Chapter III: Part 3

But however dangerous may be the knife operation, there is no danger at all to be apprehended from removing the tumors by a _ligature_. To accomplish this, take a soft cork about three-fourths of an inch in diameter, and one inch long--make a hole through the center from end to end, about one-eighth of an inch in diameter--cut crucial grooves in the top of the cork about an eighth of an inch deep, bevel down the lower end nearly to an edge, make a cord of saddler's silk, three fold twisted together and waxed, about eight or ten inches long, double this in the middle and pass the loop down through the cork out at the sharp end, the two loose ends of the string being out at the grooved end. Make a strong hickory stick about three-sixteenths of an inch in diameter, and just long enough to pass across the square end of the cork. Now have the patient protrude the Pile tumors as far out as possible, being placed on his knees with the head bent to the floor, pressing out firmly as if to evacuate the bowels. Let the tumors be dried as much as possible by gently pressing a soft, dry cloth to them; then let the loop of the string projecting from the flattened end of the cork, be pushed on over the largest tumor, and held down at its base, while an assistant places the stick in one of the grooves, ties the two ends of the cord firmly down over the stick, or _toggle_, by a square bow knot; then turn the stick round once, twice, or more, until the pressure upon the tumor is sufficient to strangulate it perfectly, and prevent the string from slipping off. Care should be taken to keep the cord down to the base of the tumor while it is being tied and tightened, as in many cases the base is much the larger part of the tumor, and the cord tends to slip up. After the ligature is applied and tightened, apply arnicated water to the parts, and a large, warm poultice of superfine slippery elm bark, wet so as not to be too soft and slippery, on the face of which Arnica may be put. Keep it on with a T bandage. The patient must be put to bed and kept quiet until the ligature and tumor come off, which will be in about six or seven days, sometimes sooner. Once a day the "toggle" must be turned part, or the whole of a circle or more, to tighten the cord as the patient can bear. This will be very painful from beginning to end of the ligating, but any, even the most sensitive, patient can bear it. The patient must have quite warm hip baths two, three, or more, times a day, or as often as the pain is severe, the poultice being replaced after each bath, and kept constantly on.

If there are several tumors protruding, apply ligatures to two of the largest, when these are removed, the others will disappear.

Injections of mucillage of slippery elm should be carefully used to move the bowels daily, or at least once in two days. Let the diet be of corn or oat meal mush, or rice. As the tumor gradually sloughs off, the surface heals, so that, though the base where the ligature was applied, may have been an inch or more across it, there will not be a raw surface of over an eighth of an inch in diameter, to which _Calendula Cerate_ should be applied. The patient must keep quiet for a few days longer. Though this is a painful operation, it is not in the slightest degree dangerous. I have effected complete and permanent cures by this mode in numerous instances.

Sea-Sickness.

_Nux Vomica_ should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness.

If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of _Nux_ should be taken, followed in an hour with _Pulsatilla_.

If the nausea comes on, _Ipecac_ and _Arsenicum_ should be taken alternately between the paroxysms of vomiting, should that symptom appear.

If practicable, the patient should lay still upon the back until the sickness passes off. I have removed sea-sickness immediately in several instances with _Pulsatilla_ alone, and the last time I had an opportunity to prescribe for this affection I gave _Podophyllin_. It removed all the symptoms in a few minutes. That is the only time I ever tried it, but from the provings I am satisfied it is one of the best remedies.

Asiatic Cholera.

I was practicing in Cincinnati during the prevalence of Cholera in the years 1849, and 1850, and in Northern Ohio in 1854, and had abundant opportunity to observe and treat it. The disease generally begins with a diarrhoea, which may continue for several days, or only a few hours before other symptoms set in, such as vomiting, then cramping in the stomach and muscles of the legs, arms, hands and feet, followed by cold sweats, great prostration, restlessness, excessive and burning thirst, drinks being immediately rejected. These symptoms continue, the patient sinking rapidly into _collapse_, when the skin looks blue and shriveled, the eyes sunken, the surface covered with a cold, clammy sweat, the extremities, nose, ears, tongue and breath cold, the voice hollow and unnatural. This condition continues from two to eight or ten hours, the patient regularly failing, sometimes becoming delirious before he dies.

In some cases the vomiting and diarrhoea set in simultaneously, and the other symptoms follow, as above described, in rapid succession. In others the cramping may be the first symptom, the others following it.

In a large proportion of cases, the disease takes the course first described above, the diarrhoea, called the _premonitory symptoms_, or sometimes _cholerine_, coming on several hours, if not a day or more, before any other symptoms.

The diarrhoea is not usually painful, hence the patient may not be alarmed so as to attend to it until the more dangerous symptoms appear. It begins in some cases with pain and some griping, the discharges rather consistent, having a bilious appearance, so that the patient supposes it to be an ordinary bilious diarrhoea, which is not dangerous, his fears being thus quieted. But however the diarrhoea begins, it becomes sooner or later, copious, watery, and light colored, (rice water) painless but rapidly prostrating.

TREATMENT.

In the early stages of the diarrhoea, _Veratrum_, taken about twice as often as the evacuations occur, will frequently arrest it in a few hours, especially if the patient lies down and keeps quiet. But if not, and it increases in frequency, or becomes more copious, or any sickness is felt at the stomach, the patient should, at once, be laid upon a bed and _strong tincture of Camphor_ should be given in drop doses, once in five minutes, for one hour or more, and as the symptoms abate, once in ten, fifteen or twenty minutes, for six or eight hours.

