Chapter VII (2)

Half a tea-spoonful of magnesia, and the same quantity of cream of tartar, mixed in half a tea-cupful of milk, an hour before breakfast, and repeated as required, will be found very efficacious.

Some practitioners have entertained the idea that the humours of the body are never vitiated to such a degree by the nettle rash as to require the use of internal remedies, and that if the irritation could be certainly allayed by external applications, there would be no necessity for any other mode of cure.

As this disorder is very frequent in spring, when a hot sun, with cold winds, prevail, the visitor will hear of a variety of herbs as “never-failing cures” of nettle rash. Among these the nettle itself is the Abernethy of the party, concocted into a sort of tea with a proportion of one-third of ground-ivy infused in it. Although in a chronic form, it is often of rheumatic origin. Nettle rash is never a dangerous malady; but care should be taken to avoid currents of air, for, if it recedes, or, as is the common expression, “driven in,” it produces sickness, and other harassing symptoms.

We have always found, in such cases as these—and, indeed, at most times—that simple remedies, easily accessible, are the most efficacious.

CONSUMPTION.

The persons most prone to consumption, are those of a sanguine or phlegmatic temperament, with long neck, sharp shoulders, narrow chest, slender fingers, clear skin, fair hair, and rosy complexion. The disease usually begins with a short dry cough, followed, after a certain length of time by a gradual loss of strength, lassitude, and great fatigue upon small exertions; the pulse is quick and small, while the cough, at first confined to the day, begins to extend into and through the night; the breathing is hurried, with a sense of tightness at the chest, accompanied with shooting pains; the expectoration at first frothy, becomes viscid, opaque, often tinged with blood; and very copious in the morning. As the disease advances, emaciation takes place, the cough, pain, and difficulty of breathing increase, the face is flushed, the soles of the feet and palms of the hands are affected with a dry burning heat, the tongue, formerly white, now becomes clean and red, the pulse is smaller and quicker, and hectic fever sets in, attended with profuse perspiration; generally occurring twice a day, and, as the symptoms grow more formidable, the appetite usually increases, filling the patient with delusive hopes of recovery. The final symptoms, and those that indicate approaching dissolution, are the setting in of diarrhœa, night sweats, prominent cheek bones, hollow and cadaverous countenance, swollen legs, great emaciation, and curved finger-nails. The expectoration has at the same time altered its character with each stage of the disease; at first scanty and frothy, it becomes opaque and presents a mixture of mucus and pus, occasionally streaked with blood, and finally becomes all purulent, sinking in water, and often combined with irregular pieces of green or yellow substances.

_Treatment._—There are three objects to be aimed at in the treatment of consumption; first, to promote the absorption of the diseased matter; second, to subdue inflammation; and, third, to improve the general health. For the first effect, it is the general practice to slightly salivate the system by small doses of calomel and kino, followed by a course of iodine, either in the form of burnt sponge, hydriodate of potass, or tincture of iodine. Inflammation is subdued by small bleedings, two or three times repeated, leeches on the chest, blisters, or the counter-irritation of the tartar emetic ointment. The general health is to be improved by exercise, cold ablutions, and friction every morning, by a light and generous diet, and tonics with the mineral acids. In confirmed consumption, and where all the worst symptoms are in operation, the treatment must depend greatly on the actual state of the patient, though the most ordinary course is comprised in the following means and remedies: counter-irritation over the chest, by the tartar emetic ointment; an opiate at bed-time; and two table-spoonfuls of such a mixture as the following, every four or six hours.

Take of

Tartar Emetic 20 grains.
Infusion of Gentian 6 ounces.
Powdered Nitre ½ drachm.

Mix. Where the sweatings are excessive, or there is spitting
of blood with the cough, from fifteen to thirty drops of the
elixir of vitriol in a wine-glass of water, is to be sucked
through a quill every three or four hours.

No practice is so fatal as the sending a confirmed consumptive patient to a warm climate, or even to remove him to a warmer residence in his own country, as the increased temperature only developes the worst symptoms more rapidly. To a patient only _predisposed_ to consumption, change of scene and climate is highly beneficial; but with the disease on him, it is suicidal. The modern practice of deluging the stomach with rancid fish oil, is a very questionable procedure, as any good that can result from its use must depend upon the amount of iodine or nitrogen the cod liver oil may possess; remedies that can be given in greater quantities, in a much less objectionable way.

In every stage of consumption, but especially in the early part of the disease, the patient should exercise the lungs as much as possible, by drawing deep inspirations of air, and inflating the organ to its fullest extent, and then slowly expiring what he has imbibed, repeating the process for ten minutes at a time, and resuming it four or five times a day. For this purpose he can either stand at a window, on a hill, or wherever the air is pure; when the atmosphere is damp, the air must be drawn through a veil, folded three or four times. This makes an infinitely better respirator than the metallic ones sold in the shops. As the natural stimulant of the lungs is air, no means are so likely to excite absorption of the tuberculous matter, as that which expands every air cell of its structure, and while healthily exercising the organ, stimulates it to increased action. That consumption is curable, is a theory now rapidly gaining ground; but this can only be effected by converting the acute into a chronic disease, and in that form following the admonitions of nature as a guide to the practice; and the most important of these is exercising the lungs themselves.

SCROFULA.

