THE FAMILY MEDICAL GUIDE. (continued 2)

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.

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.

Under ordinary circumstances, the hair may be preserved by the most simple means. In a sound and healthy constitution, the best preserver and beautifier of the hair is regular and careful cleaning. As a general rule, the head cannot be too much brushed, brushing serving as an active and healthy stimulant upon the skin, rendering the functions more vigorous, and, as a consequence, the production of hair more easy and its maintenance more certain. On this account, hard and penetrating brushes are useful, but in using them it should be borne in mind that it is the head which requires brushing more than the hair; while, therefore, the brush is actively applied to the roots of the hair, the surface should be brushed with a light and gentle hand. Occasional washing with pure water is to be recommended, providing the hair is not very long, so as to render drying difficult. To assist in drying it thoroughly, dip the brush into a very little hair powder and brush it out again; after that, a little pomatum may be brushed in.

With regard to cutting the hair, it is an operation which should not be performed too frequently, nor delayed too long; in ordinary cases, it would be well to have a small portion of the hair removed every month or six weeks. Where the hair is in an unhealthy condition, especially where much has fallen off, and a partial and impoverished growth has risen up to represent that which is lost, the short and impoverished hairs should be carefully and persistently cut, with the view of giving them bulk and strength, and improving their growth. The frequent plucking out of withered hairs is also productive of benefit, as the process is necessarily accompanied by much stimulation of the skin, which promotes the growth of the hairs individually and generally.

The excessive use of grease in dressing the hair, is a common error which cannot fail to be productive of injurious consequences. There is a natural oil secreted by the hair which in a healthy state should supply the requisite amount of moisture; sometimes this is defective, and the hair becomes dry and harsh, it is then proper to supply the deficiency by a little pomatum or oil. When the artificial grease is applied in excessive quantities, it produces a matting of the hair, prevents the pores of the scalp from acting freely, and thus the proper supply of natural moisture is not communicated freely to the hair.

The kind of grease to be used, should be animal fats in preference to vegetable oils, the latter being apt to become rancid, and not possessing such active stimulant properties as the former.

The use of soap in washing the hair, should be cautiously and sparingly observed, as it is apt to change the colour and texture of the hair. A little white soap dissolved in spirits of wine is more effectual and less injurious than soap alone. After this the hair should be well washed with pure water.

When grayness of the hair shows itself, it is and indication of want of tone in the hair-producing organs, and if this tone can be restored, the hair will cease to change, and at the same time further change will be prevented. The plan of cutting, as previously recommended, combined with judicious plucking, tends very much to prevent the extension of grayness.

Keeping the head too much covered is calculated to prove injurious to the hair, as by this means an excessive amount of heat is generated, which tends to enervate and relax the hair-producing organs, and consequently weaken and thin the hair; for this reason the wearing of nightcaps is to be condemned, and the practice of wearing the hat throughout the day is attended with similar evil consequences.

Curling the hair, especially when frequently resorted to, is a most pernicious custom—the inordinate amount of heat that is employed to produce the desired effect, drying up the natural oils, and otherwise injuring the roots and texture of the hair.

Sudden heats and chills of all kinds are also productive of ill consequences; and in short whatever accident or operation the hair is subjected to, widely differing from its normal state, must produce, more or less, those diseases and that decay to which it is peculiarly liable. In every case it should be remembered, that the preservation of the hair depends not only on local stimulation, but also on constitutional treatment. This truth is the more to be insisted upon, as a common notion prevails that the mere application of certain specifics will remedy defects without any other aid. Above all, the advertised nostrums which boast of being able to effect such extraordinary results, are not to be relied upon, and in many cases should be cautiously avoided. The simple truth is, that these specifics owe their boasted productive and restorative powers to precisely the same principle that attends the simplest formula, namely, the stimulation of the skin; and the application, therefore, must be governed by the same laws, and attended with the same results in the one case as in the other.

AFFECTIONS OF THE NOSE.