A teaspoonful of the _Camphor tincture_ may be put into a tumbler of cold water, ice water if at hand, and the water agitated until it becomes clear, giving a teaspoonful of this camphorated _cold_ water as a dose, stirring the water each time. I think this is better than to give the pure tincture. After the patient becomes quiet and easy, _Veratrum_ should be given in alternation with Camphor, a dose in four to six hours for several days, or oftener if he feels any symptoms like a threatened return of the disease. These two medicines serve as _prophylactics_ (preventives) of Cholera.

If, however, the disease continues in spite of the Camphor and Veratrum, in the first instance, or later, (as the Camphor may be given in many cases with success in the advance stage,) you must resort to other remedies.

If vomiting comes on with burning in the stomach give _Ipecac_ and _Arsenicum_ in alternation as often as the vomiting occurs, and if the diarrhoea continues give _Veratrum_ between the doses of the other two, in a violent case, as often as every ten to fifteen minutes, and at longer intervals when the disease is slow in its progress. If the vomiting and diarrhoea, or either, occur with a kind of explosion, the vomiting ceasing suddenly for the time, after the first _gush_, or the discharges from the bowels are involuntary, _Secale_ is the specific remedy.

For the cramping, _Cuprum_ and _Veratrum_ are the remedies to be given alternately.

If, however, the _cramping_ comes on as the first symptom, which is sometimes the case, the patient being suddenly seized with it before any other alarming symptoms occur, _Camphor_ is _the great remedy_, and in this case it may be given in doses of double or treble the quantity before directed.

If he sinks into the _collapse_ and lies quiet, indifferent to everything, the pulse sinking, or he is pulseless, _Carbo Veg._ will sometimes arouse and restore him, hopeless as the case appears. It should be given once in half an hour until the pulse begins to rise. If, however, instead of being quiet he is restless and thirsty, give _Arsenicum_ in alternation with _Carbo Veg._, repeating the dose as above directed. In some cases, after all the active symptoms cease, the patient will become quiet and drop to sleep, and instead of the pulse rising, as it will if he is recovering, it sinks, or does not appear if he has been pulseless, and the breathing becomes irregular and feeble--he is sinking. If aroused, he sinks back into the stupor in a few moments as before. _Laurocerasus_ is a specific for this condition. It should be given once an hour until he is aroused.

If, however, besides the stupor, the head is hot, the face red, the breathing oppressed, the pulse slow and sluggish, _Opium_ is to be used, and may be given in alternation with _Laurocerasus_.

For the irritation of the brain, and furious delirium that sometimes sets in after the cessation of cholera symptoms, _Secale_ and _Belladonna_ in alternation will prove specific.

Let the patient have warm or cold drink as he prefers, and let his covering be light or plentiful as is most agreeable. As soon as he gets easy, and the vomiting and purging cease, and his pulse begins to return, keep him quiet as possible, let the room be darkened and everything still, so that he may go to sleep, which he is inclined to do, this being the surest restorer. I am quite sure I have known several patients carried off by a return of the disease, after it had been effectually arrested, in consequence of sleep being prevented by the rejoicing officiousness and congratulations of friends, disturbing and preventing that early and quiet slumber which nature so much needs, and must have, or hopelessly sink. The diet for two or three days after recovery, should be a little oat meal gruel or rice.

Small Pox--Variola.

This disease begins with pain in the head and back, chilly sensations, followed by a high fever, so similar in all respects to a severe attack of Bilious or "winter" fever, that it is difficult or impossible to distinguish it with certainty, as Small Pox. The fact of the prevalence of the disease at the time, and the exposure of the patient, may lead the Physician and friends to suspect Small Pox. There is one very striking symptom of Small Pox, however, that exists from the beginning, which, though it may be present in fever simply, is not uniformly so. This is a severe and constant aching _pain in the small of the back_. The headache is also constant.

The Small Pox is of two varieties or degrees, _distinct_ and _confluent_. The _distinct_ is when the pustules are separated from each other, each one a distinct elevation, with more or less space between them not affected by the eruption.

The _confluent_ is where the pustules spread out from their sides and run together, covering the whole surface as one sore.

It may be distinct on some parts, as on the body, and confluent on others, as the arms, face, and parts most exposed to the air.

In the _Distinct_ variety the fever continues without abatement until the eruption appears, when it entirely subsides, and that quite suddenly. The eruption comes out about the third day of the attack, sometimes not discoverable until the end of the third or beginning of the fourth day. The eruption is at first very slight, beginning with small red pimples on the forehead, upper part of the cheeks, neck and upper part of the breast, extending by degrees to the arms, and other parts of the body and limbs. About the end of the fourth or forepart of the fifth day, the eruption is complete.

There is a symptom, not mentioned in the books, which will often determine the disease before the occurrence of any eruption. It is the appearance of hard shot-like pimples, to be _felt under the skin_ in the palms of the hands, while there is, as yet, no trace of eruption to be seen upon the surface.

On the eighth or ninth day, the eruptions become vessicular, have flattened tops, and contain a limpid fluid. The parts continue to swell, the eruptions to enlarge, and become filled with purulent matter, having a dark color at the top, up to about the fourteenth or fifteenth day, when they begin to flat down, to dry up, and some of the scabs become loose. At this time, some fever arises, often quite severe, with headache and other inflammatory symptoms. If the eruption is very severe, fever will be of corresponding violence, and lighter or wanting when the eruption is mild. This fever rarely lasts more than twenty-four hours, from which time the patient rapidly recovers.

