A treatise on the preservation of health and treatment of disease : for the use of families and others, as a guide to the proper medical treatment of all ordinary ailments and diseases containing also many valuable prescriptions, a description of drugs and chemicals in common use, with a table of doses, etc

Preface

The following concise account of the several diseases to which the human frame is subject, is published with a hope of its proving useful to unprofessional persons, for the maintenance of health, the remedy of slighter ailments, and to enable them to recognise the symptoms of severe and dangerous maladies.

For those to whom professional skill is not readily accessible, the description given in these pages of the more serious diseases will afford facilities of applying at least temporary relief. It has been the object of the author to divest the treatment of disease of much of the mystery in which it is usually involved, to compress within as small a compass as possible, consistently with utility, everything which deserves attention in connexion with the subject.

This work is not intended to supply the place of a medical man, no written instruction can approach in value practical experience ; therefore, in serious cases, if professional assistance is within reach, no time should be lost in obtaining it; meanwhile some endeavour may be made to alleviate suffering and obviate danger.

The description given of the medicinal preparations in common use, together with the table of doses and proper mode of administration, will be found invaluable as a medicine-chest companion.

The collection of valuable Formulae, to which reference is constantly made throughout the work, and the Glossary of Medical Terms employed, will, the author trusts, combine to render the volume extensively useful.

HEALTH AND DISEASE.

Health consists in the due performance of the functions of the body. If any one of them be impeded or arrested, or if the balance of action be interfered with to a certain extent, indisposition or illness must be at hand. It is often the case that the correspondence or agreement of function is habitually more or less at fault, and yet an appearance of tolerable health is maintained ; but this imperfect and fallacious state is replete with uncertainty and danger ; the mischief may be undermining the constitution and sapping the vital system, until at length it manifests itself in serious, and perhaps irremediable, malady, or, what is not uncommon, terminates in sudden and unlooked-for death. The standard of health, however, is not by any means uniform. Each individual is born with a constitution peculiar to himself, and which is subject to special modifications during the early period of life. According to constitution, one set of functions may preponderate somewhat over the others, and yet not exceed the limits of healthy relationship. Thus, in some individuals we may have a specially powerful muscular organization ; in others, acute sensibility. In lymphatic habits the soft fatty parts are largely developed, from the nutrient circulation going on in a slow and deliberate manner, causing an abundant deposition of substance, which is tardily removed ; whereas, in a true bilious habit, nutrition goes on with energy, but is fully counterbalanced by the rapid removal and destruction of the various animal tissues. Again, the amount of general tone or power may vary in different constitutions ; while in some individuals it is large, in others it is comparatively small ; but even then the latter may constitute a more healthy state, if the balance of function be just, and the equilibrium of the system be well preserved, than when the sum of power is large, but unequally and irregularly distributed.

Let us now, therefore, briefly consider the various functions of the body, so as to enable us to appreciate better that which is essentially their healthy condition, and to judge how much deviation therefrom will constitute an unhealthy or morbid state.

THE FUNCTION OF RESPIRATION

first attracts our attention, and we can readily understand how essential its due performance is to the maintenance of health. It is the origin and commencement of all the chemical change which constantly goes on in every living being. While it tends to the organization of the structures of the body, to the fitting of the different materials to their appropriate purposes, it is yet more potent in the destruction of such as have served their turn and become useless. In this

B

HEALTH AND DISEASE.

latter respect respiration is similar to the burning of a candle or piece of wood ; their carbon and hydrogen unite with the oxygen of the air, to form carbonic acid and water ; in fact, respiration, as a destructive action, is a slow process of combustion.