The membrane that lines the whole alimentary canal from the lips and mouth downwards, has special peculiarities in particular places, according to the function it has there to perform: in the nostrils, as the external seat of smell, it is beautifully and remarkably adapted for its purpose; yet, though being so incessantly in active operation, it is, perhaps, the least affected part of the body. With the rest of the lining membrane of the mouth, it suffers from cold, or in affections of the stomach, discharging a thin fluid in cases of catarrh, and showing a dry, red, and irritable surface when the bowels and stomach are affected, hence the involuntary picking of children when they have worms; but of itself, besides a thickening of its coats from various causes, and thereby blunting the perception of smell, and obstructing the reverberance of articulation, and the occasional formation of that extraordinary zoophyte, the polypus, high up in the nostril, this part of the frame has no other disease appertaining to it. For the first, an occasional errhine, as a pinch of snuff, or the smallest atom of the white of hellebore powder, imbibed in the same way, with a course of aperient medicine, is all that is generally needed; though cases may occur in which leeches and a lotion may be demanded, but they are, however, very rare. The extraction, by surgical means, of the polypus, as no local or constitutional treatment has any effect on its growth, renders any further account here of this disease unnecessary. The external parts of the nose are, however, more frequently affected than the internal, the cuticle over the cartilage being subject to warts, inflammation, small painful pimples and abscesses, and to cancer. The warts are easily removed by a daily application of caustic or blue stone; the inflammations, by a cold lotion of sugar of lead and water; and the pimples and abscesses, by the same means assisted with cooling purgatives. For the more formidable disease of cancer, surgical aid must be obtained, as the treatment, in unskilful hands, might be attended with risk.

There is a condition of the nose, usually, but not always justly, attributed to persons of dissipated habits, in which that feature becomes enlarged, of a red or purple colour, and covered with unseemly blotches, pimples, and bright-coloured excrescences, distending the organ sometimes to an enormous size. Though this disfigurement, undoubtedly, frequently marks the drunkard, it is more properly an indication of diseased liver than a characteristic of dissipation, and is more usually found in its worst form in persons of temperate, than intemperate habits. As this disease is in general a local system of a constitutional derangement, the remedies to cure it must more properly be applied to the system rather than the part. For this purpose a course of Plummer’s pill, alternated with blue pill, and a decoction of dulcamara and dandelion in water, two ounces of each, boiled from four to three pints, and a wine-glassful taken every four hours, and a pill twice a day, must be continued for some days, or even weeks; at the same time the nose should be enveloped in a poultice made of scraped Solomon’s seal, damped with vinegar, laid next the skin; and being put on at bed-time, should be allowed to remain all night.

AFFECTIONS OF THE THROAT.

The throat is subject to two forms of inflammatory action, acute and chronic; of the former, there are two conditions which, though both present acute inflammatory action, and both are diseases of a dangerous character, are very different in their symptoms and their consequences. These are—1st. Inflammatory sore throat. A disease that attacks persons of either sex, and of all ages up to forty or forty-five years; after which period it is but rarely met with. It is very often found attacking several persons at the same time like an epidemic, in spring and autumn, especially so when there are great vicissitudes of atmosphere; the disease being induced by the sudden application of cold to a heated body, or the reverse, but most frequently from wet feet, a sudden draught of cold air to the throat or nape of the neck, or even from a drink of cold water when the body is greatly heated.

The symptoms that first attract attention are, a great difficulty in swallowing, with heat, constriction, and dryness of the throat; the difficulty of swallowing rapidly increasing till at length that operation becomes impossible, every attempt ending in the ejection of the liquid through the nostrils. As the disease advances, a thick ropy phlegm, of a yellowish colour, is thrown out from the part, and after much trouble expelled; at the same time sharp pains run through the jaws and ears, the voice in some cases is reduced to a whisper, and in all is thick and hoarse. From the first sensation of dryness in the throat, symptoms of fever show themselves in the constitution, such as heat, shivering, thirst, nausea, sickness, and headache. If the earlier remedies have failed to check the inflammation, the disease at the end of five, or sometimes seven days, runs into suppuration, and one or more abscesses are formed in the tonsils, which usually burst into the mouth; but when the enlargement impedes the respiration, the abscesses must be opened and the matter discharged.

