from disease, by the wheezing, and by the peculiar sense of suffocation. It is seldom too that asthma is attended by those pyrexial or febrile accompaniments that are found in truly inflammatory affections of the chest. Prognosis. Generally unfavorable, when confirmed; when it takes place in young persons, and is traceable to obvious causes, a recovery may be expected. Its fatal termination is, for the most part, by the induction of other diseases, such as organic affections of the heart, and hydrothorax. Sometimes, indeed, positive inflammation of the lungs will be the consequence of asthma. Treatment. In habits of much plethora and high action, blood-letting is required in the paroxysm; in taking away blood, however, we must recollect the spasmodic nature of the disorder, and its tendency to terminate in hydrothorax. Antispasmodics are often freely admissible, and combinations of these with anodynes prove useful. Assafoetida glysters may be thrown up the rectum. R Spiritûs ætheris sulphurici compositi f. 3j. Tincturæ opii mvj. Mistura camphoræ f. 3ifs. Fiat haustus. Take of compound spirit of sulphuric ether a fluid drachm, tincture of opium six minims, camphorated mixture a fluid ounce and a half. Make them into a draught. One of the most powerful agents, as adapted to the circumstance of asthma, is the stramo Take of ammoniacal mixture and water of each six fluid drachms, tincture of squill ten minims, syrup of tolu one fluid drachm. Make them into a draught. The application of a blister to the chest is often highly useful. The bowels must be briskly acted on with the warm and aromatic purgatives; and both in the treatment and the prevention of asthma, but more especially in the latter, the state of the stomach, and first passage, must be sedulously attended to. Dr. Bree treats asthma as a stomach disorder; he cautiously confines the diet to easily digested materials, and gives carbonate of steel, soda, &c., to strengthen the fibres of the stomach, correct the acid fermenta tion, and alter the internal secretions. In this view, also, he recommends small doses of the mineral acids. Warm clothing is always necessary in asthma. Coffee is sometimes found to abate the violence of the disorder. Regular exercise, both of walking and horseback, should be enjoined: an assiduous care should be taken not to check perspiration. Change of air is often desirable; but there is great irregularity, and often inexplicably so, with regard to the appropriate kind of air for asthmatics; some being benefited by a warm, others by a cold atmosphere; some breathing best in a humid, some in a dry situation; some courting the vivifying air of an open country, others loving rather the smoky atmosphere of a large city. Issues are occasionally of service to old asthmas; and some are in the practice of giving an emetic just before the expected accession of the fit. 399. Difficulty of Breathing. Dyspnoea.Dyspnea is rather a symptom of other diseases than in itself a malady of a specific kind. Asthmatic and other impediments to free respiration are often obscure in their rationale; sometimes there seems to be a sort of spasmodic stricture in the bronchial cells, without inflammatory action on the one hand, or effusion of lymph, or mucus, or matter, on the other hand; and then the true spasmodic asthma is present; at other times the secretion or effusion is temporary, and the pituitous asthma is formed; then again it is permanent, and permanent difficulty of breathing, or dyspnoea, is produced. This dyspnoea may, indeed, be occasioned by other causes of a more extensive nature, such as adeps pressing upon the bronchiæ, or mal-conformation of the thoracic cavity; in the one case the remedy is obvious, in the other it must be obvious there is no remedy. 400. Whooping cough. Pertussis. Symptoms.-Whooping-cough often exists with very little more than ordinary catarrhal symptoms for two or three weeks; the breathing, however, will generally be found to be more difficult and obstructed than in common cough; at length the whooping sound is heard, which is occasioned by the air rushing through the glottis with unusual force and rapidity, to make up, as it were, for the convulsive and frequently recurring expirations. After the fit or fits are over, a considerable quantity of mucus is brought up, by which the little patient is relieved from his distressing and suffocative sensations, and he returns to his play as if nothing had happened or was again to happen. Vomiting frequently terminates a violent paroxysm, and then, for the most part, the subject of the disorder expresses a great desire for food. But the peculiarity of the complaint is certainly this, that in the intervals of the fits there are no relics of the disorder, until, by the protraction of the malady, the individual becomes worn down, or bronchial inflammation, of a permanent kind, has taken place of the mere spasin by which, in the first instance, the distemper seems to be constituted. Causes.-Specific contagion. Whether it may arise spontaneously, or whether, under epidemic peculiarities of the atmosphere, it may be made to supervene upon common catarrh, is a doubtful and disputed point. Its proximate cause seems, as just intimated, to consist of spasm in the first instance, and congestion and inflammation in the course of time. Distinctions.