By a wonderful provision of nature, atmospheric air has one constant composition, viz., about one part of oxygen mixed with two parts of nitrogen : this is not liable to much -variation, except from some artificial cause. It is of importance that this composition should he maintained, as any alteration cannot but be prejudicial to health. In ill-ventilated chambers, where numerous people are assembled, carbonic acid gas will naturally form and collect from respiratory action, and if lights are burning, they will, of course, contribute to its formation. Now, it is well known that this carbonic acid gas is a deadly poison. No animal can live in it, and if inspired, even in a very dilute state, it cannot fail to be hurtful. Hence the great importance of ventilation. Carbonic acid gas is abundantly developed by the decay of animal and vegetable substances, and thus a locality may he rendered unhealthy. Fresh-burnt and slaked lime, or even lime-wash, by their chemical affinity, readily attract the carbonic acid gas, combining with it to form carbonate of lime or chalk ; and the free access of atmospheric air, by diffusing and diluting the poisonous fluid, renders it comparatively harmless. Carburetted and sulphuretted hydrogen are also poisonous gases, which are developed by a high degree of fermentation in animal or vegetable matter, or that which is termed putrefactive action. They are poisonous in the highest degree, and, in a very diluted form, would interfere seriously with respiration. They are generated spontaneously in drains, sewers, and cesspools. Imperfect drainage and want of cleanliness are the chief causes of the generation of these gases, and it may generally be prevented by a free supply of pure air and water, and their due appliance. Many poisons doubtless obtain admittance into the blood through the medium of the lungs, and we may almost believe that some infectious diseases owe their propagation to the inspiration of air, in which the subtle and invisible poison is diffused, rather than to any contact with the surface of the body.

We may assume, therefore, that there is a certain amount of respiration necessary to give the system its due supply of oxygen, in order to remove the carbon, and that if this supply be not afforded, the blood will assume au unnatural and unhealthy condition. The lungs in health are always full of air, though in variable quantity, but each respiratory effort, consisting of inspiration and expiration, only changes about one-eighth part of the bulk thereof. Ou an average there are twenty respirations per minute, about one to rather less than four beats of the pulse. This, however, is liable to great variation. In the young both the pulse and the respiration are naturally much more frequent, but the proportion between them is still observed. The respiration may be hurried by mere temporary excitement, but if permanently quickened it must ordinarily arise from some morbid state which impedes the access ot the air to the blood, and by so diminishing the influence of each respiratory effort, renders its more frequent repetition necessary. Thus is constituted one of the chief signs of diseased lungs. When the air enters the lungs, and is diffused therein under the respiratory influence, it occasions peculiar sounds, which may be heard through the walls of the chest, and which vary in amount, differing materially in healthy and diseased states. On this is founded the use of the instrument called the stethoscope, which is of great service in recognising diseases of the chest By percussing or striking the chest we are also often able to ascertain, by the amount of resonance, whether the air has its due access to the lungs, and is duly diffused through the cells.

Unhealthy und diseased states of the respiration may be constituted in various ways. The lining mucous membrane of the larynx, the windpipe, or the

THE FUNCTION OF CIRCULATION.

bronchial tubes, may be affected in any part of their course. By congestion, which is the first stage of inflammation, it is at first rendered dry and tumid ; but as the disease advances, copious secretion of phlegm or mucus may take place : if the inflammation then subside, the natural healthy condition is gradually resumed. In the larynx and windpipe, however, the inflammation may be much more intense and dangerous, and a firm membranous substance may be formed, which cannot readily be got rid of or expectorated. The trachea or windpipe is partly muscular, and if inflammation set up in the lining membrane thereof, a kind of spasm is apt to result, especially in young children, which causes a constriction of the passage to ensue, giving rise to a peculiar embarrassment of respiration ; this constitutes Croup. The small bronchial tubes and the air-cells are apt to become permanently diseased in various ways. Their lining may be thickened, or secrete an undue quantity of mucus ; they may become liable to spasm, which may impede the due transit of air, or they may become unduly dilated, or even ruptured, and so lose their contractile power. Low temperature, or a peculiar condition of the atmosphere, have the chief part in causing a diseased state of the lining of the air-tubes. Inflammation of the lining membrane of the large or small air-passages of the lungs is called Bronchitis. The substance of the lungs, or that highly vascular structure which intervenes between the air-cells, may be affected with inflammation of various degrees.