Treatment.—When the symptoms are slight, a hot bran poultice, kept constantly to the throat, a mild aperient, and the immersion of the feet for a few minutes in hot water, is often all that is needed. In more severe cases, however, and where the constitution is robust, an emetic of ten grains of ipecacuanha and one grain of tartar emetic, should be mixed in warm water and given directly, to be followed in two hours by two compound colocynth pills, and half an ounce of Epsom salts, dissolved in a tumblerful of water an hour later. As soon as the emetic has ceased to act, the front of the throat should be rubbed with hartshorn and oil, and a hot bran poultice directly after applied round the throat. If the inflammatory action has set in strong, the emetic should be followed by bleeding from the arm, or it may be adopted at any subsequent stage of the treatment, and the poultice put aside and a blister laid on the throat, should the urgency of the symptoms warrant its use. When the thick phlegm causes annoyance and cannot be expelled, a gargle of warm vinegar and water should be employed to facilitate its removal. When suppuration sets in, which may be known by the throbbing in the part and frequent shivers, the hot poultice must be frequently changed, and the steam of hot water repeatedly inhaled, so as to promote the formation of the matter. In scrofulous constitutions, the tonsils frequently become chronically enlarged, and upon any slight exposure to heat or cold commence a tardy process of suppuration. In such cases the treatment recommended for scrofula must be adopted both internally and locally.

2. Putrid sore throat.—This serious affection is not regarded as a substantive disease by many medical men, but rather as a grave consequence, or severe symptom of some other malady, such as malignant and scarlet fever, or typhus, in which diseases it is very often found as a terminating symptom. The symptoms of this disease commence with cold shivers, pain in the head, giddiness, stiffness in the muscles of the neck, flushed face, red or suffused eyes, sore throat, nausea, sickness, and sometimes vomiting. The pulse through all these progressive changes is small, quick, and feeble, and easily extinguished by pressure. The throat, when examined, presents an inflamed appearance, the redness deepening round the fauces, which, after a time, are dotted here and there by irregular brown spots. The tongue and gums are lined with a brown fur, while small vesicles filled with a transparent acrid fluid form on the inner lips, and in the nostrils, which, on breaking, excoriate the mouth and upper lip. Concurrent with this latter symptom, diarrhœa takes place, the constitutional disturbance or fever increases, and the strength of the patient sinks rapidly; the pulse still more rapid and feeble, is also intermittent, and with increased difficulty of breathing, there is often both delirium and coma. On the third or fourth day a scarlet rash not unfrequently breaks out over the chest and arms, which, on the sixth or seventh, peels off; the mouth is covered with a dark fur, a fœtid odour issues from the throat, and the patient exhibits all the characteristics of putrid or malignant typhus. When the bright red appearance of the throat declines about the fifth day, and some return of appetite shows itself, a favourable termination may be hoped for, but when the inflammation passes rapidly into ulceration and sloughing, and a flow of acrid saliva takes place from the mouth, with coma, the result of the case is regarded as extremely doubtful.

Treatment.—The mode of treating this disease is precisely the same as for typhus, and consists in supporting the patient’s strength by the most potent and energetic means, to give him strength to resist the first shock of the disease, and then, to facilitate the separation of the sloughs and support him over the reactionary stage. To fulfil the first intention, beef tea, jellies, and a nutritious diet must be employed from the first, with doses of wine at regular intervals, and where the depression is great, brandy, either as a substitute or in addition; at the same time such a stimulating tonic as the following mixture should be administered every two hours, with, at bed-time when necessary, an addition to the last dose of fifteen or twenty drops of laudanum.

Take of

Aromatic Confection 1 drachm.

Quinine 10 grains.

Camphor Water 5 ounces.

To be rubbed smoothly in a mortar; then add

Compound Tincture of Bark 4 drachms.

Compound Tincture of Cinnamon 4 drachms.

Sal Volatile 1 drachm.

Mix and give a table-spoonful every two hours. Bottles of hot water should be kept to the feet, and a warm bran poultice placed round the throat. When the first stage of the disease has been passed, in addition to a nutritive diet, and a course of tonic stimulants, only less frequently administered, the throat must be gargled occasionally with the following gargles in succession.

Gargle No. 1.

Take of

Strong Sage Tea 1 pint.

Vinegar 4 ounces.

Mix. To be used every hour for three or four times on each occasion.

Gargle No. 2.

Boil

Bruised Oak-Bark 2 ounces.

in a pint of water for ten minutes; and add

Alum 2 drachms.

Mix. To be used as the former.

Gargle No. 3.

Take of

Infusion of Rose Leaves 1 pint.

Sulphuric Acid 30 drops.

Mix. To be used as the above.

Gargle No. 4.

Take of

Capsicum Vinegar 6 ounces.

Tincture of Catechu 4 drachms.