-The distinguishing peculiarities of the affection are the whooping noise, the complete cessation of the distressing feelings in the intervals of the fits, and the paroxysms ending in vomiting. Prognosis. When the disorder occurs after the child has got through dentition, when the strength seems but little impaired, and the tendency to pulmonary inflammation does not manifest itself, expectations of thorough recovery are well founded. The unfavorable concomitants are, early infancy, much appearance of pulmonary congestion; and the occurrence of convulsions; indeed, the bias of the disorder is often towards head affection in young children. Treatment.—If inflammatory or congestive appearances manifest themselves, put leeches upon the chest or head. Give emetics of ipecacuan and antimony combined; let the bowels be kept free; meet the pyrexial irritation by saline diaphoretics, and the supersaturated liquor ammoniæ acetatis (that is, supersaturated with ammonia), should there be much appearance of sinking. Give hyoscyamus, and conium, and digitalis, and prussic acid, in conjunction or separately, when the cough seems purely spasmodic; occasionally change these from one to the other. When there is much difficulty of expectoration, add a little of the wine of ipecacuan, and the oxymel of squills, to the above antispasmodies. Correct the stomach acidities by carbonated soda or potass. A popular remedy for whooping-cough consists of salt of tartar and cochineal, and it is said to be very efficacious. Apply blisters to the chest, or the tartarite of antimony ointment, with opium. Rub the chest and neck with diluted tincture of cantharides; give small doses of this internally; and when the violence of the disorder is abated, debility only remaining, give tonics, such as Peruvian or Cascarilla bark, or small doses of the liquor arsenicalis. Above all, change of air, which is magically operative in whooping cough, in cases of protracted convalescence, and indeed, it sometimes will prove abundantly beneficial, even during the height and violence of the complaint. 401. Water-brash. Pyrosis. Symptoms.-The fits of water-brash generally recur in the morning: there is sometimes an accompanying sensation, as if the stomach were drawn down towards the back. For the most part, as stated in the definition, the discharge is watery and thin, but it is sometimes glutinous and ropy. The pain is generally increased by an erect position of the body, which occasions the subject of the disorder to stoop forward. Causes. It appears to be a peculiar spasm of the stomach, affecting the secretions of the organ; it is sometimes brought on by poverty of diet, and mental anxiety. The lower classes of people, who live much upon food of a farinaceous kind, are very obnoxious to it. It often continues by habit for a long time. Treatment.-Antispasmodics and absorbents; a plaster composed of equal parts of the emVOL. XIV. plastrum opii and emplastrum cumini to the epigastrium; the subnitrate of bismuth. R Bismuthi subnitratis gr. vj. Pulveris rhei, gr. iij. Tragacanthæ, If. Fiat pulvis; bis terve in die sumendus. Take of the white oxide of bismuth six grains, of powdered rhubarb three grains, of gum tragacanth ten grains. Make them into a powder, to be taken three times a day. The nux vomica may be tried in doses of five or six grains. Eggs boiled hard, and eaten pretty freely, have put a stop to obstinate pyrosis. The smoking or chewing of tobacco will likewise occasionally subdue it. 402. Colic. Colica. Abdominal pain with a sense of twisting, especially about the navel; vomiting; constipated bowel. It is produced, first by spasm, second by the poison of lead, in which case we have what is called the painter's colic, marked by a gradual accession of the severer symptoms, with pains in the arms and back, the arms eventually become paralysed; third, by protracted costiveness; fourth, by acrid ingesta; fifth, by retention of the meconium in infants; sixth, by stricture in some part of the intestinal canal, occasioning windy collections and eructations; and seventh, by calculous concretions in the bowels. Distinctions. From enteritis, by the absence of pyrexia, by pressure in inflammation increasing, while in colicky spasm it sometimes diminishes pain, and by the irregular contraction in the abdominal muscles which has place in colic. Prognosis.