Chapter VII (3)

Mix.—If this does not keep up a frequent and vigorous action
on the bowels, in addition, put two drops of croton oil on the
tongue, or wipe the wet cork or stopper of the bottle on the
patient’s lips.

After twelve hours, and between that and two days, the _second stage_, or series of symptoms sets in, the headache and wild delirium cease, and are succeeded by a low indistinct muttering and a state of stupor, from which it is finally impossible to rouse the patient. Hearing and vision become imperfect and difficult, with squinting, double vision, and distended immovable pupil: the spasms have given place to twitching of the muscles, and starting of the tendons: the limbs are cold and powerless, or palsied, the countenance ghastly; a cold sweat breaks out over the body, and the patient dies in a state of profound coma.

_The treatment in this second_ and fatal stage, is necessarily one more of regimen than medicine. If the pulse is hard, a blister may be put on the head; but the great art lies in the judicious application of stimulants, such as ether, ammonia, valerian, beef tea, wine, and opiates.

The following mixture combines most of these agents, and may be employed to promote reaction, accompanied with thickened beef tea, and bottles of hot water to the feet.

Carbonate of Ammonia ½ drachm.
Powdered Opium 3 grains.
Ipecacuanha 3 grains.

Mix in a mortar, and add

Camphor Water 5½ ounces.
Compound Tincture of Cinnamon ½ ounce.
Sulphuric Ether 1 drachm.

Mix. A table-spoonful every two hours.

DELIRIUM.

A symptom of some form of disease, as of madness, inflammation of the substance of the brain, or of its coats, of fevers, erysipelas, disease of the bladder; or it may supervene after concussion or compression of the brain, injuries of the head, the result of surgical operations, or from many vegetable poisons. Delirium, though often the result of an excess of blood in the head, is by no means invariably so, as delirium frequently attends as a reactionary symptom after exhaustion; and from nervous irritation. There are many varieties of this distressing symptom, as the low muttering delirium of typhus fever, and the quick rambling chattering of other forms of cerebral disturbance. Delirium is generally attended with a quick jerking pulse, the face is flushed, the eyes red or bloodshot, with pain in the head, ringing in the ears, great antipathies to places, persons, or things, muscular exertions of the arms, or picking at the bed-clothes, constant and incoherent talk, or low indistinct muttering. The body is often hot and dry, and the feet cold; and in cases of vegetable poisoning, the pupils are generally excessively dilated.

_Treatment._—When delirium is attended with a full quick pulse and pains in the head, it will be necessary to bleed from the arm, apply four or six leeches to each temple, to place a blister on the nape of the neck, and a bag of ice on the head, or else cloths constantly wetted in an evaporating lotion; at the same time mustard poultices should be applied to the legs and feet, one drop of croton oil put on the tongue, followed in an hour by a black draught. The room is to be darkened, and the patient kept perfectly quiet. When delirium proceeds from low fever, and is attended with a small wiry pulse, the case must be met by palliatives, anodynes, and tonics. The feet are to be kept warm, the hair cut, and the head cool, the cupping glasses applied to the nape of the neck, the mental irritation soothed by an opiate, and the system roused by the careful employment of wine and arrow-root, and such other remedies as the concurrent symptoms at the time, and the original character of the disease, may seem to render expedient.

There is one precaution that should be observed in all cases of delirium, especially in the more violent kinds, and that is by moral suasion to obtain a mastery over the patient: this is to be effected by blending firmness with kindness, as nothing can be more injurious than intimidation or the threat of coercion, unless, indeed, that monstrous abuse, the strait waistcoat, an instrument of torment scarcely, if ever, called for.

DELIRIUM TREMENS.

Trembling delirium, or the drunkard’s palsy, is a disease in which the mucous membrane of the stomach and bowels, as well as the lining membranes of the brain, are in a state of chronic inflammation, resulting almost always from intemperate habits and excessive indulgence in ardent spirits. This disease is manifested by a total want of sleep, and a quivering of the lips, hands, and muscles, generally, every attempt at speech or motion increasing the tremor; rambling, and constant chattering; the skin is cold and moist, the pulse small and quick, and the tongue furred in its centre, with red edges, the countenance is anxious, the patient full of suspicion, and oppressed with dreams and frightful images.

_Treatment._—The first step to be taken is to tranquillize the system, which may be effected by giving one grain of opium as a pill every four hours with two table-spoonfuls of the following mixture every one or two hours.

Camphor Water 5½ ounces.
Brandy 2 ounces.
Ether 1 drachm.
Spirits of Sal Volatile 1½ drachm.

Mix. In addition to the mixture and pills, it is sometimes
necessary to give brandy-and-water, wine, or pure spirit. When
the trembling is subdued, and the system tranquillized, the
following mixture is to be given in the same dose and quantity
as the former, but discontinuing the pills.

Infusion of Rose Leaves 8 ounces.
Epsom Salts ½ ounce.
Syrup of Red Poppy 2 drachms.
Diluted Sulphuric Acid 20 drops.
Tincture of Opium 1½ drachms.

Mix.—When there is much congestion of the head, it will be
necessary to apply a few leeches to the temples, but as a
general rule, all depletion is injurious. During the whole
attack, the patient is to be steadily watched, kept quiet, and,
as far as possible, amused and interested.

MADNESS.