This is termed Pneumonia. When it is intense it is highly dangerous ; it rapidly solidifies the substance of the lungs, and completely prevents respiration. The arteries of the diseased part become congested, and throw out what is termed fibrinous matter. By the consequent pressure the circulation becomes more or less completely arrested, and even further change may ensue. The mischief may go on more or less rapidly, and it is serious in proportion as it affects a smaller or greater part of the lungs. Pneumonia may be excited by cold, but usually there is a peculiar state of the blood which predisposes to the disease. The most important chronic disease which affects the substance of the lungs is Pulmonary Consumption. This appears to result from irritation and congestion of the small vessels of the lungs, which cause the eflusion of tuberculous or scrofulous matter, which may be considered as animal substance originally imperfectly organized, or as the result of partial chemical disorganization of the blood itself. As the deposit of this tuberculous matter increases, the pulmonary function is more interfered with, and extra vascular action is excited, causing the softening of the tubercular matter, which is expectorated by coughing. The formation of tuberculous matter goes on rapidly, and the very substance of the lung is destroyed. This is apt to implicate the arterial vessels, causing attacks of haemorrhage, which in this disease are so often an immediate cause of death.

THE FUNCTION OF CIRCULATION

is carried on by the heart, arteries, and veins, and it is essential to health that these act with due accord.

The heart’s action must be contracting and relaxing alternately. Any alteration in the conformation of the heart, or any interference with its delicate mechanism, cannot fail to impede the due performance of its function ; thus, increase of its muscular structure renders its impulse more violent ; diminution of the muscular structure or dilatation of the cavities it surrounds, causes the action to become weak and feeble, while at the same time, it may occasion the contraction to recur more often, striving to make up in frequency what is wanting in power. If the valvular apparatus of the heart become deficient or diseased, then cardiac action will bccomo more or less irregular and uncertain, and its power will be unnaturally diminished or increased. Independently of

HEALTH AND DISEASE.

organic cliange, the heart’s action may be modified hy nervous influence or l>.y sympathy. Thus, an excited nervous state will give rise to undue action of the heart ; deficient nervous energy will cause the heart’s action to be low and weak ; and from the very same causes it may be excessively irregular. The commonest deviations of the heart’s action are, however, often the most complicated in their development : they seem to originate in a kind of sympathy. Thu3, for example, any considerable amount of impediment to capillary action will render that of the heart laborious and oppressed. An inflammatory state of the blood, as in some forms of fever and local inflammation, will cause the heart’s impulse to become full and strong. A deteriorated condition of the blood will cause the power of the heart to become much diminished, though the action may be slow or frequent. Irritation, whether intrinsic or extrinsic, always accelerates the circulation, though the average amount of power is probably not interfered with.

The arteries are elastic tubes, conveying the blood from the heart to every part of the system. They are capable of adapting themselves to the volume of their contents. With each contraction of the heart they are expanded, and by reacting on the blood cause a delay in its motion; hence the pulse is later in arteries remote from the heart than in those near it.

The chief diseases to which the arteries are liable are : alterations of their texture, partial rupture, and dilatation. They may also become thickened, and more or less converted into bone ; which changes are generally more or less connected with advance of life. The partial rupture affects the internal coats of the artery somewhat in the same way as they are affected by a ligature, as mentioned above. This mischief is usually occasioned by a violent strain, but a diseased and brittle condition of the artery usually precedes it. The dilatation of an artery usually originates in a similar cause, but it may also depend on the stretching and expansion of all the arterial coats. This dilated state of an artery is called an aneurism, and is dangerous, inasmuch as it interferes with the circulation, but more especially from its tendency finally to give way and burst, thereby occasioning violent, and even fatal bleeding.

The transit of the blood through the minute arteries or capillaries constitutes the most important part of the circulation. It is from these vessels that the nutrient and secretive processes take place, and consequently vital action is made more strongly manifest in connexion with them than at any other part of the system. The passage of the blood through these capillaries, though excited and guided by the heart’s action, does not seem altogether to depend upon it ; but it appears essentially connected with a peculiar influence mutually exerted between the fine arterial tubes and the blood itself. That such is the case is evident from the examination of a frog’s foot under the microscope, when we perceive that any local irritation will alter and divert it in many different ways, quite independently of the heart’s action. On the due relation which exists, and on the mutual action and reaction which take place between the blood and the capillary vessels, healthy nutrition and secretion must therefore depend. If the action of the capillaries be deficient or in excess, or if the composition of the blood have in any way departed from its natural standard, which two conditions arc usually combined, then the due relation is lost, and a healthy state no longer exists. Thus the passage of the blood may be slackened or arrested, giving rise to a congestive state ; and tills cannot long subsist without the vital energy making itself manifest by setting up an unnatural change and action in the blood. In this inflammation originates, giving rise to the effusion of an albuminous fluid, which is serum, or to that of fibrine, or even of purulent matter ; and if the energy of the capillary force be unable to counteract or overcome the hindrance or impediment, then the circulation of the part may even come to a stand-still, and gangrene or mortification ensue. This explana-