In the _Confluent_ variety, all the symptoms are more violent, the fever continuing after the eruption begins. The pustules burst early, and run into each other, covering nearly or quite the whole skin; the surface swells and turns black or dark brown, the lungs are more or less irritated, producing cough, and not unfrequently the stomach is nauseated, and vomiting ensues.

If the patient survives the irritation up to the fifteenth or sixteenth day, when the _secondary fever_ sets in, he is liable to be taken off by an affection of the brain or lungs, during this fever. If he recovers, his whole surface, especially that part exposed to air, is deeply pitted.

TREATMENT.

As it is not often known for a certainty, in the early febrile stage, that it is the small pox, the treatment will be first adopted that would be proper for a like fever arising from other causes. But in all my observations in this disease, and they extend to several hundred cases, I have not found in a single instance, any of the ordinary fever remedies, such as _Aconite_ and _Bell._, which would be applicable for such symptoms in an ordinary case, to do any good in small pox. They are directed, however, for these symptoms by the authorities, in the febrile stage of the small pox; but I am quite sure they are not the proper remedies.

From the great similarity, the almost absolute identity of small pox _headache_ and _backache_, with the same symptoms developed by the _Macrotys racem._ as well as the nausea and restlessness produced by the drug, I was led several years ago to the conclusion that this, or the _Macrotin_ was valuable in small pox. Not only so, but during the prevalence of small pox in Cincinnati, to an extraordinary degree in the winter of 1849-50, I treated about one hundred cases, including both sexes, and all ages, from infants a few weeks old, to very old persons, giving the _Macrotin_ to all, and had the good fortune to see _all_ my patients recover. Since that time I have prescribed it for every case successfully.

Having then, been entirely successful in so many cases, with this medicine, I am not inclined at this time to give any other the preference. I must admit, however, that though my patients all recovered, I was not able to greatly abridge the duration of the disease, nor to prevent the development of all the stages in their proper order, as is _claimed_ by M. TESTE, for his use of _Mercurius cor._ and _Causticum_. I was satisfied with so far modifying the symptoms, as to enable my patients to live through, and come _out well in the end_. I would then direct, if small pox is suspected, the patient having been exposed to contract it, or from the peculiarity of the symptoms, in the early stage, or when the disease is discovered after the eruption, to give _Macrotin_ at the first trituration, in one grain doses, once in two hours, while the fever, headache and backache continue, after which, during the whole course of the disease, give it three times a day. This will prevent the development of a dangerous secondary fever, as well as irritation of the lungs, stomach or bowels. In addition to this medicine I give the patients daily, from half an ounce to two ounces of _pure_ (_unrancid_) _Olive oil_. This serves to prevent the development of pustules in the throat, lungs and stomach; is more or less nutritious, and keeps the bowels in a healthy condition. Wash the surface once a day in weak soap suds, following it with a bath of milk and water, and keep cloths moistened with warm milk and water, constantly upon all parts that are exposed to the air, lubricating the surface with _Olive oil_ after the bath of milk and water. This keeps the surface quite comfortable.

The best diet is corn or oat meal mush and molasses, to be taken in small quantities. Cold water is the proper drink, though it should not be very cold.

The room should, at all times, be well ventillated, but in cold or cool weather, sufficient fire must be kept up, to keep the room warm and dry. A temperature of about 65° is the best. Hardly any thing can be worse for a small pox patient than to be in a cold or damp room, and to breathe _cold_ air. Uniform temperature is important.

If the eruption is tardy about appearing, or after it is out, a recession takes place, the Alcoholic Vapor bath will soon bring it out. (See Rheumatism **p. 30).

Occasionally the feet and limbs below the knees, will swell prodigiously, and become extremely painful, causing the principal suffering. For this, wrap the feet and legs in cloths wet in a strong solution of Epsom salts, quite warm, and cover with flannels so as to keep them warm. This will afford immediate relief, and reduce the swelling in a day or two. The finely pulverized Epsom salts, dry, sprinkled on the pustules, will very often prevent pitting. It is the safest and surest remedy of which I have any knowledge.

Varioloid

is small pox modified by vaccination. It is to be treated as a mild case of small pox. The _Macrotin_ has been used with apparent success as a prophylactic (preventive) to small pox, taken three times daily.

Painful Urination, Incontinence of Urine,

_Involuntary Urination._

Where the discharge of urine produces smarting and burning of the urethra, _Cantharis_ is the remedy. Where there seems to be an over secretion of acrid urine, producing inflammation of the neck of the bladder, known by pain in the glans penis, _Copaiva_, and _Apis mel._ are the remedies. If there appears to be a partial palsy of the neck of the bladder, the discharge taking place in sleep, _Podophyllin_ is the surest remedy. I have cured some bad cases by the use of these three remedies, given in rotation three or four hours apart.

