusion.

Regime n. — Simple food, in moderate quantities, with mental
and bodily quietude, are highly important.

This plan should be persevered in for a considerable length
of time, according to Boerhaave's maxim, — that chronic dis-
eases require a chronic treatment.

Rheumatic cases are much benefited by a removal from
an austere to a mild climate.

ORGANIC CHANGES OF THE HEART.

These, of late, have been multiplied with an inconceivable
minuteness of division, which, however curious it may be, serves
rather than otherwise to perplex, in practice. A common treat-
ment belongs to a large portion, and the rest, with some excep-
tions, are irremediable.

HYPERTROPHY.

This is an increase of the muscular parietes of the heart.
With this augmentation of the walls, the cavity may retain its
natural size, or it may be expanded, or contracted. The first
variety is called simple hypertrophy; the second, eccentric or
dilated hypertrophy, or hypertrophy with dilatation ; the third,
concentric or contracted hypertrophy, or hypertrophy with
contraction.

Hypertrophy may either embrace the entire organ, or it may
be restricted to parts.

S Y M P T 0 I\I S.

EARLY STAG E. — The most prominent symptom is the ex-
traordinary force of the heart's action, in which the pulse usu-
ally participates. The hand, applied to the pra^cordial region,
experiences a sort of rebound, the end of each shock being
marked by what is called the hack stroke, or diastolic impulse,
ascribed to the refilling of the ventricles. The pulse, owing to
the lengthened systole, is preternaturally protracted. The ca-
pillary system has also an unusual activity, as is evinced by a

100 DISEASES OF THE CIRCULATORY SYSTEM.

florid, or even flushed face, and brilliancy of eye. Occasionally
there is slight dyspnoea.

ADVANCED STAG E.— Disorder of system, manifested by a pal-
lid cachectic appearance; flaccidity of the integuments; dropsy,
with oedema of the face ; embarrassed respiration, or still graver
pulmonary affection. Most characteristic, however, is, perhaps,
the disposition to hcemorrliage. No organ or structure maintains
an immunity from haemorrhage, though the fatal cases are most
often presented in the form of cerebral, or pulmonary apoplexy.
There is authority for believing that three-sevenths of each of these
kinds of apoplexies are connected with this condition of heart.

CAUSES.

One of the principal causes, perhaps, is dyspnoea, from what-
ever source arising. All violent and habitual exercise. Rheum-
atism, which, by the irritation it maintains in the heart, invites
an afflux of blood to it, conducive to an excess of nutrition.
This nutrition, being vitiated by the existing morbid action,
leads to the structural derangements incident to the case.

DIAGNOSIS.

IN GENERAL HYPERTROPHY, a rare event, physical
exploration reveals only violent action of the heart, and dulness
of sound on percussion.

PARTIAL HYPERTROPHY. — 1. Of the left ventricle.
This is the most common position of partial hypertrophy.
Denoted, through the hand, and auscultation, by a very strong
impulse between the cartilages of the ffth and seventh ribs, to
which the strokes of the heart are confined ; and here the sound
from percussion is dull. Impulse of the ventricle lengthened ;
that of the auricle shortened.

2. Of the right ventricle. Stroke perceived most plainly at
the bottom of the sternum. The resonance is duller, also, in
this position. Hypertrophy of the left side is more apt to induce

HYPERTROPHY OF THE HEART. JQI

diseases, especially apoplexy, of the brain ; while hypertrophy
of the right, rather implicates the lungs.

Concentric liypertj-op/iy. Denoted by the dulness and ob-
scurity of the heart's sounds, and their limitation to the pra3Cor-
dial region.

Eccentric hypertrophy. Denoted by clearness of sound, and
its diffusion over nearly the whole chest.

Hypertrophy is, in general, more easily distinguished than
other cardiac affections. It is indicated by the fulness of the
prascordial region. From dropsy of the pericardial or pleural
sac, which also evince this fulness, it may by many symptoms
be discriminated.

PROGNOSIS.

By proper and early treatment, the disease is usually cured.
It may at other times be so checked, that the patient may live
to old age, without any serious inconvenience. Children are
apt to outgrow it.

The disease sometimes proves fatal from the supervention of
cerebral or pulmonary apoplexy, or from haemorrhagic or
hydropic effusions.

AUTOPSIC APPEARANCES.

The heart may increase in size three, or four times, or from
eight or nine ounces it may even weigh as many pounds. The
substance of the heart is redder than natural, and the coronary
arteries are turgid. The external and internal surfaces occa-
sionally exhibit evidences of inflammation.

PATHOLOGY.

Hypertrophy may result from healthy nutrition carried to an
exaggerated degree. This state is occasioned by violent and
protracted exercise of the organ, which enlarges under such
circumstances like any other muscle of the body.

102 DISEASES OF THE CIRCULATORY SYSTEM.

Or, it may arise from inflammation, particularly rheumatic.
In this case the organization is vitiated.

TREATMENT.

The same with that of carditis. Venesection and low living
should not be carried to the extent of producing nervous irrita-
bility and vitiation of the blood, which will not fail to aggravate
this, in common with other cardiac affections. It is highly im-
portant that sanguification should be well performed.

Calomel, with the various narcotics, should succeed active
measures. The iodine, much lauded, deserves a fair trial.

DILATATION OF THE HEART.

This state consists in an expansion of the cavities of the heart,
with a preservation of the original thickness of the walls, or an
attenuation of them.

It is generally found in weak constitutions, or in persons
of impaired health. The symptoms are consequently much
modified and compHcated by associate affections.

SYMPTOMS.

Early in the attack, where this is slight, and the system in a
state of tolerable integrity, the disease is difficult of recognition.

A sense of weight and uneasiness in the prsBCordial region,
or more extensively ; feeble palpitations ; pulse generally soft,
small, and slow ; frequent and violent dyspnoea, with cough and
copious expectorations, as in bronchitis, or humoral asthma;
face pale and waxy, though occasionally livid, and the ex-
tremities cold ; turgescency of the veins, particularly the ex-
ternal jugular, and consequent on this congestion, haemorrhages,
and dropsies ; senses and mental faculties obtuse ; headaches,
apparently from fulness ; and sometimes stupor, convulsions, or
apoplexy.

The disease is not always so violent as has been represented;
some of the most severe affections occurring only during the
paroxysms, to which the disease is very liable.

CAUSES.

Whatever seriously and permanently impedes the circulation
— as valvular disease of the heart, or arteries, or obstructions

104 DISEASES OF THE CIRCULATORY SYSTEM.

in the lungs, liver, &c. Whatever disturbs the heart's action,
particularly a vitiated state of the blood.

But, in addition, there must be a predisposition in the organ
to such alteration.

DIAGNOSIS.

Sometimes difficult, when the case is embarrassed with com-
plications. Distinguish it

FROM H Y P E R T R 0 P H Y, by the passive nature of its symp-
toms.

FROM ENGORGEMENT OFTHE CAVITIES OF THE
HEART, by the less round, equable, compressible distension of
the prsecordial region, and by its permanency.

FROMNERVOUSIRRITATION, byits permanency.

But it is necessary in these cases, to collate all the symptoms.

Respecting the reputed 'physical signs in this affection. Dr.
Chapman is convinced that some prove nothing very decisive,
and that the rest are fallacious.

PROGNOSIS.

A dangerous and intractable disease, particularly when con-
nected with contamination of body, or the destructive lesions to
be mentioned.

AUTOPSIC APPEARANCES.

Increased size of the heart; paleness and flabbiness, or soft-
ening of its substance ; attenuation of its walls ; disease of the
valves, septum, and columnae carneas. These changes may be
universal, or embrace only a particular auricle or ventricle.

Besides, we meet with a multitude of lesions of the lungs
and abdominal viscera.

DILATATION OF THE HEART. JQS

PATHOLOGY.

Dilatation is immediately owing to deficiency in the muscular
power of the heart, and obstruction in the circulation, inducing
accumulations of blood in the cavities of that organ, whereby
through mechanical pressure the cavities are amplified, and the
parietes attenuated.

TREATMENT.

In curable cases the treatment must be directed to the afTec-
tions from which they originate, and by which they are aggra-
vated.

But the dilatation being inveterately fixed by incurable affec-
tions of the heart, or other organs, we may hope only to alle-
viate distress ; and this may be effected to a great degree.

The leading indication is to preserve the general health.

The tone of the system should be sustained by tonics, and a
nutritive, digestible diet, and a residence in the country, espe-
cially near the sea-shore. The strictest prophylaxis should be
observed. Nervous irritation should be calmed by a stimulating
pediluvium, and a soothing nervine or an opiate. These mea-
sures not answering, the irritation will be probably reduced by
cupping between the shoulders, and counter-irritation on the
breast. Inflammation of the heart or other organs occurring,
the usual remedies should be employed.

Dr. Chapman has relieved the heart in a desperate paroxysm
of ENGORGEMENT, by the frcc and rapid abstraction of blood from
the arm. This course, however, may not always be admissible.

ATEOPHY OE THE HEAET.

SYMPTOMS.

Action of the heart very feeble, propensity to syncope, and
the characteristics of the general pathological condition with
which the cardiac disease is associated.

CAUSES.

Whatever produces a general marasmus of the body, the
pressure of liquid effused into the pericardium, ossification of
the coronary arteries.

DIAGNOSIS.

The disease cannot be certainly determined.

PROGNOSIS.

Commonly fatal.

AUTOPSIC APPEARANCE.

The heart has been found diminished to half its normal size,
and wrinkled.

PATHOLOGY AND TREATMENT.

The opposite to those of hypertrophy.

RUPTUEE OP THE HEART.

SYMPTOMS.

These may be those of the pathological condition of which
it is the effect ; though sometimes the rupture occurs without
any previous symptoms.

CAUSES.

Occurs most among males and old people. The rupture is
immediately excited by whatever produces strong action of the
heart.

DIAGNOSIS.

Distinguished from cerebral apoplexy, by the instantaneous-
ness of death, and pallidness of the countenance.

PROGNOSIS,

Nearly always fatal, — perhaps, when the rupture extends
throughout thewhole thickness, always so.

AUTOPSIC APPEARANCES.

Besides the rupture, we may discover ulcers, softenings, par-
tial atrophy, or partial hypertrophy.

TREATMENT.
Incurable.

AFFECTIONS OF THE YALYES.

Most common on the left side.

SYMPTOMS.

Not very peculiar. Generally, irregularity of the heart's ac-
tion ; variable pulse ; vv^eight, or pain in the prcBcordia ; dyspncsa,
cough, and expectoration ; venous congestion and its conse-
quences.

These symptoms aggravated greatly by mental or bodily
excitement ; and no permanent ease is enjoyed even in a state
of repose, the sleep being disturbed by agitative dreams.

Life is terminated by sudden suspension of the heart's action,
by pulmonary or cerebral apoplexy, and in various other ways.

CAUSES.

Over-action of the heart, and the ordinary causes of inflam-
mation and perverted nutrition.

DIAGNOSIS.

Very difficult. This is rendered the more so from the usual
complication, either as cause or effect, of some other organic
disease, or of endocarditis.

Auscultation, which has been extolled by some stethoscopists
as highly diagnostic, is declared by others to be very fallacious.
The last is the opinion of Stokes and Graves. But supposing
that the exact lesion could by such means be determined, what
advantage would be gained ? inasmuch as the diagnosis can
only be formed when the affection has arrived to such maturity
as to preclude the hope of relief.

AFFECTIONS OF THE VALVES. i09

PROGNOSIS.

Always formidable, though, taken in the commencement, and
where it is dependent on mere thickening from chronic inflam-
mation, it may be removed.

AUTOPSIC APPEARANCES.

A part or the whole of the valves are found altered in shape,
and, in cases of long standing, converted from mere thickening
into fibro-cartilage, cartilage, or osseous or calcareous substance.
The aperture is sometimes much contracted by the altered form
of the valve.

Vegetations may also exist along the basis, and free margins
of the valves. Besides, there often co-exist other organic
changes in the heart and other organs.

PATHOLOGY.

When the lesion consists merely in thickening, or consolida-
tion of tissue, Dr. Chapman believes it to result from inflam-
mation ; but when the substance is entirely new, he refers it to
a distemperature of the nutritive process. But the latter may
itself proceed from an inflammatory condition. How the im-
peded circulation and other effects are produced, requires no
explanation.

TREATMENT.

For this subject, Dr. Chapman refers to the Treatment of
Hypertrophy, and of Dilatation, to be here employed according
to the indication.

In consideration of the great similarity of the treatment to be
pursued in nearly all cases of organic disease of the heart, and
of the incurability of others. Dr. Chapman animadverts on the
futility of those who lay such undue stress, as it is now the
fashion to do, upon the anatomical characters, the pathology,
and the minute diacnosis of such diseases.

NEEVOUS AFFECTIONS OF THE HEAHT.

PALPITATIONS.

May be more violent than palpitations from organic disease.

CAUSES.

Either a nervous or sanguine temperament, either a full or an
anaemic condition, exhibits a predisposition.

As exciting causes of temporary palpitations, may be enume-
rated mental agitation, physical exertion, stimulants, indigesti-
ble food, the habitual use of opium, or of tobacco in any form.
Chronic palpitations generally arise from an irritation derived
from some of the abdominal or other viscera, spinal irritation,
hyperemia, or anemia.

DIAGNOSIS.

Quick, strong, irregular action of the heart and pulse, which
is very apt to be intermittent; a sense of agitation throughout
the epigastrium, and in the head ; palpitations experienced more
in repose than when up and moving about; sometimes con-
tinued the greater part of the night, increased by lying on the left
side; often gastric disorder; a disposition to urinate, the dis-
charge being pellucid and copious.

Again, we may conduct a diagnosis by exclusion — dis-
covering that the palpitations do not proceed from any par-
ticular organic disease.

In nervous palpitations, the impulse, apparently great, is
really moderate, and rarely repels the hand when placed over
the cardiac region.

The effect of antispasmodics is also very diagnostic.

PALPITATIONS. m

PROGNOSIS.

These palpitations generally do not lead to any serious con-
sequence.

AUTOPSIC APPEARANCES.

Sometimes, perhaps, hypertrophy, or dilatation, as an effect,
and serious disease of the chylopoietic viscera, or lungs, as a
cause.

PATHOLOGY.

The palpitations, at first merely irritative, may afterwards,
as we are assured, lead to disorganization of the heart.

TREATMENT.

The palpitation being brought on suddenly from moral emo-
tion, or inordinate physical exercise, the individual should rest
for some time, and may in addition resort to a nervine in the
former, and venesection in the latter case. Proceeding from
gastric disorder, employ an emetic, or, if sufficient, an antacid.

In the chronic form, we must address our treatment to the
disorder, whatever it may be, of which the palpitation is an
effect. The paroxysms are to be appeased when they occur.

MEDICAL DISEASES OE THE
BLOOD-YESSELS.

ACUTE ARTERITIS, OR INFLAMMATION
OF THE ARTERIES.

SYMPTOMS.

The disease, as an idiopathic affection, being very rare, its
symptoms are not very well understood. They are said, hovv^-
ever, to consist in a vehemence of pulsation in the phlogosed
vessel ; a sense of heat and pain along its course, with a corre-
sponding streak of redness ; extreme pain on pressure.

As general symptoms, we have extreme restlessness, nausea
and faintness, and where the aorta or pulmonary artery is
concerned, dyspncea, cough, and thoracic pain are apt to be
present.

The fever, at first perhaps ardent, is soon converted into one
of a typhoid type.

CAUSES.

Probably those of cardiac inflammation. More generally it
proceeds from an extension of pulmonary, cardiac, or abdomi-
nal inflammation.

DIAGNOSIS.

There can be no positive discrimination of internal arteritis.

ARTERITIS. 113

PROGNOSIS.

The severer forms of the disease often fatal. The chief
danger proceeds from the obliteration of the artery from efiused
lymph, or from the diffusion of the pus secreted by it, or soften-
ing, or other organic change of its texture.

AUTOPSIC APPEARANCES,

The most common are redness of the interior membrane, in-
terspersed with white spots; occasional extravasations of lymph,
and depositions of pus; and thickening, ramollescence, and ulcera-
tion of the arterial surface. In phlogosis of the great arteries
within the chest, these appearances may be extended to the
heart. Indeed the red staining sometimes pervades the vessels ;
and hence has probably arisen the erroneous notion of fever
being dependent on arteritis.

PATHOLOGY.

Mere redness is not to be regarded as a proof of previous in-
flammation, since this appearance often takes place after death,
particularly in typhoid cases, and where the blood is preterna-
turally fluid.

TREATMENT

Corresponds to that of similar inflammation of the heart.

8

114 DISEASES OF THE CIRCULATORY SYSTEM.

The arteries are subject to a CHRONIC INFLAMMATION,
which, though some authorities constitute it the more common
affection, is, in the opinion of Dr. Chapman, a comparatively
rare event. By those who hold the other notion, it is probably
made to include —

DEGENERATIONS OF ARTERIES.

These consist of extraneous deposits of fibrous, steatomatous,
cartilaginous, calcareous, osseous, and other matters. From
such metamorphosis no artery is exempt, but the remarks are
here confined to the arteries of the cavities. The artery most
usually thus affected is the aorta, and next, are the cerebral
arteries, by which is laid, as is now believed, the foundation, in
the majority of cases of cerebral apoplexy, and some of epilepsy.
The pulmonary artery is seldom thus involved.

SYMPTOMS.

The disease is seldom betrayed by any marked symptoms,
until it has reached a considerable height. Subsequently we
have that sort of distress, and other effects, which proceed from
an embarrassed circulation.

CAUSES.

The affection most incident to old age, — particularly ossifica-
tion. Other causes are the long prevalence of gout, or rheu-
matism, syphilis, the abuse of mercury, intemperance in eating
or drinking, and perhaps hereditary influence. But often these
changes occur without any appreciable cause.

DIAGNOSIS.

We cannot, either by symptoms or physical signs, diagnosti-
cate this disease with certainty.

DEGENERATIONS OF ARTERIES. II5

PROGNOSIS.

Generally incurable.

AUTOPSIC APPEARANCES.

The deposit is between the coats. Sometimes several kinds
of degeneration are exhibited at the same time, — the case pro-
gressing from the softer to the harder deposits. Of the aorta,
the beginning and arch are mostly aflected.

PATHOLOGY.

When consolidation merely has taken place in consequence
of the infiltration of lymph, or albumen, it is the effect of inflam-
mation ; but where the identity of structure has been lost, then
the change is referable to a vitiation of the nutritive process.

TREATMENT.

At an advanced period, little can be anticipated, besides mere
palliation. The measures are not materially different from those
to be pursued in organic diseases of the heart.

ANEURISM OF THE AUTEEIES.

By aneurism is meant a dilatation of an artery. This may-
occur from the simultaneous distension of all the coats, or by
some of them giving way, causing an extravasation of blood,
or by a solution of continuity in the interior coats, while the
outer one maintains its integrity. These forms receive the
respective names, true, false, and mixed aneurism.

Here will be considered aneurism of the internal vessels only.
They are all liable to the affection, but the aorta being pre-
eminently so, will be mainly regarded. The lesion is nearly
always found either in the ascending portion or arch.

SYMPTOMS.

Being deep-seated and small, it is said to be not detectible ;
and death may give the first intimation of disease. Being,
however, more developed, the symptoms are, cachectic aspect,
palpitations or other strong pulsations, dyspnoea, cough, dis-
turbed sleep, a tendency to syncope, irregular distributions of
blood, creative of congestions, and sometimes lividity of coun-
tenance, passive haemorrhage, and serous effusions. These
symptoms, though common to many of the cardiac affections,
are apt here to be more intense.

CAUSES.

Like those of associated cardiac affections, and spontaneous
aneurism in external arteries.

ANEURISM OF THE ARTERIES. 117

DIAGNOSIS.

Very pathognomonic when it exists, is a tumour-like promi-
nence in the situation of the aneurism, with a heaving pulsation.

The paroxysmal occurrence of the symptoms best distin-
guishes the nervous affections which resemble aneurism in their
manifestations.

Percussion at the top of the sternum may elicit a dull sound,
and through the stethoscope applied to the same region, we may
discover a loud, rough, or abrupt bellows sound, or a purring
murmur, or a slight whizzing.

PROGNOSIS.

Incurable hy art, aneurism of internal vessels, and even the
aorta, is occasionally cured hy nature, from the coagulation of
blood in the sac, and its ultimate conversion into a small dense
tumeroid mass.

AUTOPSIC APPEARANCES.

The artery having been ruptured, we discover the blood in
one or more of the contiguous organs. The parietes may be
found either attenuated or thickened. The rupture may occur
from the tenuity of the parietes or from ulceration. When the
aneurism is large, surrounding parts are removed by absorption,
excited by the pressure. Even bone itself cannot resist. Ossi-
fication or other degenerations in other parts of the artery may
be associated. The pulmonary artery is rarely affected.

PATHOLOGY.

From a loss of contractility, the pressure of the blood gives
rise to permanent dilatation.

118 DISEASES OF THE CIRCULATORY SYSTEM.

TREATMENT.

The plan suggested two hundred years ago by Valsalva, and
which still receives the chief suffrage of the profession, is to
bleed the patient very frequently and subject him to the most
reductive regimen. But Dr. Chapman rejects the plan for the
following reasons. 1. A cure being only effected by the
retardation of the blood in the aneurism from the roughness of
its interior surface, cannot be attained in true aneurisms, in
which the lining membrane is smooth. But nine-tenths of the
cases are true aneurism. It can, therefore, hardly be advisable
to subject the patient to such harassing and deleterious mea-
sures, when, at best, there is hope in only one case in ten. 2.
It does not appear that in the instances in which a cure has
been spontaneously effected, the system has been remarkably
low. 3. The result of excessive bleeding and inordinate absti-
nence is excitement rather than serenity of the circulation.
4. The blood becomes so impoverished that it is inadequate to
the deposit of a coagulum. 5. The coats of the artery lose
tone, and become, in consequence, still less able to resist the
morbid process, by which the aneurism is formed.

In addition to the treatment mentioned, it is common for
practitioners to rely upon the acetate of lead. But of this
remedy Dr. Chapman is equally distrustful.

Discarding all expectation of a radical cure, he confines his
efforts to the arrestation of the progress of the lesion, and to
render it as tolerable as possible. These ends are accomplished
by calming the circulation. For this purpose he resorts to
venesection and purging, lohen necessary — digitalis in the in-
tervals, a moderate amount of nutritious food, and the careful
avoidance of constipation, exercise, and whatever else may
excite the pulse. This treatment corresponds with that already

INFLAMMATION OF THE VEINS,
OR niLEBITIS.

A DISEASE of recent investisfalion.

SYMPTOMS.

Exhibited in a superficial vessel, there is pain, vastly in-
creased on pressure, with swelling, stiflness, and a streak of
redness along its course. It is an affection proceeding nearly
always in the direction of the heart. Constitutional disturbance
is soon betrayed by febrile and other manifestations. Located
in a limb, this may be more than double its natural size, while
the skin is tight, smooth, and while. The fever mny become
exceedingly typhoid. There also exists chills or rigors, and
rheumatic-like aches in the joints, or wandering about the
cavities of the body.

The case above delineated is one of marked violence, which*
unabated by our remedies, has progressed probably to the sup-
puration of the vein. The description relates particularly to
the phlebitis induced by venesection.

The disease called p/ilegmasia alba dolens, Dr. Chapman
thinks has been improperly attributed to inflammation of the
veins.

Deep-seated veins enjoy no immunity from such attacks; but
of the symptoms by which their phlogosed condition is marked,
we have no satisfactory knowledge.

Dr. Chapman is disposed to believe that the abscesses in the
lungs, liver, and other parts of the body, which so frecjuently
accompany phlebitis, are not, as is supposed, dependent upon

120 DISEASES OF THE CIRCULATORY SYSTEM.

the deposit of pus, which has been secreted by the phlogosed
vein, and transmitted with the current of blood, but that they
are dependent upon the sympathetic irritation, by which ab-
scesses are so often formed in low diseases.

CAUSES.

Nearly always arises from mechanical injury. Dr. Chapman
believes that it is never occasioned directly by a virus; thinking,
however, that the vein may become involved in the condition
of the adjacent tissues, when they are inflamed by the applica-
tion of a virus. The instances of tumefaction from the inser-
tion of a virus, he presumes to be an affection of the lymphatics.

There are certain times when phlebitis is particularly com-
mon. In certain constitutions, also, the slightest scratch will
give rise to this result.

DIAGNOSIS.

Inflammation of the interior veins can never perhaps be cer-
tainly determined. The diagnosis from inflammation of the lym-
phatics, and of the cellular tissue, can only be made out, either
before or after the period of excessive tumefaction ; when the
phlogosed vein may be perceived running in a tortuous course.
During the height of this afl^ection, or phlogosis of the lympha-
tics, the polished rotundity of surface, from an implication of
the cellular tissue, is the same with that of 'primary inflamma-
tion of that tissue.

PROGNOSIS.

Favourable when the disease is early attended to; the reverse
when the inflammation has become Intense.

AUTOPSIC APPEARANCES.

Redness of the vein in specks, or striated, or arborescent —
continuous, or in patches; effusion of lymph, sometimes agglu-
tinating the sides of the vessel; suppuration, and even ulceration.

INFLAMMATION OF THE VEINS. 121

Deposits, in various parts of the body, of pus, varying in size
from a pea, to a large peach. The organ is usually found in-
flamed immediately around the deposit.

PATHOLOGY.

Dr. Chapman accounts for the constitutional disturbance
which takes place before suppuration, by supposing that the
whole venous system experiences a sympathetic irritation.
Upon the occurrence of suppuration, we may suppose the dif-
fusion of the pus by the current of blood, to operate in the pro-
duction of the adynamic state, which characterizes a more
advanced period of the disease.

TREATMENT.

The limb should be put into a state of Absolute Rest.

V e n e S e C t i 0 n. — Only u-lien the febrile excitement is verij high.
It is apt to be followed by a fresh attack of phlebitis.

leeches. — To be repeatedly applied along the course of the
vein. *

Emollient Cataplasms.

A B 11 s t e r. — Of extraordinary value. A narrow slip of the
epispastic plaster should be placed along the course of the vein,
as far as it appears inflamed, having an opening in it at the
orifice, over which a soft poultice is to be placed; and the
blister having drawn, is to be kept freely discharging.

Purgatives and Arterial Sedatives.

Calomel, Opium, and Ipecacuanha. — Dr. Chapman re-
lies much upon the promotion, at this stage, of perspiration.
Should pain and restlessness be prominent, he directs the Dover's
powder largely.

Pus having formed, the best hope of preventing its transmis-
sion to the system is offered by the ligature of the vein ; but
this might do more harm than good; and it has never been
tried. Compression of the vein to an extent that can be tole-
rated, or cutting the vein, is inadequate to arrest the blood.

DISEASES OF THE ALIMETs^TARY SYSTEM.

ACUTE INFLAMMATION OF THE THROAT.

This is generally most displayed in phlogosis of the tonsils.
The latter has received the names of cynanche tonsillaris — an-
gina tonsillaris — tonsillitis — and the common names, sore throat,
and quinsy.

S Y M P T O M S.

Fever, pain, hiiskiness, scriatus, increase of saliva, heavily
coated tongue, and difficulty of deglutition. In addition, the •
uvula, palatine lining, eustachian tubes, and interior of /he ear
may become involved. Under such circumstances, there may
be earache, and an inability to swallow or articulate. The
inflammation may also extend to the tongue, pharynx, oesopha-
gus, and larynx. Glossitis, or inflammation of the tongue, is
evinced by ocular demonstration. In pharyngitis, and oesopha-
gitis, there is pain on pressure, and regurgitation of whatever is
attempted to be swallowed.

A person who has had several attacks of tonsillitis, may have
it without any constitutional implication. This is true, also,
"when the habit is scrofulous. But, ordinarily, the disease soon
terminates in resolution, suppuration, or induration. In some
cases, the phlogosis is very superficial and difl'usive, like that of
erysipelas.

CAUSES.

Cold. The erysipelatous variety Dr. Chapman believes to
proceed from gastric disorder.

INFLAMMATION OF THE THROAT.

123

Malignant or pellicular sore throat seems to be merely scar-
latina, without the cutaneous eruption, and to the treatise on
that subject the reader is referred.

PROGNOSIS.

Favourable. Death, however, may occur suddenly from
suffocation.

TREATMENT.

The disease being yet in \is forming stage, may be sometimes
checked by a gargle of the iyjfusion of ca'psicum, or a solution
of salt in vinegar or brandy. The nitrate of silver, or burnt
alum, is recommended. External rubefacients, and a flannel
covering to the neck, should be also employed.

These measures failing, we may resort to

An Emetic.

A Purgative and subsequent laxatives.

Venesection, when required by great excitement.

Topical Bleeding.

Poultices.

Blisters, in violent cases.

Inhalations of heated vapour of water, or of water and
vinegar.

Stimulating gargles should be withheld in the active stage.

Suppuration having occurred, as may be known by the yel-
lowish appearance of the tumour, and the throbbings and the
disposition to rigors, it will be right to open the abscess. Sub-
sequently, the patient may use mild gargles.

In glossitis, pharyngitis, oesophagitis, or laryngitis, it is neces-
sary to use depletory and other antiphlogistic measures with
the greatest vigour. When the tongue is badly inflamed, the
tension should be removed by deep incisions, and leeches may
be applied to the lower surface. There being an abscess in the
pharynx, or oesophagus, it may be ruptured by the i/iroat lancet
or the bougie, or by vomiting.

The erysipelatous variety is to be treated by an emetic, a mer-
curial purge, leeches, vesication, and detergent gargles.

124 DISEASES OF THE ALIMENTARY SYSTEM.

A typhoid state supervening, as it is sometimes said to do,
stimulants and the other treatment of malignant scarlatina may
be required.

Torpid tumours are to be removed by the application of burnt
alum, or by leeching, vesication, and discutient gargles.

Elongated uvula, when attenuated and relaxed, or when
turgid with blood, or oedematous, should be treated with the
application of burnt alum ; but being intermediate to these con-
ditions, with leeching and emetics.

Enlargement of the tonsils demands excision.

CHRONIC INFLAMMATION OF THE THROAT.

SYMPTOMS.

PRIMARY. — Redness, diffused or in streaks or patches, and
injection of vessels.

ADVANCED.— Ulceration.

CAUSES.

The consequence of the ill-cured acute affection, of an ori-
ginal disease arising from the same causes with the acute, more
slowly operating.

TREATMENT.

Any activity of phlogosis existing, the means just indicated
must be resorted to.

There being mere congestion, the vessels may be emptied by
local bleeding and vesication ; and the part may then be sub-
jected to astringent or tonic applications. Ulcerations should
be touched with lunar caustic, or treated with gargles.

The disease depending upon constitutional vitiation, the treat-
ment will, of course, depend upon the peculiar nature of that
vitiation. Yet, in general, it may be said that an alterative course
of blue pill, moderate purging, an occasional emetic when the
ulcers are very foul, or the general secretions depraved or de-
fective, and sarsaparilla, are valuable remedies.

There is a condition in which, with dryness and huskiness of
the fauces, slight teasing cough, and hawkings, the throat is
pallid and relaxed, but the constitution is sound. Dr. Chapman
believing this state to result from defective innervation, directs
topical bleeding and counter-irritation to the back of the neck,
and seldom fails in curing it.

DYSPHAGIA, OR DIFFICULTY OF
SWALLOWING.

This may result, first, from organic disease of some kind, or,
secondly, from disorder of the cerebro-spinal axis, either original,
or the result of irritations in the alimentary canal, or elsewhere.
The treatment of the second variety, is to remove these irritations
when they exist ; to employ local bleeding and counter-irritation
to the back of the neck, nauseants in some instances, the cau-
tious administration of mercury with a view to its constitutional
effect, when there is a state of excitement, but dry cups, coun-
ter-irritants, antispasmodics, and tonics, when there is a state
of enervation. Spasmodic stricture of the oesophagus may be
distinguished from organic, by observing that it is sometimes
remitted, and especially upon the introduction of a bougie.

The oesophagus is subject to chronic inflammation and ulcera-
tion. But these incidents are very rare.

CHRONIC GLOSSITIS.

This is connected with enlargement. It may terminate in
resolution, suppuration, or ulceration. Similar enlargement of
the lips maybe conjoined. The treatment consists in correcting
the depravation of the digestive and nutritive organs, on which
the disease usually depends, or whatever constitutional vitiation
may exist ; repeated leeching ; poultices to the lips, when af-
fected, and the liberal exhibition of cicuta. This state is some-
times a scrofulous disorder.

INFLAMMATION OF THE PAROTID,
OR MUMPS.

May be either common or specific. The latter form, called
cynanche parotidea, parotitis, or mumps. The former variety
so nearly resembles tonsillitis in nature and treatment as to
preclude the necessity of distinct description.

Parotitis is exhibited by a pain and swelling in one or both
parotid glands, involving the submaxillary, and accompanied by
fever. It is subject to metastasis to the testis in males, and the
mamma in females.

CAUSES.

An epidemic influence, or perhaps contagion. It resembles
contagious diseases, certainly, in there being an immunity
against a second attack.

DIAGNOSIS.

Differs from ordinary inflammation of the parotid, in the
greater rapidity of swelling, the tendency to spontaneous subsi-
dence, the difficulty of mastication, and the peculiar painfulness
in masticating sweet substances — in a more general constitu-
tional disturbance, its disposition to metastasis, and its usually
prevailing epidemically.

PROGNOSIS.

Not serious except when metastatic. It is milder and less
prone to metastasis in early life.

128 DISEASES OF THE ALIMENTARY SYSTEM.

TREATMENT.

In mild cases, the patient should keep within-doors, protect
the tumour by a flannel bandage, take a laxative, and restrict
his diet. The part may be bathed with a lotion of laudanum,
sweet oil, and brandy.

But in violent instances, the antiphlogistic system should be
fully carried out. The influence of cold must be carefully
guarded against.

Driven to the testicle, it may create much pain, swelling,
fever, and even deUrium, The testicle may also in consequence
entirely waste away. We should encourage a return to the
parotid by moderate warmth, and treat the disease as hernia
humoralis, — that is, by common depletory and sedative mea-
sures, and when the stomach is much disordered, by an emetic.

When metastasis to the mamma has taken place, we should
adopt a similar practice. Should it become inveterate, we
may direct the frequent application of leeches, mild discutients,
a low vegetable diet, an alterative course of mercury, and a
succession of emetics. The affection may degenerate into
scirrhus.

DYSENTERIA OR DYSENTERY.

INFLAMMATORY FORM.

S Y ]M P T O M S.

That variety arising from cold, so nearly resembles colitis,
already described, as to require no further exhibition.

I IV C E P T I V E. — An attack in warm weather is usually intro-
duced by anorexia, epigastric fulness, furred tongue, thirst,
bitter taste, nausea, and sometimes vomiting, uneasiness in the
abdomen, dry skin, muscular soreness and debility ; or it is in-
troduced directly by a chill and fever.

MORE A D V A N C E D.— After the constitutional disturbance,
follow griping, and a propensity to go to stool ; large, feculent,
or watery discharges for a time, and then small ones, consisting
of mucus only, or tinged with blood ; a sense of weight or
dragging in the lower part of the abdomen; and either fugitive
pain, or permanent tenderness.

But often the local affection supervenes first ; and the system
may sympathize very little throughout the case, — certainly not
to the extent of a fever.

STILL MORE A D V A N C E D.— Stools more frequent, and
painful ; every evacuation being attended with an aggravation
of tormina and tenesmus, and a good deal of borborygmi or
rumbling from flatulence. Occasional prolapsus of the intestine.
The discharges sometimes become like cheese; or they may be
purely hosmorrhagic. Again, there may be evacuated a sub-
9

130 DISEASES OF THE ALIMENTARY SYSTEM.

Stance like flesh, composed of coagulable lymph, or impacted
mucus reddened with blood ; or matter resembling the mucous
coat of the bowels. The scybalre, which are in some instances
discharged, consist of hardened balls of faeces. Little or no
bile is ever apparent in the stools. Although there be fever, the
pulse is seldom full or active, however tense and corded it
may be.

FINAL STAG E.— A depression of strength; cold skin; some-
times, petechise, or vibices ; great soreness and tension of the
epigastrium ; feeble pulse; a singularly altered, and often corpse-
like countenance.

These symptoms may be varied by a concentration of the
disease in a particular section of the bowels, or a particular coat,
or by the complication of other affections.

CAUSES.

Dysentery was once ascribed almost exlusively to contagion.
The notion of its ordinary production in this way is now pretty
much abandoned. But this question will be discussed in the
consideration of the congestive form of the disease.

Miasmata, an excess of heat, sudden variations of temperature ;
a damp, heavy, murky atmosphere; a calcareous soil, epidemic
influence, and checked perspiration, by whatever cause pro-
duced. Certain ingesta, among which may be mentioned crude
fruit, and unwholesome vegetables, and particularly, putrid or
spoiled aliment. A sudden change from an animal to vege-
table diet, or the reverse ; or from salted to fresh provisions, or
the opposite. Acid beverages, stagnant water.

With us, dysentery is mostly a disease of the country; and
of simultaneous prevalence with autumnal fevers, — the former
occurring in high situations, and the latter in the contiguous
low grounds.

DIAGNOSIS.

The only disease with which dysentery is liable to be con-

DYSENTERI A, OR DYSENTERY. " 131_

founded, is diarrhoea ; and here the treatment is so similar, that
the discrimination is unimportant.

PROGNOSIS.

As the case is open and inflammatory, with a warm surface,
and an active circulation, so will it prove manageable.

FAVOURABLE SIGNS, are a discharge of mucus, or n mo-
derate discharge of arterial blood at an early stage, bilious and
natural stools, &c.

There is a well-authenticated case, and another which has
been seen by Dr. Chapman himself, in which recovery took
place after the sloughing off of a large portion of intestine, which
was evacuated.

It is a most intractable disease, and when permitted to run
to a far advanced stage, is very apt to prove fatal.

AUTOPSIC APPEARANCES.

Very similar to those already described as belonging to
enteritis.

The lesions are chiefly seated in the mucous coat of the large
intestines, and, above all, the colon. The other coats are com-
paratively little affected. In hot countries most of the abdomi-
nal viscera are apt to share in the disease. The liver is espe-
cially apt to be congested, and may be structurally afiected.

PATHOLOGY.

Dysentery of the form now under consideration, is evidenlly
an inflammation of the mucous tissue of the primse vije, parti-
cularly of the large intestines. So long as it is insulated in the
mucous tissue, there is prostration of strength, and discharges
of mucus, variously coloured, or otherwise changed, wilh little
or no pain. Extending to the muscular coat, tormina and tenes-
mus are induced; and the darting, lancinating pain must be
ascribed to an extension to the peritoneal coat.

132 'DISEASES OF THE ALIMENTARY SYSTEM.

The skin being robbed of its fair proportion of excitement
by the irritation of the interior, becomes cold and collapsed,
until reaction takes place. Yet it finally relapses, when the
case does not proceed well, into its former condition.

The sympathetic fever is sometimes intermittent, though
oftener remittent, or continued.

The diflerence between dysentery and colitis, is like that
between gastric fevers and a gastritis. The former is a general,
proceeding from a local aflection ; the latter is the same local
affection unaccompanied by the general disorder. Dysentery
is connected with greater depravation of the secretions.

TREATMENT.

In the form now before us, we are called on mainly to re-
move inflammation with the spasm attending it, to procure a
free evacuation of the alimentary canal, and restore the healthy
secretions of it, the liver and the skin.

Venesection. — When febrile reaction has taken place. It
must be very free, or it will be nugatory. It must be, however,
early resorted to, or it will not be admissible. The phlogosis
of the mucous membrane of the large intestines is particularly
rapid, and is prone to proceed very speedily to fatal disorgani-
zations. Even within twenty-four hours, such changes may be
wrought, as will forbid the use of the lancet.

leeches.

Warm Fomentations, or Poultices. — Some recommend
Cold applications. Those may be used which, upon a trial,
suit the patient best ; Dr. Chapman, however, has not employed
the cold, except in hssmorrhagic cases.

Emetic s. — Dr. Chapman limits their employment to those
instances in which there is a stomach loaded with irritating
ingesta, or secretions, and here even, to the inchoative stage.
Yet, when there is no active phlogosis of the stomach, he does
not condemn their use on other occasions, since he has not had
much experience with them, except when given in the circum-
stances just mentioned. Zimmerman resorted to them often,
during the course of the affection.

DYSENTERIA, OR DYSENTERY. 133

Ipecacuanha has been employed in the dose of a drachm, or
more ; and for the prevention of vomiting, it is given in union
with sixty drops of laudanum, and the supine position is main-
tained. Its beneficial eflects are said to be very striking. Dr.
Chapman, however, reposes little faith in the practice.

Purgatives, to cleanse the bowels of their oppressive or
irritating contents. Castor oil is usually preferred, and may
answer in the lenient forms of the disease. But to the dysen-
teries of warm weather, mercurial purges are much better
suited. It is well, sometimes, to combine the calomel with
opium and ipecacuanha, by which the irritation is mitigated.

Evacuations having now been freely made, we may substitute
for calomel, the oil, or what sometimes answers better, the sul-
phate of magnesia.

Gamboge has been affirmed, on the ground of experience, to
be a useful purgative. Cheyne also ascribes great efficacy to
half an ounce of finely levigated cremor tartar, repeated every
four or five hours.

Even the mildest purgative sometimes excites the most dis-
tressing spasm, or, from an exaltation of nervous irritability,
passes directly through the bowels. Here an opiate should be
conjoined, which really assists in the removal of irritating col-
lections, and renders the discharge less painful.

It is a good general rule, to proceed with purgation until
natural, or, at least, essentially improved stools are manifested.
It is easy to conceive how exceedingly annoying must be the
acrid secretions which are incident to the aflection. Still these
very secretions are liable to be sustained by the irritation of our
purgatives. The rule is, therefore, limited.

Opiate S. — To obviate irritation, Dr. Chapman is accustomed
to resort much earlier to the use of opiates, than is generally
approved. Enlarged experience, however, has confirmed him
in their early use. Having, in part, the wish to produce a deter-
mination to the skin, he commonly directs opium in combina-
tion with calomel and ipecacuanha, by which its virtues are
much enhanced.

It is a good plan to give laxatives during the day, and opiates
at nis:ht.

134 DISEASES OF THE ALIMENTARY SYSTEM.

Coming to the conclusion that purgatives have been carried
suliiciently far, we may resort, during the day, to a union of
opium, ipecacuanha, and the blue mass. The usual effect of
this is to give great comfort, and to restore the healthy secre-
tions of the intestines, skin, and liver. Yet when there is a pre-
dominance of tormina and tenesmus, and especially if attended
with discharges of blood, pure or mixed with mucus, the opium
may be more advantageously combined with the acetate of lead.

Either of the preceding prescriptions, however, being given,
an intermission is required occasionally, perhaps once in twenty-
four hours, for the operation of some mild laxative.

The following prescription, called the oleaginous mixture, is
much used as a laxative, in such cases :

R.— 01. Ricini, 3].
Gum. Arab. 3j.
Sacchar. Alb. 3j.
Tinct. Opii, gtts. xl.
Aq. Menth. Siij. ■ ' '-•'

M. 3ss. may be occasionally taken.

In dysentery, particularly when it is seated chiefly in the
rectum, injections of laudanum and mucilage will be very bene-
ficiaUjff^ A suppository of two or three grains of opium will
sometimes be better retained.

Tobacco injections and fomentations have been recommended.
The former may be made of the strength of ten grains to six
ounces of hot water — the whole of which may be injected. We
ought to be very careful in the use of tobacco, on account of its
sometimes fatally depressing effects.

Cold barley water, or flaxseed mucilage, or melted lard, are
very serviceable injections. Some prefer ice-water, which might
well suit hasmorrhagic cases. These are also well treated with
the solution of acetate of lead.

But, above all, Dr. Chapman recommends leeching around
the verge of the anus, as being the best of all local measures, to
relieve the pain and spasm.

A C t J. V e S W c a t i n g. — This, after the employment of due san-

DYSEJNTERIA, OR DYSENTERY. 135

guineous and other depletion, may be properly effected by the
administration of the Dover's powder, and vapour bath.

A Flannel Bandage from the hips to the axillas, has been
said to be beneficial.

Blisters. — The activity of the phlogosis having been deci-
dedly subdued, these become quite useful. The skin having been
reddened by the blister, the latter may be taken oflT, and a poul-
tice substituted.

Upon the occurrence of a sinking state, those stimulating
remedies may be resorted to, which will be mentioned in the
consideration of the congestive form.

D 1 E T. — Should consist exclusively of the mucilages.

CONGESTIVE OE TYPHOID DYSENTEEY.

SYMPTOMS.

The most prominent feature of this form is a want of reac-
tion. Tiie skin continues cold, damp, and mottled, or, as may
happen, partially dry and heated ; the tongue loaded and dark ;
and there is much gastric, and occasionally some cerebral
disorder.

Contracted under peculiar circumstances, the disease has re-
ceived a modification partaking of the nature of scurvy. To
many of the symptoms already detailed, are here added soft,
spongy, livid gums, occasionally so ulcerated, that the teeth
become loose and fall out ; the lips and mouth are livid, and the
breath foetid ; while, more or less, over the whole body, though
particularly on the extremities, large blue or purple spots are
dispersed.

CAUSES.

The congestive species of the affection is principally met
with in crowded, ill-ventilated places, — as in ships, hospitals,
prisons, besieged towns, and camps.