A peculiar condition of the body, in which the healthy vital energy is in a measure in abeyance, where the system is less strong, the body less perfect, the organization less harmonious, and the living power to resist accidents less perfect and capable of resisting those influences of time, air, contagion, and accident, ever at war on the frame of man, and which robust health may rebut and for a time defy, but before which the less perfect organization of scrofula ultimately succumbs. It is to this unnatural weakness of the constitution that we owe many of those diseases and ills that like a scourge afflict mortality; such as consumption, mesenteric disease of the bowels in children, rickets, goître, cretinism, hare-lip, white swellings, and many other local and constitutional maladies; all deriving their origin from this physical and specific weakness of the whole or a part of the human body. Any chronic swelling of the absorbent glands is denominated scrofula, as shown both by the wen in the throat and the white, shiny, and insidious swellings in the knee; yet neither of them is, correctly speaking, scrofula, but merely the local evidence of something we feel and know, but cannot define in the system, couched in the blood, reflected in the want of general nervous energy, and manifesting itself in some local character, to which science gives a name and unprofessional wisdom assigns the disease. The chief characters by which a scrofulous diathesis is known or may be suspected, are a want of perfect bodily symmetry, small, thin, or crooked limbs, a round or pigeon-breast, excessive enlargement of certain organs, broad jaws, low forehead, long neck, and large occiput, great transparency of the skin, with a rosy tint of the cheeks; when the complexion is dark, it is of a dirty, viscid appearance, when fair, unnaturally clear; a bluish ring round the eyes, which though large, clear, and sometimes black, are more generally light blue, with swollen or puffed eyelids, long lashes, upper lips thick and projecting, and the general expression of the countenance voluptuous case, with want of decision and energy; the first teeth are small, subject to decay, and the second white, liable to split, and often become prematurely decayed.

COUGH.

A cough is an effort of nature to relieve the lungs and air passages from any obstruction of mucus, phlegm, pus, or other sources of irritation in the parts. There are, consequently, many varieties of cough, according to the nature and situation of the disease or affection that excites it: as the cough in consumption, that from bronchitis, the stomach cough of children, hooping-cough, &c., beside which there is the common cough of an ordinary cold, which this article especially refers to. The ordinary cough is, in the first instance, generally hard and dry, becoming, after a day or two, more relaxed and attended with free expectoration, which, after passing through some changes of character, as regards quantity, colour, and substance, usually cures itself. When the febrile symptoms that attend a cold and cough are too slight to demand treatment, the best cough mixture that can be taken is one composed of equal parts of the syrup of squills, syrup of tolu, paregoric, and ipecacuanha wine, of which a dessert-spoonful may be given every four hours. When the cough is attended with great difficulty and tightness, a “warming plaster” should be applied to the chest, and the following expectorant mixture, employed to promote relaxation of the parts:—

Take of

Milk of Ammoniacum 6 ounces.
Dover’s Powder ½ drachm.

Mix in a mortar, and add

Oxymel of Squills 1 ounce.
Spirits of Sweet Nitre ½ ounce.
Syrup of Tolu 1 ounce.

Mix. One table-spoonful to be given three times a day, and two
on going to bed.

ASTHMA.

Is a functional affection of the respiratory organs, frequently depending on constitutional causes, and seldom the result of organic disease. Asthma generally attacks persons of advanced years, and of a weak and lax system; it is, when not hereditary, often the result of sudden changes of temperature, disorder of the digestive organs, or of mental anxiety. An attack of asthma is usually indicated by a sense of constriction or tightness round the chest, a fulness of the stomach, lassitude, drowsiness, and headache. All these symptoms become more urgent towards evening, accompanied with laborious breathing and difficult expiration, attended at the same time with a wheezing noise in the chest and windpipe at every inspiration. As night approaches a hard dry cough succeeds to these symptoms, while the oppressed breathing and sense of suffocation become so acute, as the paroxysm reaches its climax, that the patient is compelled to spring up in bed, or rush to the open window, from fear of instant suffocation. Asthma generally attacks the patient in the night, and most frequently the severity of the fit endures for three or four hours, usually terminating about two in the morning, when, after a free expectoration of frothy mucus, the symptoms gradually subside, and the patient, after much anxiety and suffering, falls asleep. A succession of such paroxysms occur for several consecutive nights, before the symptoms give way and allow the exhausted patient time to recover his strength and tone.

_Treatment._—The first endeavour must be directed to shorten the fit and to relieve the most distressing symptoms: the next, to remove the exciting and predisposing causes. Where the patient is strong and not far advanced in life, an emetic, composed of ten grains of ipecacuanha and one grain of tartar emetic, mixed in a cup of warm water, should be given in the first stage of the attack; followed up for some hours by nauseating doses of antimony and squills, as in the following mixture:—Antimonial wine, one ounce; water, four ounces and a half; tincture of squills, three drachms. Mix; and take a table-spoonful every hour so long as the urgency of the symptoms continues. When the attack is slight, and devoid of the marked features of a paroxysm, and the difficulty of breathing and sense of tightness in the chest are the chief symptoms, much benefit will be derived from taking from five to ten drops of hydrocyanic acid in a table-spoonful of water every two hours, for three or four times.

The asthma of old age, however, must be treated very differently: here, instead of debilitating, it becomes necessary to support and stimulate the patient under the exhaustion of the paroxysms. For this purpose, warmth should be early applied to the body and extremities, by the hot bath or bottles of hot water. The chest and pit of the stomach should be rubbed for a few minutes with hartshorn and oil; hot coffee, or small doses of brandy-and-water, administered occasionally; and the following mixture, according to the age and sex, given in doses of one or two table-spoonfuls every two or four hours, as the state of the patient may demand:—Carbonate of ammonia, one scruple; Dover’s powder, half a drachm; peppermint water, six ounces; mix, and add tincture of squills, spirits of lavender, and sulphuric ether, of each one drachm. When asthma has been induced by a derangement of the digestive organs, it will be necessary to give a dose of castor oil or an alterative pill; while for the shortness of breath and difficulty of breathing that often precedes and follows the full paroxysm, a poultice, composed of equal parts of mustard and flour, and applied warm to the chest for ten or fifteen minutes, will yield considerable relief. As an aperient, two compound assafœtida pills will be found of the utmost benefit, especially to those advanced in life.