THE FUNCTIONS OF DIGESTION AND SECRETION.

tion applies alike to external and internal inflammations. Redness, swelling, pain, and heat, are the signs of inflammation. If there be more blood in a part than natural, it will, of course, cause it to show more colour, varying from a bright red to a dusky purple. The swelling also will, in the first place, depend on the greater amount of blood contained in the affected part ; and secondly, on the secretive effusion which takes place. The pain at first depends on the excited state of the nerves, and subsequently on the physical pressure which they undergo. The heat is caused also by an excited state of the nerves, which acts on the blood, circulating more slowly and in larger quantity than should be the case; it is also probable that the blood itself is somewhat changed in its nature, having become, as it were, more combustible ; and this is especially the case when, the entire system participating in the local irritation, a fever state is established.

The veins are of thinner structure and more distensible nature than the arteries, so that if the blood be unduly hurried through the heart and arteries, it can be retained awhile in the veins, until the circulation becomes again equalized and quiescent. The valves existing in the veins, afford much support under such circumstances. If the action of the heart or of the lungs be interfered with, the passage of the blood through the veins may also be impeded.

From over-distension the veins may become dilated, and the valves be broken down, which constitutes the disease known as varicose veins : this is especially apt to occur in the lower extremities, from the perpendicular pressure of the long columns of blood ; and the distension is sometimes so great, that a vein may rupture, and profuse haemorrhage result. If any impediment be offered to the return of the venous blood, the minute veins may become ruptured, and bleeding consequently ensue, which constitutes another form of venous hemorrhage. This is especially apt to occur in the stomach and bowels, from their venous blood being impeded in its passage through the liver. The same may happen in the lungs, if the venous blood be more rapidly transmitted thereto than it can be converted into arterial blood, and sent on to the heart.

THE DIGESTIVE AND SECRETIVE PROCESSES.

The pharynx and gullet, or oesophagus, do not exercise any active influence in digestion, constituting merely a passage through which the food passes into the stomach. The pharynx, however, is very apt to become affected with inflammation and ulceration, constituting sore throats of different kinds. A chill is commonly the occasion of these complaints, but a disordered state of digestion, or some peculiar constitutional derangement, especially of the blood, predisposes to them, and is often their most essential cause. The tonsils, or glands of the throat, from like cause, are apt to become enlarged and inflamed, which constitutes a quinsey ; and it generally goes on to suppuration, or formation of an abscess, which is producive of much inconvenience and distress.

The appearance of the tongue will often afford important indications as to the nature of a complaint, especially if connected with the digestive organs. Thus a want of secretion in the stomach or intestines, which will generally accompany any febrile state of the system, is usually indicated by a dry, brownish, and rather furred tongue. When the secretions of the alimentary canal are vitiated, we generally find the tongue excessively coated and furred. When the system is relaxed and debilitated, the tongue usually has a pale and flabby appearance. When there is much irritation of the system generally, or specially connected with the digestive apparatus, then the tongue cither presents a red and denuded appearance, or a pale surface, over which numerous minute red spots are apparent,

The important part which the stomach has to perform in the digestive pro-

HEALTH AND DISEASE.

