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INDEX OF DISEASES.

CONTENTS OF THE CHEST.

DIRECTIONS, &c.

      1. CASTOR OIL. — Is generally prefered in colics from the gentleness of its operation on the bowels; but although very useful on this account, it is too slow in its operation to procure speedy relief. From one table spoon to half a wine glass full, is a dose; and the best method of taking it, is to rinse the glass, cup or spoon previously with a little spirit of some sort or other. In fluxes, attended with much griping it is occasionally preferable to other purgatives; but since it has no other effect, than to unload the bowels, and since in this disease as well as in the above, there is generaly an abundance of vitiated bile, one half dose or a full dose of No. 24 should be mixed with one table spoon full of it, and then it should be taken instantly, lest the white powder should sink to the bottom and hang about the patients teeth instead of getting into the stomach,

      If loathed at stomach, or producing sickness, the doses will have to be lessened; or a few drops of No. 15, must be added to each dose. If it proves purgative, a few drops of No 20. may be mixed with each dose; and if costiveness is the effect produced by it, it may be removed by one fourth of a dose at a time of No. 25, or by the addition of half a tea spoonful of No. 6, with each dose of bark.

      Whenever patients complain of a higher degree of headach during its employment or continue unwell, without being able to express their feelings that indispose them; or when their tongue, which previously moist and white, becomes dry and their skin feverish and parched, this generally useful medicine must be set aside; until another purge has prepared the system to bear better of being strengthed by it.

      Periodical head achs, or such pains as come on at a particular time every day; or on every other day, may be treated with a vomit; and afterwards during the absence of pain, with bark.

      In the convalescence from severe fits of illness, bark may also be used to great advantage

      The easiest method of taking bark is with sweet milk; next to that with cold and strong coffee, and occasionally with wine, though water is the more generally employed vehicle to convey it into the Stomach.

      5. FLOUR OF SULPHUR. — One table spoon full mixed with an equal quantity of hogs lard is an efficacious itch ointment. One tea spoon full with as much of No. 6, furnishes with molasses an easy opening medicine, particularly applicable in piles; and when plentifully of some thin and warm liquid is drank after it at night, it frequently sweats off a recent cold.

      6. CREAM OF TARTAR. — One tea spoon full with the same quantity of No. 5, mixed with molasses and taken every night, is a justly reputed medicine to relieve the distressing uneasiness, that in an affection of the piles proceeds from costiveness. It is independently of its opening quality, cooling and quenches thirst; and hence it forms a most palatable drink in fevers, called imperial drink; to prepare it half a gallon of boiling water is to be poured into a pitcher over one table spoon full of cream of tartar, the peal of half a lemon and a quarter of a pound of loaf sugar. The whole is to be well stirred, and when cool the clear liquor is to be drank at pleasure. When put up into bottles well corked and kept a few days, a degree of fermentation takes place in it, by which it is very much assimilated to the sparkling appearance and lively taste of Champaign.

      Cream of tartar in the quantity of one small table spoon full to a dose of No. 37, improves its taste and its cooling and purgative effects. When drank with water alone, it abates very much the irritation of prickly heat and other rashes, to which persons in full health are subject in warm weather.

      8. ANTIMONIAL WINE. — Two table spoons full are a dose to produce full vomiting, but from the combination of several reasons this wine is not the most eligible medicine for this purpose. It is, more generally employed during the hot stage of fever in doses of 20, 30, 40 or 60 drops repeated from every half hour to every two hours mixed wnh a little water or combined with the saline draught. (See No. 10) In either way it has the effect to diminish the heat and force, of fever in agues and in remittents, and to bring the fits to an earlier termination by sweating. The first intention to produce this effect is to excite a little squeamishness at stomach, and when this is produced, the doses ought to be proportionally lessened or the intervals of time lengthened, so as not to produce vomiting unless particularly desirable.

      In the more malignant fevers of hot climates, attended with sickness at stomach and vomiting as a symtom, this remedy is not admissible; and to reduce the fever, the saline draughts alone should be trusted to if other more effectual remedies cannot be safely employed

      This mixture known by the name of saline mixture, is occasionally improved in its effects by the addition of a few drops of No. 8 or 20.

and small bolsters of lint being dipt into it, are to be pressed upon thd bleeding part, at first with the fingers and when the bleeding has stopped, with a circularly winding bandage, Care must be taken not to disturb this dressing for three or four days, lest the removal of the clod of congealed blood underneath it, should bring on a second bleeding. It must be understood however, that this method, though effectual in the suppression of small hemorrhages is not calculated to stop the bleeding from a large artery, in which the tourniquet (See No. 44) ought to be applied, until professional assistance can be obtained; nor is it admissible in gunshot wounds, or in wounds much torn or bruised, which from their particular nature are apt to inflame considerably, and could besides that not bear the tight pressure as above recommended.

      Proud flesh rising occasionally in ulcers, much above the edge of the skin, and the hardened, elevated and dry edges of some ulcers are destroyed by touching them, or by rubbing them gently with a piece of blue stone. Warts also on the penis are destroyed in the same manner.

      One tea spoon full of No. 20, is occasionally added to one pint of lead water, to lessen excessively painful inflammation, and three or four table spoons full of No. 7, is a useful addition in extensive bruises, sprains and inflammation, from the 5th, 6th or 7th day of the injury.

      13. SPANISH FLIES. — A blister ought in general cases not to be less than six inches by four, when intended for the ancles or wrists of half or quarter that size, and when used behind the ears or upon the temples, of the size of a dollar. No. 32 is to be spread upon a piece of sheep skin or cartridge paper; and as many of the flies are strewed over it, as can be made by pressure of the thumbs to stick to the ointment. The place to be blistered, should be previously well rubbed or bathed with hot vinegar, until the skin begins to redden; and if the plaister should have failed to draw well, a new one must be immediately applied upon the same spot. Blisters are best applied over night, and in the morning when well drawn, the lower part of them should be nipped with a pair of scissars or punctured with a needle, and the dead skin if possible, should for the first few

days be preserved. A collard leaf, a dry rag, or a rag moistened with oil, should be laid over it, and the greatest cleanliness being necessary to prevent a blister from degenerating into a foul sore, it should be bathed once or twice a day with cold water or with lead water. When greatly inflamed a few days afterwards, they must be poulticed, and healed with No. 31.

      Blisters give rarely if ever, relief from pain and internal inflammation in the commencment of a disease attended with a full strong pulse, before the use of bleeding or purging, or of both.

      Scalding of the urine and an inability to void it, sometimes succeeds the employment of a blister; & this though a highly favorable sign in dangerous fevers requires occasionally linseed tea, or barley water with No. 9; and sometimes when there is a total suppression of urine, bleeding, purging with No. 37, and the warm bath cannot be dispensed with; but in general, this symtom goes off soon and by degrees.