BRONCHITIS.

Is now much milder in its attacks, and seldomer met with than formerly, though it still remains a disease of both severity and danger. _Acute bronchitis_ is characterised by general fever, heat of the skin, difficulty of breathing, with hurried and sometimes laborious respiration; a peculiar sense of fulness and roughness of the windpipe, followed by hoarseness, oppression, or pain over the region of the heart, accompanied by a short dry cough. After from six to twelve hours, a secretion of mucus takes place in the trachea and bronchial tubes, producing a wheezing rattling noise as the patient respires; and in consequence of the blood not being freely exposed to oxygen in its passage through the lungs, the lips and cheeks assume an ashy or dusky hue. The pulse at the first is quick and hard, but after a time, becomes full and what is called, soft; but so compressible, that a little extra pressure of the finger will apparently extinguish it. There is at the same time great prostration of strength, considerable anxiety and alarm, with pain in the head, giddiness, and when the symptoms are severe, even delirium.

Bronchitis arises in general from exposure to cold and humid atmosphere; taking cold after violent exertion, or from any of the ordinary causes of cold or sore throat. The hoarseness and dry full sense, experienced in the nose and windpipe, is often felt extending far down the chest, attended with considerable sneezing; and the efforts of a dry hard cough, causing pain both in the chest and shoulders.

_Chronic Bronchitis_, when arising as a primary disease, presents some or all of the previous symptoms, but in a considerably modified form; the fulness in the windpipe, oppressed and laborious breathing, hoarseness and cough, are, however, the most general symptoms of chronic bronchitis; the expectoration, though after a time becoming more free, is far from being copious, and consists of a discoloured mucus; sometimes of a purulent appearance, at others stained with blood, or streaked with a brick-coloured fibrinous matter. The symptoms are generally exaggerated towards night, when they are attended with increased fever and night sweats.

_Treatment of Acute Bronchitis._—In full-bodied constitutions, if the disease be taken in its first stage, bleeding to the extent of eight or ten ounces may be very safely and beneficially employed; but as the debility that attends bronchitis is both great and sudden, unless adopted in the _earliest_ stage, the practice would be highly culpable, as all the physical stamina is required to throw off the collected mucus from the bronchial passages so bleeding; therefore, unless employed early, it can never properly be practised. When necessary, an emetic must be immediately given, consisting of antimonial and ipecacuanha wines, of each half an ounce, or the following powder:—Ipecacuanha 15 grains, tartar emetic 1 grain, mix; to be dissolved in a little warm water and drunk directly, following it up by frequent draughts of warm water. If the first emetic does not operate freely, repeat the same dose within the hour, assisting the action, if necessary, by tickling the throat with a feather. As soon as the vomiting has subsided, apply a blister three inches wide by six inches long, down the centre of the chest, and give a table-spoonful of the mixture below every two hours.

Take of

Distilled Water 6 ounces.
Tartar Emetic 6 grains.
Powdered Nitre 1 scruple.

Dissolve, and add tincture of colomba, 2 drachms—mix. At the
same time, between the doses, let the patient inhale the steam
of hot vinegar and water, and wear a veil over the face, so as
always to breathe through a medium. When the blister has risen
and the plaster has been removed, apply a hot bread poultice,
which repeat every hour, for two or three times; and finally,
dress with violet powder.

When the expectoration changes its character and becomes thick, greenish and ropy, it will be necessary to give stimulating expectorants, to facilitate the discharge; for that purpose, the annexed mixture, in doses of a table-spoonful every three or four hours, is to be employed.

_Expectorant Mixture._

Gum Ammoniacum 2 drachms.
Carbonate of Ammonia 1 drachm.

Rub into a powder, then add a tea-spoonful of water; triturate
till the whole is rubbed into a smooth creamy paste, when add,
by degrees, six ounces of water.

Syrup of Squills 1 ounce.
Tincture of Tolu 2 drachms.
Spirits of Sweet Nitre 2 drachms.
Paregoric ½ ounce.

Should there be much restlessness or want of sleep, 30 drops of laudanum may be taken at bed-time in a little gruel, or added to a dose of the expectorant mixture. Or when the mixture is not necessary, from 10 to 15 grains of Dover’s powder, according to the age and strength of the patient, should be taken an hour before bed-time. It is also necessary to take an occasional aperient, which should consist of two assafœtida pills at night, and a black draught the following morning; or five grains of blue pill, and a dose of Epsom salts, three hours afterwards. The patient should be kept as much as possible in one temperature during the attack; and all lengthened conversation and fatigue strictly avoided. The diet should be light, low, and farinaceous, and consist of eggs, milk, custards, and sago, and tapioca puddings; and only when the expectorant or stimulating stage has been reached, should the drink be anything stronger than gruel. But when the expectorants are indicated, it becomes necessary to give wine, or other stimulants, and support the patient’s strength by a more generous diet.

_Treatment of Chronic Bronchitis._—Where the symptoms are severe, the treatment may begin by placing a blister on the throat, and giving the expectorant mixture already prescribed. But in ordinary cases, it will be sufficient to place a large hot bran poultice on the throat and chest, renewing it every three or four hours; and twice a day rubbing the chest and throat with the following embrocation:—

Dissolve, by heat, two drachms of camphor in two ounces of olive oil, and add spirits of sal volatile half an ounce, and at the same time give the expectorant mixture in table-spoonfuls every two hours.

Where there is much loss of rest, and much anxiety, the annexed mixture to be substituted for the expectorant, and taken in doses of two table-spoonfuls every four hours.