-Favorable when the pain remits or changes its situation; when there is a discharge of wind and fæces, followed by an abatement o symptoms. Unfavorable symptoms are violen fixed pain; obstinate costiveness; sudden cessation of the pain followed by more frequent hiccough, great watchfulness, delirium, syncope, cold sweats, weak tremulous pulse, the pulse becoming hard, and the pain, before relieved, now becoming increased by pressure; in fact, all the symptoms indicating the supervention of inflammation. Treatment. To be directed, of course, to its exciting cause. Sometimes it is necessary to have immediate recourse to powerful antispasmodics, whatever shall have been the source of the disorder. Warm fomentations are always admissible, and for the most part conspicuously serviceable; the warm bath; and when we wish for evacuations, and fail in producing them, dashing cold water upon the legs and abdomen, or causing the patient to stand with his naked feet on cold marble, will sometimes relax the spasm which thus obstinately retains the fæces. Give the croton oil, in doses of two or three drops, when common purgatives fail; rub the abdomen all over with castor oil; give large doses of castor oil internally, when the stomach will bear it. This last is especially applicable in the colica pictonum, which requires also small doses of calomel and opium combined, given for some time. Warm bathing is exceedingly useful in colica pictonum; and in its chronic state, when little besides the paralysis of the arms remains, the use of the Bath waters proves of unequivocal efficacy. M In all cases of colic we should carefully watch the coming on of inflammatory symptoms; and it is partly because inflammation is so easily induced that we must, while using our antispasmodics freely, take especial care that we do not lock up fæcal, or calculous, or any other matter in the intestinal passages. The opiate confection is one of the best forms of administering opium in colicky pains; it is not so constringing as other preparations of this medicine, and its constipating tendency may be guarded against by tincture of rhubarb. Its dose may be a scruple. The opiate confection deserves to be in more frequent use than it is in the general practice of medicine. We have been principally indebted to Dr. Uwins and Dr. Hooper for the three or four last sections, having done very little more than add a few remarks on their histories and descriptions, and given a translation of their recipes. The two following sections on colica pictonum and worms we extract unaltered from Dr. Hooper's Vade Mecum. 403. Of the colica pictonum.-The colic induced by lead, is more obstinate, and longer protracted, than the same disease brought on from common causes; and frequently terminates in paralysis of the wrists and upper extremities. Treatment.-Oleum ricini, often repeated, is most effectual in procuring stools, and, with fomentations and warm bath, generally removes the disorder in a few days; afterwards mercury united with opium, to excite slight salivation; alum; electricity; chalybeate and sulphureous waters; sinapis. R Hydrargyri submuriatis gr. 4. Take of calomel a quarter of a grain, opium half a grain, conserve of roses enough to form a pill, to be taken three times a day. R Hydrargyri submuriatis gr. 4. Fiat pilula; ter in die capienda. Take of calomel a quarter of a grain, precipitate sulphuret of antimony half a grain, opiate confection five grains. Make them into a pill, to be taken three times a day. R Aluminis purificati 9fs. Fiat haustus; ter in die sumendus. Take of purified alum ten grains, infusion of roses twelve fluid drachms, syrup of the same one fluid drachm. Make them into a draught, to be taken three times a day. Colica pictonum is often productive of inflammation of the bowels and peritoneum, when the warm bath, general and local blood-letting, must be had recourse to. WORMS. The human primæ viæ are infested by five kinds of worms. 1. Ascaris vermicularis: the small white thread or maw-worm, 2. Ascaris lumbricoides: the lumbricus teres, or long round worm. 3. Trichuris; the long hair-tailed thread-worm. 4. Tania osculis marginalibus: the solium, or tape-worm. 5. Tania osculis superficialibus: the broad tape-worm. The ascarides have usually their seat in the rectum; the lumbrici occupy the small intestines, and sometimes the stomach; the trichurides the cacum; the tænia the whole tract of the intestines, more especially the ileum. Worms mostly produce symptoms of colic, and very frequently other symptoms, as variable appetite; fœtid breath; picking of the nose; hardness and fulness of the belly; sensation of heat and itching in the anus; preternaturally red tongue, or alternately clean and covered with a white slimy mucus; grinding of the teeth during sleep; short dry cough; frequent slimy stools; emaciation; slow fever, with an evening exacerbation; irregular pulse; sometimes convulsion-fits. Worms appear more frequently in those of a relaxed habit; those whose bowels contain a preternatural quantity of mucus or slimy matter; in those who live on vegetable food; in the dyspeptic; the eating of unripe fruit is a frequent cause of their production. They are evolved from ovula that exist in the human body, and in no other situation. For further information on this subject, consult An Attempt to an Arrangement of human intestinal Worms, published by the author in the fifth volume of the Memoirs of the London Medical Society. Of colica verminosa.