The cause to which, when thus appearing, it is generally
assigned, is contagion. The effluvium is by some supposed to
spring immediately from the excrementitious discharges ; while
others suppose it to be the product of their putrefaction. There
seems to be, however, no substantial demonstration of the
truth of either of these theories. The probability is, that
typhoid dysentery is the result of a contaminated atmosphere.

CONGESTIVE OR TYPHOID DYSENTERY. I37

acting at a time when there is a predisposition to dysenteric
disease.

Other causes are, epidemic influences, and those causes
ah'eady enumerated as productive of the inflammatory variety.

PROGNOSIS.

Sometimes extremely intractable, and fatal.

AUTOPSIC APPEARANCES.

Generally, in place of the marks of active phlogosis, we
meet with turgescency of the vessels of the intestines, with
ecchymosis and softening of the mucous tissue, and perhaps
gangrene of all the coats. Various other abdominal viscera
are frequently involved, and sometimes the brain.

PATHOLOGY.

The peculiarity evidently consists in there being, instead of
an actively inflammatory state, a congestive condition, with a
tendency to rapid disorganization.

TREATMENT.

A low, collapsed state existing, the skin is to be excited by
the Vapour Bath, Stimulating Frictions, Sinapisms, 6z:c.

Venesection. — Indicated by an increased warmth of skin,
a rising of the pulse, and particularly by acuteness of pain.

Cups, or Leech e s. — These may be used where venesection
is inadmissible, and are our chief dependence for overcoming
congestion. Leeches around the anus are highly useful, espe-
cially when there are large sanguineous stools.

Emetics. — Well suited to this form, even when the stomach
is not loaded with irritating contents. The best of the class is
the chloride of sodium.

Mercury, — It is the custom in India to rely much upon the
production of ptyalism. With this view some practitioners

rn

138- DISEASES OF THE ALIMENTARY SYSTEM.

there, give it in the dose of a scruple several times a day. Dr.
Chapman, however, usually directs one or more ordinary doses
of calomel, according to the urgency of the occasion, to be
hastened in their operation by the castor oil, or neutral salts,
and then a combination of it with opium and ipecacuanha, in
small and repeated doses. Now and then, he recurs to enemata
and the other palliatives of suffering enumerated under the In-
fiammatory Form.

Blisters. — To the abdomen, and extremities.

Stimulant Diaphoretics here promise a great deal.

More stimulating remedies may be henceforward demanded.
Among these may be mentioned the carbonate of ammonia, the
spiced wine, and oil of turpentine, which last is to be preferred
in the passive haemorrhage incident to the disease. Other re-
medies are the sulphate of quinia, charcoal to correct the foetor,
infusion of capsicum by mouth, and by enema, and the nitric
or nitro-muriatic acid in the scorbutic variety.

D IE T. — In the early stage, should be like that in the inflam-
matory form ; but when debility of the vital forces has super-
vened, to the farinaceous articles may be added, wine, chicken,
mutton, or beef tea.

An intermittent is sometimes conjoined with dysentery. The
best plan, here, is to neglect the former until the latter is re-
duced. The same principle holds in the complication of dysen-
tery with rheumatism, and some other diseases. But it is here
supposed that the bowel affection is strictly inflammatory. In
the low forms, the quinine might be adapted to both complaints.

'A^ . . ^ U

DIAUEHCEA, ALVI FLUXUS.

D E F I N I T I 0 N.— Any affection where the contents of the
bowels, in a fluid or thin state, are too frequently discharged.
This appellation is objectionable, as not expressing the patholo-
gical condition.

SYMPTOMS.

If the case proceed from offensive ingesta, nausea or vomit-
ing : surface cold and pallid, and pulse feeble. Sometimes
approaches as a febrile affection, commencing with anorexia,
foul tongue, chilliness and flushings, a quick, tense, irritated
pulse, and dry skin.

The bowels flatulent, rumbling; sometimes tormina and
tenesmus, with a sense of weight and distension.

The stools are thin and watery, or thick and tenacious, gluti-
nous or jelly-like, consisting of slime or mucus, and of an
ochreous, or clayish, or ashy, or slaty, or yellow, or green, or
blue, or dark, or pale, or of a milky appearance, or purely
bilious. When milky, falsely supposed to contain chyle, and
hence the term Diarrhasa cliijhsa. The discharge of bile, not
strictly diarrhoea. Or the discharges may be ingesta, fluid or
solid, passed out unaltered, and then called Lientery.

CAUSES.

Irritating ingesta, cathartics urged to excess, constipation,
cold, heat, putrid exhalations, mental emotions, dentition.

140 DISEASES OF THE ALIMENTARY SYSTEM.

DIAGNOSIS.

Resembles dysentery, and differs from it only in degree.

PROGNOSIS.

Favourable. When chronic it may run into dysentery.

AUTOPSIC APPEARANCES.

Slight phlogosis or congestion of the mucous membrane of
the large intestines, or softening, or enlarged follicles; or the
membrane pale, relaxed, and flaccid.

PATHOLOGY.

Diarrhcea is a mitigated Dysentery. In diarrhoea there is
more of irritation than inflammation. It is seated in the mucous
coat. The irritation may be of the exhalant vessels, or of the
mucous follicles, or both. When caused by cold, it is purely
catarrhal, or consists in a transfer of function from the skin to
the mucous membrane. The irritation extending to the liver,
we have bilious discharges, or a suppression of bile. Lientery
is referable to a high grade of irritability throughout the whole
of the alimentary canal.

The immediate seat of the affection is generally in the large
intestines.

TREAT I\I EN T.

Caused by iiigesia, an
Emetic, followed by

R li u b a r b, or M a g ii e s 1 a, or Castor Oil. Should there be
fever,

V e n e s e c 1 1 0 n, and a

Mild D i an li 0 r e t i c mixture, of which an

DIARRHCEA, ALVI FLUXUS. 141

Opiate is the basis. If caused by a checked perspiration,
reinstate the function of the skin, by a ^

P c (1 i 1 u V i II m, or general B a t li, followed by combinations of
ipecacuanha and opium, e. g.,

Dover's Powder. Lientery is best managed by an

Opiate, with astringents or absorbents, such as the creta-
ceous preparations, in connexion with local bleedings and
counter-irritation. The liver being implicated, a resort may
be had to

Mercury.

«

DIE T. — Same rules as in dysentery.

CHOLEIRA MORBUS.

DERIYATIONof this name, from x^^^b ^H^, and fiw, to flow,
and morbus, disease, — meaning a bile flux. This name inap-
plicable, as an excess of bile is rare, and the discharge is only a
symptom.

The disease recognised" by ancient writers. Hippocrates
alludes to it.

SYMPTOMS.

VIOLENT FORM.— Great variations in degree of violence.
An attack usually comes on suddenly, or with little premonition.
The earliest affections are soreness, and distension over the
abdomen; fulness, tensive uneasiness, and oppression at the
epigastrium, with borborygmi and twisting, colicky pain about
the umbilicus — ejections of the contents of the stomach, mixed
with a watery fluid or ropy mucus, and morbid secretions, of
different hues, cramps and pain in the back. Discharges from
the bowels, watery. Bile, rarely evacuated.

During the intervals of vomiting, there are nausea, thirst, and
wretchedness. As the case proceeds, the evacuations upwards
and downwards recur more frequently, the cramp and spasms
are exasperated, the trunk is rigid, fingers clenched, the ex-
tremities distorted, constituting a tetanoid condition. In the
interval of the paroxysms, exhaustion, confusion, noises in the
ears, or deafness.

The pulse throughout feeble, henceforward more so — increased
depression of strength — cold, damp, collapsed surface — haggard
countenance — burning in the stomach or at the umbilicus — de-
sire for cold drinks — tongue moist, white, or milky — pukings

CHOLERA MORBUS. 143

and purgings more frequent and copious, of a fluid resembling
greasy or dirty water, or like coffee-grounds, or the settlings of
port wine — scanty or suppressed urination.

Hereafter, there is a rapid sinking, approach to exhaustion —
pulse tremulous, thready, hardly perceptible — extreme jactitation
continues — muttering delirium — low, stammering, sepulchral
voice — the skin cold — lividness of the countenance, fingers, and
nails — impeded, anxious respiration, singultus, sunken eyes, hol-
low cheeks, and purple or pallid shrivelled lips. (This account
was written before Dr. Chapman had any knowledge of epidemic
cholera.)

MILDER AND MORE ORDINARY FORM. — Commences
with sickness of stomach, flatulence, puking and purging of
watery fluid, cold damp skin, weak pulse, cramp of the bowels,
and sometimes of the extremities.

Cholera is incident, chiefly, to close, sultry, autumnal weather ;
occurring, however, sporadically, at all seasons, and in every
climate. Endemic in our foggy, marshy districts, and portions
of the India Peninsula.

CAUSES.

Paludal exhalations, putrid animal eflluvia: — oftener traced to
cold or moisture succeeding to heat or dryness, to exposure to
the sun, to a draft of air, to dampness or coldness of the night,
to sleeping with open windows, to wearing thin apparel, entering
cellars, or to whatever checks perspiration. Also, excited by
offensive ingesta, by crude, unripe fruits, or raw, or imperfectly
cooked vegetables ; by tainted shell-fish, by a debauch in eating
or drinking; by poisonous matters, as copper or arsenic; by
harsh emetics or purgatives, or by fatigue. It is induced by
passion, by grief or terror.

Cholera prevails as an epidemic. It broke out in India in
1817, and has since spread over Europe and this country, visit-
ing, indeed, nearly the whole world. The true explanation of
its origin is to be sought in an epidemic influence.

144 DISEASES OF THE ALIMENTARY SYSTEM.

DIAGNOSIS.

Cholera may be distinguished from coUc, by the absence of
constipation ; from diarrhosa and dysentery, by more severity
of spasm, and by the evacuations being unmixed with bilious or
bloody matters.

PROGNOSIS.

The issue is uncertain.

FAVOURABLE SYMPTOM S.— Subsidence of cramps, and
of the turbulent state of the alimentary canal ; bilious evacua-
tions, rising of the pulse, restoration of temperature, genial mois-
ture of the surface, undisturbed sleep.

UNFAVOURABLE SYMPTOM S.— Extreme reduction of the
pulse, prostration of strength, short, hurried respiration, cold-
ness of the surface, clammy svi^eats, livid lips or fingers, tumid
abdomen, watery, greasy, and dark flocculose discharges, sup-
pression of urine, hiccup, haggard countenance, delirium.

AUTOPSIC APPEARANCES.

The stomach and bowels relaxed, flaccid, pale; the latter
contracted, convoluted, or twisted, or vessels turgid, or phlo-
gosis. Congestion of the Uver, and of the other abdominal vis-
cera. The lungs sometimes engorged, and also the brain. The
head contains thick, viscid, black blood, and the blood drawn is
of a similar appearance.

PATHOLOGY.

The primary irritation commences in the stomach, and, by
sympathy, extends to other organs. In proof of this, the causes
act primarily on the stomach, and the first ejections by vomiting
consist merely of the contents of the stomach. Bile is not thrown

CHOLERA MORBUS. I45

up, before the biliary organs are secondarily afiecled. The liver
being thus affected, it is stimulated to increased efforts, and we
have the bilious discharges. But in a short time the energies
of the stomach give way. The liver, sharing in this debility, is
unable to return the blood which rushes into it, and engorgement
and suppression of the hepatic secretion take place. These views
are sustained by the history of the causes of the disease, its symp-
toms, the phenomena on dissection, and the method of cure, and
by the fact that the disease may be imitated by certain irrita-
tions of the stomach. The change in the blood is secondary,
and this change, as well as every other link in the series of
events constituting the disease, is referable to the impressions
on the stomach, and through it on the ganglionic nerves, and
thence to the spinal marrow and brain. The state of the mucous
surface of the digestive tube, varies in different cases and stages.
At first merely irritation of the exhalants, though subsequently
inflammation may ensue.

TREATMENT.

The indication is, the removal of the gastric irritation. To
accomplish which, must first be removed, the irritating contents
of the stomach —

By an Emetic, — ipecacuanha, gr. xx., promoted by warm
water, the stomach is tranquillized, spasm overcome, congestion
removed, the balance in the circulation restored, and the system
emerges from prostration. An emetic might be hazardous or
inadmissible in extreme prostration, nor is it always demanded.

No offensive matter existing in the stomach, the indication is
to calm irritation, and subdue spasmodic pain and turbulence.

Combinations with Opium, e. g., potash mixture with lauda-
num, spirits of camphor, or camphor water, with nitrous acid,
laudanum, and acetate of lead, and opium. Laudanum, opium,
or old opium pill. Calomel, in doses of gr. viij. to gr. x., some-
tiuies.

If the stomach reject all these, an anodyne ene?na, or the en-
dermic use of morphia.

10

146 DISEASESOF THE ALIMENTARY SYSTEM.

Cups or Leeche s. — A sinapism over the epigastrium, and
the latter to lower extremities.

If heavy congestion exist, Tenesection, guided by the pain
and constitutional vigour, even if the pulse be very low, drawing
blood slowly. In doubtful cases, topical bleeding from the abdo-
men or spine, if pain in it, or spasm ; preceded by sinapism,
warm, or vapour bath, hot fomentations and frictions.

The disease soon may reach a stage requiring stimulanis.

1st. External. — Sinapism, blisters, dry heat, rubefacient
frictions.

2d. Internal remedies. — Liquor ammonias, solution of cam-
phor in ether, spirits of turpentine, tinct. of capsicum, hot toddy,
mintjuJej), and

Opium. — When not forbidden by cerebral disturbance.

To suspend the retchings and spasms, To ui'ui que ts to the
arm and thigh of opposite sides.

Strapping the patient to a board in the horizontal position,
said to suspend vomiting, and aid the retention of remedies.

As soon as the stomach becomes retentive, Purges are
usually required.

Calomel in large doses, or castor oil or other laxatives, and
afterwards, if the secretions be deficient, recur to calomel in
small doses, alone or with opium.

REGIME N. — No food ; drinks, cold lemonade, cold water, or
ice. Chicken water as soon as the stomach will bear it.

CHOLERA INFANTUM.

This disease of children is perhaps peculiar to the United
States.

The period of its greatest prevalence is between the ages of
twelve and eighteen n^onths. Tt mostly begins among us in
July, and continues till the accession of frost. It may, from its
destructiveness, be called the scourge of children.

Its popular name is the Summer Com'plaint

S Y I\l P T O M S.

It may approach like a dysentery, though sometimes its com-
mencement more nearly resembles a cholera morbus. Its most
common and characteristic presentation, however, is that of
gastro-enteritis, in every gradation of violence, from simple
irritation to the most intense phlogosis. Cerebral affection is
sometimes early manifested in a tendency to delirium or stupor.

The fever, when confirmed, is of an irregular remittent
type. The desire for drinks is now unquenchable.

The evacuations are watery, or slimy, or mucoid, or like
coffee-grounds, or deep green, or of a colourless fluid, leaving a
pink margin around the soiled portion of the napkin. They
have usually a sour or putrid odour. Great irritability of the
alimentary canal existing, the ingesta pass off immediately, as
in lientery.

When the attack runs a lengthened course, few diseases
exhibit more emaciation, or greater alteration of condition and
aspect.

The alvine discharges sometimes, at this period, amount to
forty or fifty in the twenty-four hours.

148 DISEASES OFTHE ALIMENTARY SYSTEM.

Towards death, the face and belly may become bloated, the
feet oedematous, and the mouth sprinkled with aphthae. The
mental faculties and senses are apt to become extremely torpid.

This protracted form of the disease may continue five or six
weeks,

CAUSES.

Exclusively incident to children, and almost so to those living
in cities.

Damp, murky weather, is favourable to the origination of
the disease.

Exciting causes are improprieties in diet or clothing, teething,
worms, and premature weaning.

DIAGNOSIS.

The affection may in general be easily recognised. Should
it be confounded with diarrhcea, dysentery, or cholera morbus,
it will probably, in such cases, be essentially the same with these
diseases, and exact no difference of treatment. Even when
mistaken for the common irritation of teething, the treatment is
so analogous, that nicety of discrimination is not required.

PROGNOSIS.

A prognosis is very hazardous, since the most favourably
looking cases are apt to terminate fatally, and vice versa. The
chances, however, are vastly greater, other things being equal,
when a free ventilation is commanded.

The appearance of dark bilious or natural stools, is a most
propitious sign.

Among other unfavourable signs, too obvious in their cha-
racter to be here mentioned, may be stated the purging of a
pink-coloured fluid, or the fluid which leaves a pink stain
around the soiled part of the napkin. This is an almost certain
indication of death.

CHOLERA INFANTUM. 149

AUTOPSIC APPEARANCES.

The brain in recent cases presents only slight venous con-
gestion, or where cerebral excitement has existed, phlogosis of
the membranes. But in protracted cases, effusions are often
observable.

In the alimentary canal, especially the upper part, we have
the evidences of inflammation, and often contortion and intro-
susceptions of the intestines.

The peritoneum may exhibit a morbid appearance, and effu-
sion in its cavity. The liver, in cases of long continuance, is in
some instances so much hypertrophied, as to occupy two-thirds
of the abdominal cavity. On the contrary, it has appeared atro-
phied, and the spleen correspondently augmented.

PATHOLOGY,

The disease, in its most familiar presentation, is a gastro-
enteric affection, soon involving the liver. The excitement of
the stomach and intestines, being communicated to the liver,
produces at first an increased flow of bile ; but the liver being
long subjected to this high action, becomes exhausted, and its
secretory power suspended. But in other cases, the inceptive
impression is so strong, that the secretion of bile is at once
arrested, and a lientery, perhaps, succeeds. The brain, and
system in general, become soon involved in the play of sym-
pathies-

TREATMENT.

1, The attack being of a dysenteric nature,

C a s t 0 r 0 11 a n (1 L a u d a n u in are well adapted to its cure.

2. But simulating cholera morhtts, it is proper to begin
with

An Emetic; this will clear the stomach of its irritating con-
tents, check vomijing, and create a tendency of blood and
nervous excitement to the surface.

]50 DISEASES OF THE ALIMENTARY SYSTEM.

The other treatment consists of the

Warm Bath,

Frictions and Sinapisms, and above all,

Opiate Enemata.

To quiet the stomach, when exceedingly irritated, may be-
come a leading indication.

3. We come now to the legitimate or ordinary form of the
aflfection, which has been stated to be a gastro-enteritis.

Best is it, when reaction is not complete, to resort to the

Warm B a t li, and a

Sinapism over the Stomach.

Febrile excitement, however, being developed, the measures
are.

Venesection in some cases;

Leeching at the epigastrium may generally supersede vene-
section.

Colli Applications to thi ^cal])^ kexhivg to i/ie hack of
the neck, or behind the ears, and a moderate stimulation of the
lower extremities, when there is a tendency to hydrocephalus.

The continual purging which some practitioners employ in
this and other bowel affections, is a great curse. Vitiated secre-
tions are merely the effect of the intestinal irritation.

Phlogosis having been reduced, and moderate evacimtions
having been premised. Dr. Chapman is accustomed to direct

A Combination of Opium, Ipecacuanha, and
Calomel.

This prescription is as follows.

R. — Calomel, gr, iij.
Ipecac, gr. ij.
Gum. Acac. xx.
Pulv. Opii. gr. 5
M. at in pulv. vj, div.

Of these, one powder may, on an average, be given every
two hours.

An occasional dose of the oleaginous lyiixture may be neces-
sary for the removal of acrid colluvies.

The Warm Bath. — To promote determi^iation to the sur-

CHOLERA IJVFANTUxM. 151

face, the head and belly being hot, and the feet cold, it will
be better to employ a stimulating pediluvium, and apply cold to
the heated parts.

Blisters to the extremities fulfil the same indication.

Should cholera infantum have passed by bad treatment into
a diarrhoea, the cretaceous p-eparations and opiates become
suitable.

When the diarrhtija has become purely chronic and colli-
quative, the astringents and tonics ai'C indicated. But before
making use of these remedies, we should be sure there is neither
phlogosis of the intestines, nor congestion of the liver. The
existence of the former demands the mildest anodynes, and
that of the latter, mercury and opium.

The discharges, however, being gleely and glairy, instead of
serous, the balsams and terebinthinates should be preferred.

Anodyne Enemata are as well suited to the mucous as the
watery evacuations, and particularly when there are tormina
and tenesmus.

AJlannel roller around the abdomen has been productive of
signal utility.

REGIME N. — In the early stage, when there is much gastric
disturbance, milk is apt to form tough clots, and severely aggra-
vate the inflammation. The mucilaginous drinks should there.
fore be substituted.

But when this acid condition of the stomach subsides, then
nothing is so well adapted as human milk. At a later period,
sago, tapioca, and other farinaceous articles may be preferable.

Extreme debility supervening, a little ham may be allowed.
But the best restorative is COUNTRY AI R.— Dr. Chapman
gives the following rules for prevention:

1. Never permit a child to be weaned within the year.

2. Let the cold bath be daily used.

3. Direct the use of flannel next to the skin, and worsted
stockings.

4. Let the child be fed on milk with the farinaceous articles ;

152 DISEASES OF THE ALIMENTARY SYSTEM.

and after the sixth or eighth month, it may be accustomed to
the use of weak broth without spice.

5. During dentition, lance the gum whenever it begins to
swell.

6. Above all, let the child, when practicable, be removed to
the country, early in the season, and there remain until the
return of cool weather.

COLIC A, OE COLIC.

Of this afiection, Dr. Chapmdn makes three divisions. — 1.
Crapulent or Flatulent Colic. 2. Bilious Colic. 3. Saturnine
Colic.

FLATULENT COLIC.

Much of what is said of this form, equally applies to the two
others.

SYMPTOMS.

Sickness of stomach; spasmodic pains; flatulent distension,
borborygmi, twisting around the navel, and occasionally
cramps of the abdominal muscles, and of those of the lower
extremities, and unrelenting constipation. The vomiting is
sometimes violent, the substance discharged may finally be
stercoraceous. The pulse, at first little changed, soon becomes
feeble and diminutive, and the surface cold. Should inflamma-
tion occur, the pulse is hard and corded, the temperature of the
body very unequal, and the abdomen tender.

If relief be not afforded, this state is succeeded by a return
of the diminutive pulse, cold damp skin, abatement, or cessation
of the pain, a haggard countenance, singultus, and the other
signs of approaching dissolution.

CAUSES.

Indigestible articles of food ; the vinous or alcoholic liquors ;
collections of indurated faeces.

154 DISEASES OF THE ALIMENTARY SYSTEM.

Exposure to cold, and particularly when followed by a meal
during the chill. Sympathy with distant parts. Lesions of the
spinal marrow.

The stomach and intestines sometimes acquire an extraordi-
nary irritability.

DIAGNOSIS.

To distinguish the stercoraceous vomiting proceeding from
an introsusception of the intestine, from that proceeding from
an inverted peristaltic action without an introsusception, is im-
possible.

Colic is diagnosticated from enteritis by the paroxysmal and
spasmodic nature of the pain, the relief at first afforded on pres-
sure, and by the flatulence and correspondent intumescence.

But to hernia, it is very analogous, both in the early and late
stages. In doubtful cases, an examination should always be
made.

PROGNOSIS.

Colic is for the most part easily managed. The ejection of
stercoraceous matter is an almost fatal sign.

AUTOPSIC APPEARANCES.

The intestine distended with flatus, ingesta, or fseces. It is
sometimes alternately contracted and dilated, exhibiting a series
of pouches.

The case being of long continuance, with manifestation of
spasm, we meet with the marks of phlogosis, and occasionally
with introsusceptions. The last are sometimes accompanied
with gangrene, though more generally by no lesion whatever.
Many of them are probably formed at the point of death. They
occur chiefly in the ileum. The upper is mostly received into
the lower portion. Knots in the intestine are also sometimes
formed.

The stomach occasionally participates in the spasm, and it,

FLATULENT COLIC. I55

together with the parietal peritoneum and liver, may be found
in a state of phlogosis.

PATHOLOGY.

The disease may be seated in any portion of the alimentary
canal; though its principal location is about the ileo-coecal
valve.

Commencing in simple spasm of the muscular coat, it inva-
riably terminates, if long continued, in phlogosis. This may be
confined to the muscular tissue, or it may involve the others.

The pain has been generally attributed to spasm, but more
correctly to the flatulent distension.

The immense formations of gas, are ascribable in some in-
stances to the decomposition of the intestinal contents, and in
others, to its secretion by the mucous membrane.

TREATMENT.

The colic arising from offensive matter in the stomach, it
should be removed by an Emetic. An attempt should next be
made to subdue pain and calm irritation by the cordial, carmi-
native, and anodyne preparations, such as ether, Hoffman's
anodyne liquor, ginger tea, the essential oils, &c. The same
effect is sometimes gained by large draughts of tepid water, or
still better, of very hot water, and, in particular cases, of very
cold water.

Colic dependent on constipation, demands, of course, the
Purgatives, the best of which is an ounce of castor oil, com-
bined with a drachm of the oil of turpentine. It may happen
that this state is owing to accumulations of indurated fiuces in
the rectum, to be removed by scooping them out.

Colic caused by cold only, may be cured by an opiate dia-
phoretic, without premising any evacuation. This should be
conjoined with warmth applied to the surface. For the expul-
sion of flatus, the tcrebinthinate, or assafoctida encmata are
excellent. A long bougie introduced into the intestine some-
times answers a very good purpose.

156 DISEASES OF THE ALIMENTARY SYSTEM.

For introsusception, when it can be diagnosticated, which it
never can be with any certainty, the best measure, probably, is
a large anodyne enema. This is certainly the most appropriate
treatment of stercoraceous vomiting, when not connected with
an invagination.

On the occurrence of phlogosis, every stimulating remedy
must be forborne, and the lancet resorted to. Next we may
employ topical bleeding, and ultimately a blister.

BILIOUS COLIC.

SYMPTOMS.

The attack is occasionally preceded by the evidences of
hepatic derangement. At other times, it comes on with a chill,
followed by a fever, attended w'ith more or less perturbation of
the alimentary canal, characteristic of colic. But it is as fre-
quently introduced by violent vomitings. Bile is rarely thrown
up in the commencement ; is thrown up very copiously after a
time, and ceases at a still more advanced period, owing to a
torpor of the liver from over-excitement. The retching, how-
ever, still continues.

Whatever may have been the mode of commencement, the
pulse gradually rises till it acquires much force and volume.
Sometimes, when the aggression is very violent, no reaction
takes place, and the collapse may be as complete as that in
malignant cholera.

Excruciating pain about the umbilicus ; acute or dull pain
in the head, and often depravation of vision ; mind occasionally
affected, and at times nervous tremors, or paralysis of the upper
extremities.

CAUSES.

The causes of autumnal fever; irritating ingesta ; and epi-
demic influence.

DIAGNOSIS.

Distinguish from other colic, principally by the bihary de-
rangement, and the fulness and activity of pulse.

158 DISEASES OF THE ALIMENTARY SYSTEM.

PROGNOSIS.

Pretty much like that of flatulent colic. Very favourable is
the reappearance of bile after its suppression ; and most unfa-
vourable, of course, is a want of reaction.

AUTOPSIC APPEARANCES.

Much like those of flatulent colic. The liver is disordered,
particularly by congestion. The stomach and intestines are
more afiected by inflammation than in the other variety.

P A T H O L O G Y.

The chief point of dispute, is whether the liver is preter-
naturally excited, or depressed into torpor. There is, however,
every reason to believe that in the advanced stage it becomes
torpid.

The nervous and cerebral disturbance may be either original
or secondary.

TREATMENT.

As a febrile affection, attended with intestinal spasm, or
phlogosis, and hepatic, and other congestions,

Venesection is demanded, and should in violent cases pre-
cede all other remedies.

Topical Bleeding and Fomentations, or Counter-
irritants, to the epigastrium. Not quieting the stomach by
these means, and especially if we have reason to attribute, the
nausea to irritating contents, we should direct

A n E m e t i c.

An Old 0 p i Q m P i 1 1, or an 0 p i a t e E n e m a t a.

The AVarm Bath. — As soon as the stomach will bear a pur-
gative, this should be given. But not succeeding in our attempt
to open the bowels, we may, if there be force in the pulse, or
any intensity of pain, repeat venesection. Topical bleeding

BILIOUS COLIC. 159

may be also applied to the abdomen, though, at this juncture, it
may do much greater service if applied to the spine.

Still not succeeding in procuring a stool, we resort to

Purgative Injections. — Senna tea, with a drachm of
jalap in it, is very good in this case. Tobacco enemata are
here justly esteemed. Distending the bowels with tepid water
is a further expedient. It should be recollected that the mildest
enemata, by relaxing spasm, will prove effectual, when the most
active, and particularly those of a harsh nature, are unavailing
or aggravatory.

In regard to purgatives, it ruay here be mentioned, that the
lenient articles are usually most suitable. The drastics often
render the spasm still more violent. Castor oil, or Epsom salts,
alone or combined with magnesia, are valuable ; but senna tea
is on the whole to be preferred. A great favourite with Dr.
Chapman, is a combination of a grain of opium, with five of
calomel, repeated every two or three hours.

A Blister may be applied to the abdomen, or, in the event
of spinal irritation, to the spine.

The case having been thus prepared, nothing is so valuable
as the

Mercnrial Impression.— It is well calculated to over-
come obstinate constipation, and to prevent disorganizations.

COLICA PICTONUM, OR PAINTERS' COLIC,
DEVONSHIRE COLIC, ETC.

Its popular titles with us are lead colic and drij belly-ache.
SYMPTOMS.

Coming on gradually, nothing nnay at first be complained of,
except a general feeling of wretchedness, uneasiness in the epigas-
trium, and right hypochondrium, indigestion, and constipation.

Or, without this premonition, the disease may at once com-
mence with pain at the pit of the stomach, descending to the
intestines, a twisting sensation around the navel, nausea, obsti-
nate constipation, and frequent though ineffectual desire to go
to stool.

The pains soon increase in violence, and the abdomen be-
comes exquisitely tender. The muscles of the abdomen and
the lower limbs contract in hard knots, and there is incessant
vomiting.

Some cases much resemble dysentery.

In most instances, paralytic affections supervene.

It scarcely ever lasts less than five days, and may endure
months.

When the disease becomes decidedly chronic, the nutritive
process is greatly vitiated, emaciation ensues, the countenance
is sallow or leaden, the secretions are diminished, and the mind
is very irritable, or imbecile; and thus the affection proceeds,
until usually it settles down into invincible palsy of the inferior,
though oftener of the upper extremities.

It may also terminate in mania, epilepsy, loss of some of the
senses, or dropsy.

COLICA PICTONUM. IQI

CAUSES.

The internal use of the preparations of lead, or an external
exposure to them. Thus, persons have contracted the disease,
from eating things which had been contained in a leaden or
glazed jar, from drinking liquors impregnated with some satur-
nine preparation, possibly, in some instances, from drinking
water which had been conducted through leaden pipes, from
living in the vicinity of lead-works, or even from living in rooms
recently painted.

It is ascertained that the carbonic acid commonly contained
in water, will act upon the pure metal.

Dr. Chapman has never seen the colic result from the use of
the acetate.

The affection has been ascribed to some other metals, and also
the causes already detailed as productive of the other kinds of
colic. But it is probable that in the instances in which this
reference was made, there was either some unthought of expo-
sure to lead, or the disease was really bilious colic.

DIAGNOSIS.

Distinguish from bilious colic by the unexcited condition of
the pulse, the absence of very marked biliary disorder, the ten-
dency to paralysis, and the mode of origin.

PROGNOSIS.

The cure is difficult and slow, even in the most recent and the
mildest cases ; but old and complicated ones may be deemed
desperate.

AUTOPSIC APPEARANCES.

The reports of morbid anatomists on this subject are very
inconsistent. Paris, Roche, and Sansom declare that they found
the intestines contracted ai several points, with a hard dry mat-
11

162 DISEASES OF THE ALIMENTARY SYSTEM.

ter in the intervals, and the mucous membrane reddened, thick-
ened, and ulcerated.

PATHOLOGY.

Rather uncertain. The best opinion at present seems to be
that the disease is a modified neuralgia, particularly of the
spinal and sympathetic nerves, the irritation of which, when
intense and enduring, sometimes leads to inflammation.

TREATMENT.

Taken in the inchoative stage, it may be sometimes arrested
by purgatives and a subsequent use of opiates.

But the disease being formed, more decided measures are
necessary.

The indications and remedies do not differ much from those
of bilious colic.

Notwithstanding the state of the pulse, unless it be extremely
depressed, Dr. Chapman resorts first to

Venesection, and afterwards to

local Bleeding and Blisters along the spine.

Calomel and Opium may then be used as a purgative.
Their action may be assisted by all the means pointed out in
the treatment of bilious colic. For relaxing spasm, we may
resort to the warm bath, fomentations, the tobacco cataplasm,
or tobacco fumes introduced into the abdomen.

Purgation having been elTected, the remaining treatment
consists of opiates, laxatives, and mercury. The last, used in
doses suited to produce the constitutional impression, is the
most effectual means of eradicating the disease, and its sequelas,
— paralysis, &c.V^

PROPHYLAXIS.

The effluvia from the saturnine preparations should never be
suffered to come in contact with an empty stomach. Dr.
Chapman has been assured by one of our most extensive manu-

COLICA PICTONUM. 163

facturers of white lead, that even a spoonful of oil, taken occa-
sionally, with this view, is very efficacious.

An occasional draught of diluted sulphuric acid, prepared in
the form of lemonade, will make a sulphate of lead, which is
insoluble and inert.

The hands of a workman should be washed, and his clothes
changed, after work.

As an antidote to any of the saturnine articles received into
the stomach, the sulphate of magnesia or of soda, is the best.

ACUTE PERITONITIS.

This treatise will chiefly regard parietal peritonitis.

SYMPTOMS.

Being introduced by languor, chilliness, and rigors, aches in
the back and inferior extremities, the disease is developed by
the supervention of fever, oppression of the epigastrium, more
or less acuteness of pain in the lower part of the belly, some-
times circumscribed, though it may be diffused. The pain in
the beginning is apt to fluctuate, and may be thus characterized
throughout the case ; but it is more apt to become fixed. The
covering of the bladder being concerned, there will be difficulty
of urination ; of the diaphragm, straightness, often spasmodic
uneasiness, and, uniformly, singultus; of the stomach, nausea
and vomiting ; and of the intestines, constipation, &c.

Sometimes, thirst, internal heat, and dryness of the fauces ;
pulse small, quick, and corded.

In the course of twenty-four hours, the sensibility is so great,
that the weight of the bed-clothes can scarcely be borne. The
pulse becomes upwards of one hundred in a minute, the tongue
loaded with a white fur, or clean with polished tip and edges,
and the countenance assumes the aspect of distress.

The symptoms progressing in violence, the abdomen may
become greatly swollen, from flatulence of the bowels, or em-
physema of the subcellular tissue.

At this time, it is not rare for the pain suddenly to cease.
Simultaneously, the pulse sinks in force, while it vastly in-
creases in rapidity. There are vomitings of dark blood, sin-
gultus, and collapse. In children, a sudden translation may
take place to the brain, productive of convulsions.

ACUTE PERITOJNITIS. 165

Like gastritis, this phlegmasia may exist in a state of disguise.
DURATION. — Peritonitis may run its course in five or six
days, or even half that period.

CAUSES.

No age is exempt, though that of maturity is most suscep-
tible of the disease.

Various applications of cold, mechanical violence, extrava-
sations into the peritoneal cavity, the sudden suppression of
customary discharges, parturition, recession of rheumatism,
gout or cutaneous eruptions, and epidemic influence, are among
the causes.

DIAGNOSIS.

Distinguish from gastritis, enteritis, and colic. Very charac-
teristic of peritonitis is the tenderness and early tensiveness of
the belly, rare inclination to go to stool, and the little mitigation
of pain experienced from alvine discharges. The patient lies on
his back, with the legs drawn up, in order to throw the weight
of the intestines on the spine, and relax the abdominal muscles.

It is discriminated from neuralgia of the abdominal muscles
or peritoneum, by the absence of constitutional disturbance.

PROGNOSIS.

The case being established, proves, for the most part, exceed-
ingly intractable. Being the result of injuries, or extravasated
fluids, except in the case of dropsy, the prognosis is most unfa-
vourable. The sudden cessation of pain, in the height of the
disease, is the precursor of gangrene and death.

AUTOPSIC APPEARANCES.

Vascularity, or lividness, in patches, or difllised ; adhesions
to the viscera; frequent extensions of inflammation to the tegu-
mentary peritoneum, and the subjacent tissues; extravasations

166 DISEASES OF THE ALIMENTARY SYSTEM.

of coagulable lymph, serum, blood, or pus ; and gangrene, but
never ulceration. The blood may be withdrawn from the peri-
toneum, so as to leave it pallid, in the act of death.

TREATMENT.

Copious Venesection, — Except when reaction is imper-
fect. We should not be intimidated by the weakness of the
pulse, or the appearance of general debility, since these will be
obviated by the blood-letting.

L e e c li i n g. — To the detraction of from six to ten ounces.
Warm Fomentations. — But when the inflammation is in-
tense and the skin hot, and the general vascular action high,
cdd applications may suit better.

Blister s. — When the phlogosis has been decidedly reduced
by the previous means.

Purges of castor oil ; or, where the irritation is moderate,
castor oil in union with the oil of turpentine. They should not
be employed until the inflammation has been somewhat con-
trolled by blood-letting. The bowels having been well evacu-
ated, it will be sufficient to keep them soluble with emollient
enemata.

The foregoing measures proving inadequate, we are next to
direct —

Diaplioretic s. — These determine the blood to the surface,
and change the state of the capillaries. The Dover's Powder,
aided by the Vapour Bath, answers best. This is the time for
the introduction of opium, which should henceforward enter into
combination ivith every remedial measure.

Not succeeding with the above, we may resort to the

Calomel, Opium, and Ipecacuanlia. — Mercurial fric-
tions may be used ; or the raw surface of the blister may be
dressed with the ointment.

We approach the period, in which the vital forces fail, and a
tendency to gangrene supervenes.

Carbonate of Ammonia, or, still better, Oil of Tur-
pentine.

ACUTE PERITONITIS. IQ7

The latter may be also employed in the form of enema, to
obviate the flatulence.

Wine.

The case wearing the typhoid aspect from the commence-
ment, general bleeding should be more limited, and an earlier
resort should be had to blisters, diaphoretics, and mercury.

CHRONIC OE SUBACUTE PERITONITIS.

SYMPTOMS.

May be either a degeneration of the acute disease, or primary.
Being the latter, its approach may comprehend weeks, or
months, without exciting suspicion.

A tightness, or pinching soreness, from one ilium to the other,
though the skin and abdominal muscles are loose. Tlie tight-
ness relieved by evacuations from the bowels, and much in-
creased by constipation. Pain felt on coughing, or sneezing.
Torpor of the bowels, commonly, — the stools indicating a want
of bile; the urinary secretion deficient and vitiated; digestion
depraved, and the appetite impaired ; pulse nearly natural, or
exceedingly accelerated ; tongue more or less furred in the
morning ; thirst urgent, though there is no apparent fever, or
even heat of surface ; face pale, or sallow and languid ; some-
times cough ; and towards evening cedema of the feet and
ankles.

The case being exacerbated, is developed by greater pain,
tension, gastric disorder, constipation alternating with diarrhoea,
slight fever, aggravated in the evening, and a cleaner or florid
tongue.

Those tissues which in even slight acute attacks display the
sharpest pain, may suffer the greatest disorganizations by a
gradual process, without any manifestation whatever.

The disease progressing, involves the constitution in hectic,
and a general cachexia. The cutaneous vessels may become
remarkably turgid. Diarrhcea is usual in the advanced stages.
Whether there be ascites or not, anasarca of the lower ex-
tremities almost always takes place.

May endure from a few weeks, to a space of years.

CHRONIC PERITONITIS. 169

CAUSES.

The acute affection, ill-cured ; the causes of acute peritonitis
acting on an old or impaired constitution, or one cold and
phlegmatic; habitual drunkenness; protracted intermittents.

DIAGNOSIS.

Much like that of the acute disease. Distinguish also from
colitis.

PROGNOSIS.

Usually curable, when no structural lesions have taken place.

AUTOPSIC APPEARANCES.

Besides those incident to acute peritonitis, we may observe
thickening, or a granulated, tuberculated, or ulcerated surface,
adherent hydatids, the intestines agglutinated in masses, disor-
ganization of other viscera, and serum effused in so great an
amount as to constitute ascites.

TREATMENT.

We should at first endeavour to reduce the inflammation by
the means detailed under the preceding head, tempered to the
condition of the system. Much has been said of the value of
mercurial inunctions; which on a proper reduction of phlogosis,
should be, perhaps, resorted to.

Subsequently, the disease continuing, we may maintain a
strictly regulated regimen, and direct calomel, ipecacuanha,
and opium, — the last to be freely used in case of much pain.
But mostly, these instances are probably incurable. Dropsy
coming on, diuretics may be combined.

DISEASES OE THE RESPIRATORY
SYSTEM.

Dr. Chapman begins with the aflections of the mucous tissue,
and, as most simple, he first takes

CATARRHUS OR CATARRH.

ACUTE FORM.

The etymological meaning is, a defluxion.

It consists in a phlogistic irritation of the mucous membrane
of the bronchi, larynx, trachea, fauces, nose, and frontal
sinuses ; or it may involve only a part of these structures.

This irritation being sometimes unaccompanied with a de-
fluxion, is called by Dr. Chapman, according to custom,
bronchitis. It is the same which some, by a great solecism,
call the dry catarrh.

SYMPTOMS.

The violence may vary exceedingly.

INTRODUCTORY.— A sense of fulness about the head;
sneezing; a distillation of an acrid fluid from the nose and
eyes, technically called coryza, — lassitude, muscular pains, — and,
finally, rigors, or, at least, increased sensibility to cold.

MORE A D V A N C E D.— Hoarseness, titillation of the throat;
stricture of the chest ; embarrassed respiration ; a dry, irritating
cough, or accompanied with glairy mucus raised by hawking ;

CATARRHUS OR CATARRH. 171

and fever, usually exacerbated in the evening, and associated
with acute pain about the frontal sinuses.

Af TER A FEW DAYS, in favourable cases, the affection
passes off with copious and easy expectoration of yellow mucus,
or by a watery diarrhoea. But it may run into a chronic dege-
neration.

In weakly, phlegmatic constitutions, a state of collapse ensues,
attended with wheezing and rattling from bronchial accumula-
tions. Owing to this obstruction, the blood being no longer
decarbonized, there take place lividity of countenance and
often death. But in some instances, particularly when epi-
d-emic, the disease is formidable from the beginning. This
exacei*bated condition may arise from the complication of some
other pulmonary, or a gastric, hepatic, or cerebral inflammation,

CAUSES,

Sudden vicissitudes of weather; inadequate clothing; drafts
of air, particularly when the body is heated; damp clothes;
sleeping in damp sheets, or in a damp room ; standing on wet
ground; entering suddenly a cold cellar or such other place:
certain effluvia, as from fresh paint, or particular flowers; the
irrespirable gases; the inordinate use of snuff"; and an epidemic
influence.

Proceeding from the last cause, it is called Injluenza. This
epidemic has existed at least from the fourteenth century. Its
general direction is from north to south. The susceptibility to
the disease is destroyed for the time by one attack, though, on
a return of the epidemic, it may be revived. It docs not, how-
ever, secure an individual from a catarrh, contracted in the
ordinary manner.

DIAGNOSIS.

The secretion being abundant, the rattle revealed by the
stethoscope is loud and gurgling, though occasionally sibilous;
being deficient, the tone is still more sonorous, resembling the
cooing of a pigeon, or the scrape of a large violoncello, denoting

172 DISEASES OF THE RESPIRATORY SYSTEM.

a tumidity of the lining membrane from inflammation. Con-
nected, also, with large secretions, is a suppression of the re-
spiratory murmur, which may, however, be suddenly restored,
from a removal of the obstruction by coughing.

PROGNOSIS.

The epidemic form most dangerous, and sometimes very
fatal. Either an exuberance of secretion, augmenting oppres-
sion, or a total want of it, denoting high inflammation, is unfa-
vourable. Thin and glairy sputa denote a continuance of irri-
tation ; while thick yellow sputa indicate the approach of
convalescence. Catarrh, however, from the danger of its com-
plications, or degenerations, should never be neglected.

AUTOPSIC APPEARANCES.

The membrane is found covered with the matter of sputa ;
which being wiped away, there is disclosed a redness, prevailing
mostly about the end of the trachea, and in the bronchi of the
upper lobe of one lung. In non-secreting cases, the membrane
is also tumefied. But widely spread complications are generally
associated with the fatal instances.

PATHOLOGY.

The affection commences in irritation ; which, should the
case become at all severe, is converted into inflammation. Its
first attack is commonly in the pituitary membrane of the nose,
reaching sometimes to the frontal sinuses, which is vulgarly
called a cold in. the head. It afterwards descends the trachea
and bronchii. The alimentary canal, brain, &c., may also be
implicated.

TREATMENT.

1. FOR THE FORMING STAGE.

An 0 p i a t e. — Nothing answers so well to suppress an attack.

CATAURHUS, OK CATARRH. 173

On the same principle, operate spirituous liquors, exercise, and
other diffusible stimulants.

An opiate being for any reason precluded, resort may be had
to a hot pediluvium, street spirits of nitre, anlimonial ivine, ace-
tate of a77ifnonia, or other mild diaphoretics, assisted by ivarm
diluents. Or a warm infusion of the Eupatorium perfoliatum,
may be preferable. A copious draught of cold water is occa-
sionally still more effectual. The determination to the head
being considerable, the pediluvium may be made more stimu-
lating by the addition of mustard and salt.