Dover’s Powder 1 drachm.
Carbonate of Ammonia 2 scruples.
Camphor Water 8 ounces.
Sulphuric Ether 1 drachm.

At the same time, the steam of hot vinegar and water is to be inhaled, and the patient’s strength supported by a proper and efficient dietary; with all the precautions advised in acute, observed in the management of chronic bronchitis.

INFLUENZA.

A disease which, though unquestionably common to this country from remote time, has only within the last thirty years obtained a distinctive name and character. What the peculiar state of the atmosphere is, that induces or predisposes to this disease, science has not yet discovered, though the external causes, as far as appreciation enables us to form an opinion, appear to be, a long-continued state of humidity, succeeded by sudden heats, or seasons of alternate hot and wet weather, or a long humid autumn followed by a cold and boisterous winter. In these conditions of the climate the disease often becomes epidemic and puts on a protean shape, and, though twenty persons in the same tenement are attacked with it, not two perhaps present the same chain of symptoms, or have been seized in the same way. The first sign of illness in one is a sudden coma, that deprives the patient for some minutes of all consciousness; another falls in a fit, a third is seized with an intense pain on the top of the head, others by fits of sudden heat or cold, by coughing, or pains in the back, chest, or throat; but however varied the commencement may be, or different the general run of symptoms, there are three signs that, taken together, always characterize influenza, and by which it may in every case be at once identified; these are—severe and splitting pain on the top of the head, great and sudden loss of strength, and a rough excoriated sensation in the chest behind the breast-bone, as if the lining membrane in that part was raw.

When influenza comes on gradually, the disease generally puts on the following succession of SYMPTOMS: a sense of cold, lassitude, weariness, cold chills, pains in the back, head, and loins; these symptoms are followed by flushings, weight on the head and a great oppression on the chest, sneezing, the eyes become bloodshot, a thin acrid discharge from the nostrils occurs, with inflamed fauces and throat, followed by a short cough with a thick viscid expectoration, which soon becomes thin, discoloured mucus, mixed with purulent discharge. With these symptoms there is extreme prostration of strength, loss of energy, and great depression of spirits, the pain on the head continuing with unabated violence. The pulse, which at the beginning was quick and small, becomes, as the disease progresses, sharp, weak, and irregular. From the first the appetite has failed, the tongue furred, and the stomach in a state of nausea and often irritated to vomiting. The discrepancy in the state of the pulse in influenza generally renders it an insecure guide to a knowledge of the heart’s action by the number or the frequency of the beats; the only true test of the vital strength of the patient is, the amount of pressure by the finger the pulse will bear. Influenza, if not speedily cured, is very prone to degenerate into bronchitis, pneumonia, pleurisy, or some chronic thickening of the mucous membrane of the throat, or enlarged tonsils.

_Treatment._—The foremost point to be remembered in the treatment of this disease is, that the great debility is _real_, not a prostration dependent on nervous pressure, but a _bonâ fide_ loss of vital power; consequently, bleeding, strong relaxing medicines, or blisters, are, except in very rare cases, highly injurious, and more likely to kill than cure the patient; the treatment therefore required is more a course of judicious dietary than one of physic. The medicinal means must consist of the following mixture and pills, keeping the feet hot by hot bricks, or bottles of water, and a hot bran poultice applied frequently to the neck and chest.

Take of

Powder of Compound Tragacanth 2 drachms.
Hot Water ½ pint.
Lump Sugar 2 drachms.

Mix in a mortar, adding the water slowly till a smooth thin
mucilage is made of the whole; then add—

Tincture of Tolu 1 drachm.
Ipecacuanha Wine ½ oz.
Spirit of Nitre 6 drachms.

Shake well together, and lastly, add solution of acetate of
ammonia, 1½ ounce. Mix, and make a 12 ounce mixture: of which
let the patient take two large table-spoonfuls every four
hours.

Take of

Compound Rhubarb Pill ½ drachm.
Extract of Henbane ½ drachm.

Mix, and divide into 12 pills, two to be taken at bed-time
every other day.

To support the strength, the food must be of the lightest and most nutritious kind, such as boiled mutton, custards, and sago puddings; and as frequent stimulants are indispensable, claret glasses of warm egg-flip, either made in the usual way with the addition of a little rum or brandy, or egg-sherry must be given, with toast, every two hours. By these means, and the addition of twenty drops of laudanum, at bed-time, to a dose of the mixture, all ordinary cases of influenza may be safely and expeditiously treated to recovery.

BILIOUS COMPLAINTS.

Persons are said to be bilious, when bile finds its way from the small intestines into the stomach, and there, mixing with the digesting food and irritating the coats of the stomach, becomes absorbed into the blood, on which it acts like, a species of poison, producing a constitutional disturbance of more or less severity. The symptoms that prognosticate this kind of malady are intense pains in the head, weight and tenderness of the stomach, nausea and sickness, fœtid breath, a bitter or coppery taste in the mouth and throat, a coated tongue, and a quick sharp pulse. The skin is dry, there is considerable thirst, and also occasional shiverings.

