Chapter VII (4)

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.

The causes that induce rheumatic fever, are generally exposure to cold damp air, or transitions from a warm moist atmosphere into a cold or wet one, and the period most liable to an attack is that of youth and vigorous manhood, the full-bodied and the active, rather than the spare and torpid; and men more frequently than women. The only other disease with which rheumatism can be confounded, is gout, and from this it can always be known by the indigestion and little constitutional disturbances which always precede gout; and lastly, by that disease attacking the _small joints_, as the toes or fingers, instead of, as in rheumatism, the shoulder, knee, or hip.

_Treatment._—Bleeding has always been regarded as the chief if not sovereign remedy in this disease; but as depletion is known to favour that dangerous state known as _metastasis_, or a sudden removal of the disease from one part to another; and, not unfrequently, from the surface to some internal organ, bleeding should, therefore, if possible, not be repeated, the physician depending upon other means to effect the depletion necessary. Indeed, in many cases, the extraction of blood from the system is quite uncalled for, as all its benefits can be obtained by less serious and equally efficacious remedies, and by adopting the following mode of treatment—one that will generally be found sufficient to render the lancet quite unnecessary; or should bleeding in the first stage have been adopted, it may be employed with equal advantage after; only in that case, it will be less requisite to give the aperient pills in such large doses.

Take of

Powdered Nitre 1 drachm.
Tartar Emetic 4 grains.
Camphor Water 10 ounces.
Laudanum 2 drachms.

Mix. Give two large table-spoonfuls every three hours, apply
a bottle of hot water to the feet, and administer two of the
following pills an hour after the first dose of the mixture,
and one every six hours after, till an effectual action is
excited in the bowels, when they are to be discontinued.

Take of

Compound Extract of Colocynth 1 scruple.
Calomel 15 grains.
Camphor, powdered 4 grains.
Croton Oil 2 drops.

Mix thoroughly together, make into a mass, and divide into six
pills.

Should the pain continue excessive, and the patient be debarred from sleep by the nightly irritation, either twenty-five drops of laudanum, in half a wine-glass of water, with a tea-spoonful of spirits of sweet nitre, is to be given to him, if an adult, at bed-time; or else ten grains of Dover’s powder in a little gruel; and should it be required (one or the other), repeated at night for two, three, or more occasions, as may be needed; the patient, during the day, reverting to the mixture and an occasional pill, sufficient to excite one or two actions in the twenty-four hours. Thin gruel, lemonade, or linseed tea as a diluent, are to be used frequently to quench the thirst, and a diet of the least solid or exciting kind established till all the febrile symptoms are subdued. After a lapse of from four to twelve days, the inflammatory stage, or the acute form of the disease, will generally have been passed through; after which, the treatment assumes a different form, such as _chronic_ rheumatism, though this term strictly signifies a disease of considerable standing; for the sake of perspicuity, that condition of the system existing at the termination of the acute form, has been classed under it, which, though not correct as to fact, is perfectly so as respects treatment, which is analogous in all conditions not attended with inflammatory fever. In chronic rheumatism, the inflammation and the pain are both confined to the locality or part, and the object of the treatment is to allay that pain by reducing the inflamed condition of the muscle or member. This is effected either by internal remedies, or what are called constitutional means, or through friction, by producing counter-irritation, or an artificial inflammation in the parts of the body immediately above the suffering place; or else by a judicious blending of the two modes of practice.

When the fever, or the acute stage has been subdued by the means already mentioned, and a part of the body remains swollen and tender, or when in old cases this condition comes on without other symptoms, the following mixture is to be given, and the part carefully guarded from the cold.

Take of

Solution of Acetate of Ammonia 2 ounces.
Wine of Colchicum ½ ounce.
Syrup of Saffron 2 drachms.
Camphor Water 3½ ounces.

Mix, and give a table-spoonful every three hours, and one of
the following pills every night an hour before bed-time.

Take of

Ipecacuanha 3 grains.
Acetate of Morphia 1 grain.
Liquorice Powder 10 grains.

Mix well, form into a mass with conserve, and divide into six
pills.