-1. The most esteemed remedies against ascarides and trichurides are purgatives of the submuriate of mercury, scammony, aloes, rhubarb, spigelia, cowage, tin; also assafoetida, lime-water, tobacco. R Hydrargyri submuriatis gr. ij-vj. Fiat pulvis ex melle sumendus. Take of calomel from two to six grains, powder of rhubarb twenty grains. Make into a powder to be taken with honey. Take of tobacco leaves half a drachm, boiling water ten fluid drachms. Digest, and when the liquor is cold let it be injected into the rectum. R Limaturæ stanni f. 3j. Fiat electuarium molle, de quo sumatur cochleare unum minimum quovis mane. Take of filings of tin an ounce, lenitive electuary three ounces, syrup of ginger as much as necessary to make a soft electuary, of which a tea spoonful may be taken every morning. Take of camphor a drachm, olive oil two fluid ounces. Rub them together so as to dissolve the camphor, and let the solution be employed as an enema in case of violent itching at the anus. A decoction of the geoffræa inermis, or cabbage-bark, is a remedy much used, according to Dr. Wright, in the West Indies. 2. Against the tæniæ most of the drastic purges before prescribed have been resorted to. Madame Noufer's remedy is occasionally used with success. She directs as follows: The day before the patient is to take the remedy he is to avoid all aliment after dinner, till about seven or eight o'clock at night, when he is to take a soup made thus: Take a pint and a half of water, two or three ounces of good fresh butter, and two ounces of bread cut in slices; add to this salt enough to season it, and then boil it over the fire to the consistence of panada. About a quarter of an hour after this, she gives him a biscuit and a glass of white wine, either pure or mixed with water; she even gives water alone to those who have not been accustomed to wine. If the patient has not been to stool that day, or is naturally costive (which is not usual, however, with patients in this way), Madame Noufer directs the use of a clyster. Take a handful of the leaves of mallows, and boil them in a sufficient quantity of water, mixing with it a little salt, and, when strained off, add two ounces of oil. Early the next morning, about eight or nine hours after the supper, the patient takes the following specific: Take two or three drachms of the male fern, gathered in autumn, and reduced to a very fine powder, in four or six ounces of water distilled from fern, or the flowers of the lime-tree. It will be right for the patient to drink two or three times of the same water, rinsing his glass with it, so that none of the powder may remain either in the glass or his mouth in bed; and, to avoid the nausea which this medicine sometimes occasions, he should chew lemon, or something else that is agreeable to him, or he may wash his mouth with whatever he likes, but he must be careful not to swallow any thing. He may likewise smell to vinegar, to check the sickness; but if, notwithstanding all his efforts, the nausea continues, and he is obliged to throw up the specific, it will be right for him to take a fresh dose of it as soon as the sickness is gone off, and then he should try to go to sleep. About two hours after this he must get up, and take the following: : Take of the panacea of mercury fourteen times sublimed, and select resin of scammony, each ten grains, of fresh and good gamboge six or seven grains. Reduce each of these substances separately into a powder, and mix them with some conserve into a bolus. This is to be taken at one or two different times, washing it down with one or two dishes of weak green tea, the patient walking afterwards about his chamber. When the bolus begins to operate, the patient is desired to take a dish of the same tea occasionally, until the worm is expelled; then, and not before, Madame Noufer gives him broth or soup, and he is directed to dine as is usual after taking physic. After dinner he may either lie down or walk out, taking care to conduct himself discreetly, to eat little supper, and to avoid every thing that is not of easy digestion. The panacea of mercury is the submuriate; and the male fern is the polypodium filix mas of Linnæus, and aspidium filix mas of Smith. 4. Turpentine has been given in some cases with success. In the year 1795 a letter was put into the hands of the author, from a medical gentleman in the East Indies, which contained an account of a large dose of the oil of turpentine having been swallowed by mistake, and which brought away several worms. In consequence of this, the oleum terebinthinæ was administered as an anthelmintic in the dose of from one drachm to an ounce to several patients with taniæ; the result was equally uncertain with other purgatives. Of late its use has become more general. The best way to give it is mingled with syrup, and to direct the patient to take some gruel, arrow-root, or sago, after it. It produces a slight vertigo, and a sense of warmth and heat in the esophagus and stomach, like to that produced by a glass of brandy; but these are very transient. Three or four evacuations are mostly produced by half an ounce. 405. Cholera. Vomiting and purging. Symptoms.