_Treatment._—The effect of bile on the stomach should be considered in the light of a chain of symptoms excited by the presence of some foreign or unhealthy substance; and the rational view of the treatment of such symptoms consists in expelling the intruding mischief as quickly as possible; and, as it is always better to make the bile take its natural course of exit—downwards—than urge it out of the system in an opposite direction, the treatment should commence by taking such aperients as will excite the whole alimentary canal, and carry it out of the stomach through the bowels: at the same time avoiding by every means its expulsion by vomiting. To carry off the bile by aperients, and allay the sickness, is in fact, all that has to be done, for when these objects are achieved, every other symptom will, as a natural consequence, subside. As the nausea and headache are the most urgent and distressing symptoms, they are the first to demand relief. A small blister, the size of the round of a wine-glass, should be laid on the pit of the stomach, and a dose of the subjoined effervescing mixture given every half hour; taking advantage of the first lull in the retching to give two of the aperient pills, which are to be repeated every six hours, till their action on the bowels shows that the object for which they were taken has been obtained. For females and persons of delicate constitution, one pill instead of two should be taken as a dose. If the patient is in bed, bottles of hot water should be kept at the feet; and as an after-corrective, the tonic mixture prescribed below, is to be taken twice a day for about a week; at the same time the convalescence will be facilitated, and the tone of the stomach improved, if a little toasted bacon is eaten for breakfast, and a dry biscuit and a glass of stout taken for lunch.

JAUNDICE.

Is the name given to the effect produced on certain parts and secretions of the system by a diseased state of the liver, or whatever cause prevents the bile from finding its natural outlet; and by confining it to the gall-bladder, or the secreting vessels of the liver, causes it to be absorbed into the blood, and, passing into the circulation, gives rise to those symptoms, which constitute what is called jaundice. The word “jaundice” signifies _yellow_, and is used to designate that impaired state of the liver known by the external signs of a yellow skin, a yellow tinge of the white coat of the eye, and a deep saffron colour imparted to the secretion from the kidneys, while the other alimentary discharges are almost white; these characteristics of jaundice are attended with languor, loss of appetite, sometimes amounting to a loathing of food, disturbed sleep, great avidity both of stomach and bowels, nausea, and often sickness; a heavy bitter taste, that no cleanliness can eradicate, pervades the mouth and fauces, while a dull heavy pain takes possession of the right side, just over the liver, greatly increased by pressure, but which no change of position abates. Attending these symptoms there is always more or less of what is understood as fever: when the disease is protracted, and the bile remains long unremoved from the blood, the skin and eyes darken in their colour, and assume a _green_ aspect, and when still more obstinate of cure, that green becomes of a deep purple or blackish hue, when the disease is called black jaundice.

Jaundice is a very common disease in hot climates, especially to Europeans newly arrived, and, indeed, is by no means rare in this country and the sister island; and though, as we have already said, it may proceed from any diseased condition of the liver, there are many other causes that may induce it, such as pressure on the liver by the formation of tumours, pregnancy, and the presence of gall-stones, though in this latter case the cause is generally easily discovered by the severity, sharpness, and continuance of the pain. Though the remedies employed for jaundice are under all circumstances nearly alike, it is both satisfactory and useful to discover as early as possible what is the immediate cause that, obstructing the bile, has led to its absorption by the blood; as on this knowledge much time may be saved in the treatment, which is remarkably simple, and may be undertaken with the greatest confidence without consulting any medical opinion. In all cases of jaundice, especially when attended with pain, the warm bath is of the utmost importance, as it will afford instant relief; and if the pain and disease proceeds from a gall-stone, the heat of the bath, by expanding the duct in which it is impacted, will almost immediately facilitate its passage, and thus by removing the obstruction, at once remove the cause of the disease.

As remedial means, the adult patient should take one of the following pills three times a day, or one every eight hours, and every second morning two tea-spoonfuls of Epsom salts dissolved in a tumblerful of cold water, with a wine-glassful of dandelion-tea every four or five hours, and continued as long as it is necessary to take the pills.

_Pills._

Take of

Camphor 2 grains.
Powdered Opium 2 grains.
Blue Pill 20 grains.

Mix and divide into six pills.

Take of

Dandelion Roots, washed and cut small 2 ounces.
Liquorice Root and Sassafras, of each 2 drachms.
Boiling Water 1½ pint.

Simmer slowly for twenty minutes; strain, and, when cold, give
a wine-glassful every four or five hours.

When the obstruction has been removed, and the cure has been effected—as the restoration of the skin and eyes to their natural colour will indicate—it is sometimes necessary to take a tonic for a few days, to restore the tone of the stomach; this will be best effected by taking a table-spoonful of the following mixture an hour before each meal for four or five days:—Infuse 2 drachms of gentian, 2 drachms of carbonate of soda, and 1 drachm of ginger for six hours in a pint of boiling water; and, when cold, giving it in the above doses. To those subject to jaundice, exercise and sea bathing should be vigorously adopted after each recovery, so as to work the system into an energetic and self-supporting condition; for if not excited out of its torpidity, the body is very prone to relapse into its previous torpidity.

BOWEL COMPLAINTS.

These ailments are in all cases symptoms of the effect of other causes, and never occur spontaneously, but are the result of indigestive food or excessive acidity of the stomach, the presence of a large quantity of bile in the small intestines, acrid and misacting medicines, wet feet or exposure to cold; the result of disease in the mucous or muscular coats of the bowels, exposure to miasmata or infectious air, and the inhalation of noxious gases.

1. _Bowel Complaint, attended with Sickness and Vomiting._

The vomiting should be first allayed by small effervescing
draughts, or wine-glasses of soda-water, with a tea-spoonful
of brandy, given every half hour, and a blister the size of
a crown piece laid on the pit of the stomach: while for the
relief of the bowels the following mixture is to be given in
doses of two table-spoonfuls every hour till the relaxation is
checked.

Prepared Chalk 1 ounce.
Aromatic Powder 2 drachms.
Sugar 1 drachm.
Peppermint Water 8 ounces.

Mix well in a mortar, and add

Tincture of Kino 3 drachms.

When the bowel complaint is attended with pain or griping in
the stomach, 1 drachm of the TINCTURE OF ASSAFŒTIDA, and 40
drops of LAUDANUM are to be further added to the mixture, which
is still to be taken in the same quantity, and, if necessary,
repeated as frequently.