Water, to make a pint. Mix, and use as the former. For the fœtor that arises from the sloughing, the mouth and throat are to be occasionally washed with a weak solution of chloride of lime, and, throughout the whole disease, the room should be frequently sprinkled with aromatic vinegar, or the chloride of lime or tin.

Ordinary sore throat or hoarseness, when not a symptom of any more severe illness, may usually be easily disposed of by rubbing the throat freely with hartshorn and oil, and then enveloping the throat and neck in two or three folds of hot flannel, plunging the feet two or three times quickly in very hot water upon stepping into bed, and placing a piece of Spanish juice in the mouth, allow it to dissolve there during sleep. When the sore throat is attended with cold chills, a dry hot skin and tendency to headache, before resorting to the liquorice and being well covered up with clothes, the patient should drink about half a pint of hot egg-flip made tolerably potent with a due proportion of gin or rum.

CARE OF THE HANDS.

It is acknowledged, by common consent, that dirty and coarse hands are marks of slothfulness and low breeding; while, on the contrary, clean and delicate hands are evidences of cleanliness and refinement. The person who has much manual labour to perform, cannot, of course, be expected to keep his hands of that delicate shape and texture, which another person, whose employment is light, may do. But, at the same time, it is always possible, under any circumstances, to keep the hands in that state during the intervals of labour, so that they shall not appear displeasing to the eye.

To promote the softness and whiteness of the skin, mild emollient soaps, or those abounding in oil, should alone be used, by which means, also, chaps and chilblains will generally be avoided. The coarse strong kinds of soap, or those abounding in alkali, should, for a like reason, be rejected, as they tend to render the skin rough, dry, and brittle. The immersion of the hands in alkaline lyes, or strongly acidulated water, has a like effect.

Roughness of the skin may generally be removed by a little sand being mixed with the soap, or by rubbing the hands with pumice-stone previously to applying the soap; in this operation care should be taken not to allow the gritty particles to come into contact with nails, or they will scratch them.

Dirt from the hands is more effectually removed by warm water than cold; the hands, however, are liable to become dirty sooner afterwards, and perhaps the best plan is to remove the dirt with warm water, and afterwards rinse the hands in cold.

Washing the hands too frequently has a tendency to discolour them with a brown or tawny hue. Under ordinary circumstances it will be sufficient to wash the hands three times a day, namely, on rising, before dinner, and on retiring to rest. After washing, the hands should be carefully dried with a moderately coarse towel; this will promote a free circulation through them, which will ultimately tend to enhance their appearance. Exposure to cold winds and rain is detrimental to the appearance of the hands, and gloves should always be worn.

Fruit and ink stains may be eradicated from the hands, by immersing them in water, slightly acidulated with oxalic acid, or a few drops of oil of vitriol, or to which a little pearlash or chloride of lime has been added; observing afterwards to rinse them thoroughly in clean water, and not to touch them with soap for some hours, as any alkaline matter will bring back the stains. The hands may be preserved dry for delicate work, by rubbing a little club moss, in fine powder, over them.

Hands that perspire, and are inordinately hot, may arise from some temporary derangement of the system, or from a constitutional peculiarity; this may be partially remedied, by inserting the hands into a water-jug full of water, and lowering them gradually until the elbows reach, letting them remain at this point for two or three minutes; this operation will, in general, keep the hands pleasantly cool for some hours afterwards. In conclusion, it must be observed that an over-anxious care for the state of the hands is to be deprecated. Some persons who are possessed of a small and delicate hand are so vain of it that they are constantly displaying it in an obtrusive manner, which is very offensive to the looker-on. And in some instances the fear of putting the shape and outline of the hand out of form, is so great, that every kind of work is avoided, and even accomplishments, such as the harp, piano, and guitar, are avoided, for fear of expanding the hand, and flattening the extremities of the fingers; this is a preposterous error, for the beauty of the hand does not alone consist in whiteness and a statue-like contour, but in certain indurations, which may be termed “expression,” and which are imparted by the pursuit of suitable occupations, and appropriate accomplishments.

CARE OF THE FEET.