The pain in the frontal sinuses being very severe, leeches,
vesication, and the snuffing up of various vapours, or a dose of
opium and calomel,

2. THE CATARRH BEING FULLY FORMED.

V«nescctioil. — When the case is violent. The repetition
should be regulated by the pulse and other considerations.

Local Bleeding.

Purging with Salines. The attack being violent, or at-
tended with much oppression, Calomel answers better.

Nitre, and Tartar Emetic, — Exhibited early, an emetic
is strikingly useful, and is well calculated to relieve oppression.
But it is too unpleasant to be generally used- The tartar
emetic, however, in small doses, and the nitre may be used
when there is no phlogosis of tlie alimentary canal. When
there is, we may substitute the Neutral Mixture.

Blisters. — To be used when the inflammation is reduced,
there yet remaining a hard lingering cough, and a remnant of
pain in the chest. Applied too soon, they do more harm than
good.

Calomel, Opium, and Ipeeacuanli a. — Applicable in the
same stage with blisters.

About this time, the state of fearful depression and excessive
secretion, is apt to supervene. Dr. Chapman considers it more
fully in the treatment of Bronchitis, here only remarking that it
is chiefly to be met with C arb on at e o f Ammonia, aided by
Cordial drinks.

The acute stage of catarrh being fully subdued, Cough Mix-

274

DISEASES OF THE RESPIRATORY SYSTEM.

tures, as they are called, become serviceable. They nearly
all contain Opium.

As a means of promoting expectoration, and calming the irri-
tation which excites coughing, Dr. Chapman recommends the
following compounds: —

R. — Extract. Gfycyn'h. 3iij-
Aq. ferv. f 3iv.

M. Ft. solut. et adde.
Sp. ^th. Nitr. f 3ij.
Vin. Antimon. 3j.
Tinct. Opii, gUs. x\,

R. — Carbonate of Potiash (or Soda), 3j,
Antimon. Wine, f 3j.
Tinct. of Opium, gtts. xl.
Compound Spirits of Lavender, f3ij.
Pare Water, 3iv.
Mix.

Of these preparations, may be taken half a laWespoonfulevery
two hours.

It is well ascertained that the Alkalies possess an effectual
control over this state of the mucous membrane.

As a palliative, a solution of

Su^ar, with enough lemon-juice or vinegar to acidulate it,
simmered slowly into a syrup, will prove useful.

REGIMEN.— The diet should consist of the demulcents.
Should something more be necessary, gruel, potatoes, the
vegetable soup, &c., may be employed.

Confinement in a room, with the temperature duly regulated,
should be observed, and in severe cases, the patient ought to
maintain his bed.

Sometimes a lingering cough is left, which resembles per-
tussis. It will be commonly found that this is owing to diffused
phlogosis, or relaxation about the fauces.

CATARRIIUS ^STIVUS, OR HAY FEVER. 175

CATARRHUS iESTIVUS, OR HAY FEVER.

This disease, which prevails about the time hay grass blooms —
that is, in the early part of spring — was formerly thought pecu-
liar to England. But Dr. Chapman has seen it in this city.

Attacking first the external apparatus of the eye, it thence
extends to the Schneiderian membrane, and the other parts liable
to the incursions of common catarrh. It is accompanied with
nervous irritation, rather than fever. Sometimes it is marked
by paroxysms, like those of spasmodic asthma. Enduring for a
month or six weeks, it subsides, to revert next season, which it
may do for many years, in spite of precautions.

The cause of the affection is doubtful

CHEONIC CATAERH.

The affection which Dr. Chapman considers under this name,
is that form which ultimately degenerates into what has been

called CATARRHAL CONSUMPTION.

SYMPTOMS.

Cough ; pain in the chest ; soreness of the throat ; sputa of
a glairy phlegm, in the midst of which are small masses like
boiled rice, mistaken often for pulmonary tubercle. Being
sebaceous, however, they melt on subjection to heat, while
tubercular matter does not. The expectoration gradually be-
comes more copious, mucoid, puriloid, and finally pus ; which,
however, is secreted by the mucous membrane. The purulent
matter is grayish or greenish, and occasionally tinged with
blood. It may be deficient, or may amount to even pints in
twenty-four hours. The pulse hard and accelerated, and the
system ultimately hectic. The disease invading other structures,
may assume the form of some other pulmonary disease.

CAUSES.

May succeed the acute affection, or arise from the same
causes. It is owing more frequently to the inhalation of par-
ticles thrown oft' in certain mechanical operations. Dr. Chap-
man ascribes it also to disorder of the digestive aparatus, or
uterus, to rheumatism, gout, or the repercussion of eruptions.

CHRONIC CATARRH. 177

DIAGNOSIS.

Often diflicult from the complications of the disease. Dis-
tinguish from tubercular consumption, by the fluid nature of the
sputa. Proceeding from a tubercular cavity, they are thick,
woolly, and always spit up in dabs, or separate masses. This
observation was first made by Dr. Chapman. Tubercle is
sometimes, however, productive of a catarrh.

Learning from percussion the presence, or absence, of tubercle,
we perceive, if the attack be chronic catarrh, the same sounds
as in the acute affection. We have, also, as guides, the absence
of pectoriloquism, cavernous respiration, the permanent want
of the respiratory sound from induration, &c., — sounds which
denote phthisis.

AUTOPSIC APPEARANCES.

In an early stage like those of acute catarrh. In older cases
is exhibited hardening, or softening; where the affection is
excited by acrid inhalations, small ulcers ; dilatation of the
bronchi, and sometimes merely a preternatural paleness of the
membrane. Besides, we occasionally observe extraneous com-
plications.

TREATMENT.

Concerning this subject. Dr. Chapman is brief; since both
the indications and the remedies are much like those of p/Uhisis.
Depletory methods, however, may in most cases be used more
freely.

V e u e s c c t i 0 n, local Bleeding, Blistering.

I p e c a c n a n h a, Tartar Emetic, Nitre, or such other
sedative articles, and alow Diet.

An Emetic may next be resorted to occasionally, witli great
efficiency ; as may also the

Cough Mixtures formerly mentioned, which, together
with the

12

178 DISEASES OF THE RESPIRATORY SYSTEM.

Fixed Alkalies, may be entirely substituted for the

emetics.

Tiiis course failing, have recourse to the alterative effect of
Calomel, in combination with Opium and Ipecacuanha.

This also failing, we may try the
Balsamic Medicines, of which, Dr. Chapman prefers the
T 0 1 u. — To the same description of cases, rather more

reduced, ai'e adapted the

Terebinthinate s. — We may try tar water, or inhalations

of tar. Other remedies are preparations of Iodine and

Chlorine.

BllONCHITIS ACUTA, OR ACUTE
BRONCHITIS.

This affection was formerly called Peripneumonia Notha,
or Catarrhus Suffocativus, vel Nothus. The term Bron-
chitis, is better, though objectionable from its implying inflam-
mation, which is not the real pathological condition.

SYMPTOMS.

The mode of aggression is diversified. It may commence
like ordinary catarrh, or suddenly, with heavy pulmonary op-
pression, and wheezing, and rattling from excessive secretion.
Tension, but seldom acute pain, in the chest ; cough insignifi-
cant and dry, though phlegm is sometimes sparingly expecto-
rated. No hoarseness, nor defluxions from the nose or eyes ;
the pulse rather accelerated, or slower, fuller, and more com-
pressible than natural ; the skin cold ; face pale, and hebetude
and confusion of mind.

Differing from this, we may have complete reaction, as
shown by high fever and headache. Here too, however, we
have the distressing tightness of chest, but no positive pain, and
a cough, without much expectoration.

MORE ADYANCED S Y MP T 0 MS.— Increased oppression,
cerebral heaviness, or low delirium, livid countenance, and the
various evidences of an adynamic state. The bronchial secre-
tion is, at this period, usually enormous, thin and pituitary, with
loud wheezins; and rattling.

180 DISEASES OF THE 'RESPIRATORY SYSTEM.

Death ensues from suffocation, consequent on excessive ac-
cumulations in the bronchi, from absolute exhaustion, or from
cerebral disturbance.

But the disease may be so mild as scarcely to attract atten-
tion, and it may be complicated with various pulmonary affec-
tions as w^ell as with those of the alimentary canal.

CAUSES.

Same as those of catarrh.

DIAGNOSIS.

The pathognomonic symptoms are wheezing and rattling. If
we should be embarrassed by complications, a recourse to the
stethoscope, which reveals the same sounds as in catarrh, will
dissipate the obscurity.

PROGNOSIS.

A dangerous disease.

FAVOURABLE SIGN S.— Easy expectoration of thick, yellow,
tenacious matter, improved respiration ; warm skin, and above
all, defluxions from the nose.

It terminates in three or four days, or may do so even within
a few hours.

AUTOPSIC APPEARANCES.

The bronchi will be found gorged with glairy secretions;
and the vessels sometimes injected. Yet the mucous membrane
is usually rather paler than natural. The lungs, brain, and
other structures may be also involved.

PATHOLOGY.

Differs from catarrh, in proceeding from irritation and con-
gestion, instead of inflammation of the mucous membrane, and

ACUTE BRONCHITIS. 181

in being confined more to the bronchi. Hence it is that the
secretion is pituitary rather than mucous, and that in the form
now considered, it occurs exclusively among the infirm and
aged, who cannot support any high degree of inflammation.
The lividity proceeds from an imperfect decarbonizalion of the
blood.

TREATMENT.

Venesection, when it can be borne. The detraction should
be small, and it may be repeated if it is beneficial.

Active Vomiting, — Very appropriate to an early stage.
Should not be used where there is gastric complication.

Cups, between the shoulders, and to the sides, may succeed,
if necessary, the emetics.

A Blister of large size to the breast.

Calomel Purges, though in contrariety to an antiquated
prejudice against the use of purges in pulmonary complaints.

Calomel, Opium, and Ipecacuanha. — Or, the opium,
which here never does harm, may be united with the squill,
gum ammoniac, or senega.

R. — Decoct. Rad. Senegse, 3vj.
Mel, 3j.

Tinct. Opii. Comp., 3ss.
Dose, a fluid ounce every two hours.

The Antispasmodics, and in an extremity, the
Carbonate of A m m o n i a, and 11 o t Wine AV li e y,
As palliative may be employed the vapour of hot water, or
hot water with the addition of vinegar, or tincture of tolu (an
ounce to the pint), or iodine. The sensibility of the glottis and
mucous surface being diminished, we may try the vapour of
Hoffliian's anodyne liquor, or the spirits of ammonia.

BEONCHITIS CHEONICA, OE CHEONIC
BEONCHITIS.

SYMPTOMS.

A DULL, uneasy sensation, usually under the sternum ; cough,
expectoration of glairy or frothy phlegm, sometimes becoming
puruloid, or purulent, though oftener gleety, and still more com-
monly unchanged in character, but augmented in quantity, —
attended with heavy dyspnoea, and constant wheezing and
rattling.

Pulse feeble; skin pallid and damp, with a tendency to
(Edema.

Thus, with occasional fluctuations, may the disease run on
for years.

Death may occur from suffocation, or dropsy, or absolute
exhaustion, or hectic irritation.

CAUSES.

An ill-cured acute affection ; cold and humidity operating on
a lymphatic constitution, or on a constitution vitiated by intem-
perance, gout, &c.

To dyspepsia, chronic hepatitis, and, perhaps, to worms, is it
sometimes owing.

DIAGNOSIS.

Distinguish by the wheezing and rattling, the pallor, flacci-
dity of skin (and sometimes cedema of the face), and by the
same auscultatory signs, as in acute hroncliilis.

CHRONIC BRONCHITIS. 183

PROGNOSIS.

Old, or complicated attacks, generally incurable.

AUTOPSIC APPEARANCES.

Organic alterations, — such as ulcerations, granulations, hard-
ening, &c., — are discovered in the bronchia. The lungs are
often hepatized, the abdominal viscera frequently found in a
state of disease; and dropsical effusions are common.

TREATMENT.

In uncomplicated cases, occurring in sound constitutions.

Venesectio n. — The alternate application of Gu^^ to the back,
and B 1 i s t e r S to ^//e chest.

Small doses of Calomel, Ipecacuanha (or Squills), and
Opium.

C 0 1 C li i C u m may be serviceable in arthritic cases.

The Balsams and Terebinthinates.— Thepatienthaving
been prepared, on these must we place our chief reliance. They
are particularly adapted to instances of a mucoid, purulent, or
gleety discharge.

Tonics. — When the discharges are thin and pituitary.

The bronchitis being secondary, we must, of course, cure the
primary affection.

TUSSIS VEL CATAHRHUS SENILIS.

A FORM of chronic bronchitis, incident to old age.

SYMPTOMS.

Cough and defluxions. These, however, being inseparable
from the conditions wrought by old age, hardly become objects
of medical treatment. But being aggravated by a cold, the
symptoms exhibit a morning and evening exacerbation, at
which time the dyspncea is distressing, the wheezing and rat-
tling sonorous, the pulse feeble, skin cold, and countenance
haggard. The disease may be frequently repeated upon fresh
exposures, until the powers of life are expended. The disease
is sometimes, however, continuous for years; and may be
attended with immense secretions.

TREATMENT.

Being a modified form of chronic bronchitis, the same reme-
dies are applicable; to be employed, however, with less rigour,
and to a less extent.

REGIMEN.

In all these chronic bronchitic affections, the diet should be
moderate, but nutritious; and, when the weather is dry, the
patient should go about freely in the open air.

INFANTILE BRONCHITIS, OE
CATARRHAL FEVER.

A DISEASE incident to children, and varying in nature between
a catarrh and bronchitis, and entitled accordingly by one of the
above-mentioned names.

Generally met with, between the ages of two and three ;
though often much earlier or later.

SYMPTOMS.

P R I M A R Y. — Beginning as a common cold, it may thus con-
tinue several days. Yet there is some disposition to heaviness.
Fever moderate, or entirely absent.

SECONDARY. — Fever; dry, frequent cough, sometimes
hoarseness, and constriction of the chest.

T E R T I A R Y. — A state of collapse. After a series of remis-
sions and exacerbations, the child sinks away in a comatose
state, or suddenly perishes by suftbcation.

The affection has sometimes a bronchilic character from the
commencement. Occasionally, other portions of the respiratory
apparatus are involved; and at other times, by an extension of
irritation, the primae vise are implicated.

It is remarkable how prone these catarrhal and bronchitic
afi'ections are, to degenerate into effusions in the brain.

CAUSES.

Chiefly occasioned by vicissitudes of the weather. But it
may prevail epidemically.

186 DISEASES OF THE RESPIRATORY SYSTEM.

Phthisical children are most subject to the affection ; but the
robust are very apt to contract the catarrhal variety.

FortheDIASNOSIS, PROGNOSIS, AUTOPSIC APPEAR-
ANCES^ and PATHOLOGY, the remarks on these subjects
under the corresponding diseases of adults, will suffice.

TREATMENT.

IN THE CATARRHAL FORM,

The leading remedy is

Venesection. — Subsequently we may resort to the other
measures recommended for the same state in a more advanced
age.

BUT IN THE BRONCHITIC FORM,

Teneseetion is seldom allowable; giving rise to a state of
collapse rarely overcome. Mostly, in this form, we should
commence with.

An Emetic.

Calomel Purges. — The object is to produce revulsion to
the intestines, and to arouse the secretory action of the liver,
which is always more or less impaired. We should persevere,
until we discover that welcome harbinger of amendment, dis-
charges of bile.

C u p p i n g, at an early stage.

The Antimonials, &c., while there is fever.

Blisters, A Combination of Calomel, Opium, and
Ipecacuanha, and Cutaneous Friction, with the Warm
Bath, when vascular action has subsided.

Collapse supervening,

The Carbonate of Ammonia, Wine Whey, with
Sinapisms to the Extremities.

CHEONIC INFANTILE BRONCHITIS, ETC.

The catarrhal variety has in it nothing singular. But the
bronchitic form, and especially that popularly called phthisic,
may claim a slight attention.

It is sometimes congenital, or manifested, at least, soon after
birth, and is then often connected with a contracted chest, and,
almost uniformly, with a phlegmatic temperament.

Excepting a perpetual excess of bronchial secretion, with a
wheezing and rattling, nothing is usually discovered, until an
exasperation is induced by exposure to cold, when there is an
accession of fever, with excessive pulmonary oppression.

TREATMENT.

The attack is to be managed like a case of common bron-
chitis.

In the interval of the attacks, a careful avoidance of the
exciting causes, should be observed ; and tonic medicines and
regimen become of service.

The affection arising from malconformation, we can effect
little. Puberty, however, sometimes developes a favourable
change of structure.

CYNANCHE TUACHEALIS, OR CROUP.

Popularly called hives. Consists of an inflammation chiefly
in the larynx in the commencement, and in the bronchia in the
termination.

The disease is mostly confined to early life ; and the attack
usually comes on at night.

SYMPTOMS.

AGGRESSIVE STAG E.— A dry hoarse cough, compared to
the barking of a small dog. At this time there is no appreciable
constitutional disturbance. The child soon relapses into a sleep,
from which it is again aroused by the cough. Cases of this
kind soon perish, if relief be not afforded. The attack, too,
being apparently overcome, manifests a lively disposition to
return a few hours afterwards, or, at least, the next night; or,
the disease may supervene as a cold. Catarrhs destitute of a
defluxion, are very apt to become croup.

ADVANCED STAGE. — An active tense pulse, flushed face,
and hot dry skin ; the respiration audibly impeded, and distin-
guished by a stridulous intonation, resembling cooing, or in some
instances, especially when the case is somewhat farther ad-
vanced, by a species of hissing. The cough becomes whooping,
and is always without expectoration, or defluxion from the nose
or eyes. The voice is hoarse, or whispering. The alimentary
canal is remarkably insensible to remedies. The brain shows
its afiection by flightiness, or somnolency.

Subsequently is expelled with difficulty, phlegm, or ropy mu-
cus, or albuminous matter, which, while in the larvnx, occasions

CROUP. 189

a wheezing, or rattling. Being thrown up, temporary relief is
afforded.

Henceforth tlie symptoms are those of slow suffocation. Yet,
in the hawking which is sometimes made, the coagulated
lymph, which had been effused by the larynx, is brought up, and
a cure is effected.

D U R A T 1 0 N. — The disease seldom exceeds two or three days ;
and, may, when of the spasmodic form, terminate in a few
hours.

The inflammation sometimes travels down to the remotest
ramifications, of the bronchi. The case may also be compli-
cated with engorgement of the lungs, phlogosis of their structure,
or serous covering, or with oedema of the cellular texture.

CAUSES.

PREDISPOSING.— The period of life between one and five
years— (though the afiection is probably incident to adult age).
It seems to be sometimes hereditary.

E X C I T I N C. — A moist austere atmosphere. It seems endemic
in certain situations. Thus, in Leith, the seaport of Edinburgh,
it is frightfully prevalent; while in Edinburgh, about a mile dis-
tant, it scarcely ever occurs.

Irritation of the primce via3. Spinal irritation. Mental emo-
tions.

Scarlet fever, by an extension of phlogosis to the larynx, some-
times assimilates croup.

DIAGNOSIS.

It can hardly be mistaken by those who have once seen it.

Chiefly does it resemble laryngismus stridulus, and cynanche
laryngea, the distinctive marks of which will be pointed out,
when these diseases are taken up.

To discriminate the two varieties of croup — spasmodic and
inflammatory — we need only advert to the mode of attack.

190 DISEASES OF THE RESPIRATORY SYSTEM.

The SPASMODIC FORM supervenes suddenly, and in children, and
usually at night. It is betrayed by the clangorous or barking
cough, and sometimes by manifestations of impending suffoca-
tion. In adults, it is often induced by mental emotions.

The iivFLAMMATORY FORM approachcs gradually, as catarrh,
with slight or no defluxions from the nose ; and the croupy
cough, when formed, is less clangorous.

The creation of an adventitious membrane in the windpipe,
may be inferred from a sensible abatement of intensity in the
tone of the cough, the hoarseness degenerating into a whisper,
the breathing appearing as if it were made through gauze, and
the dyspnoea amounting to strangulation. On the other hand,
the obstruction from a secretion less adhesive than plastic
lymph, allows the same sort of wheezing and rattling which
belong to catarrh or bronchitis. We may be aided by auscul-
tation.

PROGNOSIS.

Treated early and judiciously, the prospect is good ; but,
being confirmed, or the membranous exudation having been
thrown out, or the lungs having become in any way implicated,
the cure is exceedindv doubtful.

AUTOPSIC APPEARANCES.

At an early period, no lesion whatever may be observed ; or
there may be merely evidence of pre-existing spasm of the
glottis.

At a more advanced period, there may be high phlogosis of
the larynx. Its tissues may be only tumefied ; but more fre-
quently there are extravasations of ropy mucus, or of coagulable
lymph, — the latter in broken pieces, or constituting a tubular
lining down through the trachea, and sometimes to the termi-
nations of the large bronchi. This lining may be either a
yellow pulpy matter, easily detached, or it may be very tena-
cious, like pure lymph, and forming, as was formerly mentioned,
an adventitious membrane.

CROUP. ]gi

Besides, may be observed the evidences of those pulmonary
compHcations already alluded to.

PATHOLOGY.

The almost entire insusceptibility of adults of the disease, is
attributed to that mutation, which takes place in the larynx
about the age of puberty, and is evinced by the enlargement of
its calibre, and the deepening and strengthening of the voice.

The affection may either be spasmodic or inflammatory. Its
spasmodic nature is demonstrated by its occasionally super-
vening in a moment, and being connected, as appears from the
necroscopy, with no inflammatory appearances. But the spasm
is soon converted into an inflammation.

The extravasation of coagulable lymph in croup, when it
does not take place in catarrhal inflammation of the same part,
is attributable to the superior intensity of phlogosis.

In the croup of children, there is a greater inclination to the
effusion of coagulable lymph ; which results from the greater
proportion of fibrin existing in those whose system is still in a
state of growth.

TREATMENT.

Dr. Chapman's mode is simple, and so successful, that he
never lost a case, to w'hich he was early called.

Whether the affection be a spasmodic irritation or phlogosis,
the management may be identical. No allusion, however, is
now made to the hysterical and neuralgic forms, which occur
in advanced life.

N a u s e a n t s and a S i n a p i s m to the neck, sometimes arrest
the disease in its forming stage. The smoking of a cigar, or
the snuff" plaster to the breast, has been here recommended.
But the former is inapplicable to children, and the latter is
unsuited, from its occasional incontrollably depressing effects.

These failing, we endeavour at once to produce

Free Vomiting. — The syrup of ipecacuanha is preferable
for ordinary use. Tartar emetic, somewhat dangerous in the

192 DISEASES OF THE RESPIRATORY SYSTEM.

insensibility of stomach incident to croup, may, however, be
added, when necessary to induce emesis. But the surest emetic
combination, is a union of ipecacuanha, tartar emetic, and
calomel. The emetic may be given in divided doses. An in-
creased susceptibility to the emetic may be created by a

Warm Bath, which is itself curative in tendency. But the
emetic not operating, or having operated, not producing the
desired effect, we may resort to

Copious Venesectio n. — This may be followed with a re-
petition of the warm bath. The croup, now, nearly always
yields. But continuing, we direct

Topical Bleeding, — Cups being used, they should be ap-
plied to the sides, or the back of the neck.

A Blister.

The foregoing measures proving still unavailing, Dr. Chap-
man employs

Bleeding ad deliquium animi. — In the early period of
the disease, he has never known this to fail. Even where the
phlogosis is not cured by it, there results an extravasation of
thinner and less tenacious substance than plastic lymph.

Purgation by Calome 1. — To be employed when the dis-
ease is somewhat broken. It destroys the lingering symptoms,
and confirms convalescence.

Polygala Senega is a useful expectorant, when there is
still much hoarseness and tightness of chest.

But from neglect, or inadequate management, it may happen
that at this time, the forces of life being enfeebled, the disease
is still unsubdued. In this conjuncture, Dr. Chapman recom-
mends diaphoresis, produced by the

Dover's Powder and Vapour Bath.

But depletion having been inadequately resorted to, the case
may, at this period, be complicated with the exudation of a
tenacious mucus, or plastic lymph, the latter sometimes forming
a false membrane. Here we endeavour to expel the exudation
by placing the child in a warm bath, and at the same time ex-
citing vigorous emesis by some stimulating emetic. Yet the
plastic lymph, especially if membranous, is very seldom de-
tached.

CROUP. 193

The subsequent treatment consists of the pretty constant use
of the stimulating expectorants. But perhaps more will be
gained from calomel in small doses, which instituting a copious
secretion of a thin fluid, may separate the tenacious mucus, or
lymph, or even the false membrane. Dr. Chapman recom-
mends the use of small doses of tartarized antimony, in connex-
ion with the calomel, which he thinks promotes the specific
action of mercury.

These measures being ineffectual, as they probably will be,
our only resource is in tracheotomy. Yet the disease has usu-
ally implicated to such a degree the lower part of the trachea,
and the bronchia, that little is to be gained by the operation.
The affection, however, is sometimes restricted to the larynx ;
and there have been many instances reported of the operation
having been followed with a permanent cure.

For the expulsion of the adherent secretion, sternutatories
have been proposed. It occurred separately to Dr. Chapman
and to Dr. Physick, that it might be detached by the introduc-
tion of a bougie.

Croup being secondary to an inflammation of the fauces, the
latter should be touched with a strong solution of the nitrate of
silver, or with burnt alum.

It is the practice of many of the European, and, particularly,
the French physicians, to waive venesection in this disease.
But, according to their own confessions, the mortality of their
patients is awful.

Most erroneous is the common notion that children will not
well bear depletion. The truth is, they bear some of the active
remedies much better than adults, — especially vomiting, purging,
and the loss of blood. This, indeed, apart from experience,
might, from their high proportion of blood, and particularly of
the fibrinous element, from their great recuperative power, their
tenacity of life, and their predisposition to inflammatory com-
plaints, be predicated of them.

13

LARYNGISMUS STRIDULUS, OR ACUTE
INFANTILE ASTHMA.

FtRST noticed in 1769, by an English writer, of the name of

Millar.

SYMPTOMS.

The child wakes up, in an apparently suffocating condition.
This state, having lasted a few minutes, gives way, and is succeed-
ed by a long, full inspiration, attended sometimes with a whoop-
ing or a crowing noise, like that of croup. After much agitation,
the child sinks into a sweet sleep, or attended only by tempo-
rary sobbings. On waking it is well, or is cross, or dull and
drowsy, which state quickly wears away, or there may be a
repetition of attacks in rapid, or more distant succession, for an
indefinite period. Each paroxysm then is lengthened and some-
times leads to general convulsions, in which the fingers and
toes are spasmodically contracted. Death may take place in
such paroxysms ; or they may be followed by a state of lethargy.
In some protracted instances they bear the apoplectic character.
A very slight constriction of the glottis sometimes induces this
state. The disease is then apt to run a lingering course, the
paroxysm recurring every hour or two, or at intervals of days,
or weeks. It may observe, with considerable regularity, a
quotidian, tertian, or quartan recurrence.

In the acute disease, fever is never betrayed ; but, in pro-
tracted instances, some vascular excitement and determination
of blood to the head, may be exhibited. **

CAUSES.

Laryngismus, in Dr. Chapman's experience, has been con-

INFANTILE ASTHMA. ]95

fined to childhood, and chiefly within the period of dentition ;
the spasm of the glottis in adults, diflering in several respects.

THE GREAT PREDISPOSING CAUSE, is probably a pe-
culiar irritability of the respiratory tube, and smallness of its
calibre.

EXCITING CAUSES are mental emotions, and irritation of
the primae via3.

DIAGNOSIS.

It is distinguished from croup by its momentary nature, and
its being followed by no inflammation, and from asthma, by the
breathing being stridulous and dry, instead of wheezing and
rattling.

It differs from a similar closure of the glottis in adults, in the
latter resulting from a highly-wrought nervous condition.

PROGNOSIS.

In its milder forms, manageable. But the reverse is true,
when the paroxysms become very numerous, and are connected
with cerebral disturbance, and when the affection is complicated
with dentition.

AUTOPSIC APPEARANCES.

Congestion, serous effusion, or structural changes of the brain ;
engorgement of the lungs; and sometimes the thymus, or other
glands about the neck, in a state of enlargement. But, occasion-
ally there is no lesion whatever.

PATHOLOGY.

The common notion in regard to this subject, is, that the
spasm is excited by the compression of the recurrent or inferior
or laryngeal branch of the par vagum, from tumours. But it is
doubtful whether the compression of tumours, if they should be
sufficient to affect the nerve, would not rather produce paralysis.

196 DISEASES OF THE RESPIRATORY SYSTEM.

The spasm, too, in such a case, being produced by a permanent
cause, should recur more frequently. But, above all, how often
do we see the disease without any such tumours, and, con-
versely, how often do we see such tumours without the disease !

Dr. Chapman places the seat of the disease in the cerebro-
spinal axis. In the progress of the case, it is apt to be concen-
trated in the brain. The affection may either be original to
these nervous centres, or it may arise primarily from irritation
in the alimentary canal. The analogous cases of adults, are
confessedly the result of cerebro-spinal disease ; and such they
have often been demonstrated, by dissection, to be.

It is likely that the affection differs in no wise from the ordi-
nary fits of children, except in the casual accompaniment of
spasm of the glottis.

TREATMENT.

The paroxysm is usually so transient, that little can be done
for the relief of the spasm. Strong counter-irritation, with the
aqua ammonise applied along the windpipe, may be serviceable.

In the intermission,

Bleeding, General and Topical.

Warm Bath.

Emetics, and Purgatives.

R e V n 1 s 1 T e s to the lower extremities, with Cold Applica-
tions to the Head.

Counter-irritants to the head.

The primary point of irritation being in the alimentary canal,
the emetics and purgatives are to be used first. There being
worms, these are to be first destroyed by anthelmintics. The
gums are to be incised in the case of dentition. Such remedies,
however, having been premised, the employment of opiates will
be often beneficial. These are sometimes eminently valuable
in quieting irritation of the brain, especially when arising from
disorder of the primae vias.

PERTUSSIS, OR WHOOPING COUGH.

Was first observed in France in 1414. Almost exclusively
incident to childhood.

SYMPTOMS.

AGGRESSIVE.— May begin like an ordinary cold, with
more or less fever, which, though it usually soon ceases, some-
times continues throughout the course of the disease.

MORE ADVANCE D.— Commonly, in from ten days to two
weeks, the sonorous inspiration or whooping commences. The
affection now becomes strictly paroxysmal. An attack is pre-
ceded by tickling of the throat, constriction of both the larynx
and chest, and a sense of suffocation. Each paroxysm is com-
posed of a quick succession of sonorous expirations, with
scarcely, for a considerable interval, any perceptible inspiration.
The expiration, however, becomes, at length, suddenly inter-
rupted by a deep, convulsive, noisy inspiration, accompanied
by a lengthened hissing, ending usually by vomiting, or by an
expectoration of phlegm. In some paroxyms, so great a con-
gestion of the head takes place, that the blood issues from the
mouth, nose, eyes, or ears, or it may eventuate in convulsions.

The paroxysm is sometimes very soon over. At other times,
it lasts from five to ten minutes.

At this time, the intermission between the paroxysms is
usually a period of health ; though sometimes there is exhibited
derangement of the respiratory, digestive, and nervous systems.
But such derangement is more commonly met with in a subse-
quent stage.

198 DISEASES OF THE RESPIRATORY SYSTEM.

The number of paroxysms may, in the beginning, not exceed
two or three daily ; while at the height of the disease, there
may be so many as one every hour.

The affection may terminate indefinitely in from one to three,
or even six months.

CAUSES.

The affection depends on a contagion, which rarely affects
the same person more than once. It is also much subject to an
epidemic influence.

DIAGNOSIS.

It is distinguished from catarrh by the paroxysmal nature,
and other peculiarities of the cough ; generally by the absence
of fever, and, when fully developed, by the whooping nature of
the cough.

PROGNOSIS.

The disease may terminate in death from apoplexy, convul-
sions, or suffocation, or it may result in some other affection of
the respiratory apparatus, or disease of the brain.

AUTOPSIC APPEARANCES.

Inflammation of the larynx and bronchia, congestion, inflam-
mation and effusions in the brain, lesions of the spinal marrow,
and depravations of the digestive organs, especially of the
mesenteric glands.

PATHOLOGY.

The seat of the disease has been placed by different writers
in the bronchia, either in their larger trunks, or their minute
ramifications ; in the larynx ; in the pharynx ; in the spinal
marrow, or brain ; and in the alimentary canal.

WHOOPING COUGH. jgg

Again, one set of pathologists aver that the nature of the
action is purely spasmodic; while another aver it to be actively
inflammatory.

Most obviously, however, the affection originates in spas-
modic irritation, which, by protraction, may induce phlogosis
of the mucous membrane of the difl^ereni parts of the organs of
respiration, occasioning an increased secretion, variously vitia-
ted, which, accumulating, may act as an extraneous irritant,
and bring on the cough for its expulsion.

But, from the peculiarity of the cause producing it. the inflam-
mation of the pulmonary and other structures is specific.

The sonorous inspiration proceeds from spasm of the glottis,
and perhaps ultimately from tumefaction of the lining tissue
from phlogosis.

The primary point of irritation is probably in the spinal mar-
row, especially the upper part; though it is, possibly, first seated
in the respiratory or gastric surface, and be thence reflected
from the spinal marrow, by reflex action, as it is called.

T R E A T M E X T.

This, like all other diseases dependent on a specific conta-
gion, is governed by its own peculiar laws, and has proved
very intractable to our efforts. Sometimes the affection is so
mild as to require very Uttle or no treatment.

The tico indications are to restrain the violence of the disease,
and to overcome the morbid habit which keeps it up, when the
cause having produced it, is expended.

V enesf e t ion. — When there is fever with local congestion,
or phlogosis.

local Blood-letting and Blisters, to the back of the
neck, or between the shoulders.

Emetics. — Adapted to the cases of children. May be re-
peated once a day.

Calomel Purge s. — The tendency to constipation may also
be overcome by castor oil. But the calomel purges are other-
wise useful.

K a n s e a n t s. — To promote expectoration.

200 DISEASES OF THE RESPIRATORY SYSTEM.

At this stage, a great deal of trust has been reposed in the
following counter-agents ; which, however, Dr. Chapman re-
spects very slightly.

The Fixed Alkalies, may perform the same service,
which they do in common catarrh.

The Narcotics, and Antispasmodie s. — These may
be palliative.

To break up the morbid association, on which the disease
ultimately depends, is the next indication.

Sulphate of Q,uiui a, — This deserves a fairer trial than
it has received.

A r s e n i c. — Highly appreciated by Dr. Chapman, particu-
larly when united with laudanum.

The sulphate of copper has probably a similar efficacy.

I r 0 11. — This is nearly always preferred by Dr. Chapman. It
may be combined with quinine.

The tincture of cantharides was highly recommended by Dr.
Physick. It was used until strangury was produced.

Dr. Chapman considers it of great importance to obviate the
various lesions which may exist in the respiratory organs, sto-
mach, brain, spinal marroio, &c.

Of much benefit is freely going out in the open air, when the
weather is favourable.

Vaccination has been said to be a counter-agent.

REGIMEN.

A febrile or inflammatory state existing, the diet should be
low, and every other part of the antiphlogistic system should
be observed. The strictest care should be taken, to avoid
catching cold.

CYNANCHE LARYNGEA, OR ACUTE
LARYNGITIS.

Was formerly confounded with crowp ; yet it must be con-
sidered a rare disease.

It is the disease of which died Washington, and the Empress
Josephine.

SYMPTOMS.

IN CI P I E N T.— ChiHiness ; huskiness of the throat ; hawking ;
inspiration impeded, and attended with a whistling noise; no
regular cough ; voice hoarse, or whispering ; pain on pressure
of the pomum Adami, and some fever.

Or, the disease may commence as a catarrh, or as gastric
irritation, which by metastasis is thrown upon the larynx.
Again, it may begin as tonsillitis.

There is a variety, moreover, in which, in place of inflamma-
tion, there is effusion in the subcellular tissue, called laryngitis
osdematosa.

MORE ADVANCE D. — An aggravation of the preceding
symptoms ; a sinking, diminutive pulse ; cold collapsed skin ;
strangling produced by an attempt to swallow ; and the most
violent paroxysmal dyspnoea.

The average duration of the disease is from two to five days,
though it may terminate within a few hours.

202 DISEASES OF THE RESPIRATORY SYSTEM.

CAUSES.

Occurs more among males than females; among adults and
the old, than the young.

It is brought on by exposure to a cold, austere atmosphere,
and by whatever directly, or indirectly, irritates the larynx.

DIAGNOSIS.

Distinguished from croup, by the diffusively inflamed fauces,
tenderness of the larynx, difficulty of deglutition, absence of
cough and raucal intonation, and by the period of life.

In fharyngitis, the respiration is unaffected.

PROGNOSIS.

One of the most unmanageable diseases.

AUTOPSIC APPEARANCES.

Where death occurs from spasms, no lesion is sometimes
discoverable. But oftener, the lining membrane is found red
and turgid, the sides of the glottis approximated, the epiglottis
sometimes swollen and erected, and effusion of serum, lymph, or
pus in the subcellular tissue.

The trachea is seldom affected. The bronchi are occa-
sionally choked up with secretions, and the lungs oedematous,
inflamed, or congested.

PATHOLOGY.

The disease consists in a mixture of inflammation and spasm
in the upper part of the windpipe. In this respect it much re-
sembles the early stage of croup. But while the latter is so
tractable, why is the former so intractable 1 In croup the inflam-
mation is in the mucous tissue, while in laryngitis it is chiefly

ACUTE LARYNGITIS. 203

in the cellular tissue beneath. Mere swelling from phlogosis
is generally great enough in this tissue, to cause the symptoms
mostly exhibited in laryngitis ; but occasionally an effusion
takes place, which produces extreme constriction of the passage.
The remedies adapted to the removal of the false membrane,
which is the most striking peculiarity of croup, are not adapted
to remedy the disorder in the cellular tissue.

The effusion in laryngitis is usually of serum, but in croup it
is of fibrin ; — which well concurs with the respective ages to
which the two diseases are most incident. In youth, tibrin
being wanted to supply the growth of the economy, is abundant ;
but the physical developement having been completed, it be-
comes comparatively deficient.

TREATMENT.

To overcome phlogosis, so as to prevent suffocation from the
closing of the glottis by it, or by the oedematous state subse-
quently induced, is the great object of treatment.

V e 11 e s e C 1 1 0 n. — Ad deliquium animi. It should be carried to
the extent, not merely of abating action, but of subverting it. It
should be performed also immediately, lest effusion supervene,
which will render it nugatory.

An E m e t i c of tartar emetic, ipecacuanha, and calomel.

leeches.

Emollient Poultices.

A Blister.

The Inhalation of the Mildest Vapours.

A Calomel Purge.

The antispasmodics have been suggested for a relief of the
spasm. Dr. Chapman, admitting that they might be beneficial
upon a reduction of action, regards them, still, as doubtful reme-
dies, and has not used them.

Tobacco Cataplasm to the neck, or the smoking of tobacco,
where the individual is unaccustomed to its use, is of the highest
utility in relaxing spasm ; and is, perhaps, conducive to the sub-
jection of the inflammation.

204 DISEASES OF THE RESPIRATORY SYSTEM.

Depleting measures being no longer allowable, resort to sweat-
ing with the Dover's powder, and vapour bath, for several hours.

We here should endeavour to discover from physical explo-
ration, whether a part of the affection may not be owing to con-
gestion or oedema of the lungs.

The antimonials may be used with a view of further reducing
the phlogosis; and with the same view may we resort to a com-
bination of calomel, opium, and ipecacuanha, which Dr. Chap-
man predicates to be useful from its confessed efficacy in the
cure of reduced states of inflammation generally.

Cases have been alluded to where at first an oedematous dis-
position is manifested in the throat, descending afterwards to the
larynx. These cases, Dr. Chapman is convinced, belong to the
lymphatic temperament, and will not bear the loss of blood,
except, perhaps, a few leeches in the commencement. Emetics,
a blister to the neck, and touching the fauces with a strong solu-
tion of lunar caustic, or with the powder of burnt alum, are
particularly serviceable.

Dr. Chapman has suggested the plan, when effusion has taken
place, of cutting down into the cellular tissue, and evacuating
the fluid.

Laryngotomy. — This should not be performed too early,
lest the inflammed condition of the larynx be aggravated by the
incision, nor should it be delayed until sinking occur.

The operation having been performed, the quiescence enjoyed
by the most inflamed part of the larynx is favourable to its cure.
The inflammation and tumefaction having subsided, the artificial
passage may be allowed to heal. New and improved opera-
tions have been invented by Physick, and Carmichael. The
chance of success in an operation is greater in the case of
laryngitis than in croup, in consequence of the rarity of an exten-
sion of the inflammation to the lungs. Of successful operations
for croup. Dr. Chapman has collected eleven, for laryngitis,
eighteen instances.

CHRONIC LARYNGITIS.

This term is used to express a series of chronic degenerations
of the windpipe, of which the symptoms have usually no great
resemblance to the acute aflections of the same structure. The
term includes the lesions of both the larynx and trachea.

SYMPTOMS.

The most mitigated form is when the only symptom presented
is hoarseness. This affection may last a lifetime without any
deterioration.

INCIPIENT. — But in laryngitis proper we have usually an
insidious approach, manifested by the following symptoms. —
Huskiness of the fauces ; difficulty of swallowing; a short, dry,
worrying cough ; hoarseness, pain, and embarrassment in
speaking ; a failing of the voice when elevated ; a deterioration
of it experienced from a transition to either a cold or hot tem-
perature; uneasiness or stiffness in the larynx, speedily con-
verted into a stinging pain, with a constant propensity to gulp ;
sometimes pain on pressure ; spasmodic paroxysms of coughing,
with a particular wheeze on inspiration; commonly derange-
ment of the stomach and bowels; an appearance in the throat,
when examined, of injection, granulation, aphthous ulceration,
hypertrophy of the tonsils, or of elongation and other changes
in the uvula. The system, at this period, betrays its disorder
only by irritation of pulse, flaccidity of the skin, and diminution
of muscular power and mental energy.

MORE ADVANCED SY MP TO MS.— Violent inspiration; voice

206 DISEASES OF THE RESPIRATORY SYSTEM.

very rough, or lost in an indistinct whisper ; periodical dyspnoea ;
a hawking up of ropy, or thin mucus, sometimes mixed with
puriloid, or purulent matter; and spasm in the windpipe, occa-
sionally proving fatal.

Or the disease may linger along, simulating genuine consump-
tion, and bearing the title phthisis laryngitis. Here the irrita-
tion extends to the chest, and is followed by hectic.

CAUSES.

Rarely occurs in females. Dr. Chapman ascribes the fre-
quency of its attacks on clergymen, to an original imperfection
of constitution, which he regards as more common among them,
than others.

The predisposition, he thinks, is laid in the lymphatic tempe-
rament, coupled with a false nutrition ; though it also often rests
upon a vitiated habit of body, and particularly on irritated or
depraved states of the chylopoietic viscera.

The system being vitiated, the disease may be induced by
any irritant of the larynx. It may result from the repercussion
of acute or chronic eruptions, or to an extension of phlogosis
or ulceration of the fauces, either common, scrofulous, syphilitic,
mercurial, or scorbutic, &c.

It is often excited by an elongated uvula, or the irritation of
a neighbouring tumour, or carious teeth. It is also, at times,
tubercular, and may then be either followed or preceded by
pulmonary phthisis. It may be generated by inordinate speak-
ing or singing.

DIAGNOSIS.

Distinguish by an ocular examination, from lesions about the
fauces, which, by their irritation of the larynx, produce very
analogous symptoms. Distinguish, by physical exploration,
from phthisis pulmonalis, and certain forms of bronchitis. Take
care, also, not to confound it with mere affection of the muscles
or nerves concerned in the production of voice.

CHRONIC LARYNGITIS. 207

PROGNOSIS.

Very unfavourable. Cases proceeding from a tubercular or
strumous diathesis, almost hopeless.

AUTOPSIC APPEARANCES.

Inflammation of the mucous membrane of the larynx, though
more usually granulations or small ulcers, particularly around
the glottis. Conversions of the cartilages into calcareous matter,
are sometimes met with. The subcellular tissue may be dense,
or swollen with serous effusion, or may contain small abscesses.
Tubercles may be discovered.

In the trachea, also, may be found granulations, ulcers, or
tubercles.

TREATMENT.

The case proceeding from elongated uvnla, from syphilitic,
or other contamination, &c., we endeavour to eradicate the
cause.

The remaining remarks relate chiefly to chronic laryngitis of
the ordinary kind, in a sound constitution. The remedies are
General and Local Bleeding, Connter-irrltation, and
the applying to the fauces, by a brush. Burnt
Alum, once or twice a day. This last is to be done, whether
there be inflammation there or not, unless it be very severe.
The modus operandi of the burnt alum, seems to be the setting
up of a new inflammation of a healthy kind, which reaches,
by extension, the larynx, and subverts the old.

Depletory measures, however, do not always answer, even in
the instances in which tonics are highly aggravatory.

The Narcotics are of some value.

C a 1 0 m c I, so given as to produce incipient ptyalism. Adapted
to certain syphilitic and ordinary cases, but contra-indicated by
depravity of the system.

208 DISEASES OF THE RESPIRATORY SYSTEM.

Emetics. — Suited to the inchoative stage, and cases asso-
ciated with much affection of the fauces.