Disease of the brain eventuating in loss of reason, assumes many shapes, and has many forms and conditions; though the term madness with some degree of reason is applied to all, abstractedly considered, and, relatively understood, no phrase can be more faulty and objectionable. Insanity, idiocy, cretinism, imbecility, dementia, and melancholia, or melancholy madness, are some, though by no means all, the forms of mental aberration that come under this very comprehensive term. Each of these forms of madness, or loss of judgment and imagination, has a distinctive character of its own, and has either been excited by some other disease; some great commotion of the system, caused by violent excitement of the passions; by direct injury to the head; exposure, uncovered, to the influence of the summer sun, causing a sun stroke; to some diseased condition of the brain, induced by some specific affection of that organ; or an hereditary cause, the consequence of a redundancy or diminution in some of the lobes of the brain, in which case, the disease being born with the patient, there can be no hope of cure or improvement.

_Insanity_, or that madness which—of a temporary character, produced and kept alive by an active disease elsewhere in the body than the brain itself, though that organ occasionally is the primary cause—is a symptomatic form of madness subsiding, in general, when the disease that provoked it is cured.—See INSANITY.

_Idiocy_, being that hopeless state of fatuity, the consequence, as has been said, of a defective development of the brain, and born with the patient, it has been thought unnecessary to refer to it in a more particular manner, the great variety of such cases only filling the mind with painful images.

_Cretinism_ is a special variety of idiocy, indicated by a large head, square visage, wide mouth, thick ears, and goitres; in fact, it is the idiocy peculiar to that form of scrofula whose most marked feature is the _goître_, attacking whole tribes of people in different parts of the world, and who, in addition to a fatuity of mind and an enlarged neck, are noted by a dwarfish stature, seldom exceeding four feet.

_Melancholia_ is that variety of madness depending on some chronic state of disease, whose chief attributes are, a sad and desponding state of mind; a settled melancholy, that only sees despair and sorrow in every purpose of life; and though the imagination may only pursue one line of reasoning, the patient contemplates it as devoid of every ray of hope, and eagerly seeks to terminate his existence before the event he broods upon can overtake him. To such persons an unreasonable dread of poverty is the most frequent form in which the madness shows itself, and from the apprehension of which no relief offers itself to the patient but suicide. Melancholy madness most frequently results from a chronic state of insanity, or, in other words, insanity, if long standing, is in certain constitutions liable to degenerate into melancholia. The _treatment_ of this disease is almost entirely of a moral character, and must consist in frequent change of scene and society, exercise, and lively conversation, any temporary oppression of the head being relieved by a few leeches, and an occasional aperient; at the same time, without seeming to do so, maintaining an unceasing watch over the patient, and while apparently reposing confidence in his honour, never relaxing the vigilance of supervision.

_Hypochondriasis_, or vapours, as it is sometimes called, very often assumes a species of aberration closely resembling melancholy madness; and like the many varieties of what is called _monomania_, or madness on one subject, difficult to determine whether primarily depending on a diseased state of the brain, or of the digestive organs. The treatment in all such cases must conform as near as can be traced to the exciting cause, though in these instances, medicine is generally much less necessary than moral suasion, and the promotion of a healthier action of mind and body, by change of air and invigorating exercise, especially such as rowing, swimming, fencing, climbing hills, horse-riding, and quick walking.

There only remains one other form of madness to be considered, _mania_, properly so called, or raving madness; but as this is a subject so distinct from all the other forms of temporary aberration; is induced by so many and contrary causes; and demands a course of treatment so distinct, that it would be unnecessary to do more than give the general symptoms, and indicate the broad principles on which the treatment is based; all patients so affected, both for their own comfort and to further the chance of their recovery, are treated in establishments specially adapted for the purpose. There are many cases of confirmed madness, where the patient is neither raving nor furious, but in which more or less of the same symptoms are common to that condition: these are, delirium without fever, flushed face, and wild expression of countenance, sharp pains in the head, ringing in the ears, rolling and flashing eyes, grinding of the teeth, loud roarings, and violent muscular exertions, rooted antipathies to objects and places formerly beloved or attached to, insensibility or indifference to heat and cold, hunger, thirst, or watching, and attended throughout by a quick, full, and hard pulse. A remarkable peculiarity with all maniacs is, that periodically, or once a month, or at the full of the moon, all the symptoms are exaggerated, and occasionally a perfect remission of the symptoms, the patient enjoying lucid intervals; from this periodicity they are called lunatics. The _treatment_ consists in carrying out the three following objects, each indication, as it is called, requiring a distinct treatment: first, to gain a perfect command over the maniac; secondly, to divert his mind from the existing train of thought; and thirdly, to diminish the preternatural action of the brain.

INSANITY.

This alarming and dangerous state of the mental faculties, is, fortunately, more frequently the consequence of diseased action elsewhere, or in other words, a symptomatic affection, than the result of an organic or morbid condition of the brain itself. Insanity may arise from any severe constitutional disturbance, or local disease, so long continued as to affect reciprocally the system, hence it is a frequent symptom of all fevers, whether of the nervous or inflammatory type; often supervening upon severe accidents, and very frequently following the shock sustained by the system on the performance of important surgical operations. Insanity may also be idiopathic, or arise without any previous disease, as when the mind has been long kept preternaturally bent on one engrossing subject; or it may proceed from some sudden emotion of the mind, acting on the weakened frame, or from any cause that excites and keeps up a long tension of the reflective powers. It may also arise from organic disease of some part of the brain, or follow from an hereditary taint. Insanity is distinguished from madness, only by the milder character of all the symptoms, and by the subsidence of the incoherency on the suppression of the immediate cause that produced it; whereas, madness is excited by the same causes, and continues for a longer or a shorter time after the subsidence of all the excitement that gave rise to it. The insanity that constitutes what is denominated madness, as a special disease, we shall not refer to in this work, confining ourselves merely to that state which attends or follows ordinary disease.