To preserve the feet in a proper condition, they should be frequently soaked and well washed in warm or tepid water. Many persons are subject to tender feet. This frequently arises from the use of thin cotton or silk socks or stockings, and boots and shoes that are either too tight or stiff, or not sufficiently porous to allow of the escape of perspiration. Waterproof boots and shoes are on this account frequently the cause of tender feet. The best remedy for tender feet is the immediate adoption of worsted stockings or socks, and light easy shoes of buckskin, goatskin, or some other equally soft kind of leather. For the preservation of health, it is highly necessary to preserve the feet dry; persons who are therefore exposed to the wet, or who have much walking in wet weather, should be particular in wearing sound boots and shoes; through neglecting this precaution, many persons have brought on pulmonary complaints, which have frequently had a fatal termination. Coldness and numbness of the feet is a complaint to which some persons are subject, especially aged and delicate persons, and those whose employment is sedentary. The best and most natural remedy for this, is action, exercise, or friction—the former being always adopted when possible. Retiring to rest with cold feet is especially to be avoided, and persons so subject, should pace up and down the room just previously to going to bed, until their feet have attained a warm glow. Where this is impracticable, owing to weakness, old age, &c., warm woollen stockings may be put on with great advantage, or the hot water bottle had recourse to. The peculiarly disagreeable odour emitted by offensive feet, may be remedied chiefly by scrupulous attention to cleanliness, and by occasionally soaking the feet in warm water to which a small quantity of chloride of lime or sal-ammoniac has been added.

DISEASES OF THE HEART.

There are many affections of this vital organ that, professionally speaking, do not merit the name of disease, being in fact but temporary inconveniences, symptomatic derangements, or, as has been said, affections; but which, nevertheless, for the sake of perspicuity, it will be better to class generally under the one name of diseases of the heart, separating them, however, from the graver maladies by a distinct heading; and, as they form the lighter part of the subject, treating of them before considering the more serious form of this class of ailments. The heart, as the centre and source of the circulating system, is liable to a considerable number of affections, both simple and complex, which may be divided into two heads—the functional or nervous, and the structural or organic.

Functional, or Nervous Affections of the Heart.—Under this head are comprehended palpitation, syncope or fainting, angina pectoris, and neuralgia of the heart; all of which, though occasionally very distressing, and sometimes most alarming to the sufferer, are often only symptoms of other affections, and consequently of minor importance; and even when spontaneous, and producing considerable bodily disturbance, seldom cause any real apprehension, and still more rarely result in positive danger, and in this respect bear a marked contrast to those diseases of the opposite class.

Palpitation.—By this term is understood those frequent, strong, and irregular movements of the heart, occurring in individuals who have no indications of organic disease; these movements may be transient or continuous, frequently accompanied with an audible sound, so loud, as to be heard at several yards from the patient. Palpitation is often attended with a feeling of sinking and anxiety, accompanied with fainting fits or syncope, and sometimes with a pulsation at the pit of the stomach. The causes of palpitation, irrespective of a naturally nervous temperament, hysteria and weakness, are any strong emotions of the mind, long study, violent exercise, or a continued passive repose, the debility consequent on fever, or whatever weakens the standard of health. Besides these causes, palpitation may also be a symptom of organic disease of the heart. The persons most frequently affected with palpitation are females; the slightest extra exertion, or exposure to damp foggy weather, often suddenly producing a paroxysm, attended with pain in the head, and a sense of numbness in the left side or arm. Persons who suffer from spinal irritation are also liable to palpitation, attended in such cases with a remarkable acceleration of the pulse, often amounting to 160 beats in a minute. The respiration is generally difficult, or easily rendered so, on the slightest exertion or mental emotion, and frequently induced by the slightest pressure, such as that of the stays on the chest, waist, or lower part of the spine, the pain often being intolerable. Palpitation is very common in young females between the ages of 15 and 25, especially where the occupation is long and sedentary, as in factories, or in dressmakers’ establishments. Indeed, palpitation, with very rare exceptions, may be said to be a complaint peculiar to the female sex, and the more the occupation of young women confines them to a close unvarying atmosphere, the more prone are they to attacks of this troublesome disorder; and the more exposed they are to the open air, the less frequent and the less severe are all such maladies.

There are few affections, even of the gravest character, whose symptoms give rise to greater alarm in the mind of the patient, or doubt and uncertainty to the inexperienced practitioner, than those of a severe attack of palpitation: often before seeing his patient he hears the irregular throbbing of the heart; on looking on the white or lividly anxious countenance of the sufferer, fancies he reads the external signs of the most formidable organic mischief, while, in truth, a cheerful aspect, a few confident words, and the simplest remedies, will not only remove all the unpleasant symptoms, but restore the apparently diseased patient to health, and ultimately to strength. It is only when the pulse is intermittent that any organic disease is to be apprehended, the velocity or strength of the pulse depending entirely on some accidental cause, more or less easily removed.