      It is an excellent draught in all cases where No. 27, is recommended but it is rather more heating. The same precautions are therefore to be considered before it is employed. In slight colds, coughs excited by a tickling sensation at the upper part of the wind pipe, in difficulty of breathing and straightness of the chest from asthma, it is a highly valuable medicine Its effects as a sweating draught, are improved by the addition of 40 or 60 drops of No. 8.

stomach and bowels by air, this medicine gives speedy relief in doses of 20 or 30 drops upon a small lump of white sugar, and mixed with about one table spoon full of water or gin and water.

      The occurrence of a rash like eruption on the skin during the use of this medicine, requires a dose of No. 37 and an omission of the use of the drops for two or three days; when they may be again resumed without any apprehension of producing the same effect a second time.

      20. LAUDANUM. — Twenty-five or thirty drops with ten drops of No. 16 on a lump of loaf sugar and two table spoons full of water, is the handsomest method in which it can be exhibited as a draught to allay pain, restrain excessive vomiting or purging, and to procure sleep.

      In Spasms of the stomach and in cholera morbus, the patient may take 30 or 40 drops at first, and if in half an hour there are no prospects of relief, 15 drops more may be given every 15 or 20 minutes by the watch, until the object for which it was given is attained. This practice may appear bold, but without pushing it to the necessary extent, smaller quantities would rather aggravate than relieve the violence of the complaint; and it is here thought proper to remark, that although, no correct bounds can, in these cases be prescribed, it is seriously recommended not to trifle with it, and to give it in every instance of indisposition where pain and restlessness impresses the idea of giving relief by this remedy, instead of seeking it by the use of the lancet or of purgative medicines.

      In obstinate agues, that have resisted the bark, or who from their recurrence every day, leave so small an interval of time, as not to allow the use of that medicine in sufficient quantity to check it, a dose of laudanum given an hour before the fit has been expected, has entirely suspended it and given an opportunity for the use of the bark to cure the disease.

      From two to five drops of laudauum with each dose of bark are necessary if it runs off by purging.

      Laudanum always produces costiveness; and should therefore be guarded against; either before or after it has been taken, by some gentle laxative medicine.

      In fevers attended with full pulse, red face and eyes, dry skin and costiveness, it ought never to be given, as it would jeopardize the life of a patient by accumulating the diseased action on some part or other, necessary to the existence of life.

      Laudanum is used externally in the quantity of one tea spoon full occasionallv to one pint of lead water, or to 2 table spoons full of No. 19, to relieve excessive pain from irritation of inflamed parts.

      One tea spoon full rubbed in at the pit of the stomach, relieves excessive retching and sea-sickness; and 40 or 60 drops with a tea cup full of water is an admirable clyster in profuse purging, and in a retention of Urine, that may threaten the patients life.

      This medicine as an emetic is inadmissible in cases where there exists a disposition towards spitting of blood, or of a great fulness of the head, indicated by redness of the eyes and flushed face, with an apparent enlargement of the features. Persons also who are subject to be cramped at stomach should be cautious; and to vomit easier they ought to drink plentifully of weak camomile tea. Ruptured persons ought never to venture upon vomits at all.

      From three to five stools are generally procured from the exhibition of one dose; and if the continuance of high fever, a dark or blackish appearance of the excrements, and a sensation of a burning heat at the fundament at the time of voiding them, indicate a pre-ternatural sharpness or superabundance of bile, the repetition of a purge of No. 39, and 37, will in the generality of cases best answer on the next day.

      24. CALOMEL PURGES. — The same observations that have been made on No. 23, will apply to this medicine, and in highly bilious fevers, where the stomach does not retain No. 23, it will be required to repeat one of these doses every eight hours, until an effect is produced on the bowels. In some instances of indisposition, where a purge may be deemed necessary, a dose of either No. 23 or of this medicine has no effect at all, or a very trifling one on the bowels; and to prevent the inconvenience of a sore mouth which sometimes follows, a dose of No. 37 should be taken to work it off. It is on this account, in part, that Calomel with Jalap or with Rheubarb, should be given in preference to Calomel simply, in common cases, with the exceptions mentioned above in malignant fever; and in which the occurrence of a sore mouth ought frequently to be esteemed the lesser of two impending evils.

      Two thirds of a dose of this medicine, added to a dose of No. 25, is equal in strength and effect to a dose of No. 23, and in many instances is preferable, as it neither nauseates so much or leaves that degree of weakness of the stomach when done operating, that No. 23 does; but it has this disadvantage, that it operates not quite so quickly.

      25. RHEUBARB. — Is by itself, or when combined with half a dose or a full dose of No. 24, an eligible purge in lax-bowels and in dyssentery.[sic]

      In weakly persons with delicate digestive powers, a dose of Rheubarb mixed with half a teaspoon full of No. 6, is a gentle laxative.

six times daily. An injection ought not to be strong enough to produce smarting; and if this effect is perceived, particularly in the first few days of a clap, it should be weakened with water.

      32. BLISTERING OINTMENT. — Is to be spread pretty thickly on leather or on cartridge paper as a sort of paste to retain a quantity of No. 13, for the purpose of blistering.

      33. MERCURIAL OINTMENT. — The size of a nutmeg may be rubbed on the inside of the thighs every other night, if it is intended to produce salivation, as for example in chancre and buboe. For the management of salivation see No. 36.

      In malignant or yellow fever, where this effect ought to take place in a much shorter space of time four or six times that quantity may be rubbed in at once and repeated twice every day on the inside of the thighs and legs, the top of the feet, the belly and sides, and on the innerside of the upper arms; and if blisters in this disease have been applied, they may be dressed with it.

      In sluggish sores of the leg of long standing without any appearance of alteration in them for either the better or the worse, this ointment, when used, as a dressing, is frequently curative.

      In the itch, tetter or ringworm and many other eruptions on the skin, it is frequently employed to advantage; and vermin of all kinds are quickly destroyed by it.

dull appetite, slight squeamishness, pain of the eye-balls, dull head ache, costiveness and sometimes slight fever. He gave three or four over night; and if by the ensuing morning they had not operated enough he directed two more. The benefit produced by them in this way has established their fame in Virginia; and it is conceived deservedly. In a higher grade of disease, or bilious fever when formed, they would as a matter of course be superceded by more active remedies.