_Symptoms._—Insanity appears in many forms, seldom showing twice alike; but, as a general rule, its characteristics are in the following order: severe pains in the head; noise in the ears; redness of the face; peculiar wildness of the countenance; rolling and glistening of the eyes; grinding of the teeth; loud roarings; violent exertions of strength; incoherent discourse; unaccountable antipathy to certain persons, particularly to their nearest relatives and friends; a dislike to such places and scenes as formerly afforded particular pleasure; a diminution of the irritability of the body with respect to the morbid effects of cold, hunger, and watching: together with a full strong pulse.

_Causes._—Hereditary predisposition; sanguineous temperament; violent emotions of the mind; immoderate indulgence in any passion; violent exercise; frequent intoxication; sedentary life; abtruse study; parturition or lactation; tumours compressing the brain; preceding attacks of epilepsy, fever, &c.

_Treatment._—Before proceeding to the mode of treatment, the following objects are to be strictly borne in mind:—1. To gain a perfect command over the maniac. 2. To divert the patient’s mind from the existing train of thought. 3. To diminish the preternatural action of the brain. To effect these results, the following remedies must be had recourse to:—1. By bleeding, if of a plethoric habit, and the attack recent. 2. Purgatives; both the drastic and cooling aperiatives have been recommended—perhaps the former are preferable; hellebore, senna, and jalap. 3. A spare low diet. 4. Emetics of sulphate of zinc, or of tartar emetic. 5. Nauseating remedies. 6. Cold bath during the paroxysms. 7. Sedatives; hemlock, camphor, and henbane; opium is generally prejudicial. 8. Counter-irritants; blisters, setons or issues. 9. Where great debility is present from the first, or supervenes after the employment of active remedies, tonics and stimulants, as in debility from other causes.

Insanity, to a greater or less extent, may be regarded as an effect of many fevers, especially those of nervous order and typhoid type, and though in general the hallucinations of this mental disturbance subside on the decadence of the symptoms, cases arise where the balance of mental power is not restored for some considerable time after the bodily recovery, and others in which a predisposition is left behind, upon which, at the slightest excitement, the insanity returns with perhaps increased severity; in such cases the disease assumes a new phase, and more properly comes under the denomination of lunacy.

HYDROPHOBIA.

Hydrophobia, or dread of water, as the name signifies, is a disease peculiarly affecting the nervous system, caused by the bite and absorption into the blood of the saliva, or _virus_, as it is called, of some rabid or strongly irritated animal, but most frequently of the two domestic species, the dog and cat, though, from the almost analogous symptoms excited in the system by certain accidents, eventuating in what has been called _tetanus_, the two diseases by many medical men have been considered as synonymous. The influence exerted by the mind on the body, both for good and evil, is a fact well known to the most casual observer, but in no instance is that effect exercised with more dangerous consequences than in the disease under notice; for it is unquestioned that many persons have been forced into a state of hydrophobia, simply through the terror inspired by the scratch or abrasion of an animal perfectly in health, though perhaps under a temporary fit of displeasure or pain. The peculiarity of this disease, is the great length of time that usually takes place between the receipt of the accident, or bite, and the disease itself, or the manifestation of the constitutional symptoms; sometimes weeks elapse, at others months, and not unfrequently years have supervened between the cause and the effect.

_Symptoms._—At whatever time these may show themselves, they commence with wandering pains over the body, anxiety, restlessness, disturbed sleep, and frightful dreams, the patient starting up in horror and bedewed with cold perspiration; by degrees muscular contractions occur at intervals, weight and oppression of the stomach, a tightness in the throat, and difficulty of swallowing, till suddenly the crowning symptom takes place, and the patient, in attempting to drink, is seized with a sudden horror, and recoils in terror from the wished-for potation; the very sight or sound of water, or the motion of fluid, throwing the body into violent convulsions. From this stage the symptoms rush on to their climax; the countenance is contracted, the eyes wild and staring, the teeth set firmly, and with the tightened lips covered with a ropy foam, or a thin watery saliva pours from them; this state is alternated with shrieks, animal noises, bilious vomitings, convulsive jerks and plunges, till one fearful spasm that draws the body like a bent bow, resting on head and heel, releases the patient from his sufferings.

_Treatment._—The hot bath, electricity, blisters, bleeding and opium in immense doses, are the only agents that art can employ in this formidable disease; the most violent measures and the most opposite have been resorted to; but, unfortunately for science, hitherto with but little effect or benefit. In no disease is the old adage of “prevention better than cure” so applicable as in this. For the tranquillity of mind, for the satisfaction of the patient, and for motives of safety, in all cases of bite or abrasion from the tooth of an animal, the part should be cauterised. A tape or bandage being first tied tightly above the part to prevent absorption, the part is then to be washed with warm water, and lunar caustic then applied. If these steps are adopted quickly and effectually, and, if possible, the part sucked or dry-cupped before applying the caustic, and the ligature or pressure continued for some time, there will seldom be any necessity for the painful and questionable practice of excision. The patient’s mind must be soothed; an aperient and a sedative given, and a warm poultice applied over the eschar. A mode of treating hydrophobia by means of ice, internally, down the spine, over the throat and chest, has been adopted with success, but the cases are too few to warrant pronouncing it either safe or certain.