Treatment.—Though the causes that excite palpitation are numerous, they may all be reduced to two heads—that of inflammation or a state of plethora, and a state of local or constitutional debility. When palpitation can be traced to an inflammatory condition of body it will be necessary, according to the age and the condition of the patient, to reduce the circulation by bleeding, either from the arm, or what is more usual, by leeches, or cupping glasses over the region of the heart, or still better, between the shoulders, low down on the spinal column, at the same time giving nauseating doses of tartar emetic, hydrocyanic acid or tincture of digitalis, or foxglove. The following mixture, combining all the advantages to be obtained from each, may be safely substituted for one or either, having the power to allay inflammatory action, reduce the circulation, subdue pain, and promote a beneficial action on the skin.

Take of

Camphor Water 6 ounces.

Powdered Nitre 1 scruple.

Tartar Emetic 3 grains.

Laudanum 1 drachm.

Dissolve and mix. Give two table-spoonfuls at once, and one spoonful every two or three hours afterwards.

At the same time a low diet, rest, quietude, and strict attention to the state of the stomach and digestive organs, are imperatively necessary. Where, however, the exciting cause is debility, the system must be in the first case braced by cold bathing or the shower bath, followed by vigorous friction along the spine with the flesh-brush; tonics and steel in all shapes, as chalybeate waters, or steel, wine or pills, or the usual iron and myrrh mixture; to this must be added change of air, a rich and liberal diet, and exercise either on horseback or by walking. The next affection of the heart is

Syncope, or fainting, which is characterised by an indescribable sense of distress and feeling of faintness; the eyes grow dim, and are covered with a kind of film, attended with noises in the ears; the face and lips are pale, a cold perspiration breaks out on the body, the mind succumbs and grows confused, the body totters, and if not supported, falls; respiration becomes imperceptible, and the pulse is reduced to an irregular flutter. For a further account and treatment, see Fainting.

Angina Pectoris.—The first symptoms of this distressing complaint are a sudden and violent pain across the chest, coming on upon any slight exertion, such as going upstairs, or after a hearty meal. The pain gradually extends to the shoulder, and runs down to about the middle of the arm, accompanied with a sense of stricture or tightness across the chest, the pain becoming so acute as to threaten the patient with instant death. The pulse sinks and becomes weak and irregular, the countenance is colourless, cold sweats succeed, and a constant cough, and after a time an expectoration of a scanty viscid mucus. When the paroxysm first comes on, the patient is compelled to stand perfectly still, as the only relief he can obtain from the agony of his suffering is an absolute repose. After a time the fit comes on from the slightest cause or mental excitement, and often attacks him in the night upon waking from his first sleep. Angina pectoris is generally a disease of advanced life, and is often accompanied with flatulence, and common to gouty or rheumatic and sedentary habits of body; and though sometimes a symptom of functional derangement, is more frequently a characteristic of serious organic disease.

Treatment.—The first indication is to relieve the urgency of the symptoms, and then between the pauses of the paroxysm administer remedies, to prevent the return of the disease. Bleeding is occasionally beneficial in this affection, but it must be employed in the earliest stage, and only a small quantity of blood taken from the patient, who is to be kept in a recumbent position, and as quiet as possible. Where there is much dyspepsia or gastric disturbance, an emetic is useful; but the main dependence for relief lies in the employment of anti-spasmodics and carminatives.

The following mixture, as containing the best of both classes, may be taken in the manner directed.

Take of

Aromatic Confection 1 drachm.

Peppermint Water 6 ounces.

Rub smoothly down in a mortar, and add

Tincture of Cardamoms, compound 1 ounce.

Laudanum 1 drachm.

Compound Spirits of Ether, or Hoffman’s Anodyne 2 drachms.

Mix. If the pain is very severe, take three table-spoonfuls, two more in three hours, and one every four hours afterwards; or, when the symptoms are less urgent, two table-spoonfuls every four or six hours.