      Persons subject to piles had better however taken No. 1 or some other purgative dose.,

      Where these pills absolutely disagree with the bowels, recourse must be had to No. 33 and the use of either of them must be regulated by the effect they produce: as soon for instance, as the patient when venereal becomes sensible of a coppery taste, or tenderness of the gums, the use of either of the pills or the ointment should be omitted for one or two days; and if the soreness by that time has not increased, they may again be resumed, but in so cautious a manner, that the patient shall not be seized with a violent salivation at once. They are to be steadily persevered in, often and long enough to keep up the soreness of the mouth for at least four weeks. During this time patients ought to keep themselves strictly confined and warmly clad; and their diet should consist chiefly of slops, milk, or vegetables; whereas, when recovering from the salivation, they may by degrees venture on a more generous diet, and some cordial drink.

violent strainings and in many complaints of minor consideration it is a valuable medicine.

      Salts when exhibited by itself is a cooling purge and to improve this effect, a small tablespoon-ful of No. 6 is often added.

      39. SENNA LEAVES. — As many as can be held between the four fingers and thumb of one hand with one tablespoon-ful of No. 37 may be put into half a pint of boiling water, and allowed to stand near the fire for half an hour. They are then to be strained, and of the clear liquot when cold, one half is to be taken immediately and the other half in two hours.

      This preparation known by the name of Bilepurge is one of the most easy and next to Calomel the most effectual purge to discharge bile from the bowels.

      42. GUM ARABIC. — Has the same properties with No. 38; and is more agreeable to the taste. The most pleasant way of using it is to take a piece into the mouth and to suck it down by degrees; or one tablespoon-ful may be dissolved in a quart or three pints of water for common drink. A piece of gum arabic equal in size to a nutmeg, when coarsely bruised and put into a vial of injection improves its soothing quality by sheathing the urinary passage.

      The first object in bleeding is to swell the vein by tying a fillet or bandage at about three or four fingers breadth above the bend of the right elbow. When this has been accomplished, and the pulse can be felt at the wrist, it is of a sufficient degree of tightness; whereas it ought to be tightened if the veins do not swell; and it ought to be slackened, if the pulse at the wrist cannot be felt.

      The arm of the patient is next to be extended in a streight direction, when the bleeder is to grasp the arm firmly with his left hand an inch or more below the place, he intends to introduce the lancet at; and pressing with his thumb firmly upon the vein, so as to steady it, he, with the blade of the lancet at an acute angle with the handle and held steady between his right thumb and fore finger, cuts into the vein — taking care not to dip the point directly downwards, but to introduce it obliquely upwards, and raise the point, so as to bring it through the skin. The point of the lancet, if thus managed, need not at an average be buried deeper than one eight of an inch below the skin.

      On withdrawing the lancet and his left hand, he is to support and steady the arm, until a sufficiency of blood (from three gils to one pint at an average) shall be drawn.

      He then unties the fillet, places a four doubled linen rag or lint upon the orifice, in such a manner, by stroking it from the inside of the arm outwards, as to bring the two lips of the little wound into close contact; and keeping it gently pressed upon the orifice with the thumb of his left hand, he passes the bandage.

      The most prominent vein will generally insure the best success, and in proportion, as it lies more towards the outerside of the arm, in that proportion it will be more safe, since it lies most remote from the artery. But the situation of this artery may be readily ascertained by pressing the fore finger of either hand immediately upon or along side of the vein, that is intended to be opened; and if a beating or pulse can be felt very near, or immediately underneath the vein, it will be better to choose another vein, though less large; and this trial, it is understood must be made before any pressure is applied bv the fillet above the elbow.

      If faintness should be expected, or actually takes place from bleeding, the person ought to be laid flat upon the back with his head low, which will soon restore him.

      There is no difficulty in stopping the blood, when the fillet has been removed; and if it should break out bleeding anew sometime after, it is most probably owing to too much pressure of the bandage, which must be applied rather looser the second time; but if this will not succeed, a small cushion of lint placed upon the wound and pressed

with the finger for sometime without the application of the bandage will in most instances stop it.

      An accident which frequently takes place in bleeding, is an immediate swelling around the orifice from the size of a hazelnut to the size of a pidgeons egg. It arises from a free discharge of blood from the vein which can not find its way out through the external orifice; and the blood therefore insinuates itself underneath the skin. It is owing either to a change of relative position between the two orifices from twisting the arm or from a rolling of the vein: or it is owing to a larger wound in the vein than has been made in the skin. In the first case bending the arm a little, or bringing it nearly into the same position in which it was when the lancet entered the vein favors the free discharge by the external wound. In the second case the further increase of the tumour is obviated by dexterously enlarging the orifice in the skin; but if from want of resolution or confidence, neither has been done immediately; or it is found when done, that it augments so rapidly as to excite apprehension, the fillet should immediately be removed from above the elbow, and the arm tied up as before directed.

      If bleeding is deemed indispensably necessary, it should be performed in he left arm, though less convenient; or if not very urgent it may be postponed for eight or twelve hours, and be repeated in the right arm upon any vein, not surrounded with the swelling. The application of a compress fequently wetted with lead water over the tumor or a fomentation of a little vinegar and water does soon disperse it without any ill consequenses arising from it.

      In internal bruises from severe hurts, in fevers, where head-ache general pain, full and flushed countenance, red and inflamed eyes, full and strong pulse with oppression about the breast, difficult breathing and much thirst indicate inflamatory action, the lancet ought to be unsheathed without delay as the surest weapon to defeat the violence of the disease at the onset. Repeated bleedings are often necessary in dry coughs, attended with fever and with stitches on fetching a deep breath, In convulsive fits, bleeding to a large quantity is often required, before the force of the spasms can be subdued; and in rheumatism, inflamed eyes, gun-shot wounds &c. it is frequently of the greatest service to put down, or to prevent a high degree of inflamation.

      Persons, who have resided several years in an unhealthy country and have been reduced by the diseases, incident to an unhealthy climate, fat people, and such persons as have passed the fortieth year of age, do not bear bleeding so well, as those of an opposite description.

      46. INJECTION PIPE AND BAG. — Two tablespoons-full of No. 1 and of No. 37 with three gills of warm water are, when dissolved to be put into the bag and the upper part of it tied up. The end of the cork string is to be left out; and when the pipe previously greased has been introduced its whole length into the fundament, and is steadied there, this cork string is to be pulled at; and when the cork has been disengaged, firm pressure is made upon the bag with the right hand whilst with the left, the pipe is steadied and supported in the fundament The person who receives the injection ought not at the time hold his breath or bear down, which would prevent the injection from passing freely into the intestine.

      They are highly recommendable in violent colics, and in pains and uneasiness that arise from costiveness in persons too much weakened to be freely purged. The failure of the effect calls for a repetition of the injection as often until stools are procured.

      Thinly boiled starch, or linseed tea, with No. 20 is the most effectual and preferable method of giving ease and of restraining immoderate

purging in persons who are affected with looseness, and who are not able to bear these evacuations from weakness; but in the first stage of bloody fluxes, the addition of No. 20 ought to be omitted in the injection.