cess renders it liable to much disorder, and even disease. Its duty is the formation of the chyme by its acid fermentative action. That this be duly effected depends in the first place on the food taken being of proper quality, in proper quantities, and at proper intervals, and in this respect reason must direct us as well as mere appetite. In the second place, the conversion of the food into chyme depends on the healthy action of the stomach itself. There may be some primary local fault therein, interfering with its sensitive, motor, or secretive power, individually or collectively. This mischief is often connected with some remote cause. The supply of blood may be impeded and interfered with, by inaction of the liver, and thus vascular congestion take place ; or the blood may be impure from some febrile state, or other constitutional cause, rendering it unfit for the purpose of gastric secretion. And again, nervous influence has very much to do with the stomach’s healthy action, and its derangements are very often closely connected therewith. The stomach is the primary point from which the living body is formed, and maintained : it is very abundantly supplied with nerves, and is in the immediate vicinity of the great organic nervous centre, the semilunar ganglion, which is placed immediately behind it. It has a peculiar relation to every part of the nervous system, and is influenced thereby on every side. Thus, for example, in reference to the brain, any excitement of its mental or moral faculties will affect appetite and digestive action, and its vascular excitement may have the same effect, even causing the stomach to reject its contents. Nervous debility will often render appetite and digestion weak and uncertain. Nervous irritability will materially interfere with the action of the stomach, often causing it to be painful, tedious, and irregular. Any affection of the lungs, heart, liver, kidneys, &c., may in like manner exert a sympathetic influence on the state of the stomach. We also find that any affection of the stomach may, on the other hand, excite sympathy in distant organs; irritating the brain, it may cause headache; irritating the lungs, it may give rise to cough. The stomach may be affected with congestion, or even inflammation, hut its most ordinary complaints come under the denomination of dyspepsia.

The obvious function of the liver is the secretion of the bile : that this should be duly effected is of high consequence to the further performance of digestion ; and, moreover, the due secretion of bile is important as affording us some indication of that blood change in the liver which is so essential to the integrity of the economy. In the healthy state, therefore, it is necessary that a sufficiency of healthy bile should be secreted to afford due stimulation to intestinal action, at the same time to purify the blood; and it is requisite that the blood shall undergo that change in the liver which shall fit it for the further purposes of the system. If the secretion of bile be arrested, the motions become pale and clayey ; and though at first this may not appear to interfere with the health, yet it will soon produce material inconvenience and mischief, most likely as soon as the blood- change becomes seriously impeded. Excessive secretion of bile generally gives rise to bilious diarrhoea and vomiting : an undue richness of the blood predisposes to this state, and a diet of oily and stimulating character usually excites it. A vitiated state of the bile is of common occurrence; it may merely originate in diet, or it may be connected with febrile or other morbid constitutional states. The imperfect secretion of bile may give rise to jaundice; that is, when the bile, though formed, is not separated or secreted ut the proper period, but passing on with the general mass of the blood, it becomes liberated by some peculiar chemical action, when it reaches the capillaries of the skin. There is a peculiar fatal form of jaundice, which must depend not merely on want of excretion of bile, but on a paralysed state of the convertile action of the liver as well, the blood thus being rendered poisonous as well as impure. In chlorosis, or the green sickness of females, the secretion of bile is vitiated, but it is probably from other peculiar influeuces not being exerted

THE FUNCTIONS OF RESPIRATION AND SECRETION. 7

by the liver on the blood, that that fluid is reduced to such an impure and unnatural state. I have briefly alluded to states of morbid blood-change which may accompany derangements of the bile-secreting process, but also I believe that the secretive action of the liver may be duly carried on, and that, notwithstanding, the blood-change may not be properly effected, thus giving rise to a variety of ailments, if the general circulation through the liver be impeded, the passage of the blood through the capillaries of the membrane lining the abdomen will be retarded, and a watery fluid may be effused into the abdominal cavity. In such cases the organization of the blood is usually weak and imperfect. On the other hand, it often happens, when the liver becomes congested, and is loaded with bilious material, from the due secretion not going on, that the capillaries and veins of the mucous membrane lining the bowels also become congested, and then the capillaries relieve themselves by an undue secretive action, which constitutes diarrhcea ; or if the veins are affected, then those at the lower part of the bowels, near the fundament, become distended, so as sometimes to cause their rupture, constituting the painful affection called piles. From any undue irritation or excitement, slow or chronic inflammation may set up in the liver, causing alterations in its structure and texture in great variety. It may he enlarged or reduced in size ; it may be indurated or softened ; it may be converted into fatty or granular matter; &e.