Injections of a solution of borax into the bladder, have, in several cases, been sufficient to effect a perfect cure, without any other remedy. This may be used in connection with the other remedies. For painful urination with a distressed feeling in the neck of the bladder, causing a constant disposition to evacuate urine, the _Althoea Officinalis_ is a certain remedy; it acts like a charm. It is an important remedy for inflammation of the bladder. A good mode of using it is in form of a warm infusion in doses of a table spoonful every half hour or hour, according to the urgency of the symptoms. The _Althoea Rosa_ (Hollyhock) may be used as a substitute, though it is not as good. Every family should cultivate the _Althoea Officinalis_ (Marsh Mallow), so that the fresh green root, which is the best, can be procured at any time. I have been able to relieve patients with it, especially females, when all other remedies seemed unavailing. It is particularly useful for urinary difficulties of pregnant females.

Neuralgia.

_Aconite_ and _Bell._ are two important remedies in this affection. If given low, and applied directly along the course of the affected nerves, at full strength of the tincture, they will almost always effect a cure. The proper way to use them is to give them internally at the second dilution, at intervals of fifteen to thirty minutes, when the pain is severe and nearly constant, and apply _Aconite tincture_ as hot as practicable over the course of the nerve, by means of wet cloths, for an hour or two hours, and if the pain has not subsided use _Bell._ locally in the same manner.

If the Neuralgia is periodical, coming on at regular intervals, _Arsenicum_ and _China_ are the remedies, and they should be used externally as directed for the others, both at the first dilution, and given internally at intervals, in proportion to the violence of the symptoms, the _Arsen._ at the 3d and the _China_ at the first dilution. If the patient has used alcoholic drinks to excess, _Nux_ is to be used in place of Arsenicum.

_Periodical Neuralgia_ generally requires the same treatment as ague. In females when there is uterine disease, _Pulsatilla_ and _Macrotin_ are the remedies to be used, as directed above.

Jaundice.

This disease depends upon derangement of the liver. The skin and whites of the eyes become yellow; the patient grows weak, loses his appetite, is dull and sluggish in all his actions, melancholly and discouraged in his moods.

TREATMENT.

_Mercurius_ and _Podophyllin_ given in alternation, each twice a day, will nearly always effect a cure. If the patient is costive, _Nux_ should be taken at night, until his bowels become regular.

Bathing the surface daily, or oftener, is a very important measure in the treatment of this affection. As often as once in two or three days, an alkaline bath should be taken. If the patient has fever every day, or once in two days, ever so slight, _China_ should be used with _Podophyllin_. If he has been drugged with Mercury in any form, in large doses, even six months or a year before, give _Hydrastin_ in place of Mercurius.

Itch.

I shall say but little about this very common and very obstinate affection. Everybody has a "cure for itch" yet nobody cures it short of the use of _Sulphur_ in some form. Though the attenuations of Sulphur may sometimes cure itch, it must be acknowledged that such cures are so rare in this country, and the time requisite to accomplish it is so long, as a general rule, that few will trust them.

The most successful remedy, and the one that will always cure quickly, if at all, is _Hepar Sulphurus Potassium_, the common Hepar Sulphur (sulphuret of Potassa) of the shops. To succeed with it most certainly, let the patient be thoroughly bathed with warm soap suds, _quite strong_, in a room at the temperature of 90 to 100°, continuing the bathing and _rubbing_ for an hour or more, then dry off the surface with soft cloths, and apply the _Hepar sul._ with water, at the strength of thirty drops of the strong alcoholic solution, with a gill of water, wetting every eruption on the whole surface and let it dry on. This causes some smarting, but it is effectual; it kills the _acarus_, (itch animalcule) and in a few days the sores heal, the itching all subsides immediately. If every pustule has not been touched, those left may continue to itch, in which case, a second application is necessary. _Hepar Sul._ should be given internally at the third dilution, for a month, once a day, after the baths. Avoid greasy food. For the

Scald Head

of children, where there is a discharge of yellow and watery pus from the sores, and the eruption extends to the ears or face, like the disease called the _crusta lactea_ (milk crust), the same washes as for itch, are the most effectual, while at the same time, and for a month or two, the child should have _Hepar Sul._ 5th at night, and _Petroleum_ 3d in the morning. Daily ablutions of the head with warm soap suds, and keeping it covered, are absolutely essential.

Carbuncle.

This affection, though it somewhat resembles a common boil, and is by some writers considered only such, in an overgrown state, is, nevertheless, far from being identical with it.

While a _boil_ is only a sanitive effort of nature to eliminate the cause of a morbid process, and tends to a spontaneous, healthy termination, the _carbuncle_, on the contrary, is the very essence of disease; its constant tendency being towards the dissemination of diseased action, causing destruction of the parts affected. It, in fact, appears like a parasite, living by the destruction of surrounding tissues, literally absorbing them and "thriving on death." It begins with a red, livid color, slight aching and burning pains, the part swells and is elevated some like a boil, except that it does not "point," but has a broad base rising like a cone and flattened at the top. It feels soft and spongy, and will appear to fluctuate, but if punctured, blood only flows. The pain and burning increases rapidly, and sooner or later several openings appear upon the top, varying from three or four to half a dozen or more, looking like the holes in a sponge, out of which issues a fluid like thin gruel. Instead of becoming easier after the suppuration begins, as is the case with a boil, the burning increases to an alarming and unbearable extent; cold chills, loss of appetite, great depression of spirits, general nervous and muscular debility come on. The tumor continues to discharge, turns purple; gangrene beginning in the carbuncle extends to other parts and death follows.