      TREATMENT — Immediate and large blood-letting, (see No. 43.) purging freely with No 23. A cool birth, with head & shoulders pretty well elevated. An early repetition of bleeding or purging, if not recovering, if disposed to relapse, or if the pulse continues full and hard, and there remains palsy of some part of the body. Blisters next

into the neck; friction of the palsied parts with No. 19, and a continuation of purgatives are to be depended upon. Low and vegetable diet.

      SPITTING OF. — If the quantity lost has not reduced too much the pulse and strength of the patient, bleed, (see No. 43.) and give of No. 6 and No. 37, or of No. 37 with an addition of No. 15. If the pulse is weakened and a return of it is apprehended, a table spoonful of common salt, taken into the mouth dry, and swallowed, is to be immediately directed. The person is also to be kept cool, on low diet, and at rest.

      TREATMENT. — Give No. 23, apply warm poultices, and when ripe and opened, dress them with No. 30, and afterwards with No. 31.

      TREATMENT. — Keep the joint perfectly at rest until recovered; apply to it lead water, (see No. 12.) When pain, swelling or redness lessen, No. 7 may be added to it; and when on the recovery No. 7 by itself, and plentiful rubbing. For internal bruises see hurts and falls.

      CHARACTER. — Sudden and violent vomiting and purging of bilious matter with cramp, at first in the stomach and bowels, and afterwards extending to the calfs of the legs, great anxiety about the stomach and loss of strength.

      TREATMENT 1st. Immediate large draughts of weak camomile tea, (see No. 49.) of warm water, with well browned toasted bread soaked in it, weak warm chicken water, or water thickened a little with No. 42, or with starch or sago, are to be directed; and if the pulse is very full in the beginning and the pain excruciating, bleeding and a dose of No. 24.

      2ndly. When by these means a great quantity of bilious fluid has been discharged, and the vomiting continues, it is to be stopped by giving of No. 20 in a little warm grog, or in some hot and strong coffee by rubbing in at the stomach No. 19 combined with No. 20, by bathing the legs and feet in warm water, and by applying warm bricks or warm flannels, sprinkled with No. 7, to the stomach.

      The occurrence of cold sweats, and of cold feet and hands, with great weakness and a shrinking of the countenance, demands the greatest resolution and perseverance in adopting and pushing the second method of treatment at once, without encouraging any further vomiting by thin slops. — Refer to No. 23.

      To prevent the disorder from turning into inflammation of the bowels or bilious fever, the patient when recovering from the violence of the symptoms, is to be purged with half doses of No. 24, given every 6 or 8 hours; and in a few days afterwards, when the stomach and his strength will bear it, with No. 39 and No. 37. The occurrence of fever, with a quick and hard, though at the same time a small pulse, with a burning sensation at the stomach, requires the use of the lancet in addition to the above remedies.

      TREATMENT. — If accompanied with a rumbling noise and occasional belching, it is frequently relieved by No. 16 alone, or in conjunction with No. 20. If the pain is moderate, and costiveness has preceded it, one, two, or three injections, (see No. 46.) given one immediately after the other, and a dose of No. 1, are sufficient to remove it. But if the severity of the pain cannot be endured till the purging effect by these remedies is produced, a large dose of No. 20, and repeated in less quantity if necessary, must be had recourse to. And if the Colic arises from viscid bile, which it frequently does in warm climates, a table spoonful of No. 1, with a dose of No. 24, is the best calculated to remove it; and may be given an hour before or an hour after a sufficient quantity of No. 20 has been exhibited. If it should fail to purge off the bile in 12 or eighteen hours from the time it has been given No. 37 alone, or along with No. 39, should be administered; and injections (No. 46) should be persevered in. External warmth also, applied to the belly, is of great service.

      TREATMENT. — Bloodletting in sufficient quantity (see No. 43) to overcome the spasms at the time, and afterwards No. 23; followed up, if necessary, in a day or two by a repetition of the same or of No. 37; and sometimes, if head ache and giddiness indicate it, a blister (see No. 13 and 32) into the nape of the neck.

      TREATMENT. — According to the degree of illness bleed, and purge with No. 23 or No. 39 and 37; and take at night, if still feverish, sixty drops of No. 8 in a bowl-of gruel, sage, balm or elder flower tea. If only slightly affected, take one of the above purges without being bled, and a dose of No. 14 and of No. 8 at night; and if slighter still, the night draught alone with plentiful of warm slops and bathing the feet in warm water will relieve the indisposition.

      If the effect of a previous spell of sickness, the pantry and a moderate use of generous wine, good ardent spirit or malt liquor, are the

most suitable remedies: If arising from weakness of stomach, to crave and to digest the food No. 3 and No. 15 are excellent remedies: if from general and tedious indisposition, accompanied with costiveness, purging with No. 25 and half a dose of No. 24 or with No. 6: If it is a symptom in the commencement of a pleurisy or a bilious fever, such remedies as are directed for their management without any apprehension of the existing weakness, which in these cases is always lessened by bleeding and purging.

      CHARACTER. — Frequent and loose stools, without much sickness pain or fever.

      TREATMENT — If want of appetite attend it, or indigestible food or bile is the cause, vomit with No. 22; and if the looseness coninues along with a soar taste in the mouth, direct a dose of No. 25, with a teaspoon-ful of No. 2. Should the stools appear of a greenish brown or light clay colour, it will be best to encourage them by mixing No. 24 and 25 very intimately, and to give a third or a fourth part of the whole twice or three times a day. But if the person has for a long time been affected with the disease, half a dose of No. 22, one dose of No. 25, and two teaspoonsful of No. 2 are to be mixed together, and the whole of it divided into six parts, one of which may be taken every three hours in the day. And after, several days continuance of this medicine, it may be set aside, and a dose of No. 27 directed to be taken over night. But if the great weakness of the patient and the two great frequency of stools, should render any of the above purgative medicines improper, dependance is to be had on starch injections (see No. 46 and No. 20) and on the exhibition of one third or one half of a dose of No. 27 two or three times a day, and a full dose of the same, if requisite, at night.

      Vegetables and sour fruit should be avoided as hurtful; and boiled milk, thickened with flour, starch, oi arrow-root, is the best diet. Where milk cannot be obtained, rice, sago or tapioca are requisite, and No. 38 or No. 42 answer exceedingly well for common drink. If in consequence of stopping a looseness too quickly, fever, loss of appetite or pain should come on, the bowels aught immedintely to be opened by the first class of medicines, above recommended.

      In persons, recently drowned every attempt to discharge water from the stomach by tilting them on the head, rolling them on a cask &c. ought to be set aside as an injurious practice, and the following directions should be strictly attended to.