When the health is debilitated, and the appetite defective, a grain of quinine made into a pill may be taken an hour before each meal for a succession of days. If this course is not marked with early benefit, it will be necessary to employ friction, which may be carried on concurrently with the medicine, and the best agent for this purpose is the camphorated oil, which is to be rubbed gently but steadily in with the hand for several minutes three times a day, after a few days, or in old standing rheumatisms, increasing the strength at first by adding a third part of turpentine to the camphorated oil, and finally another third of spirits of hartshorn. Mustard plasters and even blisters are sometimes employed in cases of inveterate rheumatism, but the steady and judicious use of a stimulating embrocation with a hot bath, friction with the flesh-brush, warm clothing and exercise, will in almost every case cure a chronic rheumatism without the necessity of either rubifacient or blister.

TIC-DOULOUREUX.

This extremely painful affection of the nerves of the face, though receiving a special name, is in nothing different—except in the more acute violence of its pain—from the general or local forms of neuralgia; an inflamed or highly sensitive condition of a certain nerve or set of nerves, the result of constitutional disturbance, indigestion, or wounds in the course of one or other of the filaments of the nerves, being both the exciting cause and the disease itself. The causes that most frequently produce tic-douloureux, are almost always some long standing functional derangement of the digestive organs, affections of the liver or of the kidneys, or alimentary canal. Next in frequency to these causes, is exposure to long-sustained fatigue or sudden heat or cold, applied to the body, and sometimes sleeping in the sun. Tic-douloureux has been frequently known to follow a halt, during a long march in India, and like tetanus too, tic-douloureux sometimes supervenes upon wounds; and years after the injury, whether punctured, gunshot, or incised, has been healed, this agonising disease will break out upon any sudden application of heat or cold to the body, or indeed after any deep emotion of the mind. Whatever may be the predisposing cause, the suffering and consequences induced bear no proportion in their intensity to the insignificance of the agents that give rise to the disease.

The _symptoms_ of tic-douloureux commence with a sudden plunging throbbing pain, darting as it were from over the eye, out of the cheekbone, under the orbit, or from the side of the lower jaw, and spreading, if the paroxysms are long continued, over the whole of one side of the face from forehead to chin. The pain is so abrupt, peculiar, and intense, as almost to deprive the sufferer of breath in its first assault. These shooting, throbbing, and as they are justly called, agonizing pains continue for an uncertain time, from only a few minutes to one or more hours in duration, subsiding either by degrees or by an instant cessation of pain, and ending as abruptly as the first shock began. Tic-douloureux is distinguished from tooth-ache by the situation, and from rheumatism, the only other affection it can be confounded with, by the peculiarity and violence of the pain, the shortness of its duration, by always coming on in paroxysms, and by the absence of all swelling and redness over the part. A peculiarity of this disease is, that though sometimes induced by the slightest touch of the finger, or the faintest breath of cold air, at another time the part may be slapped or rubbed with impunity.

_Treatment._—This consists, in the first instance, acting on the digestive organs, correcting the functional disturbance, and lastly by elevating the tone of the system, and enabling it to restore the irritated nerves to a pristine soundness, or if this cannot be done by constitutional means, by the employment of _local_ remedies for that purpose. First, the best mode of acting on the digestive organs is by the steady employment of gentle aperients, care being taken to avoid any active or drastic purgative. For this purpose, a five grain compound rhubarb pill should be taken every night for several days till the bowels are brought into a healthy state, or a pill composed of equal parts of the compound rhubarb and colocynth pill may be substituted, where a little more active medicine is needed, the nightly dose being the same in this as the former. Secondly, to correct the functional disturbance, if, as most frequently, the result of indigestion, two table-spoonfuls of the following mixture are to be taken every four or six hours.

Take of

Hops 2 drachms.
Cascarilla, bruised 1 drachm.
Cloves, bruised 2 drachms.

Infuse in a pint of boiling water for twelve hours; add

Carbonate of Potass 2 drachms.

Dissolve, and strain for use. Or where the stomach is cold and
weak, as in advanced life, let the patient take a tea-spoonful
of _Gregory’s powder_ in a little peppermint water twice or
three times a day. Thirdly, to elevate the tone of the system,
the body must be braced by tonics, which may be effected by
either of the two following forms of medicine.

Take of

Carbonate of Iron 2 drachms.
Sulphate of Quinine 18 grains.

Mix, and divide into six powders, one to be taken three times a
day; or, take of

Infusion of Quassia 8 ounces.
Quinine 1 scruple.
Diluted Sulphuric Acid 30 drops.

Dissolve; two table-spoonfuls to be taken three times a day.
Accompanying the tonic course, the patient should take several
glasses of wine during the day, or else an equivalent of the
best stout, and should live on a liberal dietary, taking as
much exercise as is compatible with age and strength.