The disease is nearly always confined to quite feeble persons and those past the meridian of life; but I have seen it on younger though feeble patients. It is generally located on the back, occasionally on the head, where it is very dangerous from its liability to affect the brain.

TREATMENT.

If treated very early, _strong tincture of Arnica_ applied to the surface of the carbuncle, by cloths wet and laid over the tumor, will often arrest it so that the swelling will not be developed to the suppurative stage. However, to reap any benefit from _Arnica_, it must be applied while the pain is not severe, and the parts only feel bruised and tender to pressure, like a common bruise.

After the ulceration occurs, _Arsenicum_ is the great remedy to be relied on. It should be given at the second or third attenuation as often as every three hours, when the pain is severe, and applied to the surface of the carbuncle freely by cloths laid over it, wet in the first dilution, or by sprinkling the first trituration of the oxyde (1-10) freely upon the open surfaces, so that it may penetrate into the open mouths or orifices. Over this powder apply an emolient poultice, or soft cloths wet in water hot as can be endured. This will soon allay or greatly lessen the pain. It should be repeated as often as any of the burning pain peculiar to the carbuncle returns, until the tumor suppurates in a tolerably healthy manner; then lessen the strength of the _Ars._ applications, and continue them until it has the appearance of a healthy abscess, when only simple dressings are necessary. Some may suppose such strong applications injurious, but I can assure them from abundant experience, that there is not the slightest danger. The carbuncle should _never be punctured_ or _cut into_. Such operations always make them worse, and induce a more rapid approach to gangrene.

The patient should have nourishing food, and good native wine may be taken in moderate quantities, by a very feeble person, with decided advantage.

Though the knife operations for the removal of carbuncle are always injurious, the chemical effect of _Potash_ is frequently most beneficial. I have, in repeated instances, applied to the ulcerated surface, _caustic potash_ freely, allowing the dissolved caustic to penetrate to the very "core" by running into the orifices. At first it would produce some smarting, but the pain is different from that of the carbuncle, and the change is agreeable rather than otherwise. Soon after the application all pain ceases, and the tumor, under the use of a poultice, begins to slough off in a few days, leaving a raw surface, disposed to heal kindly. Occasionally, however, the healing process is tardy, when _Arsenicum_, at the third, applied and taken internally, will soon effect a cure.

I have occasionally used _Hepar Sul._ with good effect in the latter stage.

Felon--Whitlow.

For this disease, in the early stage, when the sensation is that of sharp, sticking pain, feeling as though a brier or thistle was in the finger, immerse the part in water as hot as possible, into which put common salt as long as it will dissolve; hold it in this _hot_ salt bath for an hour or more at a time, and when removed, apply finely pulverized salt, wet in _Spirits of Turpentine_; bind on the salt with several thicknesses, and keep it constantly wet with the sp'ts turpt. for twenty-four hours, when, if all symptoms of felon are gone, no further treatment is necessary. As a general rule, the hot bath should be repeated three times a day, especially if the symptoms have existed for several days and there is much pain or swelling, and the dressings should be kept on as above directed for several days, more or less, until all symptoms disappear.

I am quite confident that a large majority, if not all, of the cases if thus treated at any time before pus is formed, will be discussed and cured. If pus has begun to form before the treatment is commenced, this will not _cure_ the felon, but it is good treatment, especially the hot bath, as it will greatly lessen the pain.

By holding it in hot water for an hour or two each day, the suppurative process will be hastened, and as soon as the pus can be felt at any point, fluctuating, puncture and let it out; then continue the hot bath, with _Calendula_ (_Marygold_) flowers in the water, keeping the part all the time warm and moist.

For the restless and nervous irritability that frequently occurs, especially in females, _Aconite is the best remedy_. It should be given, one drop of the tincture to a gill of water, in teaspoonful doses, once in one or two hours, and the same applied to the sore.

DISEASES OF FEMALES

Suppression of the Menses, (Amenorrhoea.)

For sudden suppression from taking cold, as by wetting the feet, there being headache, more or less fever, the pulse frequent and variable, pains in the small of the back and cramp like pains in the pelvic region, give, in alternation, _Aconite_ and _Pulsatilla_, as often as every fifteen or twenty minutes in a violent case, and at longer intervals as the patient begins to get easy. Putting the feet into hot water, or taking a hot Sitz bath is very useful. If the patient is sick at the stomach, as is often the case, give lukewarm water freely and let her vomit; after which let her drink freely of water as hot as it can be safely swallowed, adding milk and sugar to make it palatable. The good effects that are often attributed to and experienced from the use of various hot teas in this affection, are, in my opinion, attributable more to the hot fluid alone than to any specific medicinal virtue in the substance of which tea is made. At all events, very _hot_ drink with nothing but water, milk and sugar, is equally efficacious, and my medicine (a few grains of sugar of milk) put into the hot water, seasoned as above, has often obtained great credit, when the _hot water_ was alone worthy. Rubbing the loins and abdomen briskly downwards with the hands of a healthy and vigorous nurse, will often excite the menstrual flow after a sudden suppression. If the head is hot, the face full and red, and the arteries of the neck and temples beat violently, give _Bell._ with _Pulsatilla_, and if the lungs are oppressed, use also _Bryonia_, giving the three in rotation. If, after the menstrual flow begins, there is still much pain in the pelvic region, give _Caulophyllin_, which will immediately afford relief.