2. _Bowel Complaint, the result of Improper or Undigested Food._

Prepared Chalk 1 ounce.
Carbonate of Magnesia 2 drachms.
Carbonate of Soda 1 drachm.
Carbonate of Ammonia 2 scruples.
Camphor Water 8 ounces.

Mix well in a mortar, and add

Tincture of Kino 2 drachms.

Mix and take two table-spoonfuls directly, and one every hour
afterwards.

3. _Bowel Complaint from Exposure to Cold or Wet._

Infusion of Red Roses 8 ounces.
Epsom Salts ½ ounce.

Dissolve, and add

Diluted Sulphuric Acid 30 drops.

Mix, and take two table-spoonfuls every three hours, and one of
the following pills every four hours. Should the skin be dry
and hot, give ten grains of Dover’s powder, at bed-time, in a
little gruel.

Compound Rhubarb Pill,
Extract of Henbane,

of each one scruple. Mix, and divide into eight pills.

4. _Bowel Complaint, attended with Cramps and Spasms._

Apply hot mustard poultices, made with equal parts of mustard
and flour, over the bowels, and to the inside of each thigh,
and give the following mixture and pills every hour till relief
is afforded.

Prepared Chalk 1 ounce.
Aromatic Powder 2 drachms.
Carbonate of Ammonia 1 drachm.
Mint Water 8 ounces.

Mix well, and add

Tincture of Kino 3 drachms.
Sulphuric Ether 1 drachm.

Mix; two table-spoonfuls with one pill every hour.

Camphor 6 grains.
Powdered Opium 4 grains.
Calomel 9 grains.
Extract of Hemlock, enough to make into a mass,
which is to be divided into six pills.

5. _For the Bowel Complaints of Young Children_, the most
efficacious and convenient remedy is the tincture of kino,
given in doses of 20 to 60 drops, in a little sugar and water,
and repeated every hour or two till the relaxation is stopped.
When the bowels are disordered from teething, it is best to
give an alterative powder every four hours, for two or three
times, such as the following for an infant of nine months,
increasing the strength according to the age.

Grey Powder 6 grains.
Rhubarb 2 grains.
Scammony 9 grains.

Mix well, and divide into three powders.

When the relaxation has been stopped, it is always advisable to take an aperient pill, in a day or two after, to restore the bowels to a healthy condition. In many simple cases of bowel complaint, a dose of castor oil is the only remedy required, and where resulting from improper food, by its aperient action it both removes the cause and the effect with it. The bowel complaint, or diarrhœa, that occurs as a critical symptom in fever, is on no account to be hastily or injudiciously checked; but when calling for treatment, the mixture No. 4 is the most advisable one to employ for that purpose.

FLATULENCE.

Unless in exceptional cases, such as from ill-cooked food, an excess of vegetable diet, &c., flatulence is always an indication of impaired functional action of the stomach, either proceeding from a disease of that organ or through sympathy with some other part; but by far the greater number of those who suffer from flatulence owe it to a weakened state of the stomach itself, often hereditary, frequently the result of an erroneous dietary, and sometimes from the injudicious habit of over-stimulating; besides these cases, it frequently proceeds from mental anxiety, imperfect mastication of the food, and a close sedentary habit.

Flatulence is often completely cured by strict attention to dietetic rules, such as avoiding for a time all vegetables and fruits, making the breakfast and tea on hard crusts, biscuits, or dry toast, and _chewing_ these for a considerable time before _permitting_ the food to pass into the _stomach_; at the same time taking as small a quantity of fluid in the way of tea, coffee, or cocoa, as possible, and only sufficient to facilitate the descent of the solid food; meat and bread for dinner, with a sparing draught of cold gin and water, should constitute the meal. The tea should be a repetition of the breakfast, and a supper of biscuit and cheese with a small tumbler of cold spirits and water, the same as that for dinner; a system like this, with exercise, repose on a sofa for half an hour after each meal, and using the _flesh-brush_ night and morning _over the chest and shoulders_, and especially across the stomach, so as to excite the organ to increased action, will be found to yield the fullest advantage, and in many cases will supersede the necessity of any medicine whatever. When, however, there is much acidity in the stomach, it should be neutralized by a tea-spoonful of magnesia, or half a drachm of carbonate of soda, a short time before any one of the meals, and, when the bowels require it, a compound assafœtida pill at bed-time; the same regimen as to diet being persevered in, as that above. Where the stomach has become seriously enfeebled by a long-continued state of flatulence, it will be necessary, in addition to either of the former plans, to give the organ tone and strength, by employing one or other of the subjoined pills, adopting them in the order in which they stand.

Take of

Sulphate of Zinc 10 grains—powder.
Rhubarb, Powdered 20 grains.
Extract of Gentian, sufficient to make a mass, which
divide into thirty pills, one to be taken three
times a day.

Take of

Nitrate of Silver (Lunar Caustic) 3 grains—powder.
Quinine 4 grains.
Ginger 6 grains.

Mix well, and add extract of camomile sufficient to make a
mass, which divide into twenty-four pills, one to be taken
three times a day. When flatulence is attended with a sense of
coldness in the stomach, a tea-spoonful of Gregory’s powder,
with ten grains of soda, may be taken in a little aromatic
water before breakfast each morning.

DYSPEPSIA,

Or indigestion, is that impaired condition of the stomach when the food is only half or imperfectly digested; producing want of appetite, a sense of distension, debility, headache, languor, want of sleep, and all those constitutional symptoms that usually attend an overtaxed and weakened stomach.