Ulcers existing, the compound syrup of sarsaparilla, and the
inhalation of certain vapours, as those of tolu, tar, iodine, or
chlorine, have been recommended.

The case being desperate, laryngotomy may be performed,
a number of cases having turned out favourably under the ope-
ration.

The diet is to be accommodated to the state of the system,
any thing stimulating being carefully avoided. Exercise should
be observed, when the subsidence of phlogosis, and the mildness
of the weather, permit. The voice should be hut little employed,
and never strained. The temperature should be equable.

PLEUROPNEUMONIA.

By this term is signified an inflammation of the pleura, and of
the cellular or interstitial tissue of the lungs, or, in other words,
that tissue between the pulmonary cells. These two inflamma-
tions may exist separately — that is, we may have simple pleu-
risy, or simple pneumonia — but they usually coexist, and can be
more briefly disposed of when viewed together. By Andral,
the proper seat of pneumonia is attributed to the air-vessels and
minute bronchia ; and Dr. Chapman admits that by extension,
the inflammation may comprehend these parts.

This disease presents either an inflammatory, or more rarely a
typhoid character, which latter is to be hereafter considered.

SYMPTOM S.

INCEPTIVE.— ChilUness followed by fever, though the local
affection may precede. The latter is, in the formative stage,
apt to shift its position, and resemble in the soreness and aching
of the muscles, an attack of rheumatism. Finally, however,
being fixed in the thorax, we have the

STAGE OF FULL D E V E L 0 P E M E N T.— Heavy oppression ;
acute lancinating pains, or stitches in the chest, much aggra-
vated by a deep inspiration, or coughing, or a recumbent pos-
ture. Early in the attack, the pain is increased by lying on the
aflTected side; but the acuteness of the attack having subsided,
and etTusion having taken place, to such an extent as to inter-
rupt the function of the diseased lung, a lying on the afiected
side is assumed, for the purpose of aflbrding all possible free-
dom of expansion to the sound lung. The pain is sometimes
sympathetically communicated to the sound side. Occasionally,.
14

210 DISEASES OF THE RESPIRATORY SYSTEM.

even in the most violent inflammations, it is entirely absent, or is
obtuse and gravative. The more acute and piercing the pain, the
more may the pleura be judged to be implicated.

Inspiration usually hurried and jerking, attended by a hard,
dry cough, stifled on account of pain arising from it ; expecto-
ration deficient and consisting of frothy phlegm, or thin mucus,
though it may gradually become a glutinous, tenacious mass of
diverse hues ; greenish or yellowish, or varying from a light
reddish to rusty colour.

Pulse strong and active, skin hot, headache, and sometimes
even delirious wanderings. Great thirst.

FINAL STAGE. — Increased dyspnoea; flagging pulse; re-
duced muscular strength; low animal temperature ; coma, with
low delirium ; checked expectoration, though there may be
sounds indicating accumulations of the secretions in the air-pas-
sages. The symptoms are, however, regulated somewhat by
•the mode of termination, in hydrothorax, or pulmonary ab-
cess, &c.

Either pleurisy or pneumonia may proceed to a fatal termi-
nation without a single manifestation.

DURATION. — By prompt and efficient treatment, may be
soon cut short ; but is, when otherwise treated, apt to be linger-
ing, and, according to Andral, to terminate on the seventh,
eleventh, fourteenth, or twentieth day, by a deposit in the urine,
or by perspiration.

CAUSES.

The disease is most incident to the robust, and those in the
prime of life.

EXCITING causes, are those of the phlegmasise generally;
and among others, metastasis, or misplacement of gout, or rheu-
matism. Pleurisy, and pulmonary abscess, are both apt to fol-
low great surgical operations, and are then not plainly charac-
terized by symptoms, are rapid, and almost invariably fatal.

PLEUROPNEUMONIA. OJi

But the great exxiting cause, is the damp, austere weather of
spring, or winter. Intense cold, itself, is a cause, and proves
more operative when gradually, than when suddenly applied.
It may also occur with great violence in the summer, in conse-
quence of exposure to drafts of air ; of working, especially
when fatigued, in cold cellars, &c.

As an epidemic, it spreads to a wide extent, and in a typhoid
form.

DIAGNOSIS.

Distinguished from other pulmonary affections by the activity
and force of the circulation ; the breathing with the diaphragm
rather than the costal muscles; the peculiar sputa, and the
degree of pain.

Mlien the -pleura is alone inflamed, the pulse is hard, corded,
vibratory, and accelerated ; the breathing quick, short, and
restrained ; the pain sharp and lancinating, apparently super-
ficial, and aggravated by deep inspirations or coughing, or
pressure in the intercostal spaces ; the cough frequent and dry,
or the sputa deficient and glairy. The pleural covering of the
diaphragm being phlogosed, the preceding symptoms are aggra-
vated. The pain, in this instance more acute and spasmodic,
is felt along the cartilaginous border of the false ribs, extending
even to the flanks. The dyspnoea is excessive.

The lungs, in substance, being alone inflamed, the pulse is
fuller, slower, and softer ; pain more around the mamma, or
under the sternum, or sometimes at the epigastrium, or between
the shoulders, and is obtuse, heavy, and deep-seated. Greater
labour, though less suffering, is betrayed in respiration ; cough
is not so constant and violent ; expectoration freer, and the
matter raised thick and tenacious, and rusty or tinged with
blood.

Still the diagnosis is often incorrect.

212 DISEASES OF THE RESPIRATORY SYSTEM.

PHYSICAL SIGNS. — In Ple u r i s y. — Before effusion,
the chest sounds naturally ; but this having occurred, the sound,
on percussion, is dull. Where the layer of fluid is thin, the voice
has, to an ear applied to the part, a sharp, tremulous sound, hke
the bleating of a goat, and is hence called agophony.

By mensuration, the circumference of the affected side is
sometimes half an inch longer than on the sound side.

In Pneumonia. — On percussion, the resonance is com-
monly dull, or entirely extinct, as in pleurisy after effusion
has occurred. Respiration inaudible on the affected side, is
puerile or anormally loud on the sound one. Crepitant or
crackling rhonchus, owing to a mixture of the bubbles of air
with the liquid secretion of the air-cells, is at first of very
uniform occurrence. But as the disease proceeds the crepi-
tant rhonchus disappears, the pulmonary cells being no longer
permeable to the air. In the positions corresponding to the
large bronchi, the breathing is cavernous, and the voice so
resounds, as sometimes to produce a real bronchophony. Pus
having been infiltrated through the cellular tissue, the rale
crepitant is exchanged for the 7'dle muqueux. The pus col-
lecting at a spot, so as to form an abscess, the rattle be-
comes cavernous, with a gurgling sound, and when the matter
is discharged, the bronchophony is changed into pectorilo-
quism.

PROGNOSIS.

More unfavourable in regard to infants, or the old, or those
with a phthisical taint; and almost uniformly fatal to the con-
firmed drunkard. Simple pleurisy is easily cured.

In pneumonia, when resolution is taking place, the case
retraces the steps by which it advanced.

The thick yellow sputa constitute the means by which the
lungs seem to be relieved of their inflammation.

Unfavourable signs, are the supervention of diarrhoea in an

PLEUROPNEUMONIA. 213

advanced stage, and of excessive secretions, with a sense of
suflbcation; besides a number of other things, easily suggested
by what has been already said.

AUTOPSIC APPEARANCES.

The pleura reddened in points, or streaks, and coated here
and there with coagulable lymph; or the pleural cavity dis-
tended with a serous fluid, or blood, or pus. The collection of
pus in a pleural cavity, is called empyema.

The lungs, when cut into, are seen to be reddish, and infil-
trated with a frothy sanguineous serosity or lymph, though still
cellular and crepitant.

But the phlogosis having proceeded to a higher extent, the
lung approaches more the liver in complexion and solidity,
having lost its crepitant feel, from an obliteration of the cells.
An incision being made, it appears spotted with red, white, and
black; and being held before the light, the cells seem filled with
small points resembling granulations. This state, from its re-
semblance to the liver, is called hepatization, which is, according
to the colour, either red or gray hepatization. The gray indi-
cates the existence of a higher inflammation than the red. A
still more solid state may be discovered, which, from its resem-
blance to flesh, is called cai'jiification. Again, the internal part
may be a pale yellow, and discharge on pressure a puriloid or
purulent fluid. An imposthume or pulmonary abscess, is very
rare.

There is a species of the disease, in which the inflammation
does not traverse the membrane which separates the lobules of
the lungs, and seems to originate in several points simultaneously.
This is called lobular pneumonia.

There may be also ramolicscence, or gangrene, which is dis-
tinguished by its terrible stench.

Several of these states are generally more or less blended.

In children, there is a greater disposition to lobular pneu-
monia.

Double pneumonia, or that existing in both lungs, is the most

214 DISEASES OF THE RESPIRATORY SYSTEM.

common form in the old and very young. The right lung is
more subject to inflammation than the left ; though the reverse
holds, in respect to the pleurae.

The mucous membrane, or other organs, are sometimes im-
plicated.

TREATMENT.

A bold and prompt practice is, in this disease, urgently de-
manded.

V e n e s e c t i 0 n. — Should be copious, and the blood should be
drawn in a large stream. Faintness, which is a desirable ob-
ject, is soonest procured, when the patient stands, and a vein is
opened in each arm simultaneously. Yet, since the blood gene-
rally needs a considerable reduction, these resorts are mostly
unnecessary.

Called at the height of an attack, we should not tie up the
arm, until the pain remits, and the respiration is relieved, even
though fifty ounces of blood be exacted for the purpose.

The chief exception to this freedom of depletion, occurs in the
infirm, and, above all, in drunkards of a phlegmatic tempera-
ment. In these last, where there is a predisposition to effusions,
dropsy of the pleura or cellular tissue is apt to follow ; — together
with delirium tremens, and oppressive secretions from the bron-
chia. Although, in the advanced stages, the lancet may be less
freely used, yet, whenever the pulse is active, the skin warm,
the pain severe, acute, or gravative, the chest tight, and the
respiration impeded, we are justified in resorting to venesection.

The cupped and buffed condition of the blood is not to be too
implicitly trusted; since the cup and buff" are often absent in the
early stage, when it would be right to bleed, and are present at
an advanced stage in which it would be wrong.

And again, the symptoms above-mentioned as calling for
venesection, may be absent, in consequence of the disease being
masked by certain states of the brain and nervous system, when
the inflammation is intense. The legitimate symptoms are then
unfolded by bleeding.

PLEUROPNEUMONIA. 215

Cupping, between the shoulders, unless the pain is circum-
scribed at another point.

Blisters. — Best applied, when a considerable reduction of
vascular action has been accomplished. They may, however,
be of service in the formative stage.

Emetic s. — Valuable, perhaps, as secondary means.

Purgatives. — Particularly useful, -where the chylopoietic
viscera are involved from miasmatic influence. Here calomel
should be used.

Diaphoretics. — The more stimulating are suited only to
the forming or closing stages; but, at a more active period,
we may employ the sedative diaphoretics. Among these, the
tartar emetic has acquired an especial reputation. It was given
by Rassori, and his followers, in doses varying from a scruple
to several drachms in twenty-four hours. It is said, that after
a few doses the stomach ceases to suffer from it. But given in
such quantities, it is regarded by Dr. Chapman as replete with
danger ; and it is now, after having had a trial, generally aban-
doned in this city. Yet in small doses it is an important remedy.

Opiates, should not be administered in an active stage.
They are, however, well suited to relieve the cough, which at
an advanced period causes a continuance of pain and want of
sleep; and at an earlier date, to the attacks of old persons.
characterized by irritation of the bronchia, inordinate pituitary
secretions, or an aggravating spasmodic cough. Dr. Chapman
also uses it early in the case of drunkards ; and invariably uses
it when he practises venesection, in such instances.

After the more violent symptoms appear to be very conside-
rably reduced, there may continue tightness of chest, with a
dry, short cough, difficult and penurious expectoration, slight
pain, and irritated pulse. This case is best met by a combina-
tion of calomel, opium, and ipecacuanha, repeated at short in-
tervals. This remedy may be assisted by a moderate bleeding,
and blisters.

In order that concoction or the formation of that critical ex-
pectoration by which nature relieves itself, may be induced, the
vessels should neither be so vigorous as to secrete lymph, nor so
debilitated as to eff'use serum. In the former instance they must

216 DISEASES OF THE RESPIRATORY SYSTEM.

be reduced, and in the latter stimulated. Hence results the
advantage, occasionally, of the more stimulant diaphoretics.

As soon as a loose cough, and a free discharge of thick tena-
cious mucus appears, the disease may be considered as broken,
and treated as if it were originally of a catarrhal nature, with
the demulcent drinks and cough mixtures formerly mentioned.

At this period, we sometimes meet in the aged, or infirm,
dyspnoea, and other symptoms of effusion. This condition, with
the other sequelae of the affection, will be hereafter more dis-
tinctly noticed.

The patient sinking from exhaustion, we should immediately
resort to the carbonate of ammonia and hot wine whey.

TYPHOID OR CONGESTIVE PNEUMONIA.

That form of it, which constitutes a secondary affection of
certain fevers, has been ah'eady treated of. The form now to
be considered is what is called Pneumonia Biliosa. This is
popularly termed bilious pleurisy, and is exceedingly prevalent
in our country.

S Y M P T O M S.

The characteristics of common pleurisy, or pneumonia, with
a sparing expectoration of phlegm or mucus of a bilious colour,
and very apt to be tinged with dark blood, and other slight
modifications. But to these symptoms are added many of the
features of our autumnal fevers. From the intensity of the
headache, the disease has been popularly called pleurisy of the
head.

The fever remittent, or even intermittent in the beginning,
gradually becomes more continued and typhoid.

Generally, the pulse is, at first, full, slow% struggling, and
remarkably compressible; the cutaneous surface pale, or mot-
tled, hot, or cold, with clammy perspiration, or the temperature
is very unequally diffused. Not arrested, the case proceeds to
prostration, exhibiting the lowest forms of cerebral disturbance,
and difficult respiration, with wheezing and rattling as in the
closing scenes of the worst types of bronchitis.

This delineation applies to the severer cases.

218 DISEASES OF THE RESPIRATORY SYSTEM.

CAUSES.

It is incident to nearly every climate, and to every season.
It is sonaetimes epidemic. As such, it has several times ap-
peared in the United States. In the year 1812, it spread over
the country with an unexampled mortality, and then received,
as expressive of its local peculiarities, the title of 'pneumonia
typhoides, spotted fever, cold plague. Prevailing endemically, it
is found mostly in miasmatic districts.

DIAGNOSIS.

Easily recognised, except when masked, as it sometimes is,
in epidemic cases. Physical signs become, in these cases, of
considerable importance.

PROGNOSIS.

Of rapid progress, especially in epidemic instances. Dr.
Chapman thinks, that at least nine out often, perish.

AUTOPSIC APPEARANCES.

The heaviest congestions of the pulmonary substance, bron-
chia, pleura, alimentary canal (especially the upper part), of
the liver, spleen, peritoneum, the right side of the heart, and the
brain.

TREATMENT.

Venesection can seldom be pursued, — at least to any extent,
A moderate amount of blood, thus taken, sometimes causes the
greatest prostration.

Cupping and Vesication at the seat of the local affec-
tions, wherever they may be. The latter may here be much
earlier resorted to than in the inflammatory form.

An Emetic.

Mercurial Purges.

CONGESTIVE PNEUMONIA. 219

Stimulant Diaphoretics,— They proved the most efli-
cient process in the epidemic which occurred to us some years
ago. By stimulating the secreting vessels of the surface, they
arrest the passive transpiration which is incident to the disease,
and by determining to the surface, unload internal organs.

The DoTer's Powder, aided by the vapour bath and an
infusion of the eupatorium, or pleurisy root, or serpentaria.

On the supervention of a sinking condition, we may resort to
the

Sulphate of ftuiuia, in addition to the diaphoretics.
This is peculiarly suited to miasmatic, and especially intermit-
tent cases.

In the final stage, the disease being unmitigated, we use the
carbonate of ammonia, with warm wine whey, or toddy, cam-
phor, dry heat, and other diffusible stimulants. Dry heat, how-
ever, is a powerful stimulus, and only suited to emergencies.

The disease breaking up, with a view to the assistance of
expectoration, resort may be had to the cough mixtures already
detailed.

REGIME N. — Tn this, and every other variety of pneumonic
afl^ection, the patient should be confined to bed, with his head
and shoulders considerably elevated, by which much relief is
afforded to respiration. A change of posture sometimes affords
relief, and is useful in overcoming certain passive congestions.

THE TEMPERATURE should be a medium one. Fresh
air is, however, a great requisite; and letting in the cold ex-
ternal air, may sometimes prove a useful tonic to the debilitated
lungs, restraining their inordinate secretions.

THE DIET should, in the strictly inflammatory states, be of
the lowest kind, — mere demulcent beverages. As the case be-
comes typhoid, it may consist of tapioca, sago, &c., with the
addition of a moderate portion of wine, or broth well seasoned.

There seems to be an extraordinary disposition in these dis-
eases to relapses, or more distant recurrences. Rush reports
one individual as having had twenty-eight attacks. The ex-
citing causes should, hence, be sedulously avoided.

PLEURITIS ET PNEUMONITIS CHRONICA,

OR

CHRONIC PLEURISY AND PNEUMONIA.

These affections are occasional degenerations of the acute
inflammatory form, but never of the congestive or typiioid.

Chronic pleurisy is constantly seen in the effusions into the
pleural cavity of serum, or pus. That branch of the disease,
which terminates in an effusion of serum, is discussed under the
head of Hydrothorax.

To phthisical degeneration of the lungs and their serous tissue,
will the remarks now made chiefly advert.

SYMPTOMS.

A transitory stitch in the side, or oppression and a hard, dry
cough. These symptoms continue weeks or months, attended
by remissions and exacerbations. At last, however, the pain,
oppression, and cough become more marked, the pulse quick,
hard, and febrile, and before long, a well-developed hectic
ensues. Digestion is sometimes much disordered, and the sto-
mach highly irritable.

In the closing scenes, the dyspnoea and cough become vio-
lent; and there is an expectoration of a glairy, or a thick
tenacious mucus, bloody, or puriloid, or purulent, and some-
times so copious as to convey the impression that an abscess
has burst. This is, indeed, occasionally true.

The disease is, at other times, much more disguised.

CAUSES.

Besides being superinduced upon the acute affection, it may

CHRONIC PLEURISY AND PNEUMONIA. 221

be idiopathic or primary, and proceed from cold and other
causes of inflammation. But being idiopathic, the constitution
in which it occurs, is nearly always a vitiated one.

DIAGNOSIS.

Distinguish from phthisis.

The pleuritic is discriminated from the pneumonic affection
chiefly as in the acute form. In the former, also, when there
has been effusion, the intercostal spaces are elevated to the level,
or even above the level of the ribs. An ulcerative cavity ex-
isting in the substance of the lungs, the cavernous rattle and
pectoriloquism supervene.

The distinction between a purulent, and a hydropic fluid in
the pleura, is to be drawn from the general condition. The
purulent expectoration of empyema is distinguished from that
from the lungs, by a garlicky odour.

PROGNOSIS.

Chronic phlogosis is, in itself, manageable; but empyema, or
purulent infiltration, having taken place, the case becomes a
serious one, and particularly in a vitiated constitution.

Empyema usually seeks an external opening. But the puru-
lent secretion is apt to continue, and the passage to become
fistulous.

AUTOPSIC APPEARANCES.

Essentially the same with those of the acute variety.

The lungs are often found of diminished size, from the con-
traction of the false membranes on the pleura, and the com-
pression of a fluid in its cavity.

In connexion with chronic pneumonitis, we often observe the
mature developements of phthisis.

Purulent infiltration of the cellular tissue is rarely, and an
abscess almost never, detected.

The abscess, constituting the apostematous consumption of

222 DISEASES OF THE RESPIRATORY SYSTEM.

the older writers, is formed in a cyst of coagulable lymph
poured out from the pleura on the pulmonary surface. The
enlargement of this abscess occasions a gradual compression,
and such a diminution of the lung, as sometimes to induce the
notion of its entire destruction.

The bronchia are, at times, implicated, and may be found
either contracted or dilated.

TREATMENT.

The leading object is to prevent structural lesions.

Bleeding, General and Topical.

Counter-irritation.

The Antimonials.

low Diet.

The phlogistic condition having thus been reduced, we
resort to

Mercury.— To obtain the constitutional effect betrayed by
ptyalism. It is, however, contra-indicated by the tubercular
disposition. Of all remedies, mercury is most efficient in arrest-
ing organic changes in the great viscera, or their envelopes.

For the absorption of pus, when it has been secreted, a
slender hope is afforded in the employment of

Active Purgation, and The Diuretics.

Iodine, internally and externally applied, has been much
recommended. Dr. Chapman has not, however, seen from it
the advantage promised by its friends.

This treatment proving nugatory, a resort may be had, in
empyema, to 'paracentesis thoracis, which has sometimes been
successful. Though it is likely to effect no permanent benefit
in old cases, it may afford relief; and may, in more recent
cases, be followed by a cure. But it should be performed only
in an emergency.

The other treatment is similar to that in analogous states of
tubercular consumption.

DISEASES OP THE SENSITIVE SYSTEM.
APOPLEXIA, OE APOPLEXY.

S Y M P T 0 M S.

PREMONITORY. — May supervene without premonition;
but is usually preceded by pain in the head, acute or dull; ver-
tigo ; drowsiness ; flushed face ; strange noises in the ear ; dis-
order of vision, hearing, or taste ; hebetude of mind ; deep
inspiration ; numbness of the fingers ; paralysis of the muscles of
the face ; a full irregular pulse ; cramps, or a sense of fulness,
in the stomach.

OF THE P A R 0 X Y S M.— Mostly the individual falls down
suddenly, deprived of sense and voluntary motion, and appa-
rently as if in a profound sleep ; with a florid or livid counte-
nance, stertorous breathing, frothing of the mouth, a dull, slow,
interrupted circulation, hot head and cold feet, and little or no
power of deglutition.

SYMPTOMS icheri probably the stomach is primarili/ in
fault. — Preceded by pain in the head ; severe stricture across
the forehead ; a feeling of drawing in the muscles of the back
of the neck ; vertigo ; great confusion of ideas ; tremors of
the limbs; prsecordial oppression; cramps of the stomach, or
bowels; nausea, or vomiting; pallor of the face; universally
cold surface ; and an irregular pulse. Afterwards may suc-
ceed convulsions, or paralysis (mostly hemiplegia), and other
marked symptoms.

In either the cerebral or gastric variety, life may be extin-
guished at once. But this is seldom.

Rupture of the heart, or lariie vessels, is sometimes mistaken

224 DISEASES OF THE SENSITIVE SYSTEM.

for apoplexy. A fatal paroxysm of apoplexy seldom ends sooner
than some hours, and usually endures several days.

The paroxysm having lasted for some time, it is not unusual
for the full, florid countenance to be exchanged for the pallid
one ; or, on the other hand, for a more inflammatory action to
be set up, with a hard, full, accelerated pulse, warm skin
throughout, injected eyes, dilated or contracted pupils.

When health has been restored, in other respects, the para-
lytic affection, where it exists, is little improved, and the mind
long remains impaired.

CAUSES.

PREDISPOSIN G. — Apoplexy occurs, usually, after the me-
ridian of life ; and the period most subject to it is said to be
between the ages of sixty and seventy. The male is much
more inclined to the disease than the female. It is often found
in men of large head, florid complexion, short thick neck, broad
shoulders, expanded chest, tumid abdomen, low stature, and
sanguine temperament.

Other predisposing causes are habits of intemperance, or
inactivity; extremes of temperature; antecedent lesions of the
brain, or its meninges, and especially degenerations of the
cerebral vessels, in consequence of chronic, and perhaps latent,
inflammation ; derangements of the heart, great vessels, lungs,
or any of the abdominal viscera, tumours of the neck, and
whatever else may disorder the circulation. But particularly
productive of apoplexy, is hypertrophy of the left ventricle of
the heart.

E X CI T I N G. — Excesses in eating and drinking, or irritating
ingesta ; narcotics; worms; offensive sordes in the bowels;
constipation ; the suppression of an habitual discharge ; the
repulsion of cutaneous eruptions; exposure to the sun, or hang-
ing the head over a fire; long continuance in a warm bath, or
the shock of a cold bath ; long exposure to a low temperature,
and especially the use of stimulating food or drink under such
circumstances ; violent exertion of the body, especially in a
bent position ; intense mental exercise ; loud haranguing, &c.

APOPLEXY. 225

DIAGNOSIS.

Paralysis of the brain, and in some of its forms coma, and
lethargus, are essentially of the same pathological condition.

In epilepsy there is much spasmodic and convulsive move-
ment, and especially of the muscles of the face, while in apo-
plexy there is a suspension of action in the voluntary muscles.
In epilepsy, the muscles are rigid ; in apoplexy, relaxed. The
paroxysm of the former soon passes off.

A-fit of intoxication may be distinguished from apoplexy, by
an inquiry into the history of the case, by the odour of the liquor
in the breath, and by a retention of sensibility in the upper lip
to the impression of water dropped upon it.

Distinguish from rupture of the heart, or of one of the great
vessels, by death being in the latter case immediate, and the
corpse being pallid.

That form of the disease radicated in the alimentary canal,
may be diagnosticated by the previous occurrence of dyspeptic
symptoms, or by the patient's having been engaged in a de-
bauch, or having swallowed a narcotic substance. The symp-
toms of the paroxysm differ also. The stomach being the
primary seat, there is usually much nausea or vomiting, the
face pallid, skin cold, the pulse weak and diminutive, and the
respiration comparatively little disturbed. The case very often
resembles syncope. Cases originating in the uterus, &c., may
be determined sometimes from their history.

PROGNOSIS.

The disease being uncomplicated with palsy, or, arising from
some abdominal disorder, is the more curable. The danger,
however, really depends upon the question, whether there be
merely vascular congestion, or extravasations from rupture of
vessels, or otherwise, or effusions from pre-existing irritation, or
inflammation, or some of those derangements of structure,
which are to be noticed, llecoveries sometimes take place
even after the extravasation of blood.
15

226 DISEASES OF THE SENSITIVE SYSTEM.

Apoplexy, in its more vehement forms, is always a most fatal
disease.

Symptoms of bad import are a weak, or exceedingly slow,
or an irregular, and especially an intermittent pulse, or one
not rising after venesection (showing that extravasation has
occurred), very expanded or contracted pupils, convulsions, and
particularly when of one side only, &c.

AUTOPSIC APPEARANCES.

The arteries, and veins of the brain and its meninges turgid,
or even heavily engorged. Or only a portion of structure is
involved. Most commonly, extravasation of blood, which may
be deposited either on the surface, or, as is more frequent, in
its substance. It is met with between the membranes, on the
exterior, throughout the internal cerebral structure, about the
basis of the brain, and in the ventricles. It may be pure and
of florid colour, or dark grumous, or concreted, and may vary
in quantity from a few drachms to as many ounces. The sur-
rounding brain may be either softened, or hardened. Some-
times the extravasations are serous or gelatinous. Acute in-
flammation is not seldom discoverable.

Besides, may be sometimes observed organic changes, and
degenerations of the brain, or its envelopes, or disease of other
parts of the body. These are, however, rather the causes of
the affection.

Fatal cases of apoplexy may occur without any appreciable
change on dissection. Such instances may result from mere
congestion ; though excessive doses of opium, and ardent
spirits appear to extinguish life, independently of the disorder
they induce in the circulatory and respiratory organs.

PATHOLOGY.

The proximate cause of apoplexy, in most instances at least,
is compression. This has been denied by M. Serres, of Paris,
who asserts the incompressibility of the brain. But his experi-
ments are nullified by the more cogent facts derived from other

APOPLEXY. 227

sources, which show the symptoms of apoplexy to disappear
immediately upon the removal of the coagulum, or pressure
otherwise exerted, and the symptoms of apoplexy to supervene
directly upon the application of artificial pressure to the brain.
By M. Serres it is also alleged that the absence of palsy in-
dicates the non-implication of the brain, and its presence the
implication of that organ. This is doubted by Dr. Chapman.

Abercrombie declaring that the cavity of the cranium is al-
ways perfectly full, concludes, of course, against the possibility
of any further accession of blood. He says, there is no more
blood in the cranium in apoplexy than in any other state, and
ascribes the disease "to an interrupted circulation in that organ
from more blood entering from the arteries than can be returned
by the veins." But if more blood enters by the arteries than
can be returned by the veins, then his premise, that the cavity
of the cranium is always full, cannot be true.

Those cases of supposed apoplexy, which have been reported
as being unconnected with any lesions of the brain, or its enve-
lopes, may have been really instances of rupture of the heart or
a great vessel ; or of hardening, softening, or other alterations
of the brain, until recently overlooked ; or they may have been
affections of the ganglionic system of nerves ; or the blood may
have been retracted from the cerebral vessels by copious deple-
tion, when it was, however, too late for the brain to recover
from the effects of its previous compression, or retracted, as
happens sometimes in inflammations, in the article of death.

But while it is contended that the lesion of the brain giving
rise to apoplexy, is usually dependent on compression, yet it
must be admitted that the same condition may exist indepen-
dently of compression ; and this is what was formerly called
nervous apoplexy.

Nosologists have commonly divided apoplexy into the san-
guineous and serous varieties. But such a classification has no
practical advantage. The better arrangement is into that form
which is a primary afl^ection of the brain, and that which is
syTvptomalic.

228 DISEASES OF THE SENSITIVE SYSTEM.

TREATMENT.

The head should be made to assume an elevated posture; all
ligatures should be loosed, the boots or shoes should be drawn
off", and fresh air admitted freely to the room.

The skin is sometimes cold and collapsed, and the circulation
extremely feeble. Here we must resort to the diffusible stimu-
lants. But a state of high sanguineous action existing naturally,
as it nearly always does, or having been excited by our stimu-
lants,

Venesection becomes the most efficient remedy. This may
be carried usually to the extraction of thirty or forty ounces of
blood in a robust individual, and may be required to be several
times repeated. It being advantageous to draw the blood with
rapidity, a vein is frequently opened in each arm ; but when the
general action is feeble, the blood should be taken cautiously.

The success of venesection is greater in simple congestion,
than in extravasation.

Local Bleedin g. — By leeches or cups, or by a section of
the temporal artery, or opening the jugular vein. The darker
colour of the blood drawn from the jugular vein than that from
the arm, would lead us to expect peculiar advantage from
topical bleeding in this instance. Leeches to the anus, in imita-
tion of haemorrhoids, might be advantageously tried.

Cold Applications to tlie Head. — At first should be
employed cloths wrung out of cold water. Such intense cold
as ice, is only applicable to the highest state of reaction, when
inflammation is menaced.

Revulsion by sinapisms to the lower extremities.

Emetics. — Especially to be used when the disease results
from a loaded stomach, or from narcotic poisoning, or when
the apoplexy has no sanguineous connexion. If we could as-
certain that the condition of the brain was that of mere turges-
cency, we might perhaps employ emetics in other instances
than those above-mentioned. But it would be wrong to employ
the measure in the case of extravasation.

Active Purgatives.— Calomel, and its common adjuncts,

APOPLEXY. 229

castor oil and oil of turpentine, elaterium, or croton oil. To be
given just after venesection, unless an emetic should be inter-
posed. When the patient cannot swallow, the medicine may
be introduced by the oesophagus tube. Stimulating enemata
may be combined. The purgation may be repeated daily.

Such a course having been pursued, and the case not relent-
ing, if the disease be of purely gastric origin, the

Diffusible Stimuli may be resorted to. It being of
primary cerebral origin, however, antiphlogistics are commonly
used. Here, also, may we apply blisters, first to the back of the
neck, then to the scalp, and finally to the extremities.

Mercury. — To be used internally, and externally to the
shaven scalp. It is suited to the cases in which an extravasa-
tion is to be absorbed, and is useful in correcting the secretions.

A sinking condition coming on, the diffusible stimulants should
be tried ; though death under such circumstances seems to be
inevitable.

As a great tendency remains to the reproduction of apo-
plexy, the causes should be sedulously avoided, and the least
premonition of the disease being given, blood-letting and other
antiphlogistics are demanded.

PARALYSIS, ORPALSY.

DEFINITION. — Either a loss of power in the muscles, or
loss of sensation, according as the nerves of motion or sensation
are afiected ; or both these states may be united.

By HEMIPLEGIA, is meant palsy of one side of the body, from
the head downward. By paraplegia, is meant palsy of a part
separated by a transverse plane, from the hip downwards.

There may be also general palsy (which, however, perhaps
never occurs except in apoplexy), and partial palsy, as of a
limb, or of a particular sense.

Hemiplegia is more uniformly originated in the brain, and
connected with cerebral disturbance, than paraplegia.

SYMPTOMS.

Paralysis may, as has been mentioned, be a symptom of apo-
plexy, or it may, though independent of that disease, be pre-
ceded by a train of symptoms much like those belonging to it,
or it may supervene gradually during weeks, months, or years.

The part assailed becomes flaccid, numb, cold and pale, with
sometimes convulsive twitches. The sound muscles, being de-
prived of antagonists, are contracted. The bowels are usually
torpid, though the sphincter ani, or the sphincter vesicce, being
paralysed, the excrement escapes involuntarily.

The symptoms will obviously vary according to the seat of
the disease, which may affect the nerves of any part of the
body. Of viscera, the lower bowels and urinary bladder are
most frequently affected.

In paralysis originating in the brain, the mental faculties are
apt to become weak or disordered.

PALSY. 231

PARALYSIS AGITANS, OR TREMBLING PALSY, usu-
ally commences in tremors of the hands or head. It may thus
remain for even forty years ; but commonly advances until it
pervades the whole body.

Being of an apoplectic character, paralysis is prone to run
to a speedy and fatal termination ; though in other cases it may
be rapidly cured, yet on the whole the cures are slow. Often,
after a rapid improvement in the beginning, the case becomes
almost stationary.

CAUSES.

Both the predisposing and exciting causes are much the
same with those of apoplexy.

Paraplegia and local paralysis, however, more frequently
proceed from some lesion of the spinal marrow, or of the nerve
supplying the part.

The influence of lead is a common cause. Mercury and
arsenic are said to be productive of like effects. The applica-
tion of cold to a system previously heated, is in some places a
prolific source of the disease. Being associated sometimes with
intermittent, or other autumnal fevers, miasma has been sus-
pected to be an agent in its creation.

DIAGNOSIS.

Palsy and apoplexy are mutually convertible diseases, and
may coexist.

The principal point is to determine the primary seat of the
disease ; whether in the brain, spinal marrow, nerve, or any
particular viscus. This must be done by the associate symp-
toms.

PROGNOSIS.

In proportion as the individual is older, so is the difficulty of
cure the greater.

Secondary or sympathetic palsy is more favourable than pri-

232 DISEASES OF THE SENSITIVE SYSTEM.

mary ; and palsy radicated in the spinal marrow more curable
than that of the brain. Dr. Chapman has long observed that
palsy of the right side is more intractable than that of the left.

The first indication of returning sensibility is frequently a
sense of formication, or a feeling like the creeping or stinging of
ants.

AUTOPSIC APPEARANCES.

In paralysis seated in the brain, like those of apoplexy. It
seems, from the contradictory reports of others, that no confi-
dence can be placed in the allegation of those who state that
paralysis of a certain part is always referable to a lesion in the
same portion of the brain.

We most uniformly find the seat of the lesions connected with
palsy, to be about the corpora striata, ihalami nervorum optico-
rum, and the medulla oblongata.

Similar phenomena are also observable in the spinal marrow,
and the nerves, when they are the source of the disease.

When the affection is of cerebral origin, the lesion will he found
on the side opposite to that in which the paralysis is manifested.

PATHOLOGY.

Like apoplexy, to which it is nearly allied, palsy seems mainly
to depend on pressure, whether we have regard to its being
seated in the brain, spinal marrow, or individual nerves. The
essential pathological difference between the two affections, con-
sists in the degree and extent of the pressure, it being greater in
both respects in apoplexy. But the energy of the nervous cen-
tres may be interrupted, it must be admitted, independently of
pressure.

There is one modification of the disease which seems to re-
sult from a want of irritability of the muscle ; and which, from
its being usually brought on by cold, might be perhaps referred
to rheumatism.

PALSY. 233

TREATMENT.

1. IN THE ACTIVE STAGE, the measures are Antiphlo-
gistic, and similar to those in the similar state of apoplexy. Dr.
Chapman, however, insists upon the importance of A c t i V e and
Persevering Purging. The disease being seated in the spi-
nal mari'ow, the local applications must be, of course, accom-
modated.

Tracing the attack, however, to cold, after these preliminary
measures, sweating by the Vapour Bath, and the Dover's
Powder, may be singularly successful.

In secondary paralysis, the nervous centres being usually in
the same pathological condition as when they are primarily
affected, we should direct at first the same m.easurcs as in pri-
mary paralysis; but this having been done, we should proceed
to eradicate the disease, upon which the lesion of the nervous
centres depends.

In PARALYSIS AGiTANS, WO should dircct our remedies chiefly
to the medulla oblongata, where it is probable the lesion is
situated.

In LOCAL PALsy, if the affection depend upon pressure on the
nerve by a tumour, this should be removed by an operation. In
other cases it is usual to employ local Depletion and
C 0 u n t e r ■ i r r i t a t i 0 n, as near as possible to the root of the
affected nerve. Sometimes general depletion is demanded.

2. In this stage, phlogosis, congestion, or irritation, is pre-
sumed no longer to exist. Here the internal and external Ex-
citants are indicated. Of the former, ammonia and mustard
seeds are entitled to a high regard. But as an internal medi-
cine, mercury, also, is of very great importance.

Of external applications, may be mentioned a series of blis-
ters, issues, setons, moxas, rubefacients, the hot or cold baths,
frictions, &c.

From the internal use of strychnia, or verairia, and the appli-
cation of electricity, galvanism, and electro-galvanism, Dr.
Chapman has seen little advantage.

234 DISEASES OF THE SEJNSITIVE SYSTEM.

The practitioner should be very cautious not to recur too
speedily to the stimulating measures, remembering that, for the
most part, especially in the beginning, the disease is one of
oppression, and not of debility. Even in chronic states of it,
we may find the pulse hard and corded, with other symptoms
of a febrile movement, or it may be low from oppression. Un-
der such circumstances, renouncing all tonics, we should betake
ourselves to evacuations, and especially to purgation by elate-
rium, which will be found to recruit the strength by a removal
of the disease.

The local applications, it may be again mentioned, should be
made as nearly as possible to the seat of the lesion in the ner-
vous centre ; or, when the nerve is affected, as nearly as pos-
sible to its root. Frictions may be sometimes employed to the
muscles, when the disease seems to be primary to them, and
there is no excitement.

The prevention of palsy is similar to that of apoplexy.

EPILEPSIA, OR EPILEPSY.

SYMPTOMS.

F 0 R M I N G. — The paroxysm may occur without any pre-
monition, or it may, as is more common, be preceded by lan-
guor, pain, or giddiness in the head, ringing or buzzing in the
ears, fulness of the cerebral vessels, &c. On other occasions,
the first intimation is the utterance of a loud scream or screams.
Besides, there may be vomiting, or pain in the bowels, with
looseness, or the reverse — constipation, — difficulty of respiration,
palpitations of the heart, rumbling of wind in tlie intestines,
and a rushing of it to the throat, copious discharges of pellucid
urine, coldness of the extremities, &c. But the most extraor-
dinary indication is what is called the aura epileptica. This is
a sensation like that of a gentle breeze, or of a stream of water,
or of the creeping of insects, which, arising generally at the
extremities, proceeds to the head, upon reaching which, coma
or convulsions ensue.

OF THE PAROXYS M.— This being mild, the patient, without
falling down, may be aflected only by a shaking of the head,
or agitation of the extremities, with frothing of the mouth, and
distortion of the features; these symptoms being succeeded by
sleep and recovery.

At other times the attack may amount to catalepsy, in which
the position is firmly maintained, with general rigidity of the
muscles, and mostly, with a state of stupor.

More frequently, however, the individual, after a horrible
shriek, falls to the ground. The muscles are contracted, as in

236 DISEASES OF THE SENSITIVE SYSTEM.

tetanus, or are affected with convulsions. The countenance is
pale, or livid, and hideously deformed.

DURATION. — May continue from a few minutes to many
hours. The average duration is probably fifteen or twenty
minutes. After the subsidence of the symptoms, the patient
falls asleep, or is completely aroused.

The FREQUENCY of the paroxysm varies from the inter-
mission of a very short time to that of a day, week, month,
year, or more.

T E RUN ATI 0 N S.— Death seldom takes place in the
paroxysm, though occasionally it degenerates into apoplexy,
and thus proves fatal. Continuing any great length of time, the
stomach is apt first to give way ; there may be pain in the head,
weakness, emaciation, paralysis, and decay of the intellectual
faculties, or furious mania. But examples are numerous, where
the disease has existed during a long life, without mental or
bodily suffering.

CAUSES.

P R E D I S P 0 S 1 N G.— It is often found in those with a nervous
system of extraordinary sensibility, or irritability, or mobility,
acutely alive to all impulses, physical or moral. Thus it has
often occured to men of the highest order. But, on the other
hand, we find it associated with stupidity, or even fatuity.

It is most incident to childhood. It may be hereditary.
Various lesions of the brain conduce to it, proceeding from
injury, intemperance, excess of venery, &c.

E X C I T I N G. — Great exertions, violent emotions, certain sen-
sations, or the mere force of imitation.

These are the causes of primary cerebral epilepsy. The
disease, however, may proceed secondarily from lesions of the
spinal marrow, or of a nerve.

It may arise also from irritations in the alimentary canal, —

EPILEPSY. 237

especially from dentition, worms, constipation, an excess or
improper quality of the ingesta, narcotic, or other poisons. It
arises also from irritations of the uterus, bladder, or other parts ;
from the repercussion of eruptions, the sudden arrestation of
old discharges, hyperasmia, and perhaps anaimia.

DIAGNOSIS.

Distinguish from hysteria by the great change of counte-
nance,— the livid aspect, the fixed or staring expression of the
eyes, gnashing of the teeth or firmly clenched jaws, foaming of
the mouth, and the speedy subsidence into a tranquil sleep, or
heavy stupor. Hysteria is accompanied by the globulus hys-
tericus, by sudden transition from laughing to weeping, &c.
But the case may be complicated with hysteria, or apoplexy.

The di^ase proceeding from a lesion of the spinal marrow,
the convulsions are extremely violent, and sometimes of a teta-
noid nature, and the lesion may sometimes be detected by pres-
sure on the spine. In a lesion of a nerve, besides the presence
of tenderness, we may also be directed by the paroxysm being
perhaps more apt to be preceded by the aura epileptica.

Its dependency upon an irritation in some remote organ or
tissue, must be determined by the associate symptoms which
usually characterize such a condition.

PROGNOSIS.

More unfavourable when the disease is primary, or where it
supervenes after puberty, or has long continued.

AUTOPSIC APPEARANCES.

When the disease proceeds from the brain, the phenomena
resemble those of apoplexy and palsy; and also, when from the
spinal marrow, there are similar phenomena, only seated in the
latter substance.

When the disease is secondary, the appearances, of course,
are exceedinglv diversified.

238 DISEASES OF THE SENSITIVE SYSTEM.

PATHOLOGY.

(1.) The disease commencing in cerebro-spinal nervous irri-
fation, the blood-vessels soon become involved in an irregular
circulation, with topical congestion or inflammation, and parti-
cularly of the brain.

This pathology is substantiated by a reference to the causes,
the symptoms, the necroscopy, the mutual convertibility of this
disease, and apoplexy, and palsy, into each other, and their
analogy, and lastly by the mode of cure. The essential condi-
tion of the disease is cerebral irritation; this may either be
primary or it may be secondary to the irritation of the spinal
marrow, a particular nerve, or of remote parts of the body.

This pathology is very similar to that of apoplexy and palsy.
The difference in the manifestations, may perhaps be ascribed
to the varied grades of violence, or to the particular seat of the
lesion, — irritation of the medulla oblongata being said to produce
epileptic symptoms.

(2.) But the cerebral irritation may be as well connected
with a deficiency as an excess of blood. This form of the
disease bears more resemblance to syncope. It might be re-
garded as spurious epilepsy.

Yet there are cases in which true epilepsy is accompanied
by no appearance of cerebral fulness. These, however, are
commonly found in old states of the disease, in which probably
the susceptibility of the brain has become so great as to produce
the paroxysm under the operation of only a very moderate
cerebral determination.

TREATMENT.

1. OF THE PAROXYSM.

a. In the ordinary presentation. The patient should be at
once placed in a position in which his head is elevated ; and all
lifyatures, particularly the cravat, should be loosened. The con-
vulsions being violent, the patient should be held down, and a
tourniquet applied to the arm and leg of opposite sides. A piece

EPILEPSY.

239

of cork should be interposed between the jaws to prevent lace-
ration of the tongue; by which, also, the paroxysm is said to
be sometimes arrested. The same efTect is said to result from
opening the fingers when firmly clenched; of the efficacy of
which Dr. Chapman has seen several instances.

Nervines, stimulating frictions, sternutatories, &c., are to be
excluded.

Cold to the nead.

Stimulating Pediluvia.

Active Enemata.

Emetics judiciously used. They are chiefly, though not
solely, adapted to the cases of primary gastric irritation.

Blood-letting. — General, or local. Suited to cases with
vascular fulness and excitement. It may obviate a conversion
of the paroxysm into apoplexy or palsy.

h. IlV THE FORM RESEMBLING SYNCOPE, CALLED LEIPOTHYMIA.