_Apis mel._ is very servicable in suppressed menses of several days, or even weeks duration, where there is fever, redness of the face, and pain in the head, and pains in the hips extending to the limbs, especially if there is any tendency to bloating of the abdomen and swelling of the limbs or feet. It acts _promptly_ and _efficiently_.

If the suppression has been caused by sudden fright or any strong mental emotion, _Veratrum_ should be given in connection with the two former medicines. Should there be great fullness of the vessels of the head, or bleeding at the nose, _Bryonia_ with _Pulsatilla_ are to be used. _Bell._ is also useful in this case if the pain in the head is throbbing, especially if any delirium is present.

For suppression in young females, of several months duration, I have used, with much success, _Podophyllin_ and _Macrotin_, one at night, the other in the morning, giving them for two or three weeks before the proper time for a return, and a day or two prior to the time, give also _Pulsatilla_, and give the three in rotation, a dose every six hours.

This practice has been successful with me in cases of long standing and apparently obstinate character. Where there is other disease, as an affection of the liver, lungs or stomach, this must be treated and cured, or the menses will not probably return. Great care should be exercised to keep the patient's feet and limbs warm, as upon this may depend her future health.

Dysmenorrhoea.--Painful Menstruation.

For this disorder, I know of no one remedy so valuable as the _Caulophyllin_, but _Pulsatilla_ in many cases is efficacious, and as they do not prevent each other's action, I prescribe them in alternation, giving a dose every half hour, for a short time during the paroxysm, or until the pain abates to some extent, then every hour.

If there is pain in the head, sickness at the stomach, a kind of sick headache, as is often the case, with painful menstruation, _Macrotin_ should be used with the others; _Ipecac_ is the _Specific_ for an excessive flow of the menses with great pain, especially if the stomach is nauseated. It should be given as low as the first dilution, and the tincture, in water, in the proportion of thirty drops to half a pint, injected into the vagina quite warm.

The application of extract of _Belladonna_ to the neck of the uterus will often produce immediate and perfect relief. After the patient is relieved from the painful paroxysm, she should be treated so as to prevent a return of the pains at the next monthly period. _Pulsatilla_, _Caulophyllin_ and _Podophyllin_ are the three medicines that are most certain to effect this object. They are to be given, one medicine each day, a dose at night for three weeks, then morning, noon and night, until the time for the return of the menses, when they should be used oftener if there is pain. If the patient is inclined to be costive, _Nux_ should be given at night for a few days before the menstrual period, in place of _Pulsatilla_.

Menorrhagia--Profuse Menses--Flowing.

For this affection, _Ipecac_ and _Hamamelis_ are the specifics. They should be taken alternately, at intervals of from half an hour to two hours apart, according to the urgency of the symptoms, and the _Hamamelis_ injected into the vagina. These will nearly always arrest the flooding immediately. _Secale_ should be used either alone or with the above medicines, if there are bearing down pains like labor pains, and sickness at the stomach in spite of the Ipecac. _Ipecac_ alone is often sufficient.

Nursing Sore Mouth.

Sore mouth of nursing women, as the name of the disease indicates, is peculiar to women who are suckling children. It is an inflammation of the mouth, tongue and fauces, which sometimes comes on during pregnancy, several months or but a few days before the birth of the child. It generally, however, makes its first appearance when the child is a few weeks old, and sometimes not till after the lapse of several months. In some cases the tongue and inside of the mouth ulcerate, and the irritation extends to the stomach and bowels, producing distressing and dangerous inflammation of these parts, with severe and obstinate diarrhoea.

For the sore mouth, before diarrhoea begins, give _Eupatorium Aro._ and _Hydrastin_, in alternation, a dose once in three hours, and wash the mouth with the same, each time. After the diarrhoea occurs, use _Podophyllin_ with the other medicines, giving them in rotation, three hours apart. It is best to give a dose of _Podophyllin_ night and morning.

I have treated very bad cases of this disease that had been running for more than a year, and been treated with the ordinary remedies directed in the Homoeopathic authorities without any permanent benefit, curing them perfectly in ten days with _Podophyllin_ and _Leptandrin_, giving them in alternation at the 1st attenuation in half grain doses, at intervals of from four to eight hours according to the frequency of the evacuations. These two remedies are almost certain to arrest _Chronic Dysentery_ where there is ulceration of the lower portion of the rectum, a peculiar distress felt at the stomach just before stool, with _sudden_ rush of the evacuations and inability to control the inclination even for a few minutes, with a feeling of faintness after the stool.

_Leptandrin_ is the specific for the Dysentery that often succeeds cholera, and these two, _Pod._ and _Lept._, are almost certain to relieve the "Mexican Diarrhoea," as well as that connected with the fevers along the Mississippi river.

Mammary Abscess,

(_Ague in the breast--Inflamed breast_.)

This is a disease peculiar to nursing women. The first symptom is a slight pain or soreness in some part of the "breast," which continues to increase for a day or two, when a chill, more or less severe, sets in, followed by high fever and quick pulse, headache and great restlessness. The gland swells and becomes very painful. This is generally a disease of rather slow progress, running eight or ten days and sometimes two or three weeks before abscess forms and "points" to the surface.

TREATMENT.