INTERMITTENT FEVER, OR AGUE.

The term intermittent is applied to that kind of fever which consists of a succession of paroxysms, between each of which there is a distinct and perfect decline of fever symptoms. Different names have been applied to this fever, according to the distance of time observed between the periods of its return. When it comes on within the space of twenty-four hours, it is called a quotidian; when it returns every other day, it is called a tertian; and when it attends on the first and fourth day, it is named a quartan ague. That under the tertian type is most apt to prevail in the spring, and the quartan in autumn.

Intermittents often prove obstinate, and are of long duration in warm climates; and they not unfrequently resist every mode of cure, so as to become very distressing to the patient; a fact, to which the writer can bear testimony from personal experience. It is very generally acknowledged, that marsh exhalations, or the effluvia arising from stagnant water, when acted upon by heat, are the most frequent exciting causes of ague. A low diet, great fatigue, and the sudden disappearance of eruptions, have been ranked among the exciting causes of intermittents.

Some persons imagine this fever may be communicated by contagion; but this supposition is by no means consistent with general observation. One peculiarity in this fever is, its great susceptibility of a renewal from very slight causes, as from the prevalence of an easterly wind, or from the repetition of the original exciting agency. It would appear, likewise, that a predisposition is left in the habit, which favours a return of the complaint.

Each paroxysm of an intermittent fever is divided into three different stages, which are called the cold, the hot, and the moist stage. The cold stage commences with languor, a sense of great debility, frequent yawning and stretching, and an aversion to food. The face and extremities become pale, the features shrink, the bulk of every external part becomes diminished, the nails turn a dark blue colour, and the skin, over the whole body, bears the appearance of having been exposed to excessive cold: at this time, universal rigours come on, together with pains in the head, back, loins, and joints, nausea and vomiting of bilious matter; the breathing is small, frequent, and anxious; the urine is almost colourless; the thoughts are confused; and the pulse is small, frequent, and often irregular. After a short time, these symptoms abate, and the second stage commences with an increase of heat over the whole body, redness of the face, dryness of the skin, thirst, pain in the head, throbbing in the temples, anxiety and restlessness; the respiration (breathing) is fuller and more free, but still frequent; the tongue is furred, and the pulse has become regular, hard, and full. If the attack has been very severe, delirium will perhaps arise at this time. After these symptoms have continued for some time, a moisture breaks out on the forehead, and, by degrees, becomes a profuse perspiration, extending over the whole body.

Having pointed out the phenomena usually attending a paroxysm of intermittent fever, and likewise their mode of succession, it may be as well to observe, that they prevail in different degrees of intensity, and that the series of them may be more or less complete.

The treatment of intermittents is, first, to put as speedy a stop to the fit as possible when it has taken place; and, secondly, to prevent its return at the usual, or any after period. Two drachms of Peruvian bark, powdered, may be taken every two hours, as the benefit to be expected from this medicine will greatly depend on the large quantity administered in a short space of time; for, five or six ounces of bark taken in a few days, will be attended with a much better effect than perhaps as many pounds taken in the course of some weeks. In instances where bark fails of remaining on the stomach (as in the writer’s case), arsenic is almost invariably successful: it must be prepared as follows:—

Take 64 grains of white arsenic reduced to a very fine powder, and the same quantity of vegetable alkali; mix these together; add half a pound of distilled water, and let it boil slowly until the arsenic is completely dissolved: half a pound of compound spirit of lavender is then to be added to it, and as much more distilled water as makes the whole solution amount to a pound. The dose of this is from two to ten drops, given in milk, once, twice, or even thrice in the day, according to the age and strength of the patient. Eight days’ administration of the medicine in this way will be generally found sufficient for a cure of this complaint.

Vomitings and gripings are the troublesome symptoms now and then produced by this medicine: they disappear, however, on discontinuing the drops, or only require a gentle opiate, or some warm cathartic (aperient), such as the tincture of rhubarb. I would by all means recommend those who are living in or near a town, to have the solution of arsenic made by a chemist of known respectability, and to keep it securely locked up, with _Poison_ on its label.

The food of the patient must be of a light and nourishing description, such as sago or arrow-root; but when the fit is off, he may partake of animal food, and a spare quantity of wine. The passions of the mind exercise a wonderful influence on ague; the writer has known the disease instantaneously removed by a sudden shock, and whether of surprise, fright, joy, or grief, appears immaterial; as long as it exercises a sudden and violent effect on the nervous system, the cure is complete.

APOPLEXY.

Apoplexy is a disease which arrests all voluntary motion, and deprives a person of consciousness, as though he had been struck by a blow. Sometimes a person is warned of the approach of apoplexy by various symptoms, such as giddiness, drowsiness, loss of memory, twitching of the muscles, faltering of the speech, &c.; but most frequently he falls to the ground without any warning, and lies as though in a deep sleep. While so lying he breathes heavily, with a _snorting_ kind of noise, and with considerable muscular action of the features. The face is red and swollen, the veins distended, the eyes protruding and bloodshot, remaining half open or quite closed, and a foam frequently forms about the mouth.

Apoplexy mostly arises from accumulation of blood in the system, but it may be the result of an enfeebled constitution, and general want of vitality.