_Treatment._—To effect a perfect restoration in the tone of the stomach, an entire change in the mode of diet is absolutely necessary, also in the habits and pursuits of the patient: the stomach must first be emptied and slightly stimulated by an emetic, or by a few alterative doses of blue pill and rhubarb, and the system submitted to a regular course of such tonics as infusion of camomile with carbonate of soda, gentian with potass, and, after a time, infusion of quassia with a few drops of muriatic acid. The food should be at first light and simple, and comprise the most solid aliments, and such as will compel a long mastication before swallowing; all drinks or stimulants with the meal being strictly prohibited till the salivary glands yield of themselves enough saliva to macerate the food; and this can only be effected by a long and perfect mastication.

DYSENTERY.

This is a disease more common in hot climates than cold ones, and both in its type and character approaches much more nearly than any other disease, to cholera. Dysentery is either the result of a congestive state of the bowels, or it proceeds from a chronic inflammation of the lining membrane of the colon.

_Symptoms._—Dysentery commences with shivering, a griping flatulent state of the bowels, frequent discharges of mucus, or blood and mucus, and often blood alone; with loss of appetite, sickness, fever, and great debility.

_Treatment._—When depending on inflammatory action, it is necessary to bleed and give cooling drinks with an emetic. In ordinary cases, the treatment should begin with the warm bath or fomentations, with three grains of calomel, one grain of opium, and three grains of assafœtida pill; the whole made and divided into two pills, which are to be taken every six hours, and a starch injection with assafœtida tincture twice a day. As the symptoms improve, tonics are to be given, at first mild, and gradually increased in strength, and combined with wine and a soft unexciting diet.

DIARRHŒA.

A relaxation or looseness of the bowels, consequent upon a certain condition of the mucous membrane of the alimentary canal; that is, either a state of congestion, or stagnant state of the blood in the membrane; or else from an inflammatory condition of the same tissue; or it may proceed from ulceration of the bowels, the presence of indigestible food, or acrid substances in the stomach; it may also occur as a crisis of fever, and without any direct cause of irritation. The causes that produce diarrhœa are very numerous, and often of the most opposite nature; though the chief are, sudden cold applied to the body, checked perspiration, powerful stimulants, the inhalation of noxious gases, &c.

_Symptoms._—Nausea, sickness, and vomiting, thirst, dry state of the mouth and skin, frequent and copious evacuations, and a furred or red condition of the tongue.

_Treatment._—The first step in the treatment of diarrhœa is to check the vomiting; to effect this, the feet are to be plunged into hot water and kept constantly warm, and a small blister or one or two leeches applied to the pit of the stomach. The state of the tongue must decide the nature of the subsequent treatment. When this organ is coated either with a white or brownish fur, it indicates a congested state of the membrane of the stomach, and must be treated by the exhibition of an emulsive mixture of chalk, and when the symptoms are attended with pain, by an opiate pill, as in the following prescription.

Prepared Chalk 1 ounce.
Honey ½ ounce.
Peppermint Water 6 ounces.

Mix into a smooth mass, of which give a table-spoonful every
hour, and a one-grain powdered opium pill every four or six
hours, till the pain is subdued. When, however, the tongue is
red both on its surface and sides, it indicates inflammatory
action, and must be treated by an opposite mode of practice,
and the following mixture administered; the opium, however,
being employed when pain is present, in the same form and
frequency as in the former state of the bowels.

Infusion of Rose Leaves 8 ounces.
Epsom Salts ½ ounce.

Dissolve, and add diluted sulphuric acid, half a drachm; mix,
and take a table-spoonful every hour. In all forms of diarrhœa,
the feet should be kept warm, and a hot bath, if procurable,
will, in every instance, be found beneficial. The diet should
always be soft and nutritious, but not liquid; the best dietary
consists of thick arrow-root, made with milk, blanc mange,
tapioca, sago, and semolina puddings, made with eggs, and eaten
moderately cool; and when animal food is given, it should
consist in the first instance of boiled meats, and the stomach
very cautiously brought back to digest roast or hard substances.

CHOLERA.

Although Cholera has, by the interposition of Providence, decreased in virulence, and the cases that occur are comparatively few, it is well to incorporate in our medical directions the circular issued by the Royal College of Physicians relative to the treatment of this fatal disease. In any case of sudden emergency, where medical attendance cannot be immediately procured, these instructions will be of the greatest use.

“1. No degree of looseness of the bowels should be neglected for a single hour. Medical advice should be at once sought when the looseness begins; and, previous to the arrival of a medical attendant, some of the medicines at other times used for checking diarrhœa should be taken:—for example, the chalk mixture; the compound cinnamon powder; or the compound chalk powder with opium, in doses from 20 to 40 grains for an adult.

“2. No saline aperients or drastic purgatives should be taken without the advice of a medical man.

“3. Intemperance in eating or drinking is highly dangerous; but the moderate use of vegetable as well as animal food may be recommended, and, in general, such a plan of diet as each individual has found, by experience, to be most conducive to his health; for any considerable change in the diet to which a person has been accustomed, is seldom advisable during the prevalence of an epidemic.

“4. Debility, exhaustion, and exposure to damp, render the poor especially subject to the violence of the disease. The committee urge upon the rich the necessity of supplying those in need with food, fuel, and clothing.

“5. The extreme importance of removing or counteracting all impurities, whether in the air, water, or soil—as by ventilation, cleanliness, and the free use of the chloride of lime or chloride of zinc—cannot be too strongly insisted upon.

“Lastly, since the reports made to the College of Physicians show that of the persons who were engaged about the sick in the last epidemic, the number of those who were attacked by the disease was, in proportion, exceedingly small, the fear of infection may be practically disregarded.”