The main function of the small intestine is chylification, that is, the separation of the chyle from the chyme. The chyle is an oily and albuminous fluid, which becomes diffused through the mass of the blood, to minister to its increase and reparation, and to affox-d material for various secretions. The small intestine has much liability to disorder and disease. We can easily perceive how apt it will be to become implicated in any form of indigestion : the irritation may affect the lining mucous membrane, or the muscular coat, and this irritation is very apt to run on to inflammation. There are great numbers of small glands diffused over the internal surface of the small intestines, and these will frequently become diseased and ulcerated, when the secretions assume an acrid character in connection with an unnatural and vitiated state of the blood, as in typhus fever and scrofula. Indigestion, when specially coixnected with the small intestines, is most apt to occasion inconvenience about four or six hours after eating ; it may manifest itself in pain, nausea, a sense of fulness, or some peculiar uneasiness. When it comes on more actively, it is apt to occasion those spasmodic attacks, which we find so frequently occurring where the diet has disagreed. Inflammation of the small intestines is often of a serious and dangerous charactei,) and requires to be promptly remedied; the action of the bowels becomes almost always completely arrested in this disease, from the paralysed state of the inflamed part ; this will be spontaneously relieved when the inflammation is subdued, but it is a great error to endeavour to overcome the obstruction by purgatives, especially in the first instance, for they do but render the diseased structure more irritable, and often cause it to become greatly constricted.

I he large intestine constitutes a reservoir for faecal matter, where it is retained until it has accumulated in sufficient quantities for evacuation. The common opinion lias been, that gas is secreted by the lining membrane of the large intestines, but I believe that the membrane is merely the medium of transmitting gas, which is undoubtedly materially modified by the chemical action of the residuum of the food. There are large numbei's of small glands scattered over the internal surface of the large intestines, and, as in the small bowel, their office is to secrete mucus for the dilution of the digested matter, and for the lubrication of the surface. The large intestines may be affected with inflammatory action, though rarely of such intense character as the small owels. If the external coat be affected, there will be an inaptitude for muscular contraction, and consequently a torpid state, which may exist without in-

HEALTH AND DISEASE.

flammation being present. If, however, the internal mucous membrane become inflamed, it soon passes into a state of inordinate secretion, implicating the small glands we have spoken of, and this constitutes diarrhoea, the commonest form of which, however, implicates both small and large intestines in the diseased action.

i here the inflammatory action is more intense, the lining membrane of the large bowels is apt to undergo ulceration, which constitutes dysentery, in which undue secretion is combined with a discharge of matter and blood from the ulcerated surfaces. To effect and regulate the gradual supply of venous blood which the liver requires, the veins of the great intestines are largely developed, and this seems in a great measure to give the diseases which affect them their peculiar character ; the dysenteric ulceration for example. This is more especially the case with the diseases of chronic character. Stricture of the rectum generally depends on the irritation and excitement of long continued venous congestion. Piles, as already mentioned, originate in the first instance from obstructed veins, which become over distended, and unable to resume their natural calibre. At first these occasion merely inconvenience, but at length, from pressure and friction, they become irritable, and inflammation sets up in the adjoining parts. If this be not speedily abated by appropriate local and general treatment, the surface of these piles may ulcerate, and cause a discharge of matter, and even the veins may give way, causing profuse venous bleeding. In unhealthy constitutions the mischief may be greater; the inflammation may extend into the cellular tissue which surrounds the rectum or lower bowel ; suppuration, or the formation of an abscess, may take place; the matter may burrow about in the loose, soft structure, which has no pow'er of resistance, finally making one or more points of exit, either into the bowel or from the surface of the skin in the immediate vicinity of the fundament. Thus is constituted a fistula, a most distressing complaint. The bowels undergo a considerable amount of pressure in their natural cavity, but an undue strain will often cause serious mischief by occasioning partial protrusion thereof. The small intestine is most liable to escape, and though it be but a very small portion, or even some part of the caul which covers the bowels merely, the rupture, or hernia, as it is called, becomes exceedingly dangerous, when it cannot be promptly returned. Rupture is most apt to occur at two points, the groin and at the navel, v'here there are naturally small and narrow openings.