Concurrent with the mixture, a blister or strong warming plaster should be laid over the left breast, according to the severity of the pain, and the spine between the shoulders rubbed with warm turpentine, or an embrocation composed of equal parts of camphorated oil, turpentine, and oil of amber. Having by these means, and strict repose, subdued the paroxysms, means must be adopted to prevent, if possible, a recurrence of the disease. This may be effected by removing all the exciting causes; by diminishing plethora, through aperients and low diet, by a diminution of animal and a preponderance of vegetable food; by avoiding all stimulants, spices, and heating substances, and by guarding against all violent emotions of the mind, or sudden and undue exertion or exercise. As all the symptoms of angina pectoris may be caused by dyspepsia, the state of the stomach should always command the first and most important consideration.

The next and last of the functional diseases of this organ is neuralgia of the heart, which differs chiefly from angina pectoris in being characterised by sharp darting pains in the left breast, but unattended by any obstruction in the respiration, and in most cases without any change in the heart’s action or the pulse. It is purely a nervous complaint, and, like the previous affections, most frequently dependent on dyspepsia or flatulence, and a constipated state of the system.

The treatment must be regulated by the causes that may seem to have induced the neuralgia; though, as a local application, to allay the pain of the paroxysms, a plaster of belladonna or opium and litharge will, in all cases, be found of very great advantage, and may, irrespective of any mode of internal treatment, be kept on the chest for some considerable time. There is also another form of heart affection sometimes met with, though not universally acknowledged by the profession, called spasm of the heart, in which the treatment must depend upon the age, sex, and strength of the patient; the chief remedies, however, being the hot bath, stimulants, such as ether and ammonia, and counter-irritation by friction.

The other class of diseases to which the heart is liable are those which affect the tissue or substance of the organ itself, and are known as structural or organic diseases; all of them are, consequently, highly dangerous and often mortal maladies, and are called:—1. Inflammation, chronic and acute, of the bag of the heart—Pericarditis. 2. Of the substance of the heart—Carditis. 3. Hypertrophy, or enlargement of the heart, either of the whole organ or a part, and frequently accompanied with ossification, softening, or dilatation, sometimes regarded as a distinct disease. 4. Atrophy, or wasting of the heart, a species of emaciation of the organ by which the heart of a full-grown man or woman becomes as reduced as that of a child—in other words, less than half its natural dimensions—and its texture growing so attenuated as to be as thin as tissue or bank paper. Nearly all these affections of the heart, however distressing their symptoms may be, almost always, when not the result of structural mischief, proceed from a faulty state of the digestive organs, and are frequently entirely cured by an assafœtida pill taken two or three times a week at bed-time, and a little burnt soda and rhubarb in the morning; and it is only when pain and great oppression occur that recourse need be had to ether, opium, or anti-spasmodics.

GOUT.

The chain of symptoms which give rise to those general and local affections, which are professionally denominated gout, proceed from some constitutional disturbance, of the nature of which medical science is yet completely ignorant. The symptoms have hitherto been regarded as the disease, and it has been found, that whenever these have been duly developed and have passed away, the system, as if relieved of some acrid poison, has recovered its elasticity and tone; leaving the patient in the enjoyment of a state of health superior to that usually possessed. Gout appears to be a state of diseased action, gradually vitiating the humours of the body, and accumulating a morbid condition of the system, till the impaired or overcharged organs becoming unable to perform their functions, that disturbance in the physical economy takes place known to us as gout, that is, the symptoms, which indicate the first of the three varieties into which the disease is divided, namely, the acute: the second is, when these symptoms suddenly cease in the part where they commenced, and fly to some internal organ, when it is called retrocedent; and the third, when the system becomes habituated to the malady, which, though mitigated as respects suffering, continues in a permanent but subdued force, when it is called chronic gout. Gout is usually divided into four species or distinctive forms, as—

1. Regular gout, attended with violent inflammation of the joints, enduring for several days, and then receding gradually, with swelling, itching, and disquamation or peeling off of the cuticle.

2. Atonic gout, attended with debility of stomach or some other internal part, either with or without inflammation of the joints, accompanied with flying pains and considerable dyspepsia or indigestion.

3. Retrocedent gout, marked by inflammation of the joints, suddenly disappearing, and followed by immediate debility of the stomach or some other internal organ.

4. Misplaced gout, shown by inflammation of some internal part, preceded or not by some affection of the joints, which, however, quickly disappears.