Where a person is seized as described, a medical man should be sent for, and the patient should be carried into a cool room and placed in a sitting posture, in such a situation that the air may be freely admitted to him. The neckcloth, shirt collar, waistband, and other ligatures should be unfastened, and cold water should be poured over the head. Mustard plasters may be applied to the soles of the feet and the calves of the legs, or where the mustard cannot be immediately procured, the feet and legs should be placed in hot water.

If the attack occurs with a person of _full habit_ of body, a dozen leeches may be applied behind the ears and on the temples. It is of great importance that the bowels should be freed of their contents, and as there is a great difficulty in swallowing, _one drop of croton oil_ should be placed on the tongue and repeated every two hours, until the object is entirely accomplished. Blood-letting should in no case be attempted by a non-professional person. Where the fit arises from enfeebled strength (which is indicated by a small irregular pulse) the remedies should be of a milder form, and stimulants may be cautiously administered at intervals.

The most common _immediate cause_ of apoplexy is pressure of the brain, either from an effusion of blood or serum, or from a distention of the vessels of the brain by an accumulation of the blood in them, independently of effusion.

The _predisposing causes_ are the habitual indulgence of the appetite in rich and gross food, or stimulating drinks, coupled with luxurious and indolent habits, sedentary employments carried to an undue length; the habit of sleeping, especially in a recumbent posture, after a full meal; and lying too long in bed.

The _exciting causes_ are excesses in eating and drinking; violent mental emotions; the sudden suppression of piles, gout, rheumatism; or any other cause which augments the circulation of blood to, or extracts the flow of blood from, the brain.

Persons below the middle height, robust, with large hands and short thick necks, are generally recognised as apoplectic subjects; but it is, in truth, confined to no particular conformation of the body, _all persons_ being alike liable to be attacked by it.

Persons, however, who are _predisposed_ to this disease should not fail to profit by the warnings of its approach mentioned at the commencement of this article. Their diet should be light and nutritious; all luxurious habits should be abandoned, and moderate exercise should be taken. Above all, they should avoid giving way to their passions, as it is well known that many persons have been struck with death in the midst of a fit of anger.

EPILEPSY, OR FALLING SICKNESS.

This is a disease coming on in convulsive paroxysms, returning at undefined and irregular periods, accompanied by great muscular exertion, foaming at the mouth, loss of memory and of voluntary motion, and ending in sleep or a state of coma. The attacks are often sudden, the patient without notice falling to the ground; at other times, it is preceded by a sense of weight in the head, drowsiness, and languor, indicating the approach of the fit.

The causes of epilepsy are various; in some cases it is hereditary, in others it proceeds from softening of the brain, or organic disease of that organ and the spinal marrow; it sometimes results from blows, very frequently in children from worms, or other sources of irritation in the bowels and stomach. Epilepsy is most frequent in the young, the spare, and those of a delicate organization.

_Symptoms._—The fit usually begins with an excessive and involuntary action of the muscles, the body is bent forward, or drawn violently backward with great force, the eyes roll in a rapid and furious manner, the lips are convulsed, and a frothy saliva, like the champ of a horse, covers the lips and teeth; the tongue is violently protruded, and often dreadfully injured by the spasmodic closing of the teeth; the pulse is quick and irregular, the breathing heavy and laboured, the muscular action of the arms and legs and the writhings of the body are immense, and often the exertions of more than five or six strong persons are requisite to restrain even a woman. After a time, which varies from ten minutes to half an hour, nature becomes exhausted, and the patient sinks into a state of sleep, or more properly coma, from which in a few hours he awakes, exhausted, low and feeble. The only diseases with which epilepsy could be confounded, are hysteria and apoplexy; from the first, it is known by the absence of tears, sobs, and laughter, and the rising in the throat, like a ball or lump, that always characterizes it; and from apoplexy, by the stertorous breathing and the dilated pupil.

_Treatment._—Where the patient is young, and it is the first attack, bleeding to a small extent is advisable; but in general, beyond the exhibition of stimulating draughts of ammonia and brandy, cold water dashed on the face, and heat applied to the feet, little or nothing can be done during the paroxysm beyond putting a gag in the mouth, and fastening it behind the head, so as to save the patient’s tongue; the treatment must be left till after the fit, and the remedies used with the hope of preventing a recurrence of the attack. When epilepsy proceeds from disease of the brain or spinal column, a seton should be established in the neck, the general correction of the system attended to, by change of scene, a course of mineral waters, a plain but unexciting diet, and the daily use of the subjoined pills, marked 1 and 2, continuing each for three weeks, resting one week, and then beginning the other with exactly the same routine. It may be here remarked, that no medicine has been found so efficacious in epilepsy as nitrate of silver or lunar caustic, and after that a preparation of copper.

No. 1.—Take of

Nitrate of Silver 4 grains.
Bread Crumbs 1 drachm.

Mix. Extract of gentian, sufficient to make a mass, which
divide into twenty-four pills, of which give one, three times a
day.

No. 2.—Take of

Ammoniate of Copper 6 grains.
Bread Crumbs 1 drachm.

Mix well, and add extract of camomile, enough to make into a
mass, which divide into twenty-four pills, one to be given
three times a day.