The object here being to replenish the cerebral circulation, the
head must be lowered; we must employ frictions, the fumes of
ammonia to the nose and internal stimuli, and a sinapism to the
back of the neck, or to the epigastrium, or to both.

2. TREATMENT OF THE INTERMISSION, or treat-
ment for a radical cure.

It is important to ascertain the primary seat of the disease,
the occasion of it, and the condition of the vascular system.

Venesectio n. — When the system is full, which it generally
is, and especially in the primary cerebral, or the uterine variety.

Local Bleeding may sometimes be substituted.

Emetic s. — Especially suited to the gastric variety.

Purgatives. — Useful by reducing the system, effecting de-
rivation from the brain, and removing irritating contents from
the bowels. It should be steadily persevered in. But its em-
ployment, like the other measures, should be made to accom-
modate the indications.

Cups, or Leeches, and Blisters, or Moxas, to the seat
of the local lesion, whether in the brain, spinal marrow, uterus,
stomach, or elsewhere. Repelled eruptions should be solicited

240 DISEASES OF THE SENSITIVE SYSTEM.

by stimulating frictions ; or replaced by a pustulation with
tartar emetic ointment.

Thie anthelmintics and emmenagogues should be used, when
demanded.

Some cases proceeding from depressed portions of cranium,
or the irritation of tumours, are curable by a surgical operation.

This is Dr. Chapman's early treatment of the disease, though
it is far more common to rely upon tonics, nervines, or stimu-
lants.

These remedies, though injurious at first, may become ad-
missible, when we have as much as possible removed, by the
course already detailed, irritation, congestion, or inflammation.
But on the recurrence of a phlogistic condition, they should be
immediately relinquished for a repetition of old measures. In
such instances antimonials are valuable.

Of Tonics, the phosphate of iron, and quinine, are the best.

The preparations of zinc, and copper, especially the sulphate
of copper and arsenic, are entitled to some regard. The nitrate
of silver, in large doses, has acquired a great celebrity.

Of narcotics, and nervines, it can be only said, that they allay
the mobility of the system, and may be used as palliatives.
Opium is to be preferred.

Electro-galvanism may have, perhaps, some claims to atten-
tion.

Epilepsy is rooted ordinarily in some positive lesion, and when
chronic, mostly of an organic nature. In such a condition,
mercury, given in alterative doses, is our most valuable re-
source.

In the LEiPOTHYMiAc variety, iron, a nutritious diet, and other
means calculated to enrich the blood, are indicated.

PREVENTIVES.

The patient feeling the aura epileplica, may succeed, some-
times, in preventing the paroxysm by pressure on the nerve.
Pressure on the epigastrium seems sometimes to succeed.

The paroxysm being looked for at a certain time, an antici-
patory detraction of blood, with cold to the head, and a stimu-

EPILEPSY. 241

lating pediluvium, are recommended, when there is cerebral
determination, or vascular excitement. In other instances an
opiate answers better. In the gastric variety, an emetic may
be demanded.

REGIMEN.

The diet should be adapted to the pathology. Moderate ex-
ercise on foot is desirable. The cold, or salt bath is sometimes
of service. Quietude of mind should be carefully preserved.

16

HYSTERIA, OR HYSTERICS.

SYMPTOMS.

A MOST Protean and imitative disease.

It may be preceded by various nervous phenomena, praBCor-
dial tightness, flatulence, nausea, or vomiting; or may come
on suddenly. On the latter occasion, the earliest indication is
constriction of the chest, pain about the flexure of the colon,
with a sense of fulness, and a rumbling which advances to the
stomach, and thence to the throat, occasioning pressure as of a
ball lodged there, and called globus hystericus.

The preceding symptoms are soon followed by coldness and
shivering, a fluttering pulse, and such acute pain in the head as
to be compared to the driving in of a nail, and hence called the
clavus hystericus. The chilliness is followed by no reaction.
Convulsions ensue, varying from the slightest to the most vio-
lent. The trunk is contorted backwards, or forwards, or to the
sides, the limbs are agitated, the hands clenched, the sphincter
ani firmly closed, while the sphincter of the bladder may be
relaxed, and emit copious streams of pellucid urine. During
this period there are wild shrieks, incoherent expressions, alter-
nations of laughter and crying, and a constricted respiration.

As the paroxysm subsides, deep sighings or sobbings take
place, eructations of wind, a gradual restoration of the senses,
but without any recollection of the events of the paroxysm ;
though sometimes, long after the subsidence of the fit, there re-
mains a state of stupor, with flushed face, or, on the other hand,
a pale cadaverous appearance, with great languor. There may
be either a single paroxysm, or a succession of them for several
davs.

HYSTERIA. 243

CAUSES.

May occur either in the male or female sex, though it is far
more frequent in the latter. It hardly ever occurs prior to the
age of puberty, or in advanced life. Single women and young
widows are most liable to its attacks. It is most prone to
affect the temperament of mobility, and sensitiveness, and the
feeble.

Its foundation is often laid in uterine disease (as the name
imports) ; dyspepsia, or worms ; lesions of the brain, or spinal
marrow ; and languor or depression following undue excite-
ment, or attending misfortunes.

But it may be at once excited by strong mental emotions.

DIAGNOSIS.

Be careful to ascertain the origin of the disease. Proceeding
from a uterine, or gastro-enteric affection, it will be probably
accompanied by symptoms, which when duly weighed will in-
dicate the primary source of irritation. Being of primary
cerebral origin, we find headache, a florid face, vertigo, tinnitus
aurium ; while its arising from the spine, is denoted by tender-
ness of some portion of the spine, and the violent tetanoid
spasms.

PROGNOSIS.

There have been few cases reported of a fatal issue of the
paroxysm. The disease may, however, degenerate into epilepsy,
or mania.

PATHOLOGY.

An exalted excitement, congestion, or phlogosis of the brain,
which is either primary, or the consequence of an irritation of
the spinal marrow, uterus, alimentary canal, or other part.

244 DISEASES OF THE SENSITIVE SYSTEM.

TREATMENT.

1. OF THE PAROXYSM.

The milder attacks are usually treated by the application of
pungent odours to the nostrils, or the internal administration of
the antispasmodics. But Dr. Chapman is very distrustful of
these measures, and when any great amount of cerebral affec-
tion exists, they do harm. Dashing cold water on the face, iviih
sinapisms to the extremities, is a better practice.

An E m e t i C, — Almost always restores tranquillity, and ob-
viates a renewal of the paroxysm.

Purges and Enemat a. — Particularly where we suspect
irritating colluvies in the intestines, or where constipation exists.

Nervines and Antispasmodic s.— Opium does not
answer so well as assafoetida and camphor.

The tourniquet, applied to the arm and leg of opposite sides,
may be serviceable in violent convulsions.

In cases marked by permanent stupor and flushed face,
general and topical bleeding, a blister to the nape of the neck,
cold to the head, and stimulating pediluvia, are demanded.

2. OF THE INTERMISSION.

The indication is to obviate the disorder of whose irritation
the hysteria is an effect. This being removed, we may resort
to the nervines.

The mind should be diverted, and kept happy. Green tea,
and coffee, should be avoided, and the digestive organs well
regulated.

CHOREA, OE ST. VITUS^ DANCE.

S Y M P T O M S.

The invasion may be sudden, though it is usually preceded
by a depraved, and often ravenous appetite, loss of vivacity,
tumefaction, and occasionally pains, in the abdomen, consti-
pated bowels, vitiated stools, and more or less of the cachectic
aspect.

The disease commences by a slight involuntary motion of
different muscles, particularly of the face, then of those of the
extremities, — the one or the other having precedence, they
being rarely affected simultaneously. For example, when the
arm is attempted to be raised, it is thrown into irregular con-
vulsive action, or an effort being made to walk, the same
happens, till, by continuance, the whole external muscular
system participates, even to the impeding of deglutition, articu-
lation, &c. In a state of repose, all the movements cease, to
be revived by the most trivial excitement.

Chorea is at first mostly a paroxysmal affection, with several
attacks daily, or at longer intervals ; but, not arrested, it de-
generates into a permanent condition, with scarcely any inter-
ruption, except in sleep. Generally the mental and physical
constitutions suffer very materially in the progress of the disease.

CAUSES.

Though incident to childhood, maturity, and old age, it is
most apt to occur between the ages of eight and fourteen. It
seems equally prone to attack all temperaments. It is caused
by irritations of the alimentary canal, or uterus (being connected

246 DISEASES OF THE SENSITIVE SYSTEM.

with the suppression, excess, or vitiation of the uterine dis-
charge) ; by the recession of eruptions, or the healing up of
old ulcers, &c. ; cerebral, spinal, or nervous lesions; mental
emotions, and imitation.

DIAGNOSIS.

We must endeavour to determine the location of the primary
irritation.

PROGNOSIS.

Little immediate danger, though the degenerations of the
disease have proved distressing, or even destructive of life.
Occurring before the age of puberty, a good hope is afforded
that the changes effected by that epoch, may eradicate the
affection.

AUTOPSIC APPEARANCES.

Not very certainly ascertained, yet we may presume them to
be the same in kind, with those of analogous affections.

PATHOLOGY.

In most instances the original seat is in the primse vise, or
rather in the system of ganglionic nerves, and particularly the
abdominal plexus, from which the impression is extended to the
brain. The latter happens, whatever may be the primary point
of the lesions, whether in the spinal marrow, or any other por-
tion of the body. An irritation without such cerebral affection,
could not be productive of the characteristic phenomena of
chorea. Although we do not know precisely the nature of the
pathological condition of the brain, it may be presumed to be
similar to that of the kindred diseases. We may suspect that
the basis of the brain, and especially the medulla oblongata, is
the part affected.

CHOREA 247

TREATMENT.

As in the associate aflcctions, we must regard the general
condition of the system, and the primary seat of the affection.
In a phlogistic condition it may be requisite to bleed; and where
the bowels seem to be the inceptive point of the disease, perse-
vering furgation may be serviceable. Afterwards, or in an
originally feeble condition of system, the vegetable and mineral
tonics may be resorted to. Of the former, the cimicifuga has
acquired a great reputation. Of the latter. Dr. Chapman re-
commends, in particular, the suhcarbonate of iron.

To allay the muscular spasms, the nervines and narcotics,
have been used. Opium is probably the best. Electricity and
galvanism have not been very successful. An alterative course
of mercury is often of great service.

Local irritations must be combated by local bleeding and
counter-irritation. But it should be recollected that in whatever
part of the body the irritation may have originated, the cerebro-
spinal axis ultimately becomes the subject of it, and that these
measures should be addressed to it, as well as to the primary
irritation.

REGIMEN.

The diet should conform to the general plan of the treatment.
Cold, and especially salt bathing, is of great utility, when reac-
tion follows. Exercise, and the regulation of the mind, are pre-
eminently useful.

TIC DOULOUREUX, OR NEURALGIA.

A DISEASE first distinctly noticed in the year 1756, by M.
Andre, of France. The disease probably existed before, but
was known by other names, as rheumatism, toothache, clavus
hystericus, &c.

The term neuralgia signifies nerve-ache.

This disease may affect any of the nerves in the body; and
being sealed in the nervous centre, the pain darts along the
nerve to its minute ramifications, or conversely, arising at the
branches, may be reflected on the centre.

But in its course, it is apt to entangle other nerves of the
same, or a different class, and render the aspect more complex.

S Y jM P T O M S.

The attack may come on without any premonition, or may
be preceded by dyspeptic, uterine, or arthritic disturbance.
Decidedly paroxysmal in the commencement, the paroxysms
observe the laws of periodicity, in imitation of an intermittent.
When chronic, however, it is less paroxysmal.

Immediately precursory, are often to be noticed a sense of
chilliness, slight disorder of stomach, pallor, and sometimes a
sense of formication, or the aura epileptica.

The paroxysm is made up of transient paroxysms, between
which there are commonly remissions of comparative ease.
The pain shoots along the nerve, following its distribution ; and
is sometimes terribly severe. The part is so tender that the
slightest touch cannot be tolerated, — even less tolerated than
firm pressure. Redness of the part sometimes occurs. Twitch-

NEURALGIA. 249

ing of the adjacent or remoter muscles, is occasionally observa-
ble. The circulation is little changed.

The duration of an attack varies from one or two hours to
several days. The attack may not return for a week, month,
or year.

Neuralgia most frequently assails the three divisions of the
fifth, and the facial portion of the seventh pair of nerves, tt
often attacks the intercostal muscles, those of the shoulder,
loins, hip, the large articulations, the scalp, mammae, and tes-
ticles. The brain, too, as well as other viscera, is subject to it.
It may be confined to a spot no larger than a pea.

CAUSES.

PREDISPOSIN e.— Most incident to the period of life be-
tween forty and sixty ; to the female, with a delicate, irritable,
or shattered constitution. But exceptions to the last statement
are numerous. It is apt to attack, in a mitigated form, girls at
the age of puberty, or a little later.

Mechanical injuries of nerves from wounds, or from the pres-
sure of spicule of bones or tight lacing; the chemical action of
the fluids in caries; dental irritation in facial neuralgia; mias-
mata ; excessive venery, or masturbation ; dyspepsia, or lesions
of any of the viscera (though it is probable that many cases
attributed to these causes are really founded in atonic, or mis-
placed gout) ; anaemia.

EXCITING. — Exposure to cold, moisture, or a draft of cold
air, undue corporeal or mental exercise, the emotions, or slight
mechanical disturbance.

DIAGNOSIS.

Distinguished by the acute pain darting along the nerves, its
occurrence in paroxysms, and the absence of inflammatory
signs.

It bears the closest analogy to neuritis, or inflammation of a
nerve, and particularly in the case of the tooth. But this may

250 DISEASES OF THE SENSITIVE SYSTEM.

be distinguished from genuine odontalgia, by its being deep-
seated, more obtuse, permanent, ultimately followed by swelling
of the cheek and gums, and by its ending in suppuration, &c.

It is distinguished from rheumatism by the difference of the
predisposing and exciting causes, the difference of the seat of
the pain, the absence of fever and inflammatory signs, its not
impairing the constitution or structures, even when protracted,
and the different effect of remedies.

It is very important, though sometimes difficult, to elucidate
the source of the disease. Emanating from the head, the case
is preceded by giddiness or other uneasiness of the head, dis-
order of some of the senses, congestion or increased action in
the vessels of the brain, with a sympathetic affection of the
liver or stomach.

The symptoms of the superior cervical division of the spinal
marrow, are pain in the scalp, shooting in various directions up
the occipital even to the frontal portion, or laterally along the
temples over the face, or sweeping behind the ears, or around
the lower jaw, productive of rigidity of the muscles, impeding
its movements and those of the head.

In an implication of the inferior cervical portion, the pain is
seated in the superior part of the chest, about the clavicle or
scapula, or it runs down the arm, sometimes even to the fingers ;
or passing forward, the superficial integuments, or the mammae
in females, may be involved in exquisite soreness, or intense
darting pains.

The upper part of the dorsal division being affected with
many of the symptoms just mentioned, it is more strikingly
characterized by pain in the intercostal muscles, or margin of
the ribs, or sternum, or epigastric region, or integuments behind
the chest, the acuteness of pain being occasionally exchanged
for dyspnoea in various degrees.

The lower dorsal division being affected with some of the
preceding phenomena, we have a sense of constriction across
the waist, and great tenderness and darting pain in the parietes
of the abdomen.

In disease of the lumbar and sacral section, there is a dull
ache, or acute pain in the muscles of the loins, and those of the

NEURALGIA.

251

hips, with a pain shooting down the lower extrennities, and the
tottering gait of an inebriate.

The ganglia, or branches of the sympathetic, being involved,
we have depravations of function or true neuralgic pains of the
organs deriving their nerves from this source. Thus result pal-
pitations, spasmodic asthma, angina pectoris, cramps, colic,
gastralgia, &c. Connected with these disturbances, we may
find great vitiation of the secretions, as in pyrosis, the diabetic
discharge, &c.

But generally in protracted cases one set of nerves implicates
another. This is particularly the case of the spinal and gan-
glionic nerves. The former, indeed, have seldom a distinct
affection. In colic, is exemplified the implication of the nerves
of the back, the pain in which is as great as that in the bowels.

The most certain test of spinal disease is, undue sensibility be-
trayed by pressure, or percussion, of the veriebrce, or sponging
with hot water.

PROGNOSIS.

Rather difficult of cure, especially in old cases. Those are
most favourable, which are seated in the spinal marrow; and
those seated in the ganglionic nerves the least so, especially
when connected with depravation of the abdominal viscera.

The disease, however, cannot be regarded as fatal, and it
often disappears spontaneously, or under the influence of some
new disease, especially an eruptive one, or a revolution in the
mode of living, or merely the shock of a mental emotion.

AUTOPSIC APPEARANCES.

In most instances no appreciable lesions have existed. In
many, the lesions were probably the cause instead of effect of
the disease. In a few cases the vessels of the neurilemma were
found preternaturally turgescent; and the nerve had an unna-
tural floridness, was thickened, but wanted the effusion of
serum, lymph, or pus, with the general changes of structure
incident to neuritis.

252 DISEASES OF THE SENSITIVE SYSTEM.

PATHOLOGY.

The disease, though having generally a local, may have also
a constitutional origin.

It seems certain, though inflammation of a nerve or nerve-
centre may supervene upon neuralgia, that yet it is not an
essential ingredient of it. Still, the disease may commence in
a neuritis, or myelitis, or phrenitis, which may be exchanged
for neuralgia, so as to justify a depletory plan of practice in the
beginning, and a tonic one afterwards. Or, there may be in-
flammation at the root of a nerve, and in the branches a mere
neuralgia, which may enjoy an indefinitely protracted and in-
dependent existence, after the reduction of the neuritis.

The nature of the pain, and the effect of medicines, are much
diversified by the location of the affection. It seems to be
seated, however, only in the nerves of sensation, and is asso-
ciated with a state of exceedingly exalted sensibility, — a state
the opposite of that of palsy.

TREATMENT.

1. OF THE PAROXYSM.

Venesectio ll. — When there is plethora, or a local phlogistic
condition, which, revived by cold or other means, reproduces
the neuralgia. This inflammation may be situated in the neu-
rilemma, and may be of a rheumatic character.

Leeching. — Very serviceable in myelitis, neuritis, or phlo-
gosis of the neurilemma, which, as appeared in the Pathology,
may complicate, or originate neuralgia. It should of course be
applied to the seat of the lesion.

Caustics. — Preferable to epispastics ; and particularly valu-
able when put behind the ear, in facial neuralgia.

S t e a m i Q g. — May assuage when there is exquisite tenderness.

Acupiin ct uration. — When large muscles are involved, as
those of the loins or hips, occurring mostly in gouty or rheu-
matic subjects.

Opium. — Nearly useless in facial neuralgia, it is of the

NEURALGIA. 253

greatest service in that of the gangUonic system, and above all
in the attacks of the alimentary canal. It has also considerable
power over irritations of the spinal nerves.

The external application of morphia has been successful.

C 0 1 c h i c u m. — Sometimes very serviceable.

Nau scants, or vomiting. These have an extraordinary
power to subdue pain, and are one of the best expedients in the
present instance. Nausea may be protracted several hours.

2. TREATMENT OFTHE INTERMISSION, FOR A
RADICAL CURE.

We should first endeavour to ascertain the fountain of
irritation. Arising from a tooth, or a spicula of bone, or
tumour, we must resort to a surgical operation. Those cases
dependent on a slight wound, which, after healing, irritates the
nerve, are most effectually relieved by the application of a
caustic to convert it into a running sore.

It would be needless to repeat the treatment adapted to the
various sources in which the neuralgia may arise.

An example or two will suffice. Judging the disease to
spring from a phlogistic or congestive irritation of a certain
part of the spine, we cup and use counter-irritation over the
region, and enjoin a state of rest. Supposing it to lie in a
similar condition of the sympathetic nerve, the same remedies
are suited, and may be preferably applied to the back, instead
of the front of the body, or directly over the organ assailed.
Again, concluding that neuralgia is originated or maintained
by disorder of the digestive apparatus, we must first rectify
this.

The primary causes of the disease having thus been over-
come, a resort may now be made to tonics, &c., with a view
of its eradication.

Of the tonics, perhaps, the best is the Sub carbon ate of
Iron. It seems to have the property of lessening sensibility in
most nervous diseases. It may be given in the dose of a drachm
or more, several times a day.

The nitrate of silver, and, especially in the ganglionic affec-
tion, the subnitrate of bismuth, deserve our regard.

254 DISEASES OF THE SENSITIVE SYSTEM.

From the narcotics, Dr. Chapman has derived little advan-
tage. Combined, however, with quinine, their virtues seem
improved.

Quinine and arsenic are adapted to all cases of a decidedly-
intermittent type.

Emetic s. — Very useful, and especially in neuralgia of the
pericranium.

C 0 1 e h i e n m. — In gouty or rheumatic habits.

Electricity, Galvanism, and Magnetism, sometimes
succeed.

When our diagnosis is not clear, we may be compelled to
follow an empirical and tentative practice.

REGIMEN.

Should be adapted to our views of the pathology of the case.
It may here be stated that the excision of a portion of nerve
has sometimes proved successful, and niay be resorted to, as a
last expedient.

DISEASES OF THE GENERATIVE AND
UEINAEY SYSTEM.

DIABETES.

DEFINITION. — A permanent increase, with an alteration of
the quality, of the urinary discharge.

It is usually divided into two species, according to the cha-
racter of the fluid.

Diabetes Insipidus.

Diabetes Mellitus.

Some pathologists deny the distinction, while others maintain
that the mellitic is the only form of genuine diabetes. Dr. Chap-
man, without deciding the point, directs his attention chiefly in
conformity with the latter view.

Mere hyperuresis may occur under a variety of circum-
stances.

The first observation of diabetes mellitus was published in
1684, by WilHs.

SYMPTOMS.

Preceded for the most part by general derangement of health,
especially derangement of the digestive and subsidiary pro-
cesses. This state also accompanies the actual existence of the
disease. We have also urgent thirst, parched mouth, costive-
ness, pain and heaviness in the lumbar region, general weari-
ness and aversion to exercise, and various dyspeptic symptoms.

Continuing, with an aggravation of the preceding symptoms,
we observe a loss of strength, emaciation, dyspnoea, vertigo,

256 DISEASES OF THE GENERATIVE SYSTEM.

headache, the gums ulcerated at the roots of the teeth, extreme
restlessness, cramps and spasms of the extremities, weak mind,
petulant temper, anaphrodisia, or impotency, and redness, swell-
ing and excoriation about the mouth of the urethra, with phy-
mosis.

Not terminating suddenly, which, however, it sometimes does,
the disease proceeds till the system is finally exhausted by hectic
fever, with pulmonic affections, or an inveterate dropsy.

The pulse throughout, though irritated, is generally weak.

The renal secretion, though usually excessive, varies from an
indefinitely small increase, to thirty pints in twenty-four hours,
which may be kept up for weeks and months. It is of a pale
straw-colour, with a peculiar odour, resembling sweet whey, or
milk, and somewhat of a saccharine, or honied taste. Mixed
with it, we may observe albuminous matter like chyle, and occa-
sionally clots of blood. The saline substances, though bearing
to each other about the same relative proportion, are much
diminished. The urea is much reduced, but not entirely want-
ing. On evaporation of a pint of fluid, an extract remains of an
ounce and a half.

The secretion in diabetes insipidus, is insipid, pellucid, and
very little changed.

CAUSES.

REMOTE. — A decayed and shattered constitution. It is most
incident to the debauched, in the decline of life, and especially
to such as have been addicted to ardent spirits. Whatever dis-
orders the stomach, or its dependencies, seems to predispose to
the production of the disease ; also excessive venery, and what-
ever debilitates the system.

PROGNOSIS.

It must be regarded as a most formidable disease, especially
in decayed constitutions.

DIABETES. 257

AUTOPSIC APPEARANCES.

The kidneys and liver are found most affected. The former
is in some cases flabby, enlarged, and of an ash-colour, in other
cases vascular and phlogosed. We may also observe morbid
phenomena in the other abdominal viscera, and the lungs.
Sometimes the whole force of the disease seems spent on the
chylopoietic viscera, while at others it is spent on the urinary
apparatus.

The blood is deficient in animalization; and when chemically
examined, has not its ordinary proportion of fibrin and albumen.

PATHOLOGY.

There has been much discussion, whether the primary seat is
in the kidneys, or digestive and assimilative organs. Dr. Chap-
man has no doubt of its origination in the latter. He believes
that, as in lilhiasis, the secretion of the kidneys is modified by
the state of the digestive apparatus. In the present instance
they are caused to secrete sugar, and an immense amount of
fluid. But the anormal condition of the blood, which results
from the disordered state of the assimilative organs, assists in
exciting the kidneys to the diabetic secretion. This excess of
fluid eliminated by the kidneys, is counterbalanced partly by the
deficiency of perspiration, though it is also supplied by the large
quantities of liquid taken into the stomach, and by a conversion
of the solids.

The hepatic, pulmonary, and other affections are derived from
an extension or sympathetic reflection of the gastric irritation.

The symptoms of diabetes are totally different from primary
disease of the kidneys.

TREATMENT.

The great indication is to rectify the depraved state of the
digestive organs; and, here, much of the treatment applicable
to dyspepsia will be found suitable. Afterwards the
17

258 DISEASES OF THE GENERATIVE SYSTEM.

Astringents may be serviceable. With them may be
combined

Opium, which is also highly useful in allaying the nervous
irritation. It may be given in large doses. The

Warm B a t ll at bed-time, followed by stimulating frictions,
is of vast importance. Its use is to relax the skin. With the
same view may be administered the diaphoretics. The Dover's
powder is, perhaps, the most elligible of the class.

Venesection is confessedly of great importance; and it may
be resorted to, even when the low state of the system would
seem to forbid. The quality of the blood greatly improves
under its use.

Tiiere being pain in the lumbar region, with a sense of
heaviness,

Topical Bleeding is demanded ; which may be succeeded
by a blister.

The diet should be exclusively animal. The only fluid admis-
sible is milk. This, indeed, may be used to the exclusion of
meat, in the stage of excitement. But the dietetic rules of dys-
pepsia will furnish many valuable hints. For drink may be
directed lime water, or water acidulated with a mineral acid, or
even plain water, according to circumstances.

The kidneys, or other organs being painfully, or otherwise
seriously affected, rest will be advisable; otherwise it will be
well for the patient to take exercise, particularly in the fresh
air. The regimen should be accurately observed, since by an
infraction, relapses are extremely apt to recur.

THE END.

LEA AND BLANCHARD'S LATE PUBLICATIONS.

BIRD ON URINARY DEPOSITS.

URINARY 'deposits.

THEIR DIAGNOSIS, PATHOLOGY, AND THERAPEUTICAL INDICATIONS.

BY G O L D 1 N G BIRD, A. M., M. D., &c.

In One Octavo Volutne, Cloth, with cuts.

" One of the best friiils of this ' revival' in urin.iry pathology is the work of Dr. Gold-
ing Bird, which we are about introduoing to the notice of our readers.

" In ISio, Dr. Bird delivered a course of lectures on the diagnosis and pathology of
urinary sedinienis. They were published in the London Medical Gazette, altra^ied
much aliention at the time, and were subsequently translated into German. These
lectures form the groundwork of the present publication, though much extended and
nearly rewritten.

" From the space which we have given to the consideration of this little volume, our
readers will naturally infer the exalted opinion we entertain of it. Yet we fear we
have still conveyed a very inadequate notion of its n^erits. Where almost every thing
is of value, it is difficult to select or condense. Such of our readers as wish to increase
their store of practical knowledge, and enlarge the sphere of their usefulness, we relief
to the volume itself, and recommend its possession. We now take leave of Dr. Bird,
with an expression of great readiness to meet him again in the same, or some analogous
line of investigation." — American Medical Journal.

DURLACHER ON CORNS, BUNIONS, ETC.
A TREATISE ON CORNS, BUNIONS,

THE DISEASES OF THE NAILS,

AND THE GENERAL MANAGEMENT OF THE FEET.

BY LEWIS DURLACHER,

Surgeon Chiropodist by Special Appointment to the Queen.

In One small Duodecimo Volume, Cloth.

"These important subjects are in this work lifted above the quackery which has

generally invested them, and we find them treated with evident marks of science and

education." — North American.

" This is a work by an educated scientific man, upon a subject which has been almost
given upzto quackery, but which thousands will agree to be of the highest importance.
The advice and prescriptions are of great value to all who are troubled with the dis-
eases of the feet." — Providence Journal.

LATELY PUBLISHED,

A NEW AND MUCH IMPROVED EDITION OF

DRUITT'S SURGERY.

THE PRINCIPLES AND PRACTICE OF MODERN SURGERY.

BY ROBERT DRUITT, Sl-rgeon.
FROM THE THIRD LONDON EDITION.

Illustrated by one hundred and fifty-three wood Engravings.

WITH NOTES AND CO.MMENTS,

BY JOSHUA B. FLINT, M. M., S. S.

In one volume 8vo,
" An unsurpassable compendium not only of surgical but of mcHral praclicc.'"— ion-
don Medical Gazette.

Lea and Blanchard's late Publicatioi

CHELIUS'S SYSTEM OF SUEGERY.

A SYSTEM OF SURGERY,
BY J. M. CHELIUS,

DOCTOR I.\ MEDICINE AND SURGERY, PUBLIC PROFESSOR OF GENERAL AND OPHTHALMIC
SURGERY, ETC., ETC., IN THE UNIVERSITY OF HEIDELBERG.

TRANSLATED FROM THE GERMAN,
AND ACCOMPANIED WITH ADDITIONAL NOTES AND OBSERVATIONS,

BY JOHN F. SOUTH,

SURGEON TO ST. THOMAS's HOSPITAL.

EDITED, WITH REFERENCE TO AMERICAN AUTHORITIES,

BY GEORGE W. NORRIS, M. D.

Published in Numbers, at Fifty Cents each.

SIX NUMBERS ARE NOW READY.

" Judging from a single number only of this work, we have no hesitation in saying
that, if the remaining portions correspond at all with the first, it will be by far the most
complete and scientific system of surgery in the English language. We have, indeed,
seen no work which so nearly comes up to our idea of what such a production should
be, both as a practical guide and as a work of reference, as this; and the fact that it
has passed through six editions in Germany, and been translated into seven languages,
is sufficiently convincing proof of its value. It is methodical ai>d concise, clear and ac-
curate; omitting all minor details and fruitless speculations, it gives us all the informa-
tion we want in the shortest and simplest form." — The New York Journal of Medicine.

A NEW AND IMPROVED EDITION OF

FERGUSSON'S OPERATIVE SURGERY^

A SYSTEM OF PRACTICAL SURGERY,

BY WILLIAM FERGUSSON, F. R. S. E.
SECOND AMERICAN EDITION, REVISED AND I3IPROVED,

With two hundred and Jifty-two Illustrations from dramngs by Bagg, engraved
by Gilbert.

With Notes and Additional Illustrations.

BY GEORGE VV. NORRIS, M. D.

In one beautiful octavo volume of six hundred and forty large pages.

The publishers commend to the attention of the profession this new and improved

edition of Pergusson's standard work, as combining cheapness and elegance, with a

clear, sound, and practical treatment of every subject in surgical science. Neither

pains nor expense have been spared to make it worthy of the reputation which it has

already acquired, and of which the rapid exhaustion of the first edition is sufficient

evidence. It is extensively used as a text-book in many medical colleges throughout

the country.

BRODXH'S SUHGECAI. l^ECTUH^QS.

Lea and Blanciiard will publish about March 1, 184G,

CLINICAL LECTURES ON SURGERY,

BY SIR BENJAMIN BRODIE, BART., F. R. S., &c.
In one neat octavo volume.

These Lectures, in passing through the columns of " The Medical News," (luring
the last year, have received the unanimous approbation of the profession in this coun-
try, and will no doubt be eagerly sought for in their complete state.

NEW WORKS AND NEW EDITIONS,

LATELY PUBLISHED BY LEA & BLANCHARD.

LISTON AND MUTTER'S

SURGICAL LECTURES.

A BEAUTIFUL VOLUME, PROFUSELY ILLUSTRATED.

LECTURES

ON THE

OPERATIONS OF SURGERY,

AND ON

DISEASES AND ACCIDENTS

REQUIRING OPERATIONS.

DELIVERED AT UNIVERSITY COLLEGE, LONDON.

By ROBERT LISTON, Esq., F. R. S., &c.

EDITED,

WITH NUMEROUS ALTERATIONS AND ADDITIONS, BY

T. D. MUTTER, M. D.,

PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA.

IN ONE LARGE AND BEAUTIFULLY PRINTED OCTAVO VOLUME.
With Tivo Hundred and Sixteen Illustrations on Wood.
This work contains much original matter of Professor Mutter's,
amounting to about two iiundred and fifty pages, embodying the
resuhs of his great experience, and adopting the whole to the wants
of the American Profession. The Lectures are those which have
attracted so much attention as published in the Lancet. They are
here reproduced entire, omitting none of the original wood engravings,
and introducing many new and valuable ones, rendering this alto-
gether one of the most completely ilkistrated works of the kind, that
has for some time been presented to the medical public. Among
the additions of Professor Mutter, will be found full and elaborate
Treatises on Staphyloraphy, the different Plastic Operations, Club-
Foot, Affections of the Eye, Deformities from Burns, and many other
important subjects, not to be met with in so enlarged a form in, per-
haps, any other work on Surgery. The chapters containing them
are fully illustrated with numerous original and highly curious en-
gravings.

" It is all plain and practically useful information. Illustrations abound, inter-
spersed through the 5(55 large octavo pages. Altogether it is a desirable book.
Its style, the importance of the subjects discussed, the facts detailed, and the high
authority of the lecturer, together with that ofliis annotator, must exert abeneficial
influence on the operative surgical practice of the whole country.''- " '
cal and Surgical Journal.
1

LEA & BLANCHARD'S LATE PUBLICATIONS.

NOW READY, FEBRUARY, 1846,

DUNGLISON'S THEEAPEUTICS.

A NEW EDITION, M0C]

GENERAL THERAPEUTICS AND MATERIA MEDICA.

WITH ONE HUNDRED AND TWENTY njLUSTRATIONS.
ADAPTED FOR A MEDICAL TEXT-BOOK.

BY ROBLEY DUNGLISON, M. D.,

PROFESSOR OF INSTITUTES OF MEDICINE, ETC., IN JEFFERSON MEDICAL COLLEGE; LATE PRO-
FESSOR OF MATERIA MEDICA, ETC., IN THE UNIVERSITIES OF VIRGINIA AND
MARYLAND, AND IN JEFFERSON MEDICAL COLLEGE.

THIRD EDITION, REVISED AND IMPROVED, IN TWO OCTAVO VOLUMES,
WELL BOUND.

In this edition much improvement will be found over the former ones. The author has
subjected it to a thorough revision, and has endeavoured to so modify the work as to make
it a more complete and exact exponent of the present state of knowledge on the important
subjects of which it treats. The favour with which the former editions were received,
demanded that the present should be rendered still more worthy of the patronage of the
profession, and this alteration will be found not only in the matter of the volumes, but also
in the numerous illustrations introduced, and the general improvement in the appearance
of the work.

LIST OF ILLUSTRATIONS.

Cephaglis Ipecacuanha.
Brown Ipecacuanha root.
Striated Ipecacuanha root —
Undulated Ipecacuanha root,
lonidium Ipecacuanha root.
Gillenia stipulacea.
liObelia inflata.
Sanguinaria Canadensis.
Apocynum Androssemilblium.
Erythronium Americanum.
Euphorbia coroUata.
Ficus Carica.
Ricinis communis.
Rheum palmatum.
Rheum compactum.
Aloe Socotorina.
Legume and leaflet of Acute
leaved Alexandrian Senna.
Legume and leaflet of C.obo-
vata.

Tinnevelly Senna.
Cassia Marilandica.
Podophyllum.

Hebradendron cambogio'ides
Momordica Elaterium.
Apocynum cannabinum.
Convolvulus panduratus.

VOL. I.

Chenopodium Anthelminti-
cum.

Spigelia Marilandica.
Nephrodium Filix mas.
Punica granatum.
30. Inhaling Bottles.
Balsamadendron Myrrha.
Acacia Arabica.
Oiea Europa;a.
Saccharum officinarum.
Linum usitatissimum.
Astragalus verus.
Cetraria Islandica.
Fucus vesiculosus.
Inhaler.
Cantharides.
Leontodon Taraxacum.
Erigeron Philadelphicum.
Arbutus Uva ursi.
Eupatorium perfoliatum.
Asclepias tuberosa.
Arum triphyllum.
Carthamus tinctorius.
Warm-bath.
Hip-bath.
Foot-bath.
Hyoscyamus Niger.
Datura Stramonium.

Coniura maculatum.

Humulus Lupulus.

Dried lupulinic grain with its
hilum magnified.

Cannabis .sativa.

Lycopus Virginirus.

Strychnos Nux Vomica.

Ruta graveolens.

Secale cornutum.

Cinnamomum Zeylanicum.

Cardamom.

Cariophyllus aromaticus.

Fosnieulum vulgare.

Monarda coccinea.

Hedeoma pulegioides.

Myristica moschaia.

Nutmeg in the shell surround-
ed by the mace.

Gaultheria procumbens.

Juniperus communis.

Citrus Aurantium.

Laurus Camphora.

Drymis Winleri.

Acorus Calamus.

Piper nigrum.

Electrical Apparatus for Me-
dical purposes.

1. Cocculus palraatus. (Male
plant.)

2. Gentiana Catesbeei.

3. Frasera Walteri.

4. Sabbatia angularis.

5. Coptis trifolia.

6. Aletris farinosa.

7. Aristolochia serpentaria.

8. Asarum Canadense.

9. Anthemis Cotula.

10. Magnolia glauca.

11. Magnolia macrophylla.

12. Geum Virginianiim.

13. Hepatica Americana.

14. Indigo.

15. Cornus Florida.

16. Liriodendron lulipifera.

VOL. II.
17. Dyospyros Virginiana.
IS. Heuchera acerifolia.

19. Spiraea tomentosa.

20. Statice Caroliniana.

21. Colchicum autumnale.

22. Veratrum Album. Ver. Al-
biflorum.

23. Cimicifuga racemosa.
24,25. Shower-bath.

26. Abies excelsa.

27. Ranunculus acris.

28. Aralia nudicaulis.

29. Solanum dulcamara.

30. Tacca pinnatifida.

31. Particles of Tahiti Arrow-
root.

32. Particles of white East India
Arrow-root.

33. Particles of West India Ar-

row-root.
.34. Particles of Tous-les-mois.
35. Particlesof Potato starch seen

by the microscope.
.36. .Tanipha Manihot.

37. Particles of Tapioca as seen

by the microscope.

38. Sagus Rumphii.

39. Particles of Sago-meal.

40. Particles of Potato sago.

41. Cycas revoluta or the Japan

Sago-tree.

42. Avena Sativa.

43. Particles of Wheat Starch.

"Our junior brethren in America -will find in these volumes of Professor Dunglison, a 'THKSAtTRrs
MEDIC.1.MINUM,' more valuable than a large purse of gold." — Medico- Chirurgical Review /or Jan., 1845.

2

LEA & BLANCHARD'S LATE PUBLICATIONS.

CHELIUS'S SYSTEM OF SURGERY.

A SYSTEM OF SURGERY,

BY J. M. CHELIUS,

DOCTOR IN MEDICINE AND SURGERY, PUBLIC PROFESSOR OF GENERAL AND OPHTHALMIC
SURGERY, ETC. ETC., IN THE UNIVERSITY OF HEIDELBERG.

TRANSLATED FROM THE GERMAN,

AND ACCOMPANIED WITH ADDITIONAL NOTES AND OBSERVATIONS,

BY JOHN F. SOUTH,

SURGEON TO ST. THOMAS's HOSPITAL.

EDITED, WITH REFERENCE TO AMERICAN AUTHORITIES,
BY GEORGE W. NORRIS, M.D.

PUBIISHIKG IN NUMBERS, AT FIFTY CENTS EACH.

EIGHT NUMBERS ARE NOW READY.

That this work should have passed to six editions in Germany, and have been translated into no
less than seven languages, is sufficient proof of its value. It contains what is, perhaps, embraced to
an equal extent in no other work on the subject now before the public, a complete System of Surgery,
both in its principles and practice. The additions of the translator, Mr. South, are very numerous,
bringing the work up to the very day of publication, and embodying whatever may have been omitted
by the author respecting English Surgery : while Dr. Norris will take equal care in representing the
state of the science in America.

"Judging from a single number only of this work, wo have no hesitation in saying that, if the remain-
ing portions correspond at all with the first, it will be by far the most complete and scientific sy.^tem of
surgery in the English language. AV'e have, indeed, seen no work which so nearly comes up to our
idea of what such a production should be, both as a practical guide and as a work of reference, as
this; and the fact that it has passed through six editions in Germany, and been translated into seven
languages, is sufficiently convincing proof of its value. It is methodical and concise, clear and accu-
rate; omitting all minor details and fruitless speculations, it gives us all the information we want in
the shortest alid simplest form." — Tlie New York Journal of Medicine.

"The scope of Professor Chelius's Manual lis indicated by its title: it professes to treat, systemati-
cally, of the science and art of surgery, but within such compass as to render the work an appropriate
introduction and companion to his lectures. The care, however, which has been bestowed upon its
construction, and the labour which its research evinces, would be ill-repaid were it confined to this
sphere; and we may conscientiously say that we know of no Manual of surgery, on the whole, more
deserving of publicxonfidence, or more valuable as a guide and refresher to the young practitioner.
It is not our intention at present critically to analyze Mr. South's labours; but we should be guilty
of an injustice to him and to our readers if we did not cordially recommend his work as having fair
promise of forming, what it is the translator's ambition it should be, a sound- and comprehensive
system of practical surgery. The notes and text are so intermingled as to render it continuously
readable, without presenting those abrupt transitions which are so disagreeable in many works simi-
larly arranged. The faults of omission. &c., at which we have hinted in our comments on the first
chapter of our author's work, (viz., that on 'Inflammation,') have been amply coinponsated by the
copious and excellent digest of his translator and ainiotaior, who is justly jiroud ol ava ling himself of
the labours of our own countrymen in this department of pathology, while h^- givi s iheir due meed of
notice and respect to the contributions of our continental brethren. The refcrencis which are given
to original works have evidently been carefully collated, and will be found of great value to the
student and practitioner who may wish for more copious information on any particular l)ranch of
surgery; and the practical remarks and illustrations with which the work abounds, are a good
guarantee of the translator's ability to do justice to his task, at the same time that they prove that Mr.
South has not failed to avail himself industriously of the large opportunities which his hospital appoint-
ment has afforded him."— jT/ic Britii/i and Foreign Medical Review.

" We will, therefore, content ourselves for the present with directing the alttntlon of the profession
to it, as being the most complete system of surgery in any language, and one that is of equal utility as
a practical guide and as a work ol reference. The fact of its having reached six editions in Germany,
and of its having been translated into seven languages, are more convincing proofs ol its value lliiiii
anything that we can say. I\Ir. South has performed his task with much judgment, and has certamly
made a most useful addition to the medical literature of this country by rendering Chelius's work into
English"— 2Vie Lancet.

3

LEA & BLANCHARD'S LATE PUBLICATIONS.

COMPENDIUM OF CHAPMM'S LECTURES.

A COMPENDIUM OF LECTURES

ox THE

THEORY AND PRACTICE OF MEDICINE.

DELIVERED BY PROFESSOR CHAPMAN IN THE UNIVERSITY OF
PENNSYLVANIA.

PREPARED, WITH PERMISSION, FROAI DR. CHAPMAN'S MANU-
SCRIPTS, AND PUBLISHED WITH HIS APPROBATION,
BY N. D. BENEDICT, M. D.

IN ONE VERY NEAT OCTAVO VOLUME.

CONTENTS.

Remarks on the Classification of Diseases — Fever in General — Intermittent Fever — Remit-
tent Fever — Continued Fever, (Mild, Intermediate, and Extreme Forms) — Yellow Fever
— Endemic Pneumonic, or Spotted Fever — Diseases of the Heart and Blood-vessels, (In-
flammatory, Organic, and Nervous) — Acute Carditis, Pericarditis, and Endocarditis — Chro-
nic Carditis, Pericarditis, and Endocarditis — Hypertrophy of the Heart — Dilatation of the
Heart — Atrophy of the Heart — Rupture of the Heart — Affections of the Valves of the
Heart — Palpitations — Acute Arteritis — Degenerations of Arteries — Aneurism of Arteries
— Phlebitis — Acute Inflammation of the Throat — Chronic Inflammation of the Throat —
Dysphagia — Parotitis — Dysentery, (Inflammatory) — Dysentery, (Congestive) — Diarrhoea —
Cholera Morbus — Cholera Infantum — Flatulent Colic — Bilious Colic — Colica Pictonum —
Acute Peritonitis — Chronic Peritonitis — Acute Catarrh — Catarrhus iEstivus — Chronic Ca-
tarrh— Acute Bronchitis — Chronic Bronchitis — Catarrhus Senilis — Acute Infantile Bron-
chitis— Chronic Infantile Bronchitis — Croup — Acute Infantile Asthma — Whooping-Cough
— Acute Laryngitis — Chronic Laryngitis — Pleuropneumonia — Congestive Pneumonia —
Chronic Pleurisy and Pneumonia — Apoplexy— Palsy — Epilepsy — Hysteria — Chorea —
Neuralgia — Diabetes.