General symptoms.—Dyspepsia, flatulence, lassitude, torpor, low spirits, cold and numbed extremities, with pricking and gnawing sensations in the part, cramps, turgescence of the veins of the foot and leg; the paroxysms usually coming on about two in the morning, with excruciating pains in the joint of the great toe, succeeded by shiverings, a sense of horror and general fever; the pain goes on increasing till the following evening, when it reaches its acme of suffering, from which time it gradually declines, a moisture breaks out on the body, and the patient begins to breathe in freedom, he falls into a tranquil sleep, and discovers on waking that the part so lately in torture is entirely free from pain, but swollen and inflamed.

Treatment.—In this disease the first indication is, to alleviate pain, which must be effected by giving an opiate of sufficient strength to effect that purpose, and at the same time, to shorten the paroxysm, exciting an action on the skin. To effect both these objects at once, doses of the following mixture should be taken every two hours till the desired result has been attained:—

Take of

Solution of Acetate of Ammonia 2 ounces.

Spirits of Nitre 3 drachms.

Antimonial Wine 2 drachms.

Tincture of Squills 2 drachms.

Laudanum 2 drachms.

Camphor Water 3 ounces.

Mix; two table-spoonfuls to be taken for a dose. The affected part is to be enveloped in soft wool or flannel, and the patient’s mind soothed; the limb kept at perfect rest, all exciting aliment discontinued, and where the patient is young, a low and abstemious dietary insisted on, and if necessary once or twice a week giving a mild purgative of magnesia and Epsom salts. When the paroxysms have been subdued, the colchicum, which some regard with so much favour, may be given either in half drachm doses of the wine or tincture, or in, what is better, the following formulary; but however taken, this drug should be always preceded by an aperient medicine.

Take of

Epsom Salts ½ ounce.

Magnesia 2 drachms.

Peppermint Water 6 ounces.

Wine of Colchicum 3 drachms.

Mix, and take one table-spoonful three times a day. When the joint will bear friction, the flesh-brush should be used daily, a milk and vegetable diet pursued, exercise and change of air adopted, and, where possible, the bath or chalybeate waters moderately taken. The gouty deposits or concretions formed in joints of persons afflicted with gout, or chalk stones, as they are commonly called, consisting of an insoluble urate of soda, can only be dissipated in one way, by the steady use of benzoic acid, which, in doses of one scruple combined with two drachms of the carbonate of potass, is to be taken dissolved in water every day an hour after breakfast and dinner, and continued till the depositions are absorbed.

RHEUMATISM.

A very painful disease which affects the muscles and joints of the human body, chiefly the larger joints and most important muscles, as those of and around the shoulder, hip, knees, and back. Rheumatism is divided into acute and chronic; or that condition, when the disease is in vigour and freshness attended with extreme pain, and more or less of general fever, and that state, when the system, by long acquaintance with the disease, has become familiar to its attack, and it comes on from any trifling exposure to cold, and after affecting a larger or smaller surface, declines of its own accord—all the symptoms however, being materially lighter than in the acute state. Besides being acute and chronic, rheumatism is very often both general and local, and this, under both previous conditions, and the diseases known as lumbago and sciatica, are merely forms of acute or chronic local rheumatism.

Acute Rheumatism, or Rheumatic Fever, is a disease which, in many of its symptoms, strongly resembles inflammatory fever, and usually commences after the languor, restlessness, and shivering, which precede all febrile actions, and is attended with great heat, much thirst, headache, a quick bounding pulse, white tongue, constipated bowels, and acute pain either confined to one or two parts, or more generally diffused over the body. There is at the same time an oppression in the breathing, the abdomen is often tense and tumid, and the secretion from the bladder, scant, and of a deep red colour; while, from the surface of the body a perspiration breaks out, which, though unattended with relief, by its peculiar acid smell defines the disease, and affords a good diagnosis, before asking the patient a single question. Upon entering the room the air seems redolent of stale vinegar, and this fact, while helping the physician to a suggestion of the disease, serves to define the attack from inflammatory or any other form of fever. Another characteristic and distinctive symptom of this disease, is the increase of pain in the course of the muscles on any attempt to move the patient into another position. The symptoms, if from the first unrelieved, gradually increase in intensity; and the pulse in such cases becomes, in addition to its velocity, hard and jerking. In all cases the symptoms are aggravated at night, and remit their violence in the morning. The pain though sometimes intense, is not always continuous, it is often only partial in its situation, and sometimes abates for hours, but in all cases it is the last symptom the patient loses. The disease after a course of from fifteen to thirty days subsides, often leaving one or more members in a state of chronic tumefaction.