When epilepsy is symptomatic, or the cause of worms or irritation in the bowels, it must be treated according to the provocative cause; in other cases, a course of mild aperient medicines should be adopted, and the bowels kept regularly open; exercise by walking, sea bathing, early hours, and such pastimes as give a healthy tone to the mind, steadily persisted in. For the tremor that sometimes follows the recovery from the fit, the following antispasmodic mixture will be found efficacious, though, as a general rule for symptomatic epilepsy, a regular diet, change of scene and air, exercise, and a constant mild action on the bowels, will be found sufficient.

Take of

Valerian Root 2 drachms.
Serpentaria Root 1 drachm.
Boiling Water ½ pint.

Infuse for six hours, strain, and add

Spirits of Hartshorn 3 drachms.
Sulphuric Ether 1 drachm.

Mix, and give one or two table-spoonfuls three times a day.
By adding half a drachm of quassia to this infusion, a tonic
property will be added to the antispasmodic effect of the
mixture.

FAINTING, OR SYNCOPE.

Fainting, or Syncope, as it is professionally called, very often attacks the individual without warning, though at other times, and in those subject to these distressing symptoms, fainting is preceded by well-defined sensations, such as a feeling of distress, languor, and sickness; the sight becomes dim, and the eyes appear covered by a film; an areola or dark circle appears round the orbits; a buzzing, or low singing noise, is heard in the ears; the face and lips are pale, a cold perspiration breaks out over the skin; the pulse sinks to a mere flutter, and finally ceases; the body totters, and unless upheld, falls to the ground. The loss of consciousness is sometimes complete; at others, the patient retains a partial amount of recollection; the pallor, too, is occasionally more intense, and corpse-like, the eyes shut, mouth open, the limbs flaccid, and the extremities deadly cold. This state lasts from five minutes to half an hour; a spasm of the chest and a few gasping sobs, each more prolonged than the last, are the first signs of returning consciousness. When the fit is prolonged, it may terminate in epilepsy or convulsions. The causes that predispose to faintings, are an intensely nervous state of the system, a delicate constitution, and extreme debility from whatever cause produced, or a diseased state of the heart. Youth is more subject than age to fainting, and females are more frequently affected by it than males.

_Treatment._—When fainting is the result of nervous sensibility, or when it occurs in hysterical women, there is seldom any danger; all that is generally necessary is to lay the patient on her back in the horizontal position; loosen any string that may compress the chest or neck, open the window, dash water in the face, and apply volatile salts to the nostrils, and give a draught with half a tea-spoonful of spirits of lavender, or thirty drops of sal volatile, and twenty of ether, added to the lavender and water, where the fainting threatens to merge into hysteria. Should the case be obstinate, heated bricks or mustard plasters must be applied to the feet or thighs. Where the fainting proceeds from organic disease, the treatment must be guided by the nature of the primary affection.

AFFECTIONS OF THE FACE.

Under this head must be comprehended face-ache, consequent on cold, tic-douloureux and other nervous affections, erysipelas, pimples, blotches, and other eruptive diseases of the cuticle. As many of the most serious and painful affections of the face are the result of some disorganization of the system, or disease more remotely situated, such as erysipelas, tic-douloureux, and tooth-ache, these affections must be looked for under their respective heads; the present section being confined merely to those blotches and pimples that so often disfigure the countenance. These are sometimes of a scorbutic character; when they are distinguished by irregular red or reddish brown patches on the cheeks and nose, attended with heat and itching, occasionally disappearing and again returning, after the least excitement.

_Treatment._—Take of corrosive sublimate two grains, spirits of wine, one ounce. Dissolve and mix, and take five drops in a wine-glass of decoction of dandelion, or wormwood tea, three times a day, for a week; when it is to be intermitted for a few days, and again resumed in the same order and dose. In bad cases, a lotion made by mixing milk of sulphur in elder-flower water, till the whole is of the consistency of cream, may be applied every night, in addition to the medicine, and washed off in the morning with warm water.

Black spots and freckles are to be treated by making an emulsion of bitter almonds, and dissolving in every half-pint two grains of corrosive sublimate; and after softening the cuticle by bathing the face for a few minutes with warm water, applying the emulsion so prepared before going to bed, letting the lotion dry into the skin and washing well off in the morning. At the same time, a wine-glassful of wormwood tea should be taken every day, either two or three times. In all affections of the skin, proceeding from functional disorder in the stomach, liver, or other organs, producing blemishes on the face, there is no remedy that exercises so permanently beneficial an effect as a course of wormwood; and the infusion should, therefore, in all cases where the complexion is injured, especially in females, be made the primary and principal remedial agent.

In long standing discoloration of the face, proceeding from impaired action of the liver, a steady course of alternative medicine must be persisted in for some time, if any permanent benefit is to be expected; and for this purpose a compound Plummer’s pill must be taken every night for one or two weeks, with a wine-glass of the compound decoction of sarsaparilla twice a day; alternating this treatment every week or fortnight, by one of the following pills, and a decoction of dulcamara and dandelion, in the proportion of an ounce of each to a pint of water.

_Pills._

Blue Pill 1 scruple.
Extract of Colocynth 1 scruple.
Compound Rhubarb Pill 1 scruple.

Mix and divide into twelve pills.

At the same time, under either treatment, a warm bath should be taken once a week, and a constant friction kept up over the body; and especially above the region of the liver, while in the water, by the flesh-brush, or a rough irritating towel.

AFFECTIONS OF THE EYE.