      1st. In removing the person from the waterside, the body aught to

be kept extended and lying on the back, with the head and shoulders a little elevated.

      2d. All wet cloths are to be stripped or cut off as soon as possible, and the person wiped dry.

      3d. If the sun shines out, the body should be exposed to its rays; and if it does not afford sufficient warmth the person is to be carried near a fire and wrapped up in warm blankets, which are frequently to be renewed. A warm bath of 100°. Fahrenheit, or burying the body in a dunghill, has sometimes been successful in diffusing general warmth over the surface.

      4th. A few tablespoonsful of ardent spirit are to be poured into the back part of the mouth; and by elevating a little the head and shoulders, and by an artificial imitation of swallowing in raising the tongue towards the roof of the mouth, the fluid does in part find its way into the stomach. Injections, by the fundament, likewise of warm grog, are to be recommended.

      5th. From a want of knowledge how to draw blood to greater advantage from one of the jugular veins, a gill and a half of blood is to be taken from the arm.

      6th. Whilst the previous arrangements are prepared and practised, a handkerchief is to be wrapped around the beak of a pair of bellows or of a hollow tube of any sort, and fitted into the mouth to throw air into the lungs; and this being an object of the first importance in the recovery of drowned persons, it aught to claim the earliest attention. Whilst the bellows are compressed or a person is blowing with his mouth into the tube, the fore-finger of another person is to press upon the bony protuberance of the throat, (known by the name of the core or Adams apple) to prevent the air from going into the belly, which would prevent the resuscitation of the person rather than promote it; and the nostrils are in like manner to be closed to prevent the escape of air by them. When a portion of air (say a pint in bulk) has by this process found its way into the lungs, the chest and belly are to be compressed with expanded hands to force the air out; and the inflation is next again renewed: so that by alternately blowing air into the lungs and by forcing it out, the natural process of breathing is as closely imitated as possible. Some physicians conceive that the insertion of the tube by one of the nostrils is more direct and better calculated than to introduce it bv the mouth; and in this case the other nostril and the mouth are to be kept closed, and the apple of the throat compressed as above directed.

      7th. During all this time confusion is to be avoided, and no more persons should be admitted than are absolutely necessary and useful;

and some of these should be employed in rubbing the person with their warm hands or with flannel underneath the blankets, so as not to expose the body to the cold; and the blankets, as before remarked, are to be often exchanged for warm ones. Warm bricks may also be applied to the feet, hands, and armpits, or hot salt in bags.

      8thly. These attempts should be persevered in, for at least two hours; and if a sort of sighing becomes perceptible, hopes may be entertained of an entire recovery.

      CHARACTER. — Violent griping, frequent inclination to go to stool without being able to effect a discharge, accompanied with straining. The stools are small in quantity, frequent, slimy, and mixed with blood, with little or none of the common excrement along with them, and consisting chiefly of small hard lumps. At the first onset of the disease, fever generally attends it; when of several months duration, there is commonly no fever; but it makes again its appearance when the patient is getting low in consequence of its long continuance.

      TREATMENT — Whenever the pulse is full and hard, and the skin feverish, immediate bleeding is sure to give relief; if the stomach is affected with sickness and want of appetite, give No. 22 on the same day: if it operates only upwards, give on the following day a dose of No. 25 with half a dose or a full dose of No. 24. But if No. 22 has operated freely downwards also, postpone No. 24 and 25 till the next day but one. If the griping and straining still continue violent, purge with No. 37; and depend afterwards chiefly on a sixth part of a dose of No. 22 given every three or four hours in the day; and at night No. 27 may be exhibited to ease pain and to procure rest. Sometimes the distress of this disease does not admit of the means in the above order; and to quiet the excessive griping and straining, a double dose of No. 27 with one dose of No. 24 is to be given over night at first; and this may be worked off on the following morning with No. 27. The after-treatment consists entirely in keeping the bowels open with the above remedies, and in quieting much griping with No. 27. Yet it must be understood, that although No. 27 gives immediate and apparent relief, an entire dependence upon it would confirm the disense; because it is a chief object to dislodge a vast quantity of excrement and hard lumps, that are locked up in the intestines, when nothing but slime and blood can be voided; and when the patient having for some time abstained from all solid food, impose a belief that no solid excrement can be retained. Straining and frequent inclinations to go to stool are therefore always relieved in pro-

portion to the quantity of hard lumps that are discharged by purging freely.

      In dysenteries of long standing, after the exhibitition of No. 27 over night, and a free evacuation by No. 37, or by No. 24 and 25, or by No. 1 and No. 24, on the following day a pill of No. 36 may be directed twice or thrice a day, until a slight tenderness of the gums gives evidence of a constitutional effect having been produced by them; and they should then be given in less number, but be continued with for some time. In unctions of No. 33, in old standing cases, aid this intention; and they are always preferable to the pills, when they produce too much griping. The great pain and restlessness in these cases, and the too frequently habitual use of opium renders No. 27, in conjunction with the above remedies, an indispensible medicine. A tea made of No. 40 is also an excellent remedy to abate that swelling up of the belly from wind which is apt to occur, particularly at night. Clothes wrung out of hot water, and applied to the belly, give great relief. Injections of starch, or of No. 38 with No. 20, are a most admirable remedy, [see No. 46] and they supersede in a great measure the necessity of No. 27.

      But the most judicious treatment in this dreadful complaint often fails; and would not avail at any time, if a patient were not to be put on the strictest diet. All solids, without exception, and meat in particular, must be abstained from; rice-water, barley-water, and the like, are the only allowable articles of diet for some time from the commencement of the disease. When there is no feverish disposition, and the patient from weakness requires a more strengthening diet, he may be indulged with weak chicken water or mutton broth well skimmed. In the further advance of the disease, milk, thickened with starch or flour, is often the best diet; and where the disease has baffled every effort of cure, and continues from habit with an inordinate and craving appetite for solid food, salt herring boiled, or the smallest quantity of finely minced bacon ham, has agreed better with patients, than even medicines themselves.

      ITCH. — Give a dose of No. 23. Refer for the necessary ointment to No. 5, which is to be rubbed in every night and washed off every morning with strong soapsuds.

      RASHES. — Refer to No. 6, and No. 37, and use frequent ablutions of cold water.

      ST. ANTHONY'S FIRE is usually ushered in by slight chills and a little fever, and the part affected; but more particularly some part of the face or head becomes red in irregular blotches, extending in size, or leaving one part for another, attended with smarting and a burning

heat; and sometimes drowsiness and difficulty ot breathing. It terminates most favourably, when the skin peals off like bran, and less so when it blisters; and sometimes it terminates in mortification.