It will be seen that lliis work is entirely distinct from the volumes of Dr. Chapman on Eruptive Fe-
vers, &c., and on Thoracic and Abdominal Viscera. All the works are printed and bound to match.

BIRD ON URINARY DEPOSITS.
URINARY DEPOSITS,

THEIR DIAGNOSIS, PATHOLOGY AND THERAPEUTICAL
INDICATIONS.

BY GOLDING BIRD, A.M., M. D., &c.

V In One Octavo "Volume, Cloth, with Cuts.

"One of the best fruits of this 'revival' in urinary pathology is the work of Dr. Golding Bird,
which we are about introducing to the notice of our readers.

"In 1843 Dr. Bird delivered a course of lectures on the diagnosis and pathology of urinary sedi-
ments. They were published in the London IVIedical Gazette, attracted much attention at the lime,
and were subsequently translated into German. These lectures form the groundwork of the present
publication, though much extended and nearly rewritten.

" From the space which we have given to the consideration of this little volume, our readers will
naturally infer the exalted opinion we entertain of it. Yet we fear we have still conveyed a very
inadequate notion of its merits. Where almost everything is of value, it is difficult to select or con-
' dense. Such of our readers as wish to increase their store of practical knowledge, and enlarge the
sphere of their usefulness, we refer to the volume itself, and recommend its possession. We now
lake leave of Dr. Bird with an expression of great readiness to meet him again in the same, or some
analogous line of investigalion. "—^?/i«ricara Medical Journal.

" The author of this volume is at once a chemist skilled in analysis, and a practitioner who has
for years carefully noted diseases al the bedside. It is therefore manifest, ihal he is qualified in an
uncommon degree to discuss the subjecl of urinary deposits, in which the phenomena belong as much
lo chemistry as to pathology. Such are the labourers from whom science is likely to derive the most
valuable results, as lo all the pathological conditions which involve chemical reactions. The mere
chemist is not competent to the task of unfolding them; and the palliologist without the tests and
reasents of the laboratory, is unable lo account for the series of changes. The union of the two, as it
is found in Dr. Bird, is indispensable loasucceesful prosrcuiiun of such researches. It is as a manual
for the practitioner in urinary atfeclions that he presents his work lo the profession, and in that cha-
racter it has tlie highest claims to our attention. Its matter is condensed, and so arranged, that ready
reference may be made to any lopic."— The Western Journal of Medicine and Surgery.

LEA & BLANCHARD'S LATE PUBLICATIONS.

SIMON'S CHEMI^STRY OF MAN.
ANIMAL CHEMISTEY.

WITH REFERENCE TO THE PEYSIOLOGY AND PATHOLOGY OF MAN.
BY DR. J. FRANZ SIMON.

TRANSLATED AND EDITED BY

GEORGE E. DAY, M.A. & L.M. Cantab., &c.

With Plates, in One Volume, 8vo.

"A work that obtained for its author a European reputation, and is universally regarded
as by far the most complete treatise that has yet appeared on Physiological Chemistry." —
E(lftor'>s Preface.

" No treatise on physiological chemistry approaches, in fullness and accuracy of detail,
the work which stands at the head of this article. It is the production of a man of true
German assiduity, who has added to his own researches the results of the labours of nearly
every other inquirer in this interesting branch of science. The death of such a labourer,
which is mentioned in the preface to the work as having occurred prematurely in 1842, is
indeed a calamity to science. He had hardly reached the middle term of life, and yet had
made himself known all over Europe, and in our country, where his name has been
familiar for several years as among the most successful of the cultivators of the chemistry

of man It is a vast repository of facts, to which the teacher and student may refer

with equal satisfaction." — The WesteJ'n Journal of Medicine and Surgery.

" Several reasons combine to render Dr. Simon's work peculiarly valuable. In the first
place, the author evidently understands his subject, and discusses it with great ability; in
the next place, his opinions have been formed, in a great measure, from original investiga-
tions ; and, lastly, he seems to have no theories beyond facts — no dogmas to sustain at the
expense of truth and principle; but he enters upon the investigation like a true philoso-
pher, and the result is such as we have seen." — The Western Lancet.

B U D D ON THE L IYER.

ON DISEASES OE THE LIYER.

BY GEORGE BUDD, M.D., F.R.S., &c.

WITH

WOOD-CUTS AND COLOURED PLATES,

IN THE FIRST STYLE OF ART.

In One Octavo Volume, Sheep.

" We cannot too strongly recommend the diligent study of this volume. The work
cannot fail to rank the name of its author among the most enlightened pathologists and
soundest practitioners of the day." — Medico-Chirurgical Review.

" With the new year, Messrs. Lea & Blanchard have brought out one of those sterling
works on medicine which it refreshes one to examine. It is a sound, practical guide in
every-day practice, and opportune, from the circumstance that it does not interfere with
any recent publication. Those only who have felt how difficult it is to decide, or rather
determine with certainty upon the true condition of the liver, under some indications of
the system, can appreciate a treatise like this." — Boston Med. and Surg. Journal.

DURLACHER ON CORNS, BUNIONS, ETC.

A TREATISE ON'cORNS, BUNIONS,

THE DISEASES OF THE NAILS, AND THE GENERAL
MANAGEMENT OF THE FEET.

By lewis DURLACHER,

SCaGEOX CHinOPOniST, BX special appointment, to the dUEEN.

In One small Duodecimo Volume, Cloth,

"These important subj^ris are in this work lifted above the quackery which has generally in-
vested ihem, and we find them treated with evident marks of science and education."— A'o»7A Am.

5

LEA & BLANCHARD'S LATE PUBLICATIONS.
HUGHES ON THeTuNGS AND HEART.

CLINICAL INTRODUCTION TO THE PRACTICE OF
AUSCULTATION,

AND OTHER MODES OF PHYSICAL DIAGNOSIS.

INTENDED TO SLMPLIFY THE STUDY OF

THE DISEASES OF THE HEART AND LUNGS.

By H. M. hughes, M. D., &c.

In One Duodecimo Volume, (with a Plate.)

CHURCHILI/S MIDWIFERY,

WITH NUMEROUS ADDITIONS.

NEW EDITION, JUST PUBLISHED.
L. & B. have just issued a new ediiion of this valuable and standard work on the Theory and
Practice of Midwifery, edited by Huston, in One Octavo Volume, well bound, with numerous illus-
trations.

ALSO, LATELY PUBLISHED,

NEW EDITIONS OF

PEREIRA'S MATERIA MEDICA.

REVISED, WITH ADDITIONS, BY CARSON.

In Two Large Octavo Volumes, many Cuts,

AND OF

WATSON'S PRACTICE OF PHYSIC,

EDITED BY CONDIE,

IN ONE OCTAVO VOLUME,

Of nearly Eleven Hundred Large Pages, bound in strong Leather, with raised bands.

NEARLY READY,

KIRBY & SPENCE'S ENTOMOLOGY.

AN INTRODUCTION TO ENTOMOLOGY,

OR ELEMENTS OF THE

NATURAL HISTORY OF INSECTS;

COMPRISING AN ACCOUNT OF

NOXIOUS AND USEFUL INSECTS,

OF THEIR

METAMORPHOSES, FOOD, STRATAGEMS, HABITA-
TIONS, SOCIETIES, MOTIONS, NOISES, HYBER-
NATION, INSTINCT, &c. &c.

WITH PLATES.

By WILLIAM KIRBY, M. A., F.R. S. & L.S., &c. &c..
And WILLIAM SPENCE, Esq., F. R. S. & L. S.

From the Sixl/i London Edition, Corrected, and considerably Enlarged.
IN ONE LARGE OCTAVO VOLUME.
6

LEA & BLANCHARD'S LATE PUBLICATIONS.

LATELY PUBLISHED, A NEW AND MUCH IMPROVED EDITION OF

DRUITT'S ^U RGERY.

T H E

PRINCIPLES AND PRACTICE OF MODERN SURGERY.

Br ROBERT DRUITT, Surgeon.
FROM THE THIRD LONDON EDITION.

ILLUSTRATED BY ONE HUNDRED AND FIFTY-THREE WOOD ENGRAVINGS.
WITH NOTES AND COMMENTS,

Br JOSHUA B. FLINT, M. M., S. S.

In One Volume, Octavo.

" An unsurpassable compendium not only of surgical but ot medical practice." — London ^,Ied. Gaz.
A NEW AND IMPROVED EDITION OF

FERGUSSON'S 0PE_RAT1VE SURGERY.
A SYSTEM OF PRACTICAL SURGERY.

BY WILLIAM FERGUSSON, F. R. S. E.
SECOND AMERICAN EDITION, REVISED AND IMPROVED,

With two hundred andjiflij-two Illustrations from drawings by Bags, engraved by Gilbert.

WITH NOTES AND ADDITIONAL ILLUSTRATIONS.
BY GEORGE W. NORRIS, M.D.

In one beautiful octavo volume of six hundred and forty large pages.
The publishers commend to the attention of the profession this new and improved edition of Fer-
gusson's standard work, as combining cheapness and elegance, with a clear, sound, and practical
treatment of every subject in surgical science. Neither pains nor expense have been spared to make
it worthy of the reputation which it has already acquired, and of which the rapid exhaustion of the
first edition is sufficient evidence. It is extensively used as a text-book in many medical colleges
throughout the country.

SIR ASTLEY COWeFsTuRGICAL WORKS.

COOPER ON THE ANATOMY AND DISEASES OP THE BREAST.

TOGETHER WITH

TWENTY-FIVE MISCELLANEOUS SURGICAL PAPERS:

NOW FIRST PUBLISHED IN A COLLECTIVE FORM.

IN ONE LARGE IMPERIAL OCTAVO VOLUME.

With 252 Figures on 36 Plates.

coopeI^ on hernia.

IN ONE LARGE IMPERIAL OCTAVO VOLUME.

With over 130 Figures on 26 Plates.

COOPER ON THE^isTlFANI) THYMUS GLAND.

ILLUSTRATED WITH 177 FIGURES ON 27 PLATES.
In One Imperial Octavo Volume.

COOPER ON FRACTURES AND DISLOCATIONS.

WITH 133 ILLUSTRATIONS ON WOOD.
In one neat Octavo Volume.
7

LEA & BLANCHARD'S LATE PUBLICATIONS.

BRODIE'S SURGICAL WORKS.

BRODIE'S SURGICAL LECTURES.
NOW READY,

CLINICAL LECTURES

ON

SURGERY.

IN ONE NEAT OCTAVO VOLUME.

These Lectures, in passing through the columns of "The Medical
News," during the last year, have received the unanimous approbation of
the profession in this country, and will no doubt be eagerly sought for in
their complete state.

BRODIE ON URINARY ORGANS.

LEG t"u res

ON THE

DISEASES OF THE URINARY ORGANS.

FROM THE THIRD LONDON EDITION.

WITH ALTERATIONS AND ADDITIONS.

In one small octavo volume, cloth.
This Avork has throughout been entirely revised, some of the author's
views have been modified, and a considerable proportion of new matter has
been added, among which is a lecture on the Operation of Lithotomy.

BRODIE ON THE JOINTS.

PATHOLOGICAL AND SURGICAL OBSERVATIONS

ON THE

DISEASES OF THE JOINTS.

FROM THE FOURTH LONDON EDITION.

WITH THE AUTHOR'S ALTERATIONS AND ADDITIONS.

In one small octavo volume, cloth.

" To both the practical physician and the student, then, this little volume

will be one of much service, inasmuch as we have here a condensed view

of these complicated subjects thoroughly investigated by the aid of the light

afforded by modern Pathological Surgery." — N. Y. Journal of Medicine.

THESE WORKS FORM A PART OF

SIR BENJAMIN BRODIE'S

LECTURES, ILLUSTRATIVE OF

VARIOUS SUBJECTS IN PATHOLOGY AND SURGERY,

The remainder of which will be issued.

TO THE MEDICAL PROFESSION.

The following list of the various profepsional works publislied, in press, ami preparing by the subscribers, Pin-
braces numerous TEXT-BOOKS on all the principal deparlinenu of Medical Lileraiure, as well as various valu-
able specialties. In increasing llie number and beauty of ilie illuelralions to these works, and improving thrir
general appearance and usefulness, it has been llio aim of the subscribers to keep ihcrn at prices within the
reach of all, and as low as can be afforded consistent with correct and well executed ediiions. This, from
their extensive engagements iu tliis business, and soiling exclusively Iheirown publications, they are enabled
to do with advantage.

Dealing largely with booksellers, their publications «iay be found in all lite principal stores throughout the
Union, wliere prices and all otlier information relative to Ihetn may be had ; while the subscribers will be
happy at all times to furnish, on application free of postage, any information as to new ediiiims, prices, bind,
ing, &c. From time lo lime such other good works will be added to their stock as the warns of the profession
seem to require,

I.EA & BI.AIVCIIARD, Pbiladclphia.

Anatomical Atlas, by Smith & Horner, imp. SvcCSOfigs.
Arnott'sElememsofPliysics.newed. 1 vol. Svo, 4h4pp.
American Medical Journal, quarterly at ?5 a year.
Abercrombie on the Stomach, 1 vol. (^vo, 320 pages.
Aljercrombie on the Brain, new ed.l vol. 6vo, 3-.>4 pp.
Alison's Outlines of Pathology, in 1 vol. bvo, 420 pages.
Ashwell on the Diseases of Females, complete in one

large vol. 8vo, 520 pages.
Andral on the Blood, 120 pages, Svo.
Bird on Urinary Deposits, 1 vol. Svo.
Bird's Natural Philosophy, 1 vol. Svo, preparing.
Budd on the Liver, 1 vol. Svo, preparing.
Buokland's Geology and Mineralogy, 2 vols. Svo, with

numerous plates and maps
Berzeliuson the Kidneys and Urine, 1 vol. Svo, ISO pp.
Bridgewater Treatises, with numerous illustrations, 7

vols. Svo, 32S7 pages.
Bartlett on Fevers, &c., 1 vol. Svo, 394 pages.
Barllelt's Philosophy of Medicine, 1 vol. Svo. 312 pp.
Brigham on Mental Excitement 1 vol 12mo, 2(14 pages.
Billing's Principles of Medicine, 1 vol. Svo, 304 pages.
Brodie on Urinary Organs, 1 vol. Svo, 214 pages.
Brodie on the Joints, 1 vol. Svo, 21G pages.
Brodie's Surgical Lectures, 1 vol. Svo.
Chapman on Thoracic and Abdominal Viscera, 1 vol.

Svo, 3t4 pages.
Chapman on Fevers, Gout, &c., 1 vol. Svo, 450 pages.
Chelius' Surgery, by South and Norris, at press.
Chitty's Medical Jurisprudence, Svo, 510 pages.
Clater and Skinner's Farrier, to match the Cattle Doc-
tor, 12mo, cloth, 220 pages.
Carpenter's Human Physiology, 1 vol. Svo, 644 pages,

with cuts, second edition.
Carpenter's General and Comparative Physiology, 1

vol. Svo, preparing.
Carpenter's Vegetable Physiology, 1 vol. 12mo, with

cuts, 300 pages.
Carpenter's Manual of Physiology, preparing.
Carpenter's Animal Physiolc^y, "to be published.
Cooper, Sir Astley on Hernia, imp. Svo, plates, 42Spp.
Cooper on Dislocations, 1 vol. Svo, with cuts, 500 pp.
Cooper on the Testis and Thymus Gland, 1 vol. impe-
rial Svo, many plates.
Cooper on the Anatomy and Diseases of the Breast, &.c.

&c., 1vol. imperial Svo. splendid lithographic plates.
Oondie on Diseases of Children, 1 vol. Svo, 652 pages.
Churchill on Females, 3d edition, 1 vol. Svo, 572 pp.
Ctmrcliill's Midwifery, 1 vol. Svo, 520 pp. with cuts.
CyclopEedia of Practical Medicine, by Forbes, &c.

Edited by Dunglison, in 4 large super-royal vols.,

3154 double columned pages.
Carson's Medical Formulary, in preparation.
Dewees' Midwifery, with plates, lOlh edit., GGO pages.
Dewees on Children, Sth edition, 548 pages.
Dewees on Females, with plates, Sth edition. 532 pages.
Durlacher'e Treatise on Corns, Bunions, Diseases of

Nails, &c. &.C., 1 vol. 12mo., preparing.
Dunglison's Physiology, Sth edition, 2 vols. Svo, 1304

pages, with 300 cuts.
Dunglison's Therapeutics and Materia Medica, anew

work, 2 vols. Svo, 1004 pages.
Dunglison's Medical Dictionary, Sth edition, 1 vol. Svo,

771 very large pages.
Dunglison's New Remedies, Sth edition, 1S43, Glfi pages.
Dunglison on Human Health, in 1 vol. Svo, 404 pages.
Dunglison's Practice of Medicine, 2d ed. 2 vols. Svo,

1322 pp.
Dunglison's Medical Student. 1 vol. 12mo, 312 pp.
Druitt's Surgery, 1 vol. Svo, 534 pages, 2d ed. many cuts.
Dog, The, his Treatment and Diseases, 224 pp., 12mo.
Ellis' Medical Formulary, 7ih ed. 1 vol. Svo, 202 pp.
Elliotson's Mesmeric Cases. Svo. 50 pages.
Esquirol on Insanity, by l#un"l, 490 pages.
FergUBSon's Practical Surgery , 1 vl . Svo, 2d ed. 640 pp.

Fownes' Elementary Chemistry, 1 vol. royal 12mo, 4G0
pages, many cuts.

Fevers, General and Special, edited by Clymer, pre-
paring.

Graham's Chemistry, with cuts. 1 vol. Svo, 750 pages.

Goddard's Dissector's Companion, in preparation.

Guthrie on the Bladder and Urethra, 1 vol. Svo, 150 pp.

Hobly n's Dictionary of Medical Term*:, by Hays, 1 vol.
large ]2nio, 402 pages.

Harris on the Maxillary Sinus, 1 vol. Svo. 1C6 pages.

Horner's Special Anatomy, 2 vols. Svo, 6th ed.'lll4 pp.

Masses Pathological Ana'iomy. preparing.

Hope on the Heart, 1 vol. Svo, 572 pages.

Harrison on the Nervous System, 1 vol. Svo, 292 pages.

Jones and Todd on the Ear, 1 vol., preparing.

Kirby on Animals, many plates, 1 vol. svo, 520 pages.

Lawrence on the Eye. 1 vol. Svo, 77s pages.

Lawrence on Ruptures, 1 vol. Svo, 4S0 pages.

Lision's Lectures on Surgery, by Mutter, ai press.

Miller's Principles of Surgery, 1 vol. Svo, 520 pages.

Medical Botany, with numerous cuts, preparing.

Maury's Dental Surgery, with plates, 1 vol. Svo, 236 pp.

Miiller's Physiology, 1 vol. Svo, St6 pages.

IManual of Ophthalmic Medicine and Snrgerj-, lo be
published hereafter.

Medical News and Library, published monthly.

Meigs' Translation of Colombat de I'Isere on llie Dis-
eases of Females, 1 vol Svo, 720 pages.

Prout on the Stomach and Renal Diseases, 1 vol. Svo,
with coloured plates, 466 pages.

Popular JNIedicine, by Coatcs, 1 vol. Svo, 614 pages.

Philip on Protracted Indigestion. 1 vol., 240 pages.

Pereira's iMaieria Medica. 2 vols. Svo. 15-:0 very large
and closely primed pages. Second Edition.

Royle's Materia Medica, with illustrations, preparing.

Roget's Animal and Vegetable Physiology, virilh many
cuts. 2 vols. Svo, S72 pages.

Roget's OuUines of Physiology, 1 vol. Svo. 516 pages.

Rigby's System of Midwifery.' 1 vol. Svo. 492 pages.

Ricord on Venereal, new edi'tion, 1 vol. Svo, 256 pages.

Ricord's large work on Venereal Diseases, with nu-
merous plates, preparing.

Ramsbolliam on Parturition, with many plates, 1 vol.
imperial Svo, a new and improved ediiion. 520 pp.

Robertson on the Teeth, 1 vol. Svo, 230 pages.

Stanley on the Bones, 1 vol. Svo, preparing.

Sitnon's Chemistry of Man. 1 vol. Svo.

Select Medical Essays by Chapman and others, 2 vols.
Svo, 11.50 pages, double column.''.

Taylor's New Work on Medical Jurisprudence, by
Griffith, 1 vol. Svo, 540 pages.

Traill's Medical Jurisprudence, 1 vol. Svo. 2-34 pages.

Trimmer's Geology and Mineralogy. 1 vol. Svo. 52Spp.

Todd's Cyclopajiha of Anatomy and I'hysiology, to be
published hereafter.

Thomson on the Sick Room, 1 vol. 12mo, 300 large
pages, with cuts.

Wulshe's Diagnosis of the Diseases of the Lungs, 1
vol. 12mo, 310 pages.

Watson's Principles and Practice of Physic, by Con-
die. 1 vol. Svo, 1060 pages, large type.

Wilson's Human Anatomy, with cuts, 1 vol. Svo, a new
and improved edition. 60S paees.

Wilson's Dis.sector. or Prnciical and Surgical Anato-
my, by Goddard, witli cuts. 1 vol. 12ino, 444 pages.

Wilson on the Skin, 1 vol. Svo, 370 pages.

Voualton the Horse, by Skinner, cuts, 44m pp. 1 vl. Svo.

Vouatt and Ciater's Cattle Doctor, 1 vol. 12nio, with
cuts, 2-2 page.".

Williams' Pathology, or PrincipU.s of Medicine, 1 vol.
Svo, 3S4 pages.

Williams' Lectures on Stomach, &c., preparing.

Williams on Respiratory Organs, by Clymer, 1 vol
Svo, 500 pages.

*«* They kare other works in preparation not included in this list.

LEA & BLANCHARD'S PUBLICATIONS.

THE mikl mmmkl LIBBAiY,

NOW HEABY.

THE

CYCLOPEDIA OF PEACTICAL MEDICINE,

COMPRISING

TREATISES ON THE
NATURE AND TREATMENT OF DISEASES,

MATERIA MEDICA AND THERAPEUTICS,
DISEASES OF WOMEN AND CHILDREN,

MEDICAL JURISPRUDENCE, &C. &C.

EDITED BY

JOHN FORBES, M.D., F.R.S.,
ALEXANDER TWEEDIE, M.D., F.R. S.,

AND

JOHN CONOLLY, M.D.
REVISED, WITH ADDITIONS,

By ROBLEY DUNGLISON, M. D.

This work is now complete, and forms
FOUR LARGE SUPER-ROYAL OCTAVO VOLUMES,

CONTAINING THIRTY-TWO HrNDRED AND FIFTY-FOUR UNUSUALLY LARGE PAGES IN

DOUBLE COLUMNS,

printed on good paper, with a new and clear type.

The whole well and strongly bound,

WITH RAISED BANDS AND DOUBLE TITLES.

Or, to be had, in twenty-four parts, at Fifty cents each.

This excellent work has now been before the profession for a short
time, and has met with universal approbation as containing a vast body of
information on all points connected with Practical Medicine. To physi-
cians residing at a distance from Medical libraries, or the means of procu-
ring works of reference, it will prove almost invaluable, as a work to be
constantly consulted. That the extent of it may be properly understood,
the publishers append a list of the contents. It will be seen that one of tlie
peculiar advantages of this work is that every subject has been treated by
an author whose attention has been directed peculiarly to that branch, the
most eminent physicians of Great Britain having joined in the production
of the whole; while the numerous additions of Dr. Dunglison have
brought the work up to the very day of publication and with referen(^
particularly to American practice.

LEA & BLANCHARD'S PUBLICATIONS.

Cyclopsedia of Practical Medicine, continued.

Abdomen, Exploration o( the, Dr.

Forbes.
Abortion, Dr. Lee.
Abscess, Iiileriial, Dr. Tweedie.
Abstinence, Dr. Marshall Hull.
Achor, Dr. ToJd.
Acne, Dr. Todd.
Acrodynia, Dr. Dunn;lison.
Acupuncture, Dr. Eliiotson.
Age, Dr. Rogel.

Air, Change of. Sir James Clarkft.
Alopecia, Dr. Todd.
Alteratives, Dr. Conolly..
Amaurosis, Dr. Jacob.
Amenorrhcea, Dr. Ix»cock.
Anajmia, Dr. Marshall Hall.
Anasarca, Dr. Durwall.
Angina Pectoris, Dr. Forbes.
Anodynes, Dr. Whiting.
Anthelmintics, Dr. A. T. Thomson.
Anlhracion, Dr. Dunglison.
Antiphlogistic Reginien, Dr. Barlow.
Antispasmodics. Dr. A. T. Thomson.
Aorta, Aneurism of, Dr. Hope.
Apoplexy, Cerebral. Dr. Clutterbuek.

" Pulmonary, Dr. Town- .

send.
Arteritis, Dr. Hope.
Ascites, Dr. Darwall.
Artisans, Diseases of, Dr. Darwall.
Asphyxia, Dr. Roget.

" of the New Born, Dr. Dun-

glison.
Asthma, Dr. Forbes.
Astringents, Dr. A. T. Thomson.
Atrophy, Dr. Townsend.
Auscultation, Dr. Forbes.
Barbiers, Dr. Scott.
Bathing, Dr. Forbes.
Beriberi, Dr. Scott

CONTENTS OF VOLUME I.

Blood, Determination of Dr. Barlow.
'• Morbid States of, Dr. Marshall
Hall.
Blood-letting, Dr. Marshall Hall.
Brain, Inflammation of the,

Meningitis, Dr. Quain.
Cerebrilis, Dr. Adair Craw-
ford.
Bronchial Glands, Diseases of the,

Dr. Dunglison.
Bronchitis, Acute and Chronic, Dr.
Williams
" Summer, Dr. Dunglison.

Bronchocele, Dr. And. Crawlord.
Bulla;, Dr, Todd.
Cncliexia, Dr. Dunglison.
Calculi, Dr. T. Thomson.
Calculous Diseases, Dr. Cumin.

Catalepsy. Dr. Joy.
Catarrh, Dr. Williams.
Cathartics, Dr. A. T. Thomson.
Chest, Exploration of the. Dr. Forbes.
Chicken Pox, Dr. Gregory.
Chlorosis, Dr. Marshall Hall.
Cholera, Common and Epidemic, Dr.
Brown.

" Inlaiitum. Dr. Dunglison.
Chorea, Dr. And. Crawford.
Cirrhosis of the Lung, Dr. Dunglison.
Climate, Dr. Clark.
Cold, Dr. Whiting.
Colic, Drs. Whiting and Tweedie.
Colica Pictonum. Dr. Whiting.
Colon, Torporof the, Dr. Dunglison
Coma, Dr. Adair Crawford.
Combustion, Spontaneous, Dr. Ap-

john.
Congestion of Blood. Dr. Barlow.
Constipation, Drs. Hastings and

Slreeten.

Contagion. Dr. Brown.
Convalescence, Dr. 'I'weedie.
Convulsions, Dr. Adair Crawford.

" Infaiitilo, Dr. Locook.

" J'uerperul, Dr. lx>cock.

Coryza. Dr. WilJiums.
Counter Irritation. Dr. Williani».
Croup, Dr. Cheyne.
Cyanosis. Dr Crmnpton.
Cystitis, Dr. Cumin.
Dead. Persons found. Dr. Beatly.
Delirium, Dr. Prilchard.

" Tremens, Drs. Carter and
Dunglison.
Dengue, Dr Dimglison.
Dentition. Dit^orders of. Dr. Joy.
DeiivatioH. Dr. Stokes.
Diabetes, Dr. Bardsiey.
Diagnosis, Dr. Marshall Hall.
Diaphoretics. Dr A. T. Thomson.
Diarrhcca.Drs. Cramptoii and Forbes.

'• Adipous, Dr. Dunglison.

Dietetics, Dr. Paris.
Disease, Dr. Conolly.
Disinfectants. Dr. Dunglison.
Disinfection, Dr. Brown.
Diuretics. Dr. A. T. Thomson.
Dropsy, Dr. Darwall.
Dysentery, Dr. Brown.
DysmenorrhoRa, Dr. Locock.
Dysphagia. Dr. Stokes.
Dyspnrca, Dr. Williams.
Dvsuria, Dr. Cumin.
Ecthyma, Dr. Todd.
Eczema. Dr. Joy.
Education, Physical, Dr. Enrlow.
Electricity. Dr. Apjolni.
Elephantiasis, Dr, Joy.
Emetics, Dr. A. T. Thomson.
Emmenagogues, Dr. A. T. Thomson.

CONTENTS OF VOLUME IL

Emphysema, Dr. R. Townsend.
" of the Lungs, Dr. R.

Townsend.
Empyema. Dr. R. Townsend.
Endemic diseases, Dr. Hancock.

Fever, Infantile, Dr. Joy.

" Hectic, Dr Brown.

" Puerperal. Dr. I/ce.

" Yellow, Dr. Gilkrest.
Fungus Hnemalodes, Dr. Kerr.

Enteritis, Drs. Stokes and Dunglison. Galvanism, Drs. Apjohn and Dungli- Hiccup, Dr. Ash

Haemorrhage, Dr. Watson.
Hccmorrhoids, Pr. Buriie.
Hereditary Transmission of Disease,

Dr. Brown.
Herpes, Dr. A. T. Thomson.

Ephelis. Dr. Todd. sou.

Epidemics. Dr. Hancock. Gastritis, Dr. Stokes.

Epilepsy. Dr. Cheyne. Gastrodynia. Dr Barlow,

Epistaxis, Dr. Kerr. Gastro-Enteritis, Dr. Stokes.

Erethismus Mercurialis, Dr. Burder. Glanders, Dr. Dunglison.

Erysipelas, Dr. Tweedie.
Erythema, Dr. Joy.
Eutrophie, Dr. Dunglison.
Exanthemata, Dr. Tweedie.
Expectorants, Dr. A.T. Thomson.
Expectoration. Dr. Williams.
Favus, Dr. A. T. Thomson.
Feigned diseases, Drs. Scott, Forbes

and Marshall.
Fever, general doctrine of. Dr. Twee-
die.
" Continued, and its modifica-
tions. Dr. Tweedie.
•< Typhus, Dr. Tweedie.
" Epidemic GastricDr. Cheyne.
" Intermittent, Dr. Brown.
" Remittent. Dr Brown.
" Malignant Remittent, Dr. Dun-
glison.

HoopihgCough Dr. Johnson.
Hydatids, Dr. Kerr.
Hydrocephalus, Dr. Joy.
Hydropericardium, Dr. Darwall.
Hydrophobia, Dr. Bardsley.
Hydrothorax, Dr. Darwall.
Hypera;?lliesia. Dr. Dunglison.
Hypertrophy, Dr. Townsend.
Hypochondriasis. Dr. Pritchard.
Hysteria. Dr. Conolly.
Ichthyosis, Dr. Thomson.
Identiiv. Dr. Montgomery.
Impetigo, Dr. A. T. Thomson.
Impotence. Dr. Beatty.
Incubus, Dr. Will-

Glossilis, Dr. Kerr.
Glottis, Spasm of the. Dr. Joy.
Gout, Dr. Barlow.
HcEmatemesis. Dr. Goldie.
Haemoptysis, Dr. Law.
Headache, Dr. Burder.
Heart, Diseases of the. Dr. Hope.
" Dilatation of the, Dr. Hope.
" Displacement of the, Dr.

Townsend.
" Fatly and greasy degenera- ln<iigestton. Dr. Todd.

tioii of the. Dr. Hope. Induration. ]")r. Carswell.

" Hypertrophy of the. Dr. Hope. Inlanticiile, Dr. Arrowsmith.
" Mallbrmalionsoflhe,Dr.Wil- Infection, Dr. Brown.

liams. Inflammation, Drs. Adair Crawford

" Polypus o^ the, Dr. Dunglison. and Tweedie.
" Rupture of the, Dr. Townsend.
" Diseases of the Valves of tlie,
Dr. Hope.

Influenza, Dr. Hancock.
Insanity, Dr. Pritchard.
Intussusception. Dr. DunglisoiL
Irritation, Dr. Williams.
Jaundice^ Dr. Burder.

•' of the Infant, Dr. Dunglison
Kidneys, diseases of Dr. Carter.
Lactation, Dr. l/ocock.
Laryngitis, Dr. Cheyne.

" Chronic, Dr. Dunglison.

Latent diseases, Dr. Christison.

CONTENTS OF VOLUME III.

Lepra, Dr. Houghton. Medicine, State of in the 19th Cen"

Leucorrhcra, Dr. Locock. '"T- Dr. Alison.

Lichen, Dr. Houghton. " Practical, Principles ol.

Liver, Diseases of the. Dr. Stokes. Dr. Conolly.

Liver, Diseases of the. Dr. Venatdes. MelaMia, Dr. Goldie.
" Inflammation of the. Dr. Melanosis, Dr. Carswell

Stokes. Menorrhagia, Dr. LococK.

Malaria and Miasma, Dr. Brown. Menstruation, Pathology of. Dr. LO-
Medicine, History of. Dr. Hosiock. cock.

American, before the Re- Miliaria. Dr. Tweedie.

Tolution, Dr. J. B. Beck. Milk Sickness, Dr. Dunglison.

LEA & BLANCHARD'S PUBLICATIONS.

Cyclopaedia of Practical Medicine, continued.
CONTENTS OF VOLUME III— Continued.

Mind, Soundness and Unsoundness Pancreas, diseases of the, Dr. Carter. Pneumotliorax, Dr. Houghton.

of, Drs. Pritchard and Dunglison. Paralysis, Dr. Todd. Porrigo, Dr. A. T. Thomson.

Molluseum, Dr. Dunglison. Parotitis, Dr. Kerr. Pregnancy and Delivery, signs of,

Mortification, Dr. Carswell, Parturients, Dr. Dunglison. Dr. Montgomery.

Narcotics, Dr. A. T. Thomson. Pellagra, Dr. Kerr. Prognosis, Dr. Ash.

Nauseants, Dr. Dunglison. Pemphigus, Dr. Corrigan. Prurigo, Dr. A. T. Thomson.

NephraigiaandNepliritis, Dr. Carter. Perforation of tlie Hollow Viscera, PseudoMorbid Appearances, Dr.
Neuralgia, Dr. Elliotson. Dr. Carswell. Todd.

Noli-Me-Tangere or Lupus, Dr. Pericarditi.?, Dr. Hope. Psoriasis, Dr. Cumin.

Houghton. Peritonitis, Drs. Me Adam andStokes.Plyalism, Dr. Dunglison.

Nyctalopia, Dr Grant. Phlegmasia Dolens, Dr. Lee. Puerperal Diseases, Dr. Marshall

Obesity, Dr. Williams. Pityriasis, Dr. Cumin. Hall.

CEdenifi, Dr. Darwall. Plague, Dr. Brown. Pulse, Dr. Bostock.

Ophthalmia, Drs. Jacobs and Dungli- Plethora, Dr. Barlow." Purpura. Dr. Goldie.

son. Pleurisy, Dr. Law. Pus, Dr. Tweedie.

Otalgia and Otitis, Dr. Burne. Plica Polonica, Dr. Corrigan. Pyrosis, Dr. Kerr.

Ovaria, Diseases of the, Dr. Lep. Pneumonia, Dr. Williams. Rape, Dr. Beatty.

Palpitation, Drs. Hope and Dunglison.

CONTENTS OF VOLUME IV.

Refrigerants, Dr. A. T. Thomson. Statis-tics, Medical, Drs. Hawkins Toxicology, Drs. Apjohn and Dungli-
Kheumatism, Drs. Barlow and Dun- and Dunglison. son.

glison. Stethoscope, Dr. Williams. Transformations, Dr. Due&bury.

Rickets, Dr. Cumin. Stimulants, Dr. A. T. Thomson. Transfusion. Dr. Kay.

Roseola, Dr. Tweedie. Stomach, Organic Diseases of. Dr. Tubercle, Dr. Carswell.

Rubeola, Dr. Montgomery. Houghton and Dunglison. Tubercular Phthisis, Sir Jaraes Clark.

Rupia, Dr. Corrigan. Stomatitis, Dr. Dunglison. Tympanitis, Dr. Kerr.

Scabies, Dr. Houghton. Strophulus, Dr. Dunglison. Urine, Incontinence of. Dr. Cumin.

Scarlatina, Dr. Tweedie. Succession of Inheritance, Legitima- Urine, Suppression of. Dr. Carter.

Scirrhus, Dr. Carswell. cy, Dr. Montgomery, Urine, Morbid States of. Dr. Bostock.

Scorbutus, Dr. Kerr. Suppuration, Dr. Todd. Urine, Bloody, Dr. Goldie.

Scrofula, Dr. Cumin. Survivorship, Dr. Beatty. Urticaria, Dr. Houghton.

Sedatives, Drs. A. T. Thomson and Sycosis, Dr. Cumin. Uterus, Pathology of, Dr. L«e.

Dunglison. Symptomatology, Dr. Marshall Hall. Vaccination, Dr. Gregory.

Sex, Doubtful, Dr. Beatty. Syncope, Dr. Ash. Varicella, Dr. Gregor>'.

Small Pox, Dr. Gregory. Tabes Mesenterica, Dr. Joy. Veins, Diseases of, Dr. Lee.

Softening of Organs, Dr. Carswell. Temperament, Dr. Prit<hard. Ventilation, Dr. Brown.

Somnambulism and Animal Magne- Tetanies, Dr. Dunglison. Wakefulness, Dr. Cheyne.

tism. Dr. Pritchard. Tetanus. Dr. Symonds. AVaters Mineral, Dr. T.Thompson.

Spermatorrhoea, Dr. Dunglison. Throat, Diseases of the. Dr. Tweedie. Worms, Dr. Joy.

Spinal Marrow, Diseases of the, Dr. Tissue Adventitious. Yaws, Dr. KerrJ

Todd. Tonics, Dr. A.T.Thomson. Index, &c.

Spleen, Diseases of the, Drs. Bigsby, Toothache, Dr. Dunglison.

and Dunglison.

The Publishers wish it to be particularly understood that this work not
only embraces all the subjects properly belonging to

but includes all the diseases and treatment of

WOMEN AND CHILDREN,

as well as all of particular importance on

MATERIA MEDICA, THERAPEUTICS,

AND

MEDICAL JURISPRUDENCE,

Thus presenting important claims on the profession from the greater
extent of subjects embraced in this than in other works on the mere
Practice of Medicine ; while, notwithstanding its BEAUTIFUL
EXECUTION, its REMARKABLE CHEAPNESS places it
within the reach of all.

LEA & BLANCHARDS PUBLTCATION^?.

Cyclopaedia of Fractical Aleciicine, continued.

The Publishers present a few of the notices which the work has received
from the press in this country and in England.

great extern and usefulness."— i>r. /}ar/oir'« JJt/rM*
to the Med. und Sur. Association.

" For reference, it is abive all price to every practi-
tioner."—TV/e >r«.</«r» Lancet.

"We rejoice that this work is to be placed within
the reach of the profession in this country, it being
unquestionably one of vf ry great value to the practi-
tioner. This estimate of it has not been formed from
a hasty examination, but after an intimate acquaint-
ance derived from frequent consultation of it during
the past nine or ten years. The editors are pracition-
erg of established reput^ilion, and the list of contribu-
tors embraces many of the most eminent professors
and teachers of London, Edinburgh, Dublin and Glas-
gow. It is, indeed, the great merit of this work that
the principal articles have been furnished by practi-
tioners who have not only devoted especial attention
to the diseases about which they have wriiten, but
have also enjoyed opportunities for an extensive prac-
tical acquaintance vcith them, and wliose reputation
carries the assurance of their cnmpeti ncy justly to
appreciate the opinions of others, while it stamps their
own doctrines with high and just authority." — Ameri-
can Medical Journal.

"Do young physicians generally know what a trea-
Mre is offered to them in Dr. Dunglij'm's revised edi-
tion? Without wishing to be thouglit importunate, we
cannot very well refrain from urging upon them the
claims of this highly meritorious undertaking." — Bos-
ton Medical and Surgical Journal.

'• It has been to us, both as learner and teacher, a
work for ready and frequent reference, one in which
modern English medicine is exhibited in the most
advantageous light, and with adaptations to various
tastes and expectations." — Medical Examiner.

"Such a work as this has long been wanting in this
country. British medicine ought to have set itself
forth in this way much sooner. We have often Won-
dered that the medical profession and the enterprising
publishers of Great Britain did not, long ere this,
enter upon such an undertaking as a Cyclopedia of misht advantag
Practical Medicine." — London Medical Gazette. any genllem

" It is what it claims to be, a Cyclopedia, in which
Practical Medicine is posted up to the present day,
and as such constitutes a storehouse of medical know-
ledge upon which the student and practitioner may
draw with equal advantage." — The Western Journal
{jf Medicine and Surgery.

"The Cyclopedia of Practical Medicine, a work
which does honour to our country, and to which one
is proud to see the names of so many provincial phy

"This Cyclopedia is pronounced on all hands to be
one of the njost valuable medical publicatinns of tho
day. It is meant lobe a library of Practical Medicine.
As a work of reference it is invaluable. Among the
contributors to its pages, it numbers many of the mom
experienced and learned physiciansof the ape, and as
a whole it forms a compendium of medical scirHcye
and practice from which practitioners and students
may draw the richest insiructitin "— I-Kea/ern ^ourTi.
of Med. and Surgerij.

"The contributors are very numerous, including
the most distinguished physicians in the liing<loni.
The design of the work embraces practical articles of
judicious length in Medicine, Therapeutics, Hygiene,
&c., so that, within a small compass, and of ed!*y re-
ference, the student possesses a compUte library,
composed of the highest authorities. To the country
practitioner, especially, a publiration of this kind is
of inestimable value."— JJ. S. Gazette.

"When it is considered that this great work em-
braces three hundred original essays, from sources of
the highest authority, we cannot but hope that our
medical friends will offer all the requisite encourage-
ment to the publishers."- i?os/<w» Medical and Sur-
gical Jmirnul.

"Incur last number we noticed the publication of
this splendid work by Lea & Blanchaid. We havo
since received three additional parts, an examination
of which has confirmed us in our first impression, that
as a work of reference for the practitioner— as a Cy clo-
peedia of Practical Medicine— it is admirably adapted
to the wants of the American profession. In fact, it
usly find a place in the library of
ho lias leisure and taste for looking
somewhat into the nature, cauFPs, and cure of dis-
eases."— Western Journal of Med. and Surgery.

"The favourable opinion which we exprefsed on
former occasions from the specimens then before us,
is in ne degree lessened by a further acquaintance
with its scope and e:!iecm\on."— Medical Ex&7niner.

"The Cyclopedia inusl be regarded as the most
coHiplete work of Practical Medicine extant; or, at
least in our language. The amount of information eu

specis, it is much to be pr( fcrred. During the original
publication, many of the articles not being in readl-
ness to be printed in preper alphabetical order, it be-
came iieceesary to incluile them together in a single
volume, as a supplement to the work. This diDlcMliy
is obviated in the American edition. On the whsle,
we advise those who desire a compendious collection

Bicians attached."— /?r. Hastings' Address to Pro- every topic which it embraces, is posted up to the
vincial Medical and Surgical Association. present time ; and so far as we are able to judge, it is

"Of the medical publications of the past year, one generally more free from natural e.xclusiveness and
may be more particularly noticed, as partaking, from prejudices, than is usually the case with British pub-
its extent and the number of contributors, somewhat licalioiis. The getting up of the American edition is
of the nature of a national undertaking, namely, the very creditablelolUe Publishers. It will compare very
'Cyclopedia of Practical Medicine.' It accempliehes favourably with the English edition. In seme re-
what has been noticed as most desirable, by present'
ing, on several important topics of medical inquiry,
full, comprehensive, and well digested expositions,
showing the present state of our knowledge on each.
In this country, a work of this kind was much wanted:
and that now supplied cannot but be deemed an im
portant acquisition. The difficulties of the undertak

ing were not slight, and it required great energies to of the latest and most important information in the
surmount them. These energies, however, were pos- various depaninents of Practical Medicine, including
sessed by the able and distinguished editors, who. Midwifery, Materia Medica, Medical Jurisprudence,
with diligence and labour such as few can know or &c., to possess themselves of this work."— TA« Buf-
appreciate,have succeeded in concentrating in a work /alo Medical Journal.
of moderate size, a body of practical knowledge of

*^* In reply to the numerous inquiries made to them respecting Twccdie's Library of Practical
Medicine, the Publishers beg leave to state that its place is supplied, in a great measure, by the
Cyclopedia of Practical Medicine, a work much more extended in its plan and execution. Tlie
■works are entirely distinct and by difl'erent authors. The " Library"con8i8ts of essays on discnses,
systematically arranged. The " Cyclopedia" embraces these subjects treated in a more extended
manner, together with numerous interesting essays on all important points of Medical Jurispru-
dence, Materia Medica, Therapeutics, Diseases of Women and Children, History of Medicine, &o.,
&C., by the first physicians of England, the whole arranged alphabetically for casi-ir reference.

LEA & BLANCHARD'S PUBLICATIONS.

WATSON'S PRACTICE

NEW AND IMPROVED EDITION.

Now Ready,
LECTURES

ON THE

PRINCIPLES AND PRACTICE OF PHYSIC.

DELIVERED AT KING'S COLLEGE, LONDON.

By THOMAS WATSON, M. D., &c. &c.

SECOND AMERICAN, FROM THE SECOP LONDON EDITION.

REVISED, WITH ADDITIONS,
By D. FRANCIS CONDIE, M. D.,

Author of a work on the " Diseases of Children," &c.

In one Octavo Volume.
Of nearly eleven hundred large pages, strongly bound with raised bands.