-The characteristic symptom of this sometimes very severe malady is the combination of vomiting and purging of bilious matter, and when the disorder is violent there is extreme sinking and painful feeling about the epigastrium, with spasms of the legs as mentioned in the definition; very great exhaustion of powers; hurried fluttering pulse, heat, thirst, and oppressed respiration. When the attacks are made with malignant violence, a fatal termination is sometimes the consequence, and that within twenty-four hours from the first occurrence of the sickness. In this case death is preceded by cold clammy sweats, very great irregularity in the pulse, and very violent cramps in the legs; hiccough, too, for the most part, precedes death. Causes. This is a disorder of the autumnal season, and seems to be occasioned by an acrimony of the bile produced by the combination of heat and moisture, connected in its manifestation with the cold, which, in the autumnal season, often quickly succeeds to heat, and tends to increase the disposition to the internal direction of the secretions, by obstructing the vessels on the surface of the body, or interrupting the irregularity of cutaneous discharge. The autumnal fruits have been supposed to be one main cause of the disorder appearing in the autumnal season; and, as far as these are difficult of digestion (plumbs and cherries in particular), there may be some justice in the allegation; but we very often find persons who never taste fruit the subjects of these violent bilious attacks; and it should seem, as above intimated, that the malady is rather referrible to sudden changes in atmospheric temperature, to cold and damp nights succeeding to hot days, and probably to some sort of specific influence that this combination of heat, and cold, and moisture, may have upon the biliary secretion, in increasing its quantity and imparting to it acrimony. In the tropical climates cholera shows itself with a force and malignity of which we in this latitude know nothing but by history; and this circumstance is in favor of the principle we now intimate as the most probable one to which its source may be attributed. Distinctions.-Diarrhoea often occurs with some violence from the mere acrimony and overflow of the bile, but if the discharges are not accompanied by vomiting the disorder is without the essential of cholera morbus. In colic, too, and other enteric affections, there is often on the other hand considerable vomiting, but then the bowels are costive, and the disease therefore is different from cholera. Prognosis. When the oppression and exhaustion are extreme we may anticipate an unfavorable termination. In this country, however, the disorder does not, as above stated, in the general way put on so much malignity of character and aspect, and if the interference of art be prompt and judicious, the malady usually terminates speedily and favorably. Treatment.-We are for the most part told by authors that a great deal of diluent drink should be thrown into the stomach, such as barley water, thin water gruel, and linseed tea, in order to lessen the acrimony of the bile, or sheath the coats of the stomach against its morbid influence. We are a little doubtful, however, with regard to the theory upon which the stomach is thus ordered to be drenched, and in the general way should avoid the practice. Opium should be speedily given, and, if the stomach is too irritable to bear it, enemas may be administered of starch in which there is a considerable dose of tincture of opium. The cholera which we meet with in this country will be usually controlled by a grain of opium and a grain of calomel given in the form of a pill; and, whether it is on account of the specific influence which the calomel as mercury has upon the liver, or from any other cause, certain it is that its combination with opium will often occasion the latter to stay on the stomach and assist in subduing the violence of the vomiting. Five grains of blue pill, with a grain, or half a grain, of opium, may be em- . ployed with the same intention and effect. A small draught, in which from ten grains to a scruple of opiate confection is rubbed down with some mint water, will sometimes be received by the stomach in spite of its irritability. Warmth applied externally, in the way of fomentation, to the epigastrium and abdomen generally, will often prove very serviceable, and sometimes the discharge of bile will be checked by the application of a blister either to the epigastrium or the back. The external application of a liniment, in which tincture of opium is mixed, as in the following formula, may also be advisable in these and some other cases of irritable stomach; indeed, external applications are not perhaps used and appreciated to the extent they deserve. R Linim. camphoræ comp. f. 3i. Fiat linim. in ventriculi regionem fricatione sæpe applicandum parvâ quantitate. Take of compound camphor liniment a fluid ounce and a half, tincture of opium two fluid drachms. Make them into a liniment; a small quantity of which is to be rubbed on the stomach frequently. When the extreme irritability of the stomach has somewhat abated, and from the first in ordinary cases, tincture of rhubarb may be administered in small quantities. The following formula will be found, in many cases of sickness which should hardly amount to the violence of cholera, to be exceedingly beneficial; indeed, we have passed season after season, and have had public establishments to take care of, without the necessity of much more in the way of an immediate medicinal for ventricular complaints of the kind now referred to. R Tinct. rhei f. 3iij. |