Most of the affections of this organ are of too complicated a character to be popularly treated. In this place the only disease noticed will be that condition of the organ known as general inflammation, and those affections that belong to the appendage of the eye. Inflammation of the eye commences with heat and pricking, and a sense of tightness in the part; the upper lid first and then the lower, become red, swollen, and extremely painful, attended with great tenderness when pressed; the eyeball itself is bloodshot, intolerant of light, and feels as if particles of sand were between the ball and the lids, the surrounding parts sympathize in the swelling, and there is an abundant flow of tears. The constitution at the same time suffers, there is more or less fever, a quick pulse, and considerable pain in the head.

_Treatment._—The patient should either be bled from the arm or cupped on the temple, four or six leeches applied round the orbit, the bowels at the same time acted on quickly by one of the following powders every three hours, and a dose of the accompanying mixture every four hours, till they are thoroughly relieved, the patient all the time being kept quiet, and in a darkened room.

_Powders._

Calomel 12 grains.
Antimonialis 12 grains.
Jalap, powdered 2 scruples.

Mix, and divide into four powders.

_Mixture._

Take of

Infusion of Senna 5 ounces.
Epsom Salts 1 ounce.

Dissolve, and add

Syrup of Buckthorn 1 ounce.

Mix. Take two table-spoonfuls for a dose. After the leeches
the eye should be fomented with warm water, or a decoction of
poppy-heads, and should the skin remain dry and hot, a sweating
draught must be given at bed-time, preceded by a mustard and
water foot bath.

_Draught._

Acetated Solution of Ammonia 1 ounce.
Tincture of Squills 30 drops.
Tincture of Opium 30 drops.
Antimonial Wine 1 drachm.
Spirits of Nitre 2 drachms.

AFFECTIONS OF THE EARS.

The delicate yet important organ of the ear is subject to many diseases and accidents. The most frequent mischief to which the _external_ part of the organ is subject, is partial or complete loss of the cartilage or shell of the ear, a result that either follows sabre cuts, gunshot wounds, or sloughing from blows or pressure. Inflammation seldom attacks the external parts, or, if it does, is in general of an erysipelatous character. When the cartilage has been lacerated, or part of its structure destroyed, the separated parts are to be placed as near as possible in their natural position, and kept together by two or three stitches, a warm moist poultice laid over the part, and a light bandage passed round the head to keep the dressing in its place. The external ear is also frequently the seat of scrofulous ulcers and ill-conditioned sores, and the skin behind the ear is particularly liable to small encysted tumours, which are very tedious in their suppuration, and cause considerable pain and inconvenience.

The treatment is nearly the same for all these affections; a course of alterative and tonic medicines, a warm bran or bread poultice night and morning on the part, and when the discharge is fœtid and thin, a lotion made by dissolving two grains of nitrate of silver in an ounce of rose or distilled water, is to be used as a wash to the sores, once or twice a day; in very obstinate cases a small blister applied to the nape of the neck will speedily effect a cure, though in general, cleanliness, attention to the diet, and an alterative and tonic course of medicine, will effect a sure and far more satisfactory cure than can be obtained by any counter-irritant remedy that can be used.

_Ear-ache_ is a very painful affection of the auditory passage, consequent on cold or a slight degree of inflammation in the membrane of the ear; in all such affections the soothing system will be found the best and safest practice, and this consists of a little cotton dipped in oil with a few drops of laudanum placed in the ear, and a warm bran poultice over all, repeating the poultice every two hours; when, however, the pain is more intense, apply a leech below or behind the ear, and promote the bleeding by poultices.

AFFECTIONS OF THE LIPS.

The lips, or rather the lip, for it is to the lower lip that disease is generally confined, is subject to several affections such as inflammation and enlargement, ulceration, chapping, and excoriation—all in themselves trivial and harmless—and is only subject to one, and fortunately rare disease of any serious moment—cancer. Leaving this for the present out of consideration, all the others may be regarded as symptomatic of the state of the stomach, or else are caused by direct irritation from contact with jagged teeth. The most prevalent form of sore lips is that of deep cracks or fissures, that on the first stretch of the cuticle bleed; in persons of a scorbutic habit, instead of cracking, the skin peels off in scales, leaving a raw, irritable, and painful abrasion, aggravated by heat or moisture, and which sometimes continues for weeks; both of these conditions are dependent on the state of the system, and can always be cured in a few hours, or in the worst case in two or three days, by a dose or two of aperient medicine, such as a dose of blue pill, and a spoonful of Epsom salts some hours after, repeating both for two or three times, should the obstinacy of the case require it. When inflammation and swelling of the lip takes place, as it sometimes does, from the presence of a broken tooth, keeping up a constant irritation from the sharp edge pressing on, or coming in contact with, the soft part, the spicule should be at once filed down, or else the tooth withdrawn, for while the exciting cause remains, no means will afford relief. This having been done, a cold lotion of sal-ammoniac, vinegar, and water applied by means of wetted pledgets of rag, will speedily reduce the swelling, when a pill and a draught, such as have been already ordered, will insure a permanent recovery of the part to health. The lip in all cases should be kept as dry as possible, and especially from the saliva and the tongue; and as all such cases are symptomatic of the state of the system, their own permanent cure is, as we have shown, by an aperient medicine. An excellent application is a little tallow rubbed in by the finger before going to bed, the tallow having the advantage over all other grease, in not becoming rancid.