The rapid sale of the first edition of this work is an evidence of its
merits, and of its general favour with the American practitioner. To
comnieud it still more strongly to the profession, the publishers have gone
to a great expense in preparing this edition with larger type, finer paper,
and stronger binding, with raised bands. It is edited with reference par-
ticularly to American practice, by Dr. Condie ; and with these numerous
improvements, the price is still kept so low as to be within the reach of
all, and to render it among tne cheapest works offered to the profession.
It has been received with the utmost favour by the medical press, both
of this country and of England, a few of the notices of which, together
with a letter from Professor Chapman, are submitted.

"We tnow of no work better calculated for being " We find that, from the great length we have gone
placed in the hands of the student, and for a text book, in our analysis of this work, we must close our notice
and as sucli we are sure it will be very extensively of it here for llie present— not, however, without ex-
adopted. On every important point the author seems pressing our unijualified approbation of the manner in
Xo have posted up his knowledge to the day." — Ameri- which the author has performed his task. But it is as
tan Medical Journal. a book of elementary instruction that we admire Dr.

-In the Lectures of Dr. Watson, now republished Watson's woTk-^'—Medico-Chirurgical Revitw.

here in a large and closely-printed volume, we have "One of the most practically useful books that eyer

a body of doctrine and practice of medicine well cal- was presented to the student— indeed a more admira-

culated, by its intrinsic soundness and correctness of ble summary of general and special pathology, and of

style, to instruct the student and younger practitioner, the application ot therapeutics to diseases, we are free

and improvi^ members of the profession of every age." to say has not appeared for very many years. The

— Bulletin of Medical Sci(n/:e. lecturer proceeds through the whole classification of

'•We regard these Lectures as the best exposition liuman ills, a capite ad calcem, showing at every step
of their subjects of any we remember to have read, an extensive knowledge of his subject, with the ability
The author is assuredly master of his art. His has of communicating his precise ideas in a style remark-
been a life of observation and study, and in this work able for its clearness and simplicity." —iV . Jottmat
he has given us the matured results of these mental 0/ Medicine and Surgery.
•fforts."— iV«« Orleans Medical Journal.

LEA & BLANCH ARD'S PUBLICATIONS.

"WATSON'S FRACTICX:— Continued.

Philadelphia, September 21th, 1844.
Watson's Practice of Physic, in my opinion, is among the most com-
prehensive works on the subject extant, replete with curious and important
matter, and written with great perspicuity and felicity of manner. As
calculated to do much good, I cordially recommend it'to that portion of
the profession in this country wlio may be influenced by my judgment.

N. CHAPMAN, M.D.

Professor of the Practire and Theory c/ Medici nt
in the University oj Pennsylvania.

"We know not, indeed, of any work of the same " We are free to state thai a careful eiamination of
size that contains a greater amount of interesting and this volume has satisfied us that it merits all the corn-
useful matter The author is evidently well acquainted mendation bestowed on it in this country and at
with everything appertaining to the pr;nciple3 and home. It is a work adapted to the wants ^ young
practice of medicine, and has incorporated the stores practitioners, combining, as it does, sound princip.es
of his well stocked mind, in the work before us, so and substainial practice. It is not too much lo say
ably and agreeably, that it is impossible for the inie- that it is a represemaiive of llie actual s':-.ie of medi-
rest of the reader to flag tor a moment. That they are cine as taught and practised by the tnosi eminent phy-
well adapted for such a purpose all must admit; but sicians of the present day, and as such we would
their sphere of usefulness may extend much beyond advise every one about embarking in the practice of
this. We are satisfied, indeed, thai no phys cian. well physic to provide himself v^-ith a copy of il." — Western
read and observant as he may be, can rise Irom their Journal of Medicine and Surgery.
perusal without having added largely to his slock of '"It is the production of a physician of undoubted
valuable information." — Medical Ernminer. talent and great learning, and whose industry in per-

'•The medical literature of this coun'ry has been forming the most laborious duties of this profession

enriched by a work of standard excellence, which we has been well known for a long series of years. * *

can proudly hold up to our brethren of oilier couiilrifts Let us not forget lo add that the style and general

as a representative of the natural stale of British me- character of the work are peculiarly practical ; and

dicine, as prolessed and practised by our most en- the cases which Dr. Watson has from time to time

lightened physicians. And, for our own parts, we are introduced lo illustrate his views, are highly appro-

not only willing that our characters as scientific phy- priale and interesting, and add much to ihe value of

sicians and skill"ul practitioners may be deduced Irom the work; and this certainly must be admitted to be

the doctrines contained in ihis book, but we hesitate one of the great advantages of casting ihis work in

not to declare our belief that for sound, truslworihy the shape of lectures, in which these cases assuredly

principles. and substantial good practice, it cannot be appear more filly, and in which they are introduced

paralleled by any similar production in any other more easily and naturally than they could have been

country. * * * * We would advise no one to set had the form of the work been different. Lastly, we

himself down in practice unprovided with a copy." — are well pleased to observe that a strong vein of

British and Foreign Mtdirnl Review. common sense, as well as good taste, runs through

" We cannot refrain from calling the attention of the whole treatise, and sustains both the interest and

our younger brethren as soon as possible, to Dr. Wat- the confidence of the reader throughout." — Edinburgh.

son's I-eciures, if they want a sale and comprehensive Medical and. Surgical Journal.

guide to the study of practical medicine. '■ In calling the attention of the profession to the ele-

" In fact, to any of our more advanced brethren who gant volume recently published by Lea it, Ulanchard

wish lo possess a cominodions book of reierence on —the lectures delivered at King's College. London, by

any of the topics usually ireated of in a course ol lec-
tures on the practice of physic, or who wish to have
a simple enunciation of any facts or doctrines which,
from their novelty or their dilTicully, the busy practi-
tioner may not have made himself master of amidst
the all-absorbing loils of his prolessional career, we

Dr. Watson — we do not suppose any one at all con-
versant with the medical literature'of the day to be
unaccjuainted with its general character. Dr. W. de-
livered these now celebrated bciures during the me-
dical sess on of 1836-7. 'I'hey have been revised by
ihe author, and those who now study these erudite

commend these lectures most cordially. Here product ons will have them divested of any objection-

matter that niight have lormerly crept in through
inadvertence. Tb.cre are ninety leciures, I'ully wriiien,
embracing the whole domain of human maladies, with
their treatment, besides an appendix particularly re-
markable for its richness in important practical infor-
mation. \\"e could not give even a tolerable synops's
of the subjects discu>sed in this great undertaking
without materially entreiicliing on the limits assigned
to other matter. ♦ * * Opfn this huge, well-finished
volume wherever we may. ihc eye immediately resi.s
on something that carries value on its front. \Ve are
impressed at once with the strength and depih of the
lecturer's views: he gains on our admiration in pro-
portion to the extent of our acquaintance with Ins
profound researches. Whoever owns this book

can ;

•we meet with none of lliose brilliant theories which
are so seductive to young inen. because they are made
to explain every plienomenon, and save all the trouble
of observation and reflection; here are no exclusive
doctrines; none of those

'Bubbles that glitter as they rise and break
On vain Philosophy's all babbling spring '
But we have the sterling production of a liberal, well-
stored and truly honest m nd. possessed of all that is
currently known and established of professional know-
ledge, and capable of pronouncing a trustworthy and
impartial juilginenl on those numerous points in wliicli
Truth is yet obscured with I'alse facts or false hypo-
theses '■'—Provincal Medical .fournnl.

"The style is correct and pleasing, and the matter have an acknowledged treasure, if the combined wis-
worthv the attention of all practitioners, young and ('oni ofibr highest antlioniies is appreciated."— Boitoti
old''— Western Lancet. Med-.eal and Surgical Journal.

HORNER'S^NATOMy.
SPECIAL ANATOMY AND HISTOLOGY.

BY WILLIAM E. HORNER, M.D.,
Professor of Anatomy in the University of Pennsylvania, Member of the Imperial Mcdico-Chirurgical Academj,-
of St. Petersburg, of the Am. Philosophical f«ociety, &c.. &c.
Sixth Edition, in two Volumes, Svo.
"Another edition of this standard work of Professor Horner has made its appearance to which
many additions have been m.nde, and upon which much labour has \wn bestowed by the author. —
The additions are chiefly in the department of Histology, or Elementary Anatomy, and so import-
ant are thev that the Professor has added the term to the title of his work. Every part of thia
edition seems to have undergone the most careful revision, and its readers may re.st assured of hav-
ing the science of Anatomy fully brought up to the present day." — Am. Med. Journal.

SMITH & HORNER'S ANATOMICAL ATLAS.

Just Published, Price Five Dollars in Parts.

AN

ANATOMICAL ATLAS
ILLUSTRATIVE OF THE STHUGTURE OF THE HUMAN SDBY.

BY HENRY H. SMITH, M.D.,

FiUoio of the College of Physiciatis, ^c.
UNDER THE SUPEETISION OF

WILLIAM E. HORNER, M.D.,

Professor of Anatomy m the University of Pennsylvcuua.

In One large Volume, Imperial Octavo.

This -work IS but just completed, having been delayed over the time intended by the great difficulty in giving
to the illustrations the desired finish and pertection. It consists of five parts, whose contents are as follows:

Part I. Tlie Bones and Ligaments, with one hundred and thirty engravings.

Part II. The Muscular and Dermoid Systems, with ninety-one engravings.

.Paet III. The Organs of Digestion and Generation, with one hundred and ninety-one engravings.

Part IV. The Organs of Respiration and Circulation, with ninety-eight engravings.

Part V. The Nervous System and the Senses, with one hundred anil twenty-six engravings.
Forming altogether a complete System of Anatomical Plates, of nearly

SIX HUNDUED AND FIFTY FIGURES,
executed in the best stj-le of art, and making one large imperial octavo volume. Those who do not want it in
parts can have tho work bound in extra cloth or sheep at an extra cost.

Tliis work possessfjs novelty both in the design and the execution. It is the first attempt to apply engTavii>g
on wood, on a large scale, to the illustration of human anatomy, and the beauty of the parts issued induces the
publishers to flatter themselves with the hope of the perfect success of their undertaking. The plan of the
work is at once novel and convenient. Each page is perfect in itself, the references being immediately under
tJie figures, so that the eye takes in the whole at a glance, and obviates the necessity of continual reference
backwards and forwards. The cuts are selected from the best and most accurate sources ; and, where neces-
sary, original drawings have been made from the admirable Anatomical Collection of the University of Penn-
s-ylvania. It embraces all the late beautiful discoveries arising from the use of the microscope in the investi-
gation of the minute structure of the tissues.

In the getting up of this very complete work, the publishers have spared neither pains nor expense, and they
now present it to the profession, with the full confidence that it will be deemed all that is wanted in a scientific
ami arlistical point ol view, while, at the same time, its very low price places it within the reach of all.

It is particularli/ adapted to supply the place of skeletons or subjects, as the profession will see by examining tlie list
of plates now annexed.

"These figures are well selected, and present a complete and accurate representationof that wonderful fabric,
the human liody. The plan of this Atlas, which renders it so peculiarly convenient for the student, and its
superb artistical execution, have been already pointed out. We must congratulate the student upon the
completion of this atlas, as it is the most convenient w^ork of the kind that lias yet appeared ; and, we must
add, the very beautiful manner in which it is 'got up' is so creditable to the country as to be flattering to our
national pride." — American Medical Journal.

-This is an exquisite volume, and a beautiful specimen of art. AVe have numerous Anatomical Atlases,
but we will venture to say that none equal it in cheapness, and none surpass it in faithfulness and spirit. We
strongly recommend to our friends, both urban and suburban, the purchase of this excellent v^-ork, for which
both editor and publisher deserve tlie thanks of the profession." — Mtdical E.vaminer.

'• We would strongly recommend it, not only to the student, but also to the working practitioner, who,
although grown rusty in the toils of his harness, still has the desire, and often the necessity, of relreshing his
knowledge in this fundamental part of the science of medicine." — New York Journal of Medicine and Surg.

" The plan of this Atlas is admirable, and its execution superior to any thing of tlie kind before published m
this country. It is a real labour-saving aflair, and we regard its publication as the greatest boon that could be
conferred on the student of anatomy. It will be equally valuable to the practitioner, by aflbrding him an easy
means of recalling tho details learned in tlie dissecting room, and which arc soon forgotten." — American Medi-
cal Journal.

" It is a beautiful as well as particularly useful design, which should be extensively patronized by physicians,
surgeons and medical students." — Boston Med. and Surg. Journal.

" It has been the aim of the author of the Atlas to comprise in it tne valuable points of all previous works, to
embrace the latest microscopical observations on the anatomy of the tissues, and by placiii;; it at a moderate
price to enable all to acquire it who may need its assistance in the dissecting or operating room, or other fieM
of practice." — Western Journal of Med. and Surgery.

" These numbers complete the series of this beautiful work, which fully merits the praise bestowed upon the
earlier numbers. We regard all the engravings as possessing an accuracy only e(|ualled by their beauty,
and cordially recommend the work to all engaged in tlie study of anatomy." — A'ei» York Journal of Medicine
and Surgery.

" A more elegant work than the one before us could not easily be placed by a physician upon the table of
his student." — Western Journal of Bledicine and Surgery.

" We were much pleased with Part I, but the Second Part gratifies us still more, both as regards the attract-
ive nature of the subject, (The Dermoid and Muscular Systems,) and the beautiful artistical execution of the
Jlustrations. We have hero delineated the most accurate microscopic views of some of the tissues, as, for
instance, the cellular and adipose tissues, the epidermis, rcte mucosura and cutis vera, the sebaceous and
perspiratorj- organs of the skin, the perspiratory' glands and hairs of the skin, and the hair and nails. Then
follows the general anatomy of the muscles, and, lastly, their separate delineations. We would recommend
Uiis Anatomical Atlas to our readers in the very strongest terms.''— JVfW York Jaurnal of Medicine and Siw
eery.

LIST OP

THE ILLUSTRATIONS

EMBRACING

SIX HUNDRED AND THIETY-SIX FIGURES

IN SMITH AND HORNER'S ATLAS.

A HiGHLY-riNISHED ViEW OF THE BoNES OF THE HeAD,

View of Cuvier's Anatomical Theatre,

facing the title-pago.
• • . . vignetle.

PART L— BONES

Fig.

1 Front view of adult skeleton.

2 Back view of adult skeleton.
S Foetal skeleton.

4 Cellular structure of femur.

5 Cellular and compound structure of tibia.

6 Fibres of compact matter of bone.

7 Concentric lamellx of bone.

8 Compact matter under the microscope.

9 Haversian canals and lacuuse of boue.

10 Vessels of compact matter.

11 Minute structure of bones.

12 Ossification in cartilage.

13 Ossificatiou in the scapula.

14 Puncta ossificationis in femur.

15 Side view of the spinal column.

16 E[)ipbyses and diaphysis of bone.

17 External periosteum.

18 Punctum ossificationis in the head,

19 A cervical vertebra.

20 The atlas. 21 The dentata.

22 Side view of the cervical vertebrs.

23 Sido view of the dorsal vertcbrie.

24 A dorsal vertehra.

25 Si<le view of the lumbar vertebra.

26 Side view of one of the lumbar vertebrse.

27 Perpendicular view of the lumbar vertebrte.

28 Anterior view of sacrum.

29 Postei'ior view of sacrum.

30 Tiie bones of the coccyx.
SI Outside view of the innominatuntu

32 Inside view of the innominatum.

33 Anterior view of the male pelvis.

34 Anterior view of tlie female pelvis.

35 Front of the thorax. 36 The first rib.

37 General chai-acters of a rib.

38 Front view of the sternum.

39 Head of a Pei-uvian Indian.

40 Head of a Clioctaw Indian.

41 Front view of tiie os frontis.

42 Under surface of the os frontis.

43 Internal surface of the os frontis.

44 External surface of the parietal bone.s

45 Internal surface of the pariet.\l bone.

46 External surface of the os occi{)iliB.

47 Internal surface of the os occipitis.

48 External surface of the temporal bone.

49 Internal surface of tlie temporal bone,

50 Internal sui-face of the sphenoid bone.

51 Anterior surface of the sphenoid bone.

52 Posterior surface of the ethmoid bone.

53 Front view of the bones of the face.

54 Outside of the upper maxilla.

55 Inside of tlic u\)[ier maxilla.

56 Posterior surface of the palate bone,

57 Tlie nasal bones.

58 The OS unguis. 59 Inferior spongy bone.
60 Right malar bone. CI The vomer.
fi2 Inferior maxillary bone.
63 Sutures of the vault of the cranium.

PART II.— DERMOID AND MUSCULAR SYSTEMS.

129 Muscles on the front of the body, /iz/Z/enj-^A. 133 Blood-vessels of fat.

131 Muscles on the back of tlie l)0(iy,/ii// /«/^;A. 134 Cell membrane of fat vesicles.

130 The cellular tissue. 132 Fat vesicles. 135 Maguifiud view of the epidcrmU.

AND LIGAMENTS.

Fiff.

64 Sutures of the posterior of the cranium.

65 Diploe of the cranium.

66 Inside of the base of the cranium.

67 Outside of the base of the cranium.

68 The facial angle. 69 The fonUnels.

70 The OS hyoides.

71 Posterior of the scapula.

72 Axillary margin of the scapula.

73 The clavicle. 74 The humerus.
75 The ulna. 76 The radius.

77 The bones of the carpus.

78 The bones of the hand.

79 Articulation of the carpal bones.
SO Anterior view of the femur.

81 Posterior view of the femur,

82 The tibi.H. 83 The fibula.

84 Anterior view of the jiatella.

85 Posterior view of the patelU.

86 Tlie oscalcis. 87 The aslragalug.
88 The iiaviculare. 89 The cuboid bone.

90 The tiiree cuneiform bones.

91 Top of the foot.

92 The sole of the foot. 93 Cells in cartilage.

94 Articular cartilage under the microscope.

95 Costal cartilage under the microscope.

96 Magnified section of cartilage.

97 Magnified view of fibro-cariilage.

98 White fibrous tissue.

99 Yellow fibrous tissue,

100 Ligaments of the jaw.

101 Internal view of the same,

102 Vertical section of the same.

103 Anterior vertebral ligaments.
lOl Posterior vertebral ligaments.

105 Yellow ligaments.

106 Costo-vertebral ligaments.

107 Occipito-altoidien ligaments.

108 Posterior view of the same.

109 U])per part of the same.

110 Mo<Ieiator ligaments.

111 Anterior pelvic ligaments.

112 Posterior pelvic ligaments.

113 Sterno-clavicular ligaments.

114 Scapulo-hunieral articulation.

115 External view of elbow joint.

116 Internal view of elbow joint.

117 Ligamentsof the wrisL

118 Diagram of the carpal synovial membrane

119 Ligaments of the hip joint.

120 Anterior view of the knee joint.

121 Posterior view of tiie knee joint.

122 Section of the right knee joint.

123 Section of the left knee joint.

124 Internal side of the ankle joint.

125 External side of the ankle joint.

126 Posterior view of the ankle joint.

127 Ligamentsof the sole of the fooU

128 Vertical section of Uie foot.

JIlustraiio7is to Smith and Horner^s */9llas, continued.

Fig. F,g.

136 Cellular tissue of the skin. 180

137 Rete mucosutn, &c., of foot, 181

138 Epidermis and rete mucosum. 182

139 Cutis vera, magnified. 183

140 Cutaneous papillae. 184

141 Internal face of cutis vera. 185

142 Integuments of foot under the microscope. 186

143 Cutaneous glands. 144 Sudoriferous organs. 187

145 Sebaceous glands and hairs. 188

146 Perspiratory gland magnified. 189

147 A hair under the microscope. 190

148 A hair from the face under the microscope. 191

149 P'ollicle of a hair. 150 Arteries of a hair. 192

151 Skin of the beard magnified. 193

152 External surface of the tiiumb nail. 194

153 Internal surface of the thumb nail. 195

154 Section of nail of fore finger. 196

155 Same highly magnified. 197

156 Development of muscular fibre. 198

157 Another view of the same. 199

158 Arrangement of fibres of muscle. 200

159 Discs of muscular fibre. 201

160 Muscular fibre broken transversely. 202

161 Striped elementary fibres magnified. 203

162 Strise of fibres from the heart of an ox. 204

163 Transverse section of biceps musele. 205

164 Fibres of the pectoralis major. 206

165 Attachment of tendon to muscle. 207

166 Nerve terminating in muscle. 208

167 Superficial muscles of face and neck. 309

168 Deep-seated muscles of face and neck. 210

169 Lateral view of the same. 211

170 Lateral view of superficial muscles of face. 212

171 Lateral view of deep-seated muscles of face. 213

172 Tensor tarsi or muscle of Horner. 214

173 Pterygoid muscles. 174 Muscles of neck. 215

175 Muscles of tongue. 216

176 Fascia profunda colli. 217

177 Superficial muscles of thorax. 218

178 Deep-seated muscles of thorax. 219

179 Frontview of abdominal muscles.

Side view of abdominal muscles.
External parts concerned in hernia.
Interniil parts concerned in hernia.
Deep-seated muscles of trunk.
Inguinal and femoral rings.
Deep-seated muscles of neck.
Superficial muscles of back.
Posterior parietes of chest and abdomen.
Under side of diapliragm.
Second layer of muscles of back.
Muscles of vertebral gutter.
Fourth layer of muscles of back.
Muscles behind cervical vertebra.
Deltoid muscle.

Anterior view of muscles of shoulder.
Posterior view of muscles of shoulder.
Another view of the same.
Fascia brachialis.
Fascia of the fore-arm.
Muscles on the back of the hand.
Muscles on the front of the arm.
Muscles on the back of the arm.
Pronators of the fore-arm.
J'lexor muscles of fore-arm.
Muscles in piilm of hand.
Deep flexors of the fingers.
Superficial extensors.
Deep-seated extensors.
Rotator muscles of the thigh.
Muscles on the back of the hip.
Deep muscles on the front of thigh.
Superficial muscles on the front of thigh.
Muscles on the back of tlie thigh.
Muscles on front of leg.
Muscles on back of leg.
Deep-seated muscles on back of leg.
Muscles on the sole of the foot
Another view of the same.
Deep muscles on front of arm.
Deep muscles on back of arm.

PART III.— ORGANS OF DIGESTION AND GENERATION.

220
221
222
223
224
225
226
227
228
236
244
252
260
266

268
269
270
271
272
273
£74
275
276
277
278
279
280
281
282
£83
284
285
286
287

Digestive organs in their whole length.

Cavity of the mouth.

Labial and buccal glands.

Teeth in the upper and lower jaws.

Upper jaw, with sockets for teeth.

Lower jaw, with sockets for teeth.

Under side of the teeth in the upper jaw.

Upper side of the teeth in the lower jaw.

to 235. Eight teeth, from the upper jaw.

to 243. Eight teeth from the lower jaw.

to 251. Side view of eight upper jaw teeth,

to 259. Side view of eight lower jaw teeth.

to 265. Sections of eight teeth,

to 267. Enamel and

teeth.

Bicuspis tooth under the microscope.

Position of enamel fibres.

Hexagonal enamel fibres.

Enamel fibres very higlily magnified.

A very highly magnified view of fig. 268.

Internal portion ot the dental tubes.

External portion of tiie dental tubes.

Section of the crown of a tooth.

Tubes at the root of a bicuspis.

Upper surface of the tongue.

Under surface of the tongue.

Perigloltis turned off the tongue.

Muscles of the tongue.

Another view of the same.

Section of the tongue.

Styloid muscles, kc.

Section of a gustatory papilla.

View of another piipilla.

Root of the mouth and soft palate.

Front view of the pharynx and muscles.

288 Back view of the pharynx and muscles.

289 Under side of the soft pal.ite.

290 A lobule of the parotid gland.

291 Salivary glands.

292 Internal surface of the pharynx.

293 External surface of the pharynx.

294 Vertical section of the pharynx.

295 Muscular coat of the oesophagus.

296 Longitudinal section of the oesophagus.

297 Parietes of the abdomen.

298 Reflexions of the peritoneum.

299 Viscera of the chest and abdomen.

300 Another view of the same,
structure of two of tlie 3Ul The intestines in situ.

S02 Ston)ach and aisophagus.

303 Front view of the stomach.

304 Interior of the stomach.

305 The stomach and duodenum.

306 Interior of the duodenum.
S07 Gastric glands.

308 Mucous coat of the stomach.

309 An intestinal villus. 310 Its vessels.
311 Glands of the stomach magnified.
S12 Villus and lacteal.

313 Muscular coat of the ileum,

314 Jejunum distended and dried.
SI 5 Follicles of Lieberkuhn
316 Glands of Brunner. 317 Intestinal glands.
318 Valvuloe conniventes. 319 Ileo-colic valve.
320 Villi and intestinal follicles.
S21 Veins of the ileum.
322 Villi filled with chyle. 323 Peyer's glands

324 Villi of the jejunum under the microscope.

325 The ctecum. 326 The mesocolon and colon,
S27 Muscular coat of the colon.

Illustrations to Smith and Horner* s Atlas continued.

S'28 Muscular fibres of the rectum.
3'29 Curratures of the Ixrge intestine.
350 Mucous follicles of the rectum.

331 Rectal pouches.

332 Follicles of the colon, highly magnified.

333 Folds anil follicles of the stomach.

334 Follicles, kc. of the jejunum.

335 Villi aiul follicles of tiie ileum.

336 Muciparous glands of the stomach.

337 Ileum inverted, &c.

338 Glands of Pejer magnified.

339 Peritoneum of the liver injected.

340 Liver in situ.

341 Under surface of the liver. 342 Hepatic vein.

343 Parenchyma of the liver.

344 Hepatic blood-vessels. 345 Biliary ducts.
346 Angular lobules of the liter.

34" Hounded hepatic lobules.

348 Coats of the gall bladder.

349 Gall bladder injected.

350 Vena portarum.

S5I External face of the spleen.
352 Internal face of tlie spleen. -
S53 Splenic vein.

Fig.

373 Sphmcfer apparatus of the bladder.

374 Prostate and vesiculae seminales.

375 Side view of the pelvic viscera.

376 The glans penis injected.

377 The penis distended and dried.

378 Section of the same.

379 Vertical section of the male pelvis. &c.
3S0 Septum pectiniforme.

381 Arteries of the penis.

382 Vertical section of the urethra.
SS3 Vesiculae seminales injected.

384 Muscles of the male perineum.

385 Interior of the pelvis, seen from above.

386 I'estis in the fteius.

387 Diagram of the descent of tlie testis.

388 Tunica vaginalis testis.

389 Transverse section of the testis.

390 Relative position of tlie prostate.

391 Vas deferens.

392 Vertical section of the bladder.

393 The testicle injected with mercury.

394 Another view.

395 Minute structure of the testis.

396 Female generative organs.

398 External organs in the ftetus.

399 Muscles of the female perineum.

400 Side view of the female pelvis, 'fccc.

401 Relative position of the female organs. '

402 Section of the uterus, See.

403 Fallopian tubes, ovai'ies, &c.

404 Front view of the mammary gland.

405 The same after removal of the skin.

406 Side view of the breast.

354 Pancreas &c., injected. 355 Urinary organs. 397 Another view of the same,
356 Right kidney and capsule.
.^57 Left kidney and capsule.

358 Kidney under the microscope.

359 The ureter. 360 Section of right kidney.
361 Section of the left kidney.
S62 Pyramids of Malpighi.

363 Lobes of the kidney.

364 Renal arteries, 8cc., injected.
S65 Section of the kidney highly magnified.
366 Copora Malpighiana. 367 Same magnified. 407 Origin of lactiferous ducts.

S68 'I'ubuli uriniferi. 369 Corpora Wolffiana. 408 Lactiferous tubes during lactation.

370 The bladder and urethra, full length. 409 Minute termination of a tube.

371 Muscular coat of the bladder. 410 Ducts injected 5 after Sir Astley Cooper.

372 Another view of the same.

PART IV.— ORGANS OF RESPIRATION AND CIRCULATION.
41t Front view of the thyroid cartilage. 450 The external carotid artery.

412 Side view of the thyroid cartilage. 451 A front view of arteries of head and neck.

413 Posterior of the arytenoid cartilage. 452 The internal maxillary artery.

414 Anterior of the arytenoid cartilage. 453 Vertebral and carotid arteries with the aorta.

415 Epiglottis cartilage. 416 Cricoid cartilage. 454 Axillary and brachial arteries.
417 Ligaments of the larynx, "' t-l- . l:-i --......

418 Side view of the same.

419 The thyroid gland.

420 Internal surface of the larynx,

421 Crico-thyroid muscles.

422 Crico-aryteiioid muscles.

423 Articulations of the larynx.

424 Vertical section of the larynx.

425 The vocal ligaments. 426 Thymus gland.

427 Front view of the lungs.

428 Back view of the lungs.

429 The trachea and bronchia.

430 Lungs, heart, &c.

431 First appearance of the blood-vessels,

432 Capillary vessels magnified.

433 Another view of the same.

434 Blood globules.

435 Another view of the same.
4S6 The mediastina.

437 Parenchyma of the lung.

438 The heart and pericardium.

439 Anterior view of the heart.

440 Posterior view of the heart.

441 Anterior view of its muscular structure.

442 Posterior view of the same.

443 Interior of the right ventricle.

444 Interior of the left ventricle.
4-15 Mitral valve, the size of life.

446 The auriculo-ventricular valves.

447 Section of the ventricles.

448 The arteries from llie arch of the aorta.

449 Tlie arteries of Uie neck, the size of lire.

455 The brachial artery.

456 Its division at the elbow.

457 One of the anomalies of the brachial artery.

458 Radial and ulnar arteries.

459 Another view of the same.

460 The arcus sublimis and profundus.

461 The aorta in its entire length.

462 Arteries of the stomach aiid liver,

463 Superior mesenteric artery,

464 Inferior mesenteric artery.

465 Abdominal aorta.

466 Primitive iliac and femoral arteries.

467 Perineal arteries of the male.

468 Position of the arteries in the inguinal canal,

469 Internal iliac artery. 470 Femoral artery.

471 Gluteal and ischiatic arteries.

472 Branches of the ischiatic artery.

473 Popliteal artery.

474 Anterior tibial artery.

475 Posterior tibial artery.

476 Superficial arteries on the top of the foot.

477 Deep-seateil arteries on the lop of the foot,

478 Posterior tibial artery at the ankle.

479 The plantar arteries.

480 Arteries and veins of the face and neck.

481 Great vessels from the heart.

482 External jugular vein.

483 Lateral view of the vertebral sinuses.

484 Posterior view of the vertebral sinuses.

485 Anterior view of the vertebral sinuses,
4S6 Superficial veins of the arm.

487 The same at tlte elbow.

Illustrations to Smith and Horner's Atlas continued.

F.g.
488
489
41W
4'Jl
4<J3
4'J4

49C
4U-
4'J8

The veins of the hand.

The great veins of tlie trunk.

Positions of tlif arteries and veins of the trunk.

Tim venK cavse. 492 The vena i>ortarum.

Deep veins of the back of the leg.

Positions of the veins to tlie arteries in the

arm. 495 Superficial veins of the thigh.
Saphena vein.
Superficial veins of the leg.
Lymphatics of the upper extremity.

Fig.

499 The lymphatics and glands of the ax-lla.

500 The lemoral and aortic lymphatics.

501 The lymphatics of the small intestines.

502 The thoracic duct.

503 Tlie lymphatics of the groin.

504 Superficial lymphatics of the t-iigh.

505 Lymphatics of the jejunum.

506 Deep lymphatics of the thigh.

507 Superficial lymphatics of the leg.

508 Deep lymphatics of the leg.

PART v.— THE NERVOUS SYSTEM AND SENSES.

509 Dura mater cerebri and spinalis.

510 Anterior view of brain and spinal marrow.

511 Anterior view of the spinal marrow, &c.

512 Lateral view of the spinal marrow, hic.\

513 I'osterior view of the spinal marrow, &.c.

514 Decussation of Mitischelli.

515 Origins of the spinal nerves.

516 Anterior view of spinal marrow and nerves.
5 17 Posterior view of spinal marrow and nerves.

518 Anterior spinal commissure.

519 Posterior spinal commissure.

520 Transverse section of the spinal marrow.
5'2l Dura mater and sinuses.

522 Sinuses laid open.

523 Sinuses at the base of the cranium.

524 Pons Varolii, cerebellum, &c.

525 Superior face of the cerebellum.

526 Inferior face of the cerebellum.

527 Another view of the cerebellum.

528 View of the arbor vitse, &c.

529 Posterior view of the medulla oblongata.

530 A vertical section of the cerebellum.

531 Anollier section of the cerebellum.

532 Convolutions of the cerebrum.

533 Tlie cerebrum entire.

534 A section of its base.

535 The corpus callosum entire.

530 Diverging fibres of tlie cerebrum, 8ic.

537 Vertical section of the head.

538 Section of the corpus callosum.

539 Longitudinal section of the brain.

540 View of a dissection by Gall.

541 The commissures of the brairu

542 Lateral ventricles.

543 Corpora striata-fornix, &c.
5-14 Fifth ventricle and lyra.

545 Anotherjview of the lateral ventricles.

546 Another view of the ventricles.

5A7 Origins of the 4th and 5th pairs of nerves.
5iS The circle of Willis.

549 A side view of the nose.

550 The nasal cartilages.

551 Bones and cartilages of the nose,

552 Oval cartilages, kc.

553 Schneiderian membrane.

554 External parietes of the left nostril.

555 Arteries of the nose.

5.56 Pituitary membrane injected.

557 Posterior ^s^^es. 558 Front view of the eye.

559 Side view of the eye.

560 Posterior view of the eyelids, &c.

561 Glandulx palpebrarum.

562 Lachrymal canals.

563 Muscles of tlie eyeball.

564 Side view of the eyeball.

565 Longitudinal section of the eyeball.

566 HorizontMl section of the eyeball.

567 Anterior view of a transverse section.

568 Posterior view of a transverse section.

569 Choroid eoat injected.

570 Veins of the choroid coat.

571 The iris. 572 Thejret'ia and lens.

573 External view of the same.

574 Vessels in the conjunctiva.

575 Retina, injected and magnified.

576 Iris, highly magnified.

577 Vitreous humour anii lens.

578 Crystalline adult lens.

579 Lens of the fiEtus, magnified.

580 Side view of the lens.

581 Membrana pupillaris,

582 Another view of the same.

583 Posterior view of the same.

584 A view of the left ear.

585 Its sebaceous follicles.

586 Cartilages of the ear.

587 The same with its muscles.

588 The cranial side of the ear.

589 Meatus auditorius externus, &o.

590 Labyrinth and bones of the ear.

591 Full view of the malleus. 592 Theinctis.

593 Another view of the malleus.

594 A front view of the stapes.

595 Magnified view of the stapes.

596 Magnified view of the incus.

597 Cellular structure of the malleus.

598 Magnified view of the labyrinth.

599 Natural size of the labyrinth,

600 Labyrinth laid open and magnified.

601 Labyrinth, natural size,

602 Labyrinth of a foetus.

603 Another view of the same.

604 Nerves of the labyrinth.

605 A view of the vestibule, &o.

606 Its soft parts, &cc.

607 An ampulla and nerve.

608 Plan of the cochlea.
60n Lamina spiralis, &c.

610 The auditory nerve.

611 Nerve on tue lamina spiralis.

612 Arrangement of the cochlea.

613 Veins of the cochlea, highly magnified,

614 Opening of (he Eustachian tube in the throat.

615 Portio mollis of the seventh pa ii- of nerves,

616 The olfactory nerves.

617 The optic and seven other pairs of nerves,

618 Third, fourth and sixth pairs of nerves.

619 Distribution of the filth pair,

620 The facial nerve.

621 The hypo-glossal nerves.

622 A plan of the eighth pair of nerves,
C23 The distribution of theeigiith pair.

624 The great sympathetic nerve.

625 The brachial plexus.

626 Nerves of the front of the arm.

627 Nerves of the back of the arm.

628 -Lumbar and ischiatic nerves.

629 Posterior branches to the hip, &C,

630 Anterior crural nerve.

631 Anterior tibial nerve.

632 Brandies of llie popliteal nerve.

633 Posterior tibial nerve on the leg.

634 Posterior tibial nerve on the foot.

LEA & BLANCHARD'S PUBLICATIONS. 15

PROFESSOR mJiSLISON'S WORKS.

The Works of Professor Dunglison on various departments of Medicine are here presented. —
Nearly all of thcin are extensively used as text books in the branches of science to which they re-
Jate, and the proicssion and students may rely upon the great cure and accuracy of the author in
having each new edition of liis works posted up to the day of publication.

A KEW EDITION OF THE STANDARD KEDICAL DICTIONARY.

A DICTIOPyARY OfIvJEDICAL SCIEESSCE;

CONTAINING A CONCISH ACCOINT OF THK VAllIOUS SlJiJKCI-S A\D TKR:\IS, WITH
THE FRENCH AND OTHER SYNONYMES, NOTICES OF CLIMATES AND OF CELE-
BRATED MINERAL WATERS, FORMULAE FOR VARIOUS OFFICINAL AND EMPIRI-
CAL PREPARATIONS, &c.
Fifth Edition, Extensively Modified and Imi-roved over former Editions.
BY ROULEY DUNGLI^^ON, M.D.
Professor of the Institutes of Medicine, &c., in Jefferson Medical College, Philada.; Secretary to
the American Philosophical Society, &c., &c.
In one large royal octavo volume of nearly b'UO double coluiniicil pnfris, and bound witli raisrd bnnd?.
The author's object has not been to make the work a mere Lexicon, or Dictionary of terms, but
to afford, under each, a condensed view of its various medical relations, and thus to render the
work a complete epitome of the existing condition of medical science. This he has been in a great
measure enabled to do, as the work is not stereotyped, by adding in each successive edition all
Dew and interesting matters or whatever of importance had been formerly omitted. To show
the advantage of this, it need only be remarked thnt in the present work will be found at least two
thousand subjects and terms not embraced in the third edition.

" To execute such a work requires great erudition, unwearied industry, and extensive research;
and we know no one who could bring to the task higher qualifications of this description than Pro-
fessor Dunglison." — American MedicalJournal.

DUNCLISON'S PRACTIGE", A NEW EDITION.

THE VKACTICB OF MEDIGSHEl.
OR A TREATISE ON SPECIAL PATHOLOGY AND THERAPEUTICS.

BY ROBLEY DUNGLISON, M.D.,

Second Edition, carefully Revised and with Additions.

In Two Large Octavo Volumes of over thirteen hundred pages.

The Publishers annex a condei^sed statement of the Contents: — Diseases of the Mouth, Tongue,

Teeth, Gums, Velum Palati and Uvula, Pharynx and (Esophagus, Stomach, Intestines, Peritoneum,

Morbid Productions in the Peritoneum, and Intestines. — Diseases of the Larynx and Trachea, Bron-

diia and Lungs, Pleura, Asphyxia. — Morbid conditions of the Blood, Diseases of the Heart and

Membranes, Arteries, Veins, Intermediate or Capillary Vessels, — Spleen, Thyroid Gland, Thymus

Gland, and Supra Renal Capsules, Mesenteric Glands, — Salivary Glands, Pancreas, Biliary Appara-

bis, Kidney, Ureter, Urinary Bladder. — Diseases of the Skin, Exanthematous, Vesicular, Bullar,

Pustular, Papular, Squamous, Tuberculous, Macula;, Syphilides. — Organic Diseases of the Nervous

Centres, Neuroses, Diseases of the Neryes. — Diseases of the Eye, Ear, Nose. — Diseases of the

Male and Female Organs of Reproduction. Fever, — Intermittent, Remittent, Continued, Eruptive,

Arthritic. — Crchexies, Scrofulous, Scorbutic, Chlorotic, Rhachitic, Hydropic and Cancerous.

This work has been introduced as a text-buokin manjr ot'the Mcdictil Colleges,
and the general favour with which it has been received, is a guarantee ofits value
to the practitioner and student.

" In the volumes before us. Dr. Dunglison has proved that his acquaintance with the present facts
and doctrines, wheresoever originating, is most extensive and intimate, and the judgment, skill,
and impartiality with which the materials of the work have been collected, weighed, arranged, and
esposed, are strikingly manifested in every chapter. Great care is everywhere taken to indicate
the source of information, and under the head of treatment, formulse of the most appropriate reme-
dies are everywhere introduced. We congratulate the students and junior practitioners of Ame-
rica, on possessing in the present volumes, a work of standard merit, to which they may confidently
refer in their doubts and difhculties." — British and Foreign Medical Review, for July, 1S4C.

" Since the foregoing observations were written, we have received a second e<lition of Dungli-
son's work, a sufficient indication of the high character it has already attained in America, and
justly attaiiied." — British and Foreign Medical Review, for October, 1844.

"We hail the appearance of this work, which has just been issued from the prolific press of
Messrs. Lea & Blanchard of Philadelphia, with no ordinary degree of pleasure. Comprised in two
large and closely printed volumes, it exhibits a more full, accurate, and comprehensive digest of
the existing state of medicine than any other treatise with which we are acquainted in the English
language. It discusses many topics — some of them of great practical importance, which are en-
tirely omitted in the writings of Eberle, Dcwces, Hosack, Graves, Stokes, Mcintosh, and Gregory ;
and it cannot fail, therefore, to be of great value, not only to the student, but to the practitioner, as
it affords him ready access to information of which he Btands in daily need in the exercise of hi«
profession." — LouistilU Journal.

16 LEA & BLANCHARD'S PUBLICATIONS.

PROFESSOR DUMGLISON'S WORKS— Continued.

GEMEeAL TSIEBAPEOTICS km MATERIA ^EDICA,

ADAPTED FOR A MEDICAL TEXT-BOOK.

BY ROBLEY DUNGLISON, M.D.,
In two Volumes, Syo.

" The subject of Materia Medica has been handled by our author with more than usual judgment.
The greater part of treatises on that subject are, in eft'ect expositions of the natural and chemical
history of the substances used in medicine, with very brief notices at all of the indications they are
capable of fulfilling, and the general principles of Therapeutics. Dr. Dunglison, very wisely, in
onr opinion, has reversed all this, and given his principal attention to the arti&les of the Materia

Medica as medicines In conclusion, we strongly recommend these volumes to our readers. —

No medical student on either side of the Atlantic should be without them." — Forbes' British and
Foreign Medical Review.

" Our junior brethren in America will find in these volumes of Professor Dunglison a ' Thesau-
rus Medicaminum,' more valuable than a large purse of gold." — Medico-Chirurgical Review, for
January, 1845.

WITH UPWARDS OF THREE HUNDRED ILLUSTRATIONS,

BY ROBLEY DUNGLISON, M.D.,

FiTTH Edition, Greatly Modified and Improved, in 2 Vols, of 1304 Large Octavo Paces.

" We have on two former occasions, brought this excellent work under the notice of our readers,
and we have now only to say that, instead of falling behind in the rapid march of physiological
science, each edition brings it nearer to the van. VVithout increasing the bulk of the treatise, the
author has contrived to introduce a large quantity of new matter into this edition from the works of
Valentin, Bischoff, Henle, Wildebrand, Muller, Wagner, Mandl, Gerber, Liebig, Carpenter, Todd
and Bowman, as well as from various monographs which have appeared in the Cyclopjcdias, Trans-
actions of learned societies and journals. The large mass of references which it contains renders
it a most valuable bibliographical record, and bears the highest testimony to the zeal and industry
of the author." — British and Foreign Medical Revieiv.

" Many will be surprised to see a fifth edition of this admirable treatise so rapidly succeeding the
fourth. But such has been the rapid progress of physiology within a short period that to make his
work a fair reflection of the present state of the science, no less than an account of its extensive
popularity. Dr. Dunglison has found it necessary to put forth a new edition with material modifica-
tions and additions. To those who may be unacquainted with the work, we may say that. Dr. D.
does not belong to the mechanical, chemical, or vital school exclusively; but that, with a discri-
minating hand he culls from each and all, making his treatise a very excellent and complete digest
of the vast subject." — Western Journal oj Medicine and Surgery.

NEW REMEDIES,

PHMMAGEUTICALLY ANB THEHAPEUTIGALLY G0ISII1ERE3,

BY ROBLEY DUNGLISON, M.D.,
In One Volume, Octavo, over 600 pages, the Fourth Edition.

Or, the Influence of Atmosphere and Locality, Ciiange of Air and Climate,

Seasons, Food, Clothing, Bathins; and Mineral Springs, Exercise,

Sleep, Corporeal and Intellectual Pursuits, &c., &c., on

Healthy Man : Constituting ^

ELEMENTSOF HYGIENE.

BY ROBLEY DUNGLISON, M.D.
A New Edition with many Modifications and Additions. In One Volume, Svo.
"We have just received the new edition of this learned work on the ' Elements of Hygifene.' —
Dr. Dunglison is one of the most industrious and voluminous authors of the day. How he finds
time to amass and arrange the immense amount of matter contained in his various works, is almost
above the comprehension of men possessing but ordinary talents and industry. Such labour de-
serves immortality." — St. Louis Med. and Surg. Journal.

A NEW EDITION OF

THE MEDICAL STUDENT,

OR AIDS TO THE STUDY OF MEDICINE.

A REVISED AND MODIFIED EDITION.

BY ROBLEY DUNGLISON, M.D.,

In One neat 12mo. Volume.

LEA & BLANCHARD'S PUBLICATIONS. 17

CHAPMAN^S WORKS ON THE PRACTICE OF MEDICINL
CHAPMAN ON FEVERS, ETC.