      If pulse is hard and full, bleed; but take not more than half a pint at first, or at most 3 gills — purge freely with No. 37 and No. 6 combined; and if general heat of skin demands cooling medicines afterwards, give No. 6 as a common drink, and add to it one teaspoon-ful of No. 8. The inflamed part is to be kept cool and wet with cold water; and the patient is not to expose himself with it to the sun. — When the redness grows of a dark and livid colour, instead of getting paler, and when the pulse gets small and quick, the tongue yellowish, and the heat of the part increases, mortification is to be apprehended; and in this case give No. 3, and apply warm poultices.

      TETTER. — Anoint them with No. 33, or touch them with No. 11 repeatedly, until an increase of inflammation requires the omission of this practice.

      If necessary, bleed, and give No. 23; apply a soft poultice of bread and milk over night between soft linen, and blister behind the ears, and after the violence of the disease is abated, use eye-water of No. 4l, or dissolve a powder of No. 28 in a bottle full of clear water; and keep the eye wet with it by means of four doubled linen rags, laid over them. A slight degree of inflammation may be cured by eye water only.

      CHARACTER. — Slight chills, followed by violent and continued heat, flushed countenance, red eyes, frequent, strong, and full pulse, acute pain of the head and back, white, rough, and dry tongue, thirst, high coloured urine, disturbed sleep, &c. — It is called Pleurisy when preceded, accompanied, or succeeded with a sudden attack of pain of some part of the chest, with difficulty of breathing and with cough, at first short and dry, and afterwards with a discharge of flegm, sometimes streaked with blood. — Intense pain and a sense of fulness of the head, impatience of bearing light and noise, continued watchfulness, and fierce delirium, constitute Inflammation of the brain. — With redness and swelling of the throat, and difficulty of swallowing, it is Quinsy — And the symptoms of inflammatory fever denote Inflammation of the liver, when attended with violent and tensive or dull and heavy pain about the short ribs on the right side, increased on pressing it with the hand, or taking in a long breath, or on laying on the left side, pain of the right shoulder, oppression and streightness about the pit of the stomach, and occasionally dry cough and a sallow countenance.

      TREATMENT. Blood-letting of a pint or more gives uniformly relief at the onset of the disease; and is to be repeated as often as the continuation or increase of symptoms demands. and the strength of the pulse will bear. Purgatives of No. 23 should at the same time be commenced with; and their effect, if not sufficient, increased by the successive employment of No. 37 with No. 39, or of No. 37 with No. 6 When by the unintimidated perseverence of these means the violence of the fever has been broken, the local symptoms are to be relieved by a blister to the painful part of the chest, throat, or side or into the nape of the neck, according to the part particularly affected. No. 8 now also taken every two or three hours, the saline mixture, (see No. 10) or No. 26 are most usefully employed to keep down the fever, by sweating the patient with the assistance of a plentiful allowance of barley or tamarind water, of No. 38, of lemonade, or of cold water simply. In the commencement occasionally of inflammatory fever under any of the above heads, the pulse is small in proportion to the intensity of the pain or the violence of the other symptoms; and it is in these cases observable, that the force of the pulse does increase, soon after the vein has been opened; and this is a very good criterion to judge by, that the disease requires blood-letting in particular for its cure. Faintness also occurring when but little blood has been taken, is no good reason why the practice should be discontinued; for though it will be best to stop it for the time, any succeeding bleeding will rarely produce the same effect.

      The fever of the winter and spring seasons require blood-letting chiefly; whereas those of the fall season admit of it in a very limited degree; and at this season it is frequently found, that on the third or fourth day, the disease undergoes a material change. The tongue acquires a yellowish or brown colour, the pulse becomes quick and feeble in its stroke, the skin is affected with an uncommon degree of pungent heat, the eyes, though continuing red, indicate languor, the breath and stools are offensive, and delirium is apt to take place. — Under these circumstances, the inflammatory disease has changed to a nervous fever, which does not admit of blood-letting; and is to be treated chiefly with No. 24, with No. 37 and 39, with the mixture of No. 10, with No. 13 and 32, with No. 8, and with No. 27; and when the heat of the skin does admit of it, diluted wine, or porter and water with a light and strengthening diet is to be allowed. Debauched and bloated people, though young and occasionally of a healthful appearance, are most subject to this last kind of fever.

      The distinctness and regular order of symptoms, occurring in a fit of ague, divide the paroxism into three different stages. The accession of the cold stage is ushered in by indolence, yawning, stretching,

and paleness of countenance; actual cold shiverings and shaking then take place, attended with pain of the back and head. Transient flushes of heat next alternate with the sensation of cold; and these, sometimes accompanied with retching, commence the hot stage, which by degrees grows to a dry and burning heat all over, with great restlessness and violent headache. Lastly, the moisture begins on the neck and face, and forms, when general, the third or sweating stage. One of these fits ought not to last longer than twelve hours, and returns on every other day, on every day, or on every third day; and during the intervals from one fit to another, patients are entirely free from disease.

      TREATMENT. — Purge freely with No. 23 or 37 and 39, or give No. 24 in the commencement of the hot fit, and work it off next day with No. 37 and 39. Treat the next paroxism with warm drinks during the cold stage; and with No. 8, or the mixture of No. 10, & with plentiful drink during the hot and sweating stages. As soon as freed from fever, employ No. 3, allow a generous diet, wine sangaree, toddy, or the like, so as to strengthen the patient. On the next day in course, that the ague is to return, give, an hour or an hour and a half before the fit is expected, twenty-five or thirty drops of No 20. But if the patient has not been freely purged, or the state of his stomach bears evidence of accumulated bile, exhibit about an hour before the expected fit No. 22 instead of No. 20. If, nevertheless, the fit comes on, treat it in the manner above recommended; and use plentifully of bark as soon as the fever is off. Neither No. 20, however, nor No. 22, are to be given if the cold fit has already commenced; for to prevent it would then be too late. In the hot fit of ague, if the fever runs very high and produces delirium, or is attended with pain in the breast or side, blood-letting should without delay be directed as the speediest means to obviate ill consequences. If bark likewise is found of no avail in curing the disease, blisters should be tried.

      Is so called, because the fever abates once or twice in the twenty four hours, but does not entirely go off; and it is called bilious, because the bile is more copiously discharged by vomiting and purging, than in other fevers.

      Greater debility, dejection of mind, occasional and transient chills, succeeded by hot flushes, and these by constant and often intense heat of skin, distinguish the attack of remittent fever from ague. The pulse generally is quick and throbbing, and frequently hard, the tongue is white and glairy, the stomach is often affected with sickness, pain and burning heat, and a vomiting of slimy or bilious matter. — The patient is restless, sighs often, and complains of a great load about the pit of the stomach. His sweats are partial and of a faint

smell; he is watchful, and sometimes delirious. In a few days the pulse becomes weaker, and the heat of skin lessens; his lips, tongue, and teeth are encrusted with black and sooty matter, the retching is almost constant, and a coffee coloured fluid is brought up: hiccup, also, yellowness of skin, stupor, or violent delirium, attend the last stage.