Cancer of the lip is usually characterized by a callous thickening of the cuticle and the formation of a warty excrescence; or it may begin by a painful pimple, which after once or twice being removed, degenerates into a small irritable ulcer, that discharges a thin ichorous exudation, and rapidly affects the glands under the jaw, which become distinct and knotty; the ulcer, after remaining for a length of time in passive, irritant state, closing over, and again breaking out, suddenly assumes an active form, and is attended with stiffness in the muscles of the jaw and darting pains, till it finally assumes all the features of this much dreaded disease; for which, though caustic and arsenic are the best remedies we possess, there is no certain cure but excision, in the same manner as for hare-lip. Though cancer of the lip is generally confined to _men_ in mid-life, and inveterate smokers, it would appear more to depend upon some occult state of the blood than on any social habit, however objectionably pursued.

PRESERVATION OF THE TEETH.

The preservation of the teeth ought to form an important item in the care of the person. The possession of sound teeth is a great blessing, as they not only promote the process of digestion, but keep the breath sweet and pure. Unsound and unclean teeth are also most unsightly and unpleasant for other persons to be brought in contact with; for these combined reasons, the greatest care should be observed in the management of these important organs. It must be understood that the teeth are bones thinly covered over with a fine enamel, and this enamel is more or less substantial in different persons. Whenever this enamel is worn through by too coarse a powder or too frequently cleansing the teeth, or eaten through by a scorbutic humour in the gums, the tooth cannot long remain sound. The teeth, therefore, are to be cleaned but with great precaution, for if the enamel is worn off faster by cleaning the outside than nature supplies it within, the teeth will probably suffer more by this method than by neglect. A butcher’s skewer, or the wood with which they are made, must be bruised and bit at the end till with a little use it will become the softest and best brush for this purpose; and in general, the teeth may be cleaned with this brush without any powder. It is necessary to observe that, very near the gums of persons whose teeth are otherwise good, there is apt to grow a false kind of enamel, both within and without, and this false enamel or tartar, if neglected, pushes the gums higher and higher till it leaves the fangs of the teeth quite bare, above the true enamel, so that sound teeth are destroyed, because the gum has forsaken that part which is not sheathed and protected. In the summer months this tartar may be effectually removed by partaking daily of strawberries; eating plentifully of watercresses is also considered a good remedy. An excellent tincture for this defect will be found as follows:—Mix six ounces of tincture of Peruvian bark with half an ounce of sal-ammoniac. Shake these well for a few moments every time before the tincture is used. The method of using it is, to take a spoonful and hold it near the teeth, then with a finger dipped in, rubbing the gums and teeth, which are afterwards to be washed with warm water. Another method of preserving the teeth is to wash out the mouth with water after every meal, especially if animal food has been eaten; by these means the particles of food lodging about the teeth and gums are dislodged, which, when allowed to remain and accumulate, prove excessively injurious. Much harm is frequently done to the teeth by cleaning them with too hard a brush or deleterious dentifrices, in either case the enamel being scratched and otherwise injured. As a matter of course, the preservation of the teeth is greatly influenced by what is eaten and drunk. All things that are either very hot or very cold are extremely bad; acids are especially injurious, as are also sweets.

_The decaying of teeth_ is partly due to chemical decomposition of the food lodged between the teeth in eating. When there is joined to this an unhealthy or weak condition of the ivory, which is thus rendered incapable of resisting the action of external causes, and also the continual pressure of the adjacent teeth, when too close together, then decay is almost sure to take place in some part or other of the crown. When it occurs in the sides of the necks, just below the enamel, the cause always is in the food, and generally so when in the middle of the crown of the molars; but sometimes decay takes place beneath the enamel, and long before the slightest fissure in this part can be detected by any ordinary observation, or, at all events, while there is no opening large enough to admit the food. Besides these causes, another exists in the uncovered state of the roots, or fangs, or on these being covered by tartar instead of gum, both of which circumstances tend to produce decomposition and decay, and should be cautiously guarded against. When a cavity is actually developed, the sooner it is filled the better. When it is small and has not opened into the natural cavity of the tooth gold leaf is the best material, the dentist previously cutting away the decayed matter and pressing in the gold with great force. When, however, this cavity is exposed, gold is useless under ordinary circumstances. The following are some of the best methods of filling teeth when beginning to decay:—1. Mix thirteen parts of pure finely powdered caustic lime with twelve parts of anhydrous phosphoric acid. This powder is moist during the mixing, and while in that state is to be introduced into the decayed tooth. The place in the tooth is to be made dry before receiving the mixture. This kind of filling must be used two or three minutes after being prepared. Soon after it is lodged in the decayed cavity, it becomes very solid. 2. Take pure anhydrous phosphoric acid forty-eight grains, pure caustic (unslaked) lime forty-two grains. Finely pulverize each separately, and keep them separate in well-stopped bottles till wanted. For use, mix the required quantity in a small mortar, as rapidly and perfectly as possible, and at once press the dry mixture in the cavity of the tooth. The surface should then be smoothed off and finished by moistening with water. This cement soon acquires great hardness; it is very white and durable, and in its composition resembles the natural earthy matter of the teeth. The whole process requires expertness to succeed; but the latter, when attained, will amply repay for one or two failures. If the composition be not mixed and applied quickly it becomes moist, and is therefore unfit for use. In many cases the odour arising from carious teeth is very offensive; to remedy this, the mouth should be well rinsed with a tea-spoonful of the solution of chloride of soda in a tumbler of water, which will have the desired effect.

PRESERVATION OF THE HAIR.