Nearly every chemist keeps an “anti-cholera mixture” in a state of preparation, during the cholera season. And as these mixtures are prepared from recipes issued by the Board of Health, or by medical men skilled in the treatment of cholera, they may generally be depended upon. The great thing to be borne in mind is to _take medicines to check looseness of the bowels before the system becomes exhausted_.

FEVER.

Fever is the result of a diseased or impaired action of the system, and though sometimes attending or following certain diseases as a symptom or consequence, most frequently falls on the constitution as a substantive disease, either developing its characteristic symptoms, as the disease advances, or following the slow maturity of a chain of morbid actions. Fevers may, in the first instance, be divided into those which proceed from some indirect or secondary cause, and those that arise from contagion, or causes the direct precursors of fever, having a definite rise, an understood progress, and a well ascertained termination. In the first named class of fevers, are comprised those febrile symptoms that appear during or after some organic disease, accidents, surgical operations, or other causes of physical suffering.

The second, or spontaneous class, is divided into two chief heads—nervous and inflammatory fevers: under nervous fevers are classed typhus, intermittent, continued, and remittent fevers; and under that of inflammatory fevers, first, all eruptive fevers, as scarlet fever, small-pox; and, secondly, the fevers attending all inflammatory actions of organs or viscera, such as inflammation of the liver and bowels.

The general characteristics of fever are cold chills, lassitude, headache, loss of appetite, thirst and nausea, with a moist furred tongue, or else a tongue dry and coated, pain in the back and loins, succeeded by cold shiverings, which gradually give place to heat, diffusing itself over the body and becoming permanent; ringing in the ears, intolerance of light, and cold extremities; the pulse is either small and quick, or full and hard. Special fevers, and constitutional temperament, very much magnify, or even mitigate these symptoms; still those given are the ordinary characteristics, and sufficient to indicate the presence of fever to the least accustomed eye.

The _treatment_, on the same broad principle, resolves itself into relieving the congested organs, breaking the chain of morbid actions on which fever depends, equalizing the circulation, and lastly, by the adoption of a course of medicinal agents, correcting the vitiated state of the secretions, and restoring the functions to a healthy performance of their several duties. To effect the first it is often found necessary to bleed, or else by leeches, cupping, or blisters, relieve the overloaded organs; the second object is generally effected by an emetic, which in some instances it becomes necessary to repeat. The warm, the hot, or the shower bath, or aspersions of cold vinegar and water, are the means employed to effect an equalization of the circulation, and restore blood and warmth to the surface. The therapeutic means to be employed during the career of a fever, must depend entirely upon the character of the disease to be treated, and will be entered upon more particularly under their several heads.

A remarkable peculiarity belonging to all fevers, is a periodicity of the disease, or a property that all fevers have of arranging their effects into periods of regular sections; as, first, into fits and paroxysms, then into remissions, and finally into critical days. Most fevers have three stages, called the _cold_, _hot_, and _sweating_; in some, these divisions are perfect and distinct, in others, broken and imperfect; these fits following in regular order, comprise a paroxysm, which may return at certain hours or only at irregular periods.

The critical days are regarded as the 3, 5, 7, 9, 11, 14, 17, and 20; and the non-critical days are the intervening ones.

The ages at which persons are most liable to fever, are from 20 to 30, and in the following order, gradually declining from 30 to 40, 40 to 50, and 50 to 60. As respects sex, females are more subject to fever than males, but only in a small degree. All fevers are not infectious, but those that are so are communicated by contact, exposure to the atmosphere surrounding a fever patient, and whatever depresses the mind or weakens the body, predisposes the system to infection. The best preventive against the worst form of fever, is cleanliness, a cheerful disposition, and an active body.

BRAIN FEVER.

Brain Fever is characterized by two distinct epochs or stages—excitement and collapse; and though often distinct and well-defined, it occasionally happens that the one stage is so blended with the other as not to be appreciable, till the graver consequences of the second period evince themselves. The symptoms of the first stage are deep and intense pain in the head, tightness across the forehead, throbbing of the temporal arteries, ringing in the ears, flushed face, bloodshot eyes, and a wild and glistening stare; the pupils are contracted, and particularly sensitive to light, while the ears are impatient and irritable to the sense of noise: violent delirium, want of sleep, convulsive paroxysms, attended with a hot dry skin, hard quick pulse, a white coated tongue, great thirst, nausea and vomiting, and a confined state of the bowels. Sometimes delirium is the first symptom, or the disease may progress to a culminating point in a more insidious manner, often commencing with an apparent attack of biliary vomiting. This formidable disease usually proves fatal in a few days, sometimes in twelve hours.

_The mode of treatment_ resolves itself into blood-letting, purgatives, and cold applications to the head. In bleeding, respect must be had to the _effect_ produced, and not to the _quantity_ abstracted, that is, till the pulse is affected, or fainting takes place; for this purpose, the patient should be bled _standing_, and from a _large_ orifice, in a full stream. About half an hour after the bleeding, and when the patient has rallied from the fainting, cupping is to be employed behind the ears, or the nape of the neck, while half a dozen leeches are applied to each temple. At the same time, bladders of ice are to be applied to the shaved head, occasionally varied by rubbing ether over the scalp briskly, and allowing it to evaporate. As constipation is a marked feature of brain fever, powerful purgatives must be employed from the first indication of the disease; for this purpose, one of the following powders should be given every three hours, and _three_ table-spoonfuls of the accompanying mixture every _four_ hours.

_Powders._

Calomel 30 grains.
Jalap 2 drachms.
Ipecacuanha 6 grains.

Mix and divide into six powders.

_Mixture._

Infusion of Senna 7 ounces.
Epsom Salts 2 ounces.
Syrup of Buckthorn 1 ounce.
Sal Volatile 1 drachm.