LECTURES ON THE MORE liMPORTANT

ERUPTIVE FEVERS, HAEMORRHAGES AND

DROPSIES, AND ON GOUT AND RHEUMATISM,

DELIVERED IN THE UiMVERSITY OF PEMSILVANIA.

By N. chapman, M.D.,

Professor of the Theory and Practice of Medicine, &.C. &c.

In one neat Octavo Volume.
This volume contains Lectures on the following subjects :

EXANTHEMATOUS FEVERS.

Variola, or Small Pox ; Inoculated Small Pox; Varicella, or Cliickeii Poj ; Variola; Vaccinia", or Vaccinia,
or Cow-pock ; Varioloid Disease ; Rubeola, MorliiUi. or >reasles ; Scarlatina vel Febris Rubra — Scarlet Fever.
HAEMORRHAGES.

H«cmoptysis, Spitting of Blood; Haemorrhagia Narium, or HtEinorrhage from the Nose; Hjematemesis, or
Vomiting of Blood ; Hsematuria. or Voiding of Bloody Urine ; Hajmorrhagia Uterina, or Uterine Haemorrhage j
Haemorrhois or Ha;morrhoids ; Cutaneous Ha-niorrhage ; Purpura Hsemorrliagica.

DROPSIES.

Ascites; Encysted Dropsy; Hydrothorax; Hydrops Pericardii; Hydrocephalus Internus, acute, subacute,
aud chronic : Anasarca; \vilh»a Disuuisiiiou on the Management of the whole.
GOUT, RHEUMATISM, &c. &c.

"The name of Chapman stands deservedly high in the annals of American medical science. A teacher and a
lecturer for nearly forty years, in the oldest and, we believe, the first medical school on this side of the Atlantic,
the intimate triend and companion of Rush, Kuhn, Physick, Wisiar, VVoodhouse, Dewees, and a host of others
scarcely less renowned. Professor Chapman reflects upon the profession of this generation something of the
genius and wisdom of that which has passed; he stands out the able and eloquent champion of the doctrines
nnd principles of other times, when Cullen's "first lines" formed the rule of faith for all the Doctors in Medicine
throughout Christendom. In him is embodied the experience of three score and ten, strengthened by reading,
and enlightened by a familiar intercourse with many of the ablest medical men in the New and Old World.

" In conclusion, we must declare our belief that the name of Chapman will survive when that of many of his
cotemporaries shall have been forgotten ; when other generations shall tread the great theatre of human
affairs, and when other discoveries yet undisclosed, shall shed a brighter light upon the path of medical science.
The various lectures which he has been publishing, containing, as they do, the doctrines that he has so long
and so eloquently taught to large and admiring classes, we doubt not will be welcomed with delight by lus uiv-
Juerous pupils throughout the Union."— iV*M) Orleans Medical Journal.

CHAPMAN ON THORACIC VISCERA, ETC.

LECTURES ON THE MORE IMPORTANT DISEASES

OF THE

IHORACIC AND ABDOMINAL VISCERA.

DELIVERED L\ THE UNIVERSITY OF PENNSYLVAKL\.
By N. CHAPMAN, M. D.

Professor of the Theory and Practice of Medicine, &c.

In one Volume, Octavo.

WILLIAMS km CLYMER ON THE RESPIRATORY ORBANS, ETC.

A TREATISE ON THE

DISEASES OF THE RESPIRATORY ORGANS,

INCLUDING

THE TRACHEA, LARYNX, LUNGS, AND PLEURA.
Bv CHARLES J. B. WILLIAMS, M.D.,

Consulting Physician to the Hospital for Consumption and Diseases of the Chest; Author of
" Principles of Medicine," &c. &c.

WITH NUMEROUS ADDITIONS AND NOTES.
By MEREDITH CLYMER, M. D.,

Physician to the Philadelphia Hospital.

In one neat 8vo. Volume, Avith Cuts.

This work recommend.s itself to the notice of the profession as containing a more particu«
lar and detailed account of the affections of which it treats than perhaps any other volume
before the public.

"The wood cuts illustrating the physical examination of the chest, are admirably executed, and the whole
mechanical execution of the work, does much credit to the publishers. Tliis work is undoubtedly destineJ to
taUe precedence of all others yet published on the "Respiratory Organs," and as a text book for teachers aud
students, no better iu the present state of the science is lo be expected "—iVeto York Journal ef Medicine.

18 > LEA & BLANCHARD'S PUBLICATIONS.

NOW KSAD^,

A NEW AND IMPROVED EDITION

or RAMSBOTHAM'S STANDARD WORK ON PARTURITION.

THE PRINCIPLES AND PRACTICE OF

OiSTETll!^ MEDiCINE AND SURSERYj

IN REFERENCE TO

THE PROCESS OP PAETUEITION.

ILLUSTRATED BY

One hundred and forty-eight Ssarge Figures on 85 ILithographic Plates.
By FRANCIS H. RAMSBOTHAM, M. D., &c.

A NEW EDITION, FROM THE ENLARGED AND REVISED LONDON EDITION.

In one large imperial octavo volume, well bound.

The present edition of this standard work will be found to contain numerous and important improvements
over the last. Besides much additional matler, there are several more plates and wood-cuts, and those which
were before used have been re-drawn. This book has long been known to the profession, by whom it has
been most flatteringly received. The publishers lake great pleasure in siabmitling the following testimony to
its value from Professor Hodge, of the Pennsylvania University.

Philadelphia, August Gth, 1S43.
Gentlemen:— I have looked over the proofs of Ramsbotham. on Human Parturition, with its important
improvements, from the new London edition.

This Work needs bo commendation from me, receiving, as it does, the unanimous recommendation of the
British periodical press, as the standard work on Midwifery ; " chaste in language, classical in composition,
happy in point of arrangement, and abounding in most interesting illustrations."*

To the American public, therefore, it is most valuable— from its intrinsic undoubted excellence, and as
being the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive through-
out our country.

There is, however, a portion of Obstetric Science to which sufficient attention, it appears to me, has not
been paid. Through you, I have promised to the public a work on this subject, and although the continued
occupation of my time and thoughts in the duties of a teacher and practitioner have as yet prevented the ful-
filment of the promise, tlie day, I trust, is not distant, when, under the hope of being useful, I shall prepare
an account of the JIechanism of Labour, illustrated by suitable engravings, which may be regarded as an
addendum to the standard works of Ramsbotham, and our own Dewees.

Very respectfully, yours,

HUGH L. HODGE, M. D.,
Professor of Obsteiries, ^-e. ij-e., in the University of Pennsylvania.
Messrs. Lea & Blanchard.

" This new edition of Dr. Ramsbotham's work forms one of the most complete and thoroughly useful treatises
on Midwifery with which we are acquainted. It is not a mere reprint of the first edition; the entire work
has undergone a careful revision, with additions. We have already given specimens of the work sufficient
to justify our hearty recommendation of it as one of the best guides that the student or young practitioner can
follow."— British ami Foreign Medical Review, Jan., 1845.

" The work of Dr. Ramsbotham may be described as a complete system of the principles and practice of
Midwifery ; and the author has been at very great pains, indeed, to present a just and useful view of the pre-
sent state of obstetrical knowledge. The illustrations are numerous, well selected, and appropriate, and en-
graved with great accuracy and ability. In short, we regard this work, between accurate descriptions and
useful illustrations, as by far the most able work on the Principles and Practice of Midwifery that has ap-
peared for a lang time. Dr. Ramsbotham has contrived to infuse a larger proportion of common sense, and
plain unpretending practical knowledge into this work, than is commonly found in works on this subject;

• Narlhern Journal of Medicine far July 1845.

LEA & BLANCHARD'S PUBLICATIONS. 19

RAZVESBOTUAZME OTJ FAHTUHZTIOrT— Continued.

and as such we have (rreal pleasure in recommending il to the alteniion of obstetrical practitioners."— £d»»-
burgh Medical and Surgical JouTnal.

"This is one of the most beatlifal works which have lately issuetl from the medical press; and is alike
cretliiable to the talents of the author and the enterprise of the ptiblisker. Il is a good and ihoroMglily prac-
tical treatise ; the differenl subjects are laid down in a clear and perspicuous form, and whatever is of import
ance, is illustrated by I^rst rate eiipravinss. A remarkable feair.re ol iliis work, which ought to be mentioned,
is its extraordinary cheapness. As a work conveying good, soand, practical precepts, and clearly demonstra-
ting the doctrines of Obstetrical Science, we can confidently recommend it either to the student or practi-
tioner."— Edinburgh JouiKal of Medical Science.

"This work forms a very handsome volume. Dr. Ramsbolham has treated the subject in a manner worthy
of the repntation he possesses, and has succeeded in forming a book of reference for practitioners, and a solid
and easy guide for students. Looking at the contents of the volume, and its remarkably low price, we have
no hesitation in saying that il has no parallel in thehislory of publishing." — Provincial Medical and Surgi-
cal Journal.

"It is the book of Midwifery for students; clear, but not too minute in its details, and sound in its practi-
cal instructions. It is so completely illustrated by plates (admirably chosen and executed,) that the student
must be stupid indeed who does not understand the details of this branch of the science, eo far at least aa
description can make them intelligible." — Dublin Journal of Medical Science.

"Our chief object now is to state our decided opinion, that this work is by far the best that has appeared in
this country for those who seek practical information upon Midwifery, conveyed in a clear and concise style.
The value of the work, too, is strongly enhanced by the numerous and beautiful drawings, which are in the
first style of excellence." — London Medical Journal.

"We most earnestly recommend this work to the student who wishes to acquire knowledge, and to the
practitioner who wishes to refresh his memory, as a most faithful picture of practical Midwifery ; and we can
with justice say, that altogether it is one of the best books we have read on the subject of Obstetric Me^\-
^ine."—Medico-Chirurgical Revieic.

"All the organs concerned in the process of parturition, and every step of thia process, in all its different

forms, are illustrated with admirable plates When we call to mind the toil we underwent in

acquiring a knowledge of this subject, we cannot but envy the student of the present day the aid which this

work will afford him We recommend the student who desires to master this difficult subject with

the least possible trouble, to possess himself at once of a copy of this work." — American Jouinal of the Me-
dical Sciences.

"It is intended expressly for students and junior practitioners in Midwifery ; it is, therefore, as it ought to
be, elementary, and will not consequently, admit of an elaborate and extended review. Our chief object
now is to state ouf decided opinion, that this work is by far the best that has appeared in this country, for
those who seek practical information upon IMidwifery, conveyed in a clear and concise style. The value of
the work, too, is strongly enhanced by the rumerousand beautiful drawings by Bagg, which are in the first
style of excellence. Every point of practical importance is illustrated, that requires the aid of the engraver
to fix it upon the mind, and to render it clear to the comprehension of the student."— Z-o»(io?» Medical
Gazette.

" We feel much pleasure in recommending to the notice of the profession one of the cheapest and most ele-
gant productions of the medical press of the present day. The text is written in a clear, concise, and simple
style. We offer our most sincere wishes that the undertaking may enjoy all the success which it so well
merits." — Dublin Medical Press. '

" We strongly recommend the work of Dr. Ramsbotham to all our obstetrical readers, especially to those
who are entering upon practice. It is not only one of the cheapest, but one of the most beautiful works in
Midwifery."— Urj^sA and Foreign Medical Beview.

" Among the many literary undertakings with which the Medical press at present teems, there are few that
deserve a warmer recommendation at ciur h;aiids than the work— we might almost say the obstetrical library,
comprised in a single volume— which is now before us. Few works surpass Dr. Kamsbotham's in beauty and
elegance of getting up, and in the abundant and excellent engravings with wliich it is illustrated. We hear-
tily wish the volume the success which il merits, and we have no doubt that before long it will occupy a
place in every medical library in the kingdom. The illustrations are admirable; they are the joint production
of Bagg and Adlard, and comprise within the series the best obstetrical plates of our best obstetrical authors,
ancient and modern. Many of the engravings are calculated to fix the eye as much by their excellence of
execution, and their beauty aa works of art, as by their fidelity to nature and anatomical accuracy." — T/tc
hancet.

"■ This is a work of unusual interest and importance to students and physicians. It is from the pen of Dr.
Bamsbolham, consullinj' physician in obstetric cas^s of the London HoFpilal, and embodies in one veluma
the Principles and Practice of Obstetric Medicine and Surgery. The treatise is admirably written, and illus-
trated by a great variety of engravings: Indeed every thing in the obstetric art, capable of being explained
by engravings, is displayed to the eye in these admirably executed prints. A medical correspondent of the
New York American, says, that the 'universal voice of the British journals accords in con-iiiiending this
work to the profession, as one of the best elementary treatises in the language,' and we can only say, in addi-
tion, that the American publishers have, as far as we can judge from the execution of the plates In their edi-
tion, done full justice to theoriginal work. Wesincerely hope that il may meet with entire success, and we
cannot di'ubt that, when its merits are fully known, it will be found iu every medical library in the country."
—Saturday Evening Post.

LEA & BLANCHARD'S PUBLICATIONS.

Now Ready ^
CHEMISTRY FOR STUDENTS

ELEMEMTARY CHER^ISTRY, THEORETICAL AMD PRACTICAL.

By GEORGE FOWNES, Ph. D.,

Chemical Lecturer in the Middlesex Hospital Medical School, &c. &c.

With Numerous Illustrations. Edited, with Additions,
By ROBERT BRIDGES, M. D.,

Professor of General and Pharmaceutical Chemistry in the Philadelphia College
of Pharmacy, &c., &c.

In one large duodecimo volume, sheep or extra cloth.

This is among the cheapest volumes on Chemistry yet presented to the pro-
fession. The character of the work is such as should recommend it to all col-
leges in want of a text-book as an introduction to the larger and more advanced
systems, such as Graham's and others. The great advantage which it possesses
over all the other elementary works on the same subject now before the pubhc,
is the perfect manner in which it is brought up to the day on every point, em-
bracing all the latest investigations and discoveries of importance, in a concise
and simple manner, adapted to the time and comprehension of students com-
mencing the science. It forms a royal 12mo. volume of 460 large pages, on small
type, embellished with over one hundred and sixty wood engravings, which
will be found peculiarly instructive as to the practical operations of the labora-
tory, and the new and improved methods of experimenting.

It has already been adopted as a Text-book by Professor Silliman of Yale Col-
lege, and by otlier Colleges in different parts of the country.

Extract from a letter from Professor Millington, of being omitted, and appears to ns extremely well

William and Mary College, Va. adapted as a text-book for the pupil attending a course

of lectures on chemistry. Indeed we have no doubt

"I have perused the book with much pleasure, and ^^^^ .^ ^.„ ^^^■^^^^^^ become the medical student's

find it a most admirable work ; and, to my mind, such ^^^^^^-^^ manu.l."-Du6/m Medical Press.

a one as is just now much needed m schools and col- „ j^^^._^„ examined it with some attention, we feel

leges. * * * AH the books I have met with on che-

qualified to recommend it to our younger readers as an

m.stry axe either loo puerile or too erudite, and I con- ^^^j^^^le exposition of the present state of chemical

fessDr. Fownes' book seems to be the happiest medium ^^ ^^^ ^j^^^j^ ^^.^^^^^ ^,^j displaying a

I have seen, and admirably suited to fill up the hiatus." ^^^^^^^^ ^^^^^.^^1 knowledge of its details, as well as

a profound acquaintance with its principles." — British

.^ , and Foreign Medical Revieio.

Extract from a letter from Professor W. E. A. Atkin, of „ Numerous and useful as are the works extant on

the University of Maryland. ^^^ g^.^^^^^ ^C chemistry, we are nevertheless pre-

« The first cursory examination left me prepossessed pared to admit that the author of this publication has

In its favour, and a subsequent mo.re careful review made a valuable addition to them by offering the stu-

has confirmed these first impressions. I shall certainly dent and those in general who desire to obtain informa-

recommend it to my classes, and feel sure that they tion> an accurate compendium of the state of chemical

will profit by using it during the session of lectures. science; which is, moreover, well illustrated by ap-

" As a judicious compendium, I think Fownes' Che- propriate and neatly executed wood engravings. * *

mistry cannot fail to be highly useful to the class of After what we have stated of this work, our readers

readers for whom it was designed." will not be surprised that it has our hearty commenda-
tion, and that, in our opinion, it is calculated, and at a

" trifling expense, to spread the doctrines of the intricate

« Mr. Fownes' work, although consisting of only a science which it so clearly explains."— ATedtoi-CA*-

eingle thick 12mo. volume, includes a notice of almost rurgieal Review.
ever>' branch of the subject, nothing of any importance

LEA & BLANCHARD'S PUBLICATIONS. 21

"This IS an unpretending, but decidedly valuable its more abstruse subjects. Such a treatise is the one

ueatise, on the elements of chemistry, theoretical and whicli we have now the pleasure of introducing to our

practical. Dr. Bridges has a perfect idea of what is readers ; no manual of chemistry with which we have

needed, and the preparation of this excellent guide met comes so near meeting the wants of the beginner.

sJiould have the countenance of all public instructors, All the prominent truths of the science, up to the pre-

ttiid especially those of medical students."— Boston sent time, will be found given in it with the utmost

Med. S^ Surg. Journal. practicable brevity. The style is admirable for its

''This is a very excellent manual for the use of Btu- conciseness and clearness. Many wood-cuis are

dents and junior practitioners, being sufllciently full supplied, by which processes are made intelligible-

aiid complete on the elements of the science, without The author expresses regret, that he could not enter

canitting any necessary information, or extending too more largely into organic chemistry, but his details

far into detail. It is written in a clear and concise will be found to embrace the most important facts in

style, and illustrated by a sufficient number of well that interesting branch of the iicience. AVe shall re-

axecuted wood-cuts and diagrams. The Editor has commend his manual to our class next winter."— T/i-e

OJCecuted his task in a creditable manner, and we have Western Journal of Medicine and Surgery.

no doubt the work will prove entirely satisfactory, as " We are presented with a work, not only compre-

an introduction to the science of which it treats."— jV. hensive as regards general principles, but full of prac-

y. Journal of Med. ^- Surgery. ti^.al details of the working processes of the scientific

" He has succeeded in comprising the matter of his laboratory; and in addition, it contains numerous

work iiw460 duodecimo pages, which, assuredly, is a wood engravings, showing the most useful forms of

recommendation of the volume as a text-book lor stu- apparatus, with their adjustments and methods of use.

dents. In this respect it has advantages over any "The original work having been full and complete,

treatise which has yet been ofl'ered to American siu- as far as the limits of such a volume would permit,

dents. The difficulty in a text-book of chemistry is to and on every point brought up to the dale of its publi-

treat the subject with sufficient fullness without going cation (in September last,) the task of the editor has

too much into detail. For students comparatively been to add any important matter which appeared

ignorant of chemical scienge, the larger systems are since, and to correct such typographical errors as had

unprofitable companions in their attendance upon lee- escaped the author. That this task has been wall

lures. They need a work of a more elementary cha- a„(j ^j^iy performed, the known zeal and competency

racter, by which they may be inducted into the first ^f q^ Bridges afford a sufficient guarajitee."— TAj

principles of the science, and prepared for mastering Medical Examiner.

GHAHAM'S CHBMISTRIT.

THE ELEKNTS OF GHEiliiSTilY.

INCLUDING THE APPLICATION OF THE SCIENCE TO THE ARTS.

With Numerous Illustrations.

BY THOMAS GRAHAM, F. R. S. L. and E. D.
Professor of Chemistry in University College, London, &c. &c.

WITH NOTES AND AUDITIONS,

BY ROBERT BRIDGES, M.D., &c. &c.

In One Vol. Octavo.

The great advancement recently made in all branches of chemical investigation, ren-
ders necessary an enlarged work which shall clearly elucidate the numerous discoveries,
€!specially in the department connected with organic Chemistry and Physiology, in
which such gigantic strides have been made during the last few years. The present
treatise is considered by eminent judges to fulfil these indications, and to be pecu-
liarly adapted to the necessities of the advanced medical student and practitioner. In
adapting it to the wants of the American profession, the editor has endeavoured to render
his portion of the work worthy the e.valted reputation of the first chemist of England.
It is already introduced in many of the Colleges, and has universal approbation.

Though so recently published, it has been translated into German, by Dr. F. Julius
Otto, the eminent professor at Brunswick, and has already passed to a second edition.

22 LEA & BLANCHARD'S PUBLICATIONS.

A NEW MEBlCAIi BICTSONARIT. '

In one Yolitme, large 12aiso., now ready, at a low price.

A DICTIONARY OF

THE TEEMS USED IN MEDICINE

AND

THE COLLATERAL SCIENCES:

By RICHARD D. HOBLYN, A.M., Oxon.
FIRST AMERICAN, FRDM THE SECOND LONDON EDITION.

REVISED, WITH NUMEROUS ADDITIONS,

BY 1 S AAC HAYS, M.D.,

EDITOR OF THE AMEHICAN JOURKAL OF THK MEDICAL SCIEJTCES.

Believing that a work of this kind would be iisefni to the profession in
this country, the publishers have issued an edition in a neat form for the
office table, at a low price. Its object is to serve as an introduction lo the
larger and more elaborate Dictionaries, and to assist the student commenc-
ing the study of Medicine, by presenting in a concise form an explanation
of the terms most used in Medicine and the collateral sciences, by giving
the etymology and definition in a manner as simple and clear as possible,
without going into details ; and bringing up the work to the present time
by including the numerous terms lately introduced. This design the author
has so ably executed as to elicit the highest encomiums of the medical
press, a few of the testimonies of which are subjoined.

It has been edited with especial reference to the wants of the American
practitioner, the native medicinal plants being introduced, with the for-
mulae for the various officinal preparations ; and the whole being made to
conform to the Pharmacopoeia of the United States. It is now ready in
one neat royal duodecimo volume of four hundred pages in double co-
lumns.

Extract from a Letter from Professor Watts of the College of Physicians mid Surgeons, N. York.

" It is a valuable book for those more advanced in the profession, but especially for
students of Medicine, and I shall take pleasure in recommending it to my class during
the coming session."

OPINIONS OF THE PRESS.

•' We hardly remember to have seen so much valuable matter condensed into
such a small compass as this little volume presents. The first edition was pub-
lished in 1835, and the present may be said to be almost re-written, introducing
the most recent terms on each subject. The Etymology, Greek, Latin, &c., is
carefully attended to, and the explanations are clear and precise. We cannot too
strongly recommend tiiis small and cheap volume to the library of every student and
every practitioner." — Medico-Chirurgkal Review.

" We gave a very favourable account of this little book on its first appearance,
and we have only to repeat the praise with increased emphasis. It is, for its size,
decidedly the best book of the kind, and ought to be in the possession of every
student. Its plan is sufficiently comprehensive, and it contains an immense mass
of necessary information in a very small compass." — British and Foreign Medi-
cal Review.

" A work much wanted, and very ably executed." — London Medical Journal.

" This compendious volume is well adapted for the use of students. It contains
a complete glossary of the terms used in medicine — not only those in common
use, but also the tnore recent and less familiar names introduced by modern wri-
ters. The introduction of tabular views of different subjects is at once compre-
hensive and satisfactory." — Medical Gazette.

" Concise and ingenious." — Johnson's Medico-Chinir. Journal.

"It is a very learned, pains-taking, complete, and useful work — a Dictionary
absolutely necessary in a medical library." — Spectator.

LEA & BLANCHARD'S PUBLICATIONS. 23

A NEW EDITION OF

OAKPEHTE^'^ HUMAH PHY^IOLO^T.

REVISED AND MUCU BIPROVED.

PRINCIPLES OF HUMAN PHYSI0L06Y,

WITH THEIR CHIEF Al'ri-ICATIONS TO

PATHOLOGY, HYGIENE & FORENSIC MEDICINE.
By WILLIAM B. CARPENTER, M.D., F.R.S., &c.

SECOND AMERICAN, FROM A NEW AND REVISED LONDON EDITION.

WITH NOTES AND ADDITIONS,

BY MEREDITH CLYMER, M.D., &c.,
With Two Hundred and Sixteen Wood-cut and other Illustrations.

In one octavo volume, of about 650 closely and beautifully printed pages.

The very rapid eale of a large impression of the first edition is an evidence of the merits of this
valuable work, and that it has been duly appreciated by the profession of tbis country. The pub-
lishers hope that the present edition will be found still more worthy of approbation, not only from
the additions of the author and editor, but also from its superior execution and the abundance of
its illustrations. No less than eighty-five wood-cuts and another lithographic plate will be found
to have been added, affording the most material assistance to the student.

" We have much satisfaction in declaring our opinion that this work is the best systematic treat-
ise on physiology in our own language, and the best adapted for the student existing in any lan-
guage."— Medico-Chirurgical Review.

XOW READY.

A NEW AND IMPROVED EDITION OF

A SYSTEM OF PRACTICAL SURGERY.
By WILLIAM FERGUSSON, F.R.S.E.

Second American Edition, Revised and Improved.

WITH TWO HUNDRED AND FIFTY-TWO ILLUSTRATIONS FROM DRAWINGS BY BAGG, ENGRAVED BT
GILBERT, WITH NOTES AND ADDITIONAL ILLUSTRATIONS,

BY GEORGE W. NORRIS, M.D., &c.
In one beautiful octavo volume of six hundred and forty large pages.

The publishers commend to the attention of the profession this new and improved edition of
Fergusson's standard work, as combining cheapness end elegance, with a clear, sound and practical
treatment of every subject in surgical science. Neither pains nor expense have been spared to
make it worthy of the reputation which it has already acquired, and of vhich the rapid exhaustion
orf the first edition is sufticient evidence. It is extensively used as a text-book in many medical
colleges throughout the country.

The object and nature of this volnme are thus described by the author :^—" The present work
has not been produced to compete with any already before the Profession; the arrangement, the
manner in which the subjects have been treated, and the illustrations, are all different from any of
the kind in the English language. It is not intended to be placed in comparison with the elemen-
tary systems of Cooper, Burns, Listen, Symes, Lizars, and that excellent epitome of Mr. Druitt. —
It may with more propriety be likened to the Operative Surgery of Sir C. Bell, and that of Mr.
Averill, both excellent in their day, or the more modern production of Mr. Ilargrave, and the
Practical Surgery of Mr. Listen. There are sulijects treated of in this volume, however, which
none of these gentlemen have noticed ; and the author is sufliciently sanguine to entertain the idea
that this work may in some degree assume that relative position in I3ritish Surgery, which the
dassical volumes of Velpeau and Malgaigne occupy on the Continent."

"If we were to say that this volume by Jlr. Fergu6son,is one excellently adapted to the stu-
dent, and the yet inexperienced practitioner of surgery, we should restrict unduly its range. It is
ci' the kind which every medical man ought to have by him for ready reference, as a guide to the
{■ronipt treatment of many accidents and injuries, which whilst he hesitates, may be followed by
incurable defects, and detbrmitics of structure, if not by death itself. In drawing to a close our
notice of Mr. Fergusson's Practical Surgery, we cannot refrain from again adverting to the nume-
rous and beautiful illustrations by wood-cuts, which contribute so admirably to elucidate the de-
scriptions in the text. Dr. Norris has, as usual, acquitted himself judiciously in his office of
aauotator. His additions are strictly practical and to the point." — Bulletin of Medical Science.

24 LEA & BLANCHARD'S PUBLICATIONS.

ZiATSIiir riTBIiISHSS.D,

A NEW EDITION OF

"WILiSON'S HUMAN ANATOMY,

Much Improved. ■^

GENERAL AND SPECIAL.

BIT ZISIASI^US ^^ZZiSO^, ]^.B.,

Lecturer on Anatomy^ London.
SECOND AMERICAN EDITION, EDITED BY

PAUL B. GODDARD, A.M., M.D.,

Lecturer on Anatomy and Demonftrator in the University o/ Pennsylvania, ^e,

WITH OVER TWO HUNDRED ILLUSTRATIONS,
Beautifully Printed from the Second London Edition.

IN ONE VERT NEAT OCTAVO VOLUME.
From the Pre/ace to the Second American Edition.

" The very rapid sale of the first edition of this work, is evidence of its appreciation by the pro-
fession, and is most gratifying to the author and American editor. In preparmg the present edition
no pains have been spared to render it as complete a manual of Anatomy for the medical student as
possible. A chapter on Histology has therefore been preilrjed, and a considerable number of new
cuts added. Among the latter, are some very fine ones of the nerves which were almost wholly
omitted from the original work. Great care has also been taken to have this edition correct, ami
the cuts carefully and beautifully worked, and it is confidently believed that it will give satisfaction,
oifering a further inducement to its general use as a Text-book in the various Colleges."

" Mr. Wilson, before the publication of this work, was very favourably known to the profession
by his treatise on Practical and Surgical Anatomy; and, as this is the Second American Edition,
from the second London Edition, since 1840, any special commendation of the high value of the
present work, on our part, would be supererogatory. Besides the work has been translated at Be^•
lin, and overtures were repeatedly made to the London publisher for its reproduction in France. —
The work is, undoubtedly, a complete system of human anatomy, brought up to the present day. —
The illustrations are certainly very beautiful, the originals having been expressly designed and exe-
cuted for this work by the celebrated Bagg of London; and, in the American edition they have
been copied in a masterly and spirited manner. As a text-book in the various colleges we would
commend it in the highest terms." — New York Journal of Medicine.

8N THE THEOey AND PRACTIOE @F MfOWIFERY,

BY FLEETWOOD CHURCHILL, M.D., M.R.I.A.,

PHYSICIAN TO THE WESTERN LYING-IN-HOSPITAL, ETC., ETC.

WITH WrOTES Ii.-NJ> ADDITIONS

BY ROBERT HUSTON, M.D.,
Professor in the Jefl'erson Medical College, &c., &c.

And One Hundred and Sixteen ILIiE$trafion§,

Engraved by Gilbert from Drawings by Bagg and others.
In one volume, octavo.
This work commends itself to the notice of the profession from the high reputation of the author
and editor, and the number and beauty of its illustrations. Besides accurate directions for
THE PRACTICE OF MIDWIFERY,
a portion of the work is also devoted to
THE PHYSIOLOGY AND PATHOLOGY
connected with that essential branch of medical knowledge.
" It is impossible to conceive a more useful or elegant manual : the letter-press contains all that
the practical man can desire ; the illustrations are very numerous, well chosen, and of the most ele-
gant description, and the work has been brought out at a moderate price." — Provincial Med. Jour.
" We expected a first rate production, and we have not been in the least disappointed. Although
we have many, very many valuable works on tokology, were we reduced to the necessity of pos-
sessing but one, and permitted to choose, we would unhesitatingly take Churchill." — Western Med.
and Surg. Journal.

This work is printed, illustrated and bound to match Carpenter's Physiology,
Fergusson's Surgery and Wilson's Anatomy, and the whole, with Watson's Prac-
tice, Pereira's Materia Medicaand Graham's Chemistry, are extensively used in
the various colleges.

LEA & BLANCHARD'S PUBLICATIONS. 25

PEREIM'S MATERIA MEDICA.

WITH NEAR THREE HUNDRED ENGRAVINGS ON WOOD.
A NHJJir EDITION NO'W READV.

THE ELEMENTS OF MATERIA~MEDICA AND THERAPEUTICS.

COMPREHENDING THE NATURAL HISTORY, PREPARATION, PROPERTIES, COMPO-
SITION, EFFECTS, AND USES OF MEDICINES.
BY JONATHAN PEREIRA, M.D., F.R.S. and L. S.
Member of the Society of Pharmacy of Paris; Examiner in Materia Medica and Pharmacy of the
University of London; Lecturer on Materia Medica at the London Hospital, &c., &c.
Second American, from ihe last London Edition, enlarged and improved. With Notes and Additions
BY JOSEPH CARSON, M.D.,
In two volumes, octavo.

Part I, contains the General Action and Classification of Medicines and the Mineral Materia Me-
dica. Part II, the Vegetable and Animal Kingdoms, and including diagrams explanatory of the
Processes of the Pharmacopoeias, a tabular vievi' of the History of the Materia Medica, from the
earliest times to the present day, and a very copious index. From the last London Edition, which
has been thoroughly revised, with the Introduction of the Processes of the New Edinburgh Phar-
macopoeia, and containing additional articles on Mental Remedies, Light, Heat, Cold, Electricity,
Magnetism, Exercise, Dietetics and Climate, and many additional Wood-cuts, Illustrative of Phar-
maceutical Operations, Crystallography, Shape and Organization of the Feculas of Commerce, and
the Natural History of the Materia Medica.

The object of the author has been to supply the Medical Student with a Class Book on Materia
Medica, containing a faithful outline of this Department of Medicine, which should embrace a con-
cise account of the most important discoveries in Natural History, Chemistry, Physiology, and The-
rapeutics, in so fir as they pertain to Pharmacology, and treat the subjects in the order of their
natural historical relations.

The opportunity has been embraced in passing this New Edition through the hands of the Editor,
Dr. Carson, to make such additions as were required to the day, and to correct such errors as had
passed the inspection of the Author and Editor of the first edition. It may now be considered as
worthy the entire confidence of the Physician and Pharmaceutist as a standard work.

This great Library or Cyclopadia of Materia Medica has been fully revised, the errors corrected,
and numerous additions made by DR. JOSEPH CARSON, Professor of Materia Medica and Phar-
macy in the "College of Pharmacy," and forms Two Volumes, octavo, of near 1600 large and
closely printed pages. It may be fully relied upon as a permanent and standard work for the coun-
try— embodying, as it does, full references to the U. S. Pharmacopoeia and an account of the Medi-
cal Plants indigenous to the United States.

" An Encyclopoedia of knowledge in that department of medical science — by the common con
sent of the profession the most elaborate and scientific Treatise on Materia Medica in our lan-
guage."— Western Journal of Medicine and Surgery.

" Upon looking over the American edition of the Materia Medica of Dr. Pereira, we have seen no
reason to alter the very favourable opinion expressed in former numbers of this Journal. (See Am.
Med. Journal, XXIV, 413, and N. S., I. 192.) We are glad to perceive that it has been repub-
lished here without curtailment. Independently of the injustice done to an author by putting tbrth
an abbreviated edition of his works, without his superintendence or consent, such a course would
in the present instance have been unjust also to the public, as one of the chief recommendations
of Dr. Pereira's treatise is its almost encyclopedic copiousness. We turn to its pages with
the expectation of finding information upon all points of Materia Medica, and would have good
reason to complain were this expectation disappointed by the scissors of an American Editor.
Indeed, the main defect of the work, in relation to American practitioners, was the want of
sufficient notices of the medicines and preparations peculiar to this country. In the edition
before us this defect has been supplied by the Editor, Dr. Joseph Carson, who was, in a high
degree qualified for the task, and, so far as we are able to judge from a very partial perusal, has
executed it with judgment and fidelity. The nomenclature and preparations of our national
standard have been introduced when wanting in the English edition, and many of our medical
plants, either briefly noticed or altogether omitted by Dr. Pereira, because unknown in Europe,
have been suflicientiy described. We must repeat the expression of our opinion that the work will
be found an invaluable storehouse of information for the physician and medical teacher, and con-
gratulate the profession of this country that it is now placed within their reach." — Am. Mcd.Journ.

«' To say that these volumes on Materia Medica and Therapeutics, by Dr. Pereira, are comprehen-
sive, learned and practical, and adapted to the requirements of the practitioner, the advanced stu-
dent, as well as the apothecary, expresses the opinion, we will venture to assert, of nearly every
judge of the subject, but fails to convey to those who are not acquainted with the work, a definite
idea of its really distinctive traits, according to our general usage, we shall, therefore, proceed to
place these before our readers, so that they may know what it is, and why we praise. Valuable
and various as are the contents of the volumes of Dr. Pereira, we have no hesitation in assert-
ing, despite the adverse cant in some quarters on the subject of the American additions to English
works, that the value of the present edition is enhanced by the appropriate contributions of
Dr. Carson, who has introduced succinct histories of the most important indigenous medicines of
the United States Pharmacopoeia." — Select Med. Library.

LEA & BLANCHARD'S PUBLICATIONS.

THE SURGICAL WORKS JF SIR ASTLEY COOPER.

LEA & BLANCHARD have now completed Ihe last volume of the illustrated vrorks of Sir Astley Cooper.
They form an elegant series; the works on Hernia, the Testis, the Thymus Gland and the Breast, being prim-
ed, illustrated and bound to match, in imperial octavo with numerous LI THOGR APHIC PLATES, while the
Treatise on Dislocaiious is in a neat medium octavo form, with NUMEROUS WOOD-CUTS similar to the
last London Edition.

COOPER ON THE

ANATOMY AND DISEASES OF THE BREAST, &c,,

This large and beautiful volume contains THE ANATOMY OF THE BREAST;

THE COMPARATIVE ANATOMY OF THE MAMMARY GLANDS j

ILLUSTRATIONS OF THE DISEASES OF THE BREAST;

And Twenty-five Miscellaneous Surgical Papers, now first published in a collected form.

By SIR ASTLEY COOPER, Bart., F.R.S.,&c.

The whole in one large imperial octavo volume, illustrated with two hundred and filty-lwo figures on
thirty six Lithographic Plates ; well and strongly bound.

SIR ASTLEY OGSPIB ON (JEBHiA,

Jf*Uh One Hundred and Thirty mgures in Ijiihog-rapliy,

THE ANATOMY AN3 STOIGAL TREATMBMT OF

ABBOMiNAii mmi

By Sir ASTLEY COOPER, Bart.
Edited by C. Aston Key, Surgeon to Guy's Hospital, &.c.

This important work of Sir Astley is printed from the authorized second edition, published in London, rn
large super-royal folio, and edited by his nephew. Professor Key. It contains all the Plates and all the Let-
terpress—there are no omissions, interpolations, or modifications— it is the complete work in

One Iiarge Imperial Octavo "Volume.
WITH OYER 110 FIGURES ON 21) PLATES, AND OVER 400 LARGE PAGES OF LETTERPRESS.

The correctness of the Plates is guaranteed by a revision and close examination under the eye of a distia-
gtiished Surgeon of this city.

ANOTHER VOLUME OF THE SERIES CONTAINS HIS TREATISE

ON THE STRUCTURE AND DISEASES OF THE TESTIS.

Illustrated by 120 Figures. From the Second London Edition.
By BRANSBY B. COOPER, Esq.

AND ALSO

ON THE ANATOMY OF THE THYMUS GLAND.

Illustrated by 57 Figures.

The two works together in one beautiful imperial octavo volume, illustrated with twenty-nine plates ia
the best style of lithography, and printed and bound to match.

COOPER m PRACTURES AND BISLOSATIONS,

WITH NUMEROUS WOOD-CUTS.
.VTIONS AND FRACTURES OF THE JOINTS. :
Bakt., F. R. S., Sergeant t«urgeou to tlie King, &c.

WITH NUMEROUS WOOD-CUTS.
A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS. By SIR ASTLEY COOPF.R,

A new edition much enlarged ; edited by BRANSBY COOPER, F.R.S., Surgeon to Guy's Hospital, with ad

ditional Observations from Professor John C. Wakren, of Boston. With numerous engravings on wood.

after designs by Bagg, a memoir and a splendid portrait of Sir Astley. In one octavo_volume.

The peculiar value ofthis, as of all Sir Astley Cooper's works, consists in its eminently practical character.
His nephew, Bransby B. Cooper, from his own experience, has added a number of cases. Besides this, Sir
Astlev left behind him very considerable additions in MS. for the express purpose of being introduced into tliia
edition. The volume is embellished with ONE HUNDRED AND THIRTY-THREE WOOD-CUTS, and
contains the history of no less than three hundred and sixty-one cases, thus embodying the records of a life of
practice of the Author and his various editors. There are also additional Observations from notes furnithed
by John C. \Yarren, M.D.. the Professor of Anatomy and Surgery in Harvard University.

" Al"ter the fiatof the profession, it would be absurd in us to eulogize Sir Astley Cooper's work on Fractures
and Dislocations, It is a nalioual one, and will probably subsist as long as English surgery."— Jlfcdico-CA»a(«sr
gical Ra'iew,

LEA & BLANCHARD'S PUBLICATIONS.

LATELY PUBLISHED.

MEIGS' TRANSLATION

X OF

C8L0MBAT DE L'ISEBE CH THE DISEASES OF FEMALES.

A TREATISE ON THE DISEASES OF FEMALES,

AND ON

THE SPECIAL HYGIENE OF THEIR SEX.

WITH NUMEROUS WOOD-CUTS.
BY COLOMBAT DE L'ISfeRE, M.D.,

Ckevaiier o/lhe Legion of Honor; late Surgeon to the Hospital of the Kue de Valois, devoted to the Diseases qf
Femala:, ^-c. ^-c.

TRANSLATED, WITH MANY NOTES AND ADDITIONS,
By C. D. MEIGS, M.D.,

Professor of Obstetrics and Diseases of Wo7nen and Children in the Jefferson Medical College, ^c, *c.
In One Large Volume, 8vo.
" We are satisfied it is destined to take the front rank in this department of medical science; it is
beyond all comparison, the most learned Treatise on the Diseases of Females that has ever been
■written, there being more than one thousand distinct authorities quoted and collected by the inde-
fatigable author. It is in fact a complete exposition of the opinions and practical methods of all
the celebrated practitioners of ancient and mode'rn times. The Editor and Translator has per-
formed his part in a manner hardly to be surpassed. The translation is faithful to the original, and
yet elegant. More than one hundred pages of original matter have been incorporated in the test,
constituting a seventh part of the whole volume." — New York Journal of Medicine.

ASHWELL ON THE DISEASES OF FEMALES.

A PRACTICAL TREATISE ON THE

DISEASES PECULIAR TO WOMEN,

ILLUSTRATED BY CASES DERIVED FROM HOSPITAL AND PRIVATE PRACTICE. '
Br SAMUEL ASHWELL, M.D.,

Member of the Royal College of Physicians; Obstetric Physician and Lecturer to Guy's Hospital, &c.

WITH ADDITIONS,

By PAUL BECK GODDARD, M.D.

The whole complete in one Large Octavo Volume.

" The most able, and certainly the most standard and practical work on female diseases that we

have yet seen." — Medico-Chirurgical Review.

A NEW EDITION OF CHURCHILL ON FEMALES.
THE DISEASES OF FEMALES,

INCLUDING THOSE OF "

By FLEETWOOD CHURCHILL, M.D.,

Author of •'Theory and Practice of Midwifery," &c., &c.
THIRD AMERICAN, FROM THE SECOND LONDON EDITION.

With Illustrations. Edited with Notes,

By ROBERT M. HUSTON, M.D., &c., &c.
In One Volume, 8vo.

" In complying with the demand of the profession in this country for a third edition, the Editor
has much pleasure in the opportunity thus afforded of presenting the work in its more perfect form.
All the additional references and illustrations contained in the English copy, are retained in this.-'

TAITLOR'S JURISPRUDBNCB.

MEDICAL JURISPRUDENCE,

BY ALFRED S. TAYLOR.

Lecturer on Medical Jurisprudence and Chemistry at Guy's Hospital.

With numerous Notes and Additions, and References to American Law.

BY R. E. GRIFFITH, M. D.
In one Tolume; octavo, sheep. AlsO; done up in neat law sheep.

LEA & BLANCHARU'S PUBLICATIONS.

CONDZiO ON GHlIaBRBN.

A PRACTICAL TREATISE

ON

THE DISEASES OF CHILDREN,

BY D. FRANCIS CONDIE, U. D.

Fellow of the College of Physicians; Member of the American Philosophical Society, &c. &c.

In one volume, octavo.

J>5~ The Publishers would particularly call the attention of the Profession to an examination

of this work.
" Dr. Condie,fronithe very great labour which he has evidently bestowed upon this book, is entitled
to our respect as an indefatigable and conscientious student; but if we consider the results of his
labour, we cannot but admit his claim to a place in the very first rank of eminent writers on the
practice of medicine. Regarding his treatise as a whole, it is more complete and accurate in its
descriptions, while it is more copious and more judicious in its therapeutical precepts than any of
its predecessors, and we feel persuaded that the American medical profession will very soon regard
it, not only as a very good, but as the very best ' Practical Treatise on the Diseases of Children.' "
— Am. Med. Journal.

THOBZSON ON THS SICK ROOM.
THE DOMESTIC MANABEMENT OF THE SICK ROOM,

NECESSARY, IN AID OF MEDICAL TREATMENT, FOR THE

CURE OF DISEASES.

BY A. T. THOMSON, M. D., &c. &c.

First American, from the Second London Edition.

Edited by R. E. GRIFFITH, M.D.
In one royal 12mo. volume, extra cloth, with cuts.

" There is no interference with the duties of the medical attendant, but sound, sensible, and
clear advice what to do, and how to act, so as to meet unforeseen emergencies, and co-operate with
professional skill." — Literary Gazette.

I^IIiIiER'S PRZNCIPLSS7}F SURGHR'Sr.

THE PRINCIPLES OF SURGERY,

By JAMES MILLER, F.R.S.E., F.R.C.S.E.,

Professor of Surgery in the University of Edinburgh, &c. ^

In one neat 8vo. volume.
To match in size with Fergussoii's Operative Surgery.

"No one can peruse this work without the conviction that he has been addressed by an accom-
plished surgeon, endowed with no mean literary skill or doubtful good sense, and who knows how
to grace or illumine his subjects with the later lights of our rapidly advancing physiology. The
book deserves a strong recommendation, and must secure itself a general perusal."- — Medical Times.

WILLIAMS' PATHOLOGir.

PRINCIPLES OF MEDICINE,

COMPRISING

GENERAL PATHOLOGY AND THERAPEUTICS, and a general view of ETIOLOGY,

NOSOLOGY, SEMEIOLOGY, DIAGNOSIS AND PROGNOSIS.

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FhUaddpkia, October^ 1845.

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