      Yellow fever may be considered a higher grade of the above bilious fever, common to tropical climates; and it is more violent in its attack, and comes sooner to a termination.

      TREATMENT. — A full and hard pulse in the commencement of the fever imperiously demands the interposition of the lancet, and repeated purgatives, [see No. 23, No. 24, &c.] are to be given without delay. A bucket full, also, of cold water poured over the patient, when the skin is excessively hot, parched, and dry, is an admirable remedy, and need not be feared as a dangerous practice. The patient is immediately after to be wiped dry and put to bed; and the same affusion is to be repeated as often as excessive heat and dry skin does indicate the propriety of it. The mixture of No. 10 also may be advantageously employed; and, if the state of the stomach admits of it, No. 26. But if the patient appears to get worse, endeavour to relieve delirium with a blister into the nape of the neck, vomiting, with a blister to the stomach, &c.; and dress these and anoint with No. 33 very extensively. No. 20 proves occasionally a necessary medicine to abate the affection of the stomach; but the management of it in this fever, and the failure in many instances, renders it a doubtful remedy for indiscriminate use.

      Blood-letting in many cases, therefore, in the first instance, repeated purgatives, cold water, mercury, and blisters, are the most valuable remedies to be put in practice.

      Indicated by sickness, headache, bad taste, and want of appetite; relieved by No 23, or by No. 24 and 25 combined; or more directly by No. 22.

      Every uneasy sensation or difficulty in voiding urine is erroneously believed to arise from the above cause; but since soothing medicines can only be used in all such cases where no medical aid can be obtained, it is recommended to attend to the directions given in the last paragraph of No. 13; and when these fail, to dissolve one small teaspoonful of No. 10 in one pint of water, and to take half a gill or a gill three times a day.

      If from foul stomach, puke; if from too great a fulness of blood bleed; if from costiveness, purge; if nervous, take No. 22, and afterwards No. 20. If recurring every day or on every other day at about the same time, treat it like intermittent fever. [See No. 3.]

      CHARACTER. — Severe falls or blows on the head produce either instantly or some days after the accident, sickness or vomiting, privation of sense and voluntary motion, besides a train of other symptoms, less perceptible to common observers.

      TREATMENT — Bleed largely and repeatedly, purge with No. 23, give purgative injections, and keep the patient on a low diet.

      Bleed, [see No. 43] give No. 6 and 37 as a purge, use lead-water externally, if any outward part is bruised; or rub in No. 7.

      CHARACTER. — Yellowness of the skin, commencing in the eyes and roots of the nails, deeply coloured urine, bowels costive or loose, Stools pale or clay coloured, languor, drowsiness, and impaired appetite.

      TREATMENT — Refer to No. 22, 23, 24, and 25; to No. 34, 35, and 36.

      TREATMENT — If costive, No. 25 and 24; if bowels lax, No. 22 and afterwards No. 25. If belching attends it, No. 2, or No. 2 & No. 25 combined, or No. 15. — The aforesaid medicines having answered their intention, strengthen the stomach with No. 4 alone, or combined with No. 15.

      Diet should be light and nutritious, vegetables and malt liquor should be used in less quantities than animal food; and moderate exercise is in particular to be attended to.

      CHARACTER. — A tumid and blushing appearance of the skin, ending in blisters, filled with water or a turbid fluid; and the parts underneath it loosing their sense of feeling, becoming dark and black, and being at last thrown off. It occurs in wounds, bruises, and ulcers, and is in the majority of instances preceded by a high degree of inflammation. Delirium, small and quick pulse, a high degree of restlessness, and circularly flushed cheeks, denote danger.

      TREATMENT. &nmdash; To abate the excess of inflammation is the first object by the application of poultices, of linen rags dipped into spirit and water, by general blood-letting, and a dose of No. 23. But when mortification has commenced, the patient must be supported by No. 3, 8 and when the heat of the skin admits of it he may be allowed wine, porter, or ardent spirits. At night 30 or 40 drops of No. 20 may be administered to procure rest. The mortifying parts are to be covered with a warm poultice, or fomented with warm water; and they may be treated, if extensive, with a poultice made of port wine or of spirit and water.

      Refer to No. 5 and No. 6; and when they are very distressing, puncturing the largest of them at the fundament gives relief and is without danger.

      TREATMENT. — If the person is robust or otherwise in strong health, bleed, give a dose of No. 23, direct No. 19 to be rubbed in, and give for common drink No. 6, with about one teaspoonful of No. 8, during the day, and if the pulse is after these remedies not too full, administer No. 27, and direct plentiful warm drink to be taken over night to sweat. When unattended with fever or redness of the part, the same treatment applies to it, with the exception of bleeding; and when the pain has been confined for some time steadily to one and the same joint, it may be blistered.

      The most important circumstance to be attended to in a scald is to preserve the blisters entire; and when they have broke of their own accord, to preserve the skin at any rate. They are to be very freely fomented with lead water, [see No, 12;] and if the skin should have been removed by accident or unavoidably, and the inflammation is very great, rags dipped in linseed oil may be used; and in a day or two, when the tenderness of the part is enabled to bear the weight of a poultice, it may be employed; and be treated like a blister in a state. of inflammation. [See No. 13.]

      In burns where not only the skin, but a good deal of substance, has been destroyed, spirit of turpentine is used to advantage; and whenever there is observed much chill or fever, or excessive and continued pain, and sometimes delirium, No. 20 or No. 27 in sufficient dose to procure rest is necessary.

      In explosions of gunpowder, as much of the powder should be picked out with the point of a needle as can be done without giving much pain; and a poultice may be applied afterwards.

      CHARACTER. — Languor, lowness of spirits, fetid breath, spongy and bleeding gums, a palid and bloated countenance, stiffness of the hams, and blue and purple spots underneath the skin, like bruises, &c.

      TREATMENT. — A nutritive diet supersedes all medicines; but No. 3 and No. 15 may be given to advantage. Porter or small beer, made from a decoction of rice, hops, or barley, with molasses and porter, and fermented for three or five days is grateful and of advantage.

      see Foul Stomach. &imdash; But when it is a symptom in the second stage

of a highly bilious fever, it demands the greatest attention; and a blister to the stomach with the saline mixture, [see No. 10).] internally, are perhaps best calculated to remove it.

      Depends generally upon a disordered state of the stomach, and after exhibiting a dose of No. 24 and 25, or of No. 22, a mouth-water of No. 41, &c. relieves it; but sometimes the internal use of No. 3 is requisite to cure it entirely.