_Phosphorus_ is to be taken internally, and the first dilution put in water, twenty drops to one gill, and applied to the surface by means of cloths wet in the mixture, as hot as it can be borne, and laid over the whole breast. If this is done and the medicine given internally every hour, as early as the first and frequently as late as the second or third day, it is quite sure to remove the disease and prevent an abscess. It is best to use it even much later. In fact it often succeeds as late as the fifth or sixth day, and if it does not prevent the abscess, it so far palliates the severe symptoms as to render the pain but slight and keep the patient comfortable.

An application of the Tincture of Cantharides diluted with water and applied to the breast by cloths wet in it, to the extent of producing considerable redness and even eruptions, and the second dilution of the same taken in drop doses every three hours, has proved successful in subduing the inflammation after _Phos._ had failed, and it was supposed an abscess would form in spite of any treatment.

I recently succeeded in giving perfect relief with _Apis Mel._ internally, applying it externally after the pain and swelling was very great. I am of opinion that the _Apis_ is a valuable remedy.

_After abscess forms_ as soon as the pus can be felt at any point, soft and fluctuating under the skin, _puncture_ and let it out, then poultice it for a few days until it heals, giving _Phosphorus_ and applying it to the sore. In _puncturing_, always be _very particular_ to have the lancet or knife enter so that the edge will look towards the point of the nipple, so as not to cut _across_ the milk ducts, which all run toward that point, and if cut off will close up so that the milk which may be secreted at any future time cannot get out, and swelling, pain and severe inflammation, abscess and ulceration will be the consequence; whereas, if the cut is made lengthwise of the ducts, very few, if any will be cut off, and all future danger will be avoided. Apply an elm poultice from the beginning to the end of treatment. For malignant ulcers of the breasts, the _Cornus Sericea_ is a most potent remedy. It is to be taken internally at the first dilution, and applied in strong infusion or diluted _Tr._ of the bark to the sore.

Sore Nipples.

This affection of nursing women frequently comes on before the birth of the child, but generally does not make its appearance until after the suckling has continued for a week or more. It seems in some cases to be connected with the aphthæ (sore mouth) of the child, or at least to be aggravated by contact with the sore mouth; on the other hand it sometimes seems as though the sore nipples produced the sore mouth of the child.

TREATMENT.

I treat both the nipple and the child's mouth with the same remedy _Eupatorium aro._, applied at the strength of 6 drops of the tincture, to a teaspoonful of water, the application being made by a soft cloth, wet and laid over the nipple; give drop doses of the same strength internally every three hours, which will, in nearly all cases effect a cure in one or two days. The child's mouth should be wet with the same each time just before nursing. The oil from the pit of the butter nut, (Juglan's Cinerea,) obtained by heating the pit and pressing out the oil, applied to the nipple, will generally cure it after 3 or 4 applications about six hours apart. The child may take hold when the oil is on, without danger. This remedy is sufficient in nearly all cases.

Leucorrhoea and Prolapsus Uteri--Whites, Female Weakness.

The disease depends in all cases upon _inflammation_ of the uterus, or vagina, or both.

The inflammation may be simply in the neck of the uterus extending to the posterior surface of the vagina, or the latter may not be affected; or it may extend to the whole internal surface of the uterus, producing swelling of that organ, both the fundus and neck.

The swelling may be confined mostly to the fundus, causing it to be too large for the space it ordinarily fills, hence there will be more or less _displacement_ of the womb, and crowding upon other parts, as the bladder or rectum. In some cases, the swelling is more on one side than on the other, so that it will be crowded over to the opposite side. These displacements are often called _prolapsus uteri_, or "_falling of the womb_," carrying the idea that the difficulty depends upon a morbid relaxation of the ligaments that support the organ. Not one case in a hundred is of this latter character, but nearly, if not all, depend upon the inflammation and swelling above mentioned. How futile then, not to say _hurtful_, must be all instruments for, and all attempts at replacing and supporting it by _force_! All such mechanical meddling is injurious, and should, with all the "supporters," be condemned and discarded.

They may afford temporary relief, but this is at the expense of future health. Cure the disease, relieve the inflammation, and nature will replace the organ. Leucorrhoea is always present where there is ulceration of the neck of the womb, and this ulcerated condition exists to a greater or less extent, in many cases where it is not suspected by the patient. It is vastly more prevalent than is generally supposed. The _symptoms_ are numerous. Among the more prominent are a sense of weight and bearing down in the pelvis, pains extending down the limbs, aching and weakness of the small of the back, headache, more or less gastric disturbance, dyspepsia, the food souring on the stomach. There is often, especially when there are ulcers on the parts, a distressing sense of heat or a smarting sensation. The menstrual function is frequently deranged, the bowels costive, the urethra, by being pressed, becomes irritable and burns and smarts whenever the urine is evacuated. The sleep is disturbed and unrefreshing, and the whole nervous system is unstrung.

The discharge from the diseased surfaces, in an ordinary case without ulceration, is of a mucous or muco-purulent character, not unlike an ordinary catarrhal secretion. When ulceration exists it is dark, fetid or bloody, or sanious and purulent, sometimes it is acrid, excoriating the parts.

TREATMENT.

Inflammation or ulceration, either acute or chronic, in these parts does not differ essentially in its characteristics from the same affection in other mucous surfaces.

The proper treatment for a catarrh of other mucous surfaces will be applicable to these, though there is no doubt but that some medicines are more specifically adapted to these than to other organs.