      If attended with much fever, bleed; give a dose of No. 23, and on the next or on the third day a dose of No. 37 and No. 6; and use on those days that none of the above medicines are given, No. 8 in quantity of 30 or 40 drops, &c. Externally No. 19 or a blister is of the greatest service; and a gargle made according to the directions of No. 41 is to be frequently used.

      "Whilst attended with considerable redness of the surrounding skin, and whilst their surface has a dirty grey or dark appearance, poultice them and give a dose of No. 23 and afterwards dress them with No. 30 and No. 31. Occasionally No. 33 succeeds best in old standing ulcers; and when they continue at a stand without a disposition to heal, their edges are occasionally to be touched with No. 11. No. 29 also is a very appropriate dressing; and sometimes in scorbutic habits, vinegar poultices are of use.

      CLAP. — During the height of the disease from the commencement of it, dip rags into lead water, wrap them around the penis, and renew them frequently. Take also one tablespoonful of No. 37 and two teaspoonsful of No. 9, dissolve them in a black-bottle-ful of water, and drink one fourth of it every night and morning to keep the bowels open. Scalding and pain is abated by the use of No. 9, No. 38, and No. 42; and if excessive and not relieved, take three times a day as much of No. l0 as will lay on a 9d. (a bit) in half a pint of water or in common drink. Chordee is to be treated with No. 33, rubbed in underneath the penis; or No. 20 may be added to the preparation of No. 12. If the violence of the symptoms still progresses, use warm fomentations to the genitals and the lower part of the belly; and as soon as they abate, and not before, have recourse to No 28 and No. 45, and should the discharge continue in the form of a gleet withou pain, use No. 17, and continue with No. 28, prepared with rather less water than is directed.

      SWELLED TESTICLE — At about the time that the symptoms of clap lessen, one of the testicles is apt to become painful and swelled: it ought therefore to be a golden rule in clap to suspend them

[see No. 50] at the very onset of indisposition. But when the swelling has taken place, it is to be kept wet and cool with No. 12; and sometimes, where this does not agree, apply warm poultices. Confinement upon the back, and an entire omission for the time of No. 28, are requisite. The penis ought however to be frequendy bathed with warm water; and if fever attends, blood-letting should be recommended to lessen it. No. 37 also, or No. 25 with No. 24, will be effectual remedies to lessen the inflammation.

      CHANCRE begins in the form of a small white pimple, which on breaking leaves a deep ulcer with irregular and hard edges. In this infection No. 33 and No. 36 are indispensibly necessary; and should be commenced with after a dose of No. 24 has been exhibited. But sometimes the height of inflammation produces great swelling of the foreskin, which cannot be pulled back; and then it is advisable to desist from the above remedies, to give No. 23 and to apply warm poultices, until the dropsical affection of the foreskin is abated, when they again should be resumed. A similar swelling of the foreskin, when confined behind the head of the penis, so as to leave the head bare, without being able to pull it forward, is not to be treated with warm applications, but with the preparatiou of No. 12. [These affections of the foreskin occur likewise in clap; and are to be reduced by the same means.] No. 30 or No 33 are the fittest dressings for a chancre; and if in the course of three or four weeks it shows no disposition to heal, it may be touched occasionally with No. 11. Cleanliness of the ulcer with strong soapsuds is above all things necessary.

      BUBOE is a common but uncertain consequence of chancre; and may likewise take place without having been preceded by chancre; No. 33 and 36 are the chief means to be depended upon; and locally the preparation of No. 12 is to be employed. The access of much redness on the surface of the swelling, requires a dose of No. 33, the diligent application of No. 12, and probably bleeding; where as No. 33 and 36 should be set aside for three or four days, until this appearance vanishes. But if in spite of this attention, the redness increases, the swelling is affected with a beating pain, and begins probably to get soft, discontinue every remedy above recommended, apply warm poultices & give No. 3 three times a day, until it is soft enough to the feel to be opened, which ought to be done at the lowest part of the soft place to be felt, by a simple puncture with the lancet. Three or four days after this, No. 3 is no longer necessary, and No. 33 and No. 36 must be persevered in. No. 30 is the usual dressing employed for the sore, and which in like manner ought to be kept as clean as possible by frequently washing it.

      The most simple wounds are those made with any sharp cutting-

instrument. They should be rinsed and washed clean; and their edges, when drawn together, be retained by slips of No. 29; a bit of lint laid over them, and confined with a bandage. With this dressing, if tolerably easy, the wound should be left undisturbed for 4 or 5 days, and when on opening it, it looks partly healed, and is not much inflamed, the dressings are to be renewed in the same way; but if the parts are inflamed, highly painful, separated, and soaked in matter, No. 29 should be exchanged for warm poultices; and the cure perfected by ointments.

      When an artery has been wounded, it is known from a spouting of the blood, which alternately is thrown to a greater or a less distance [See No. 44.] The effusion of blood from a small artery is often stopped by the coagulated and clotted blood that lies over it: and in this case it would not be prudent in gentlemen not medical, to remove it by washing out the blood. Besides securing a blood-vessel, by passing a double or treble waxed thread around it, and tying it; and which could not be easily accomplished but by a surgeon, it is advised to make pressure upon the bleeding part by layers of lint and a bandage: and if this alone proves ineffectual, to strew and fill up the wound with common flour, and then by lint and bandage to confine it, until surgical assistance can be obtained. [See also No. 11 & No. 15.]

      In wounds, that are bruised or torn, in punctured and in gun-shot wounds, much inflammation must be expected; and blood-letting, therefore, low diet, and frequent applications of warm poultices, are required until matter has been formed in them, when they may be dressed with common ointments. If in gun-shot wounds the bullet can be felt immediately underneath the skin, it might without danger be cut upon by almost any person; but if otherwise, it should be left entirely undisturbed.

      A punctured wound in the sole of the foot by a nail, f. i. or any other pointed weapon, is to be dressed with spirits of turpentine, unless it is very painful, when it should be poulticed.

      The infliction of a wound into the lungs is known from a discharge of frothy blood by the mouth, brought up by hawking, and from a difficulty of breathing that attends it. Immediate and repeated bloodlettings are in no instance more requisite, than in a case of this kind; and the external wound, if bleeding freely, ought by no means to be plugged up, and the escape of blood from it outwardly prevented:

      If a cut has penetrated into the belly, and any of the intestines protrude by it, they should, after having been rinsed clean with luke-warm water, be reduced into the belly, and be prevented,from falling out again by uniting the wound. Bleeding, low diet, gentle purgatives, and clysters, form the treatment.

Heermann, Lewis, 1779-1833.
      Directions for the medicine chest.
New-Orleans: Printed by John Mowry, & Co., 1811.
[6], 6-35 p.

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