In the early stage of the complaint, while the inflammation is acute, or sub-acute, the discharge thin or white, _Copaiva_ and _Macrotin_ are to be given once in 6 hours alternately. During the same time let injections into the vagina of warm soap and water be used twice a day, to cleanse the parts of the secretion, followed in half an hour by a wash of warm water, into which _tr. of Macrotys_ has been put in proportion of 40 drops to half a pint. The application should be made with an 8 ounce or at least 6 ounce curved pipe syringe, so as to throw it with considerable force. If there is a burning sensation, use the washes quite warm, until the heat of the parts is allayed. Avoid the use of _cold_ injections as long as any inflammation exists. If the bearing down is present with burning in the parts, _Bell._ is to be used in rotation with the two former remedies. If the sensation is that of smarting, _Cantharis_ is to be used in place of Bell.

Where the disease comes on soon after child-birth, _Podophyllin is the Specific_. It is to be given at the first attenuation three times daily in half gr. doses of the trituration. In this case let the parts be freely washed daily with a solution of borax, quite warm. In the _chronic_ form of the disease, especially where _barrenness_ exists, _Macrotin_, _Podophyllin_ and _Hydrastin_, given morning, noon and night, in the order named, will, in nearly all cases, afford relief.

For females who have never borne children, give _Phos. acid_, 2d and _Eryrgium Aquaticum_ 1, night and morning for a week, and then give them at the 3d dilution until the symptoms subside. If there are headache and derangement of the stomach, _Macrotin_ and _Podophyllin_ should be used, each once a day, between the latter remedies. When the discharge is colored and the pains darting, cutting or smarting, indicating ulceration, or if ulceration is discovered by examination, use _Macrotin_ and _Hydrastin_ internally, injecting the latter upon the affected parts freely. The ulcerated surfaces should be well washed off every day with soap and water, or a solution of borax, and the medicine (_Hydrastin_) in form of infusion, used half an hour after the other wash. If the neck of the womb looks dark, and is ulcerated, or is hard and painful to the touch, especially on probing the cavity, _Cornus Sericea_ must be used both as a wash to the parts, and at the first dilution internally, using them twice a day. This remedy will often cure malignant cases.

It takes a long time in some instances to cure a chronic case, but if persevered in, these remedies will not be likely to fail.[2]

[2] NOTE.--The late Prof. Morrow was remarkably successful, and became justly celebrated for curing hard cases of Leucorrhoea ulceration and "Prolapsus uteri."

Almost his entire reliance in their treatment were the _Macrotys_ and _Caulophyllum_, given internally and by injection upon the parts. He gave the Macrotys in the form of tincture every day to the extent of producing specific head symptoms when he discontinued it till the next day, using the Caulophyllum in the meantime in small doses. He rarely if ever failed.

Morning Sickness of Pregnant Females.

The most efficient and certain remedy for this symptom is _Macrotin_. It should be taken at the first attenuation, a dose before rising in the morning, and one every six hours during the day, as long as the sickness is troublesome. It will generally relieve in a few days. If the stomach is sour use _Pulsatilla_ with the _Macrotin_.

As a _preparation for labor_, a dose (one grain) of _Macrotin_ at the first attenuation given in the morning, and the same of _Caulophyllin_ at evening, is of great service.

Whatever others may think or say in relation to any preparatory treatment for labor, I have reason to know as well as anything in medicine be known, that patients treated as here directed, pass through labor much quicker, frequently in one-fourth the usual time. Their sufferings are comparatively trifling, and the length of time for recovery to ordinary health after labor is abridged from three-fourths to nine-tenths that of former labors. I am quite confident that the medicines produced this difference.

For _irregularity of labor pains_, and for distressing _after pains_, the _Caulophyllin_ is specific.

During labor it should be given at the 2d attentuation in about half grain doses, every half hour, until the pains are regular. Two or three doses at most, and generally one will suffice.

For the after pains it may be given in alternation with _Ipecac_ or _Aconite_ if there is flooding, or with _Pulsatilla_ when the flooding is not troublesome, a dose once in half an hour, until the pains are checked.

For _Rigidity_ of the soft parts and severe, _retarded and long protracted labor_, where the pains are strong and irregular, and great pain and exhaustion is experienced on account of the unyielding condition of the parts, _Lobelia Inflata_ given in drop doses of the tr. in water, once in twenty minutes, in alternation with _Caulophyllin_ as above directed, will in a short time produce the proper condition of the parts, while they render the pains stronger, regular and progressive.

In urgent cases I have given the medicines every 5 or 10 minutes, with decided benefit.

A Useful Hint to Mothers.

Children push beans, peas, corn, &c., into the nose and ear, causing much alarm. To remove such a body take a syringe that works tightly, put the end of the pipe against the bean, shot, or other substance, draw back the piston so as to _suck_ up the article firmly as the pipe is withdrawn from the cavity.

LOCAL APPLICATIONS.

That medicines act locally, that is, manifest their symptoms by peculiar derangement or disturbance of some particular part of the system, more prominently than of any other part, for the time, no one will deny. That each one has some particular locality or tissue upon which its action is more perceptible than anywhere else, is equally undeniable, and that the prominent symptoms are often external and local, is also true. Yet, with these truths clearly demonstrated, there are those of our school who discard the external or local application of all remedies except _Arnica_.

Why this is done, is difficult to determine, unless we can believe that such physicians suppose it to be _heresy_ to make use of any remedy in a different manner from what was recommended by the "Father of Homoeopathy," and abjure all possibility of _improvement_ in our practice.