DR. PIERCE'S COMPOUND EXTRACT OF SMART-WEED. This quickly diffusible stimulant and genial anodyne we have spoken of under the head of Anodynes. But its medicinal properties equally entitle it to a place and mention under the class of stimulants. As a stimulant it spurs the nervous system and arouses the circulatory forces. Congestion of the lungs, liver, bowels, or uterus, embarrasses the functions of these organs. Frequently this congestive difficulty may be entirely obviated, and the circulation of the blood restored to the surface of the body, by the administration of a few doses of this pleasant remedy. Thus it often acts like magic in giving relief, promoting the circulation, and restoring the organs to their accustomed functional activity. Full directions accompany every bottle.

TONICS.

Tonics are remedies which moderately exalt the energies of all parts of the body, without causing any deviation of healthy function. While stimulants are transient in their influence, tonics are comparatively permanent.



WHITE POPLAR (Liriodendron Tulipfera), called also American Poplar, or White Wood. The part used is the inner bark. This is a mild but valuable tonic for domestic use. Dose—Of the infusion, from one-half to one ounce; of tincture, from one to two teaspoonfuls.

CHAMOMILE (Anthemis Nobilis). The part used is the flowers. This is a mild, unirritating tonic. Dose—Of infusion (one-fourth ounce of flowers to a pint of water) one-half to one ounce.

GENTIAN (Gentiana Lutead). The root is the part used. This is a favorite domestic tonic in many localities. Dose—Of powdered root, five to ten grains; of the tincture, ten to twenty drops; of the fluid extract, five to ten drops, four or five times a day.

NUX VOMICA (Strychnos Nux Vomica), or Dog Button. This is a powerful tonic. It increases innervation and is particularly valuable in cases marked by feeble circulation and general impairment of muscular power. In overdoses it is poisonous, and hence must be employed with much caution. Dose—Of the tincture, three to five drops; of the fluid extract, ONE TO THREE DROPS.

WILLOW (Salix Alba). Willow is a tonic and an astringent. Dose—Of the decoction, from one to two fluid ounces; of the concentrated principle, Salicin, from two to four grains.



DOGWOOD (Cornus Florida). Dogwood, also known Boxwood, is tonic, astringent, and slightly stimulant. Dose—Of the solid extract, from three to five grains; of the infusion, from one to two ounces; of the fluid extract, from ten to twenty drops.

WAFER-ASH (Ptelea Trifoliata), also called Swamp Dogwood. The bark is used. This is a pure, unirritating tonic. Dose—Of tincture, one-half to one teaspoonful; of fluid extract ten to twenty drops; of the infusion, one to two fluid ounces.



GOLDEN SEAL (Hydrastis Canadensis). Golden Seal is a powerful and most valuable tonic. It is a valuable local remedy when used as a general injection in leucorrhea. Dose—Of the powder, from ten to thirty grains; of the tincture, from one-half to one fluid drachm; of the fluid extract, from ten to twenty drops; of the concentrated principle, Hydrastin, from two to three grains; of the muriate of hydrastia, from one-half to one grain.



AMERICAN COLOMBO (Frasera Carolinensis). American Colombo is a simple tonic. Dose—Of the powdered root, from ten to fifteen grains; of the infusion one-half to one fluid ounce, three or four times a day; of the active principle, Fraserin, one to three grains.



GOLD THREAD (Coptis Trifolia). Gold Thread is a pure and powerful, bitter tonic, and is also efficacious as a wash for sore mouth or as a gargle. Dose—Of the decoction, from two to six fluid drachms; of the tincture, from one-half to two teaspoonfuls; of fluid extract, from ten to twenty drops.

IRON (Ferrum). Different preparations of iron are frequently prescribed by physicians. They are particularly valuable in anaemic conditions of the system. The following are a few of the preparations of this metal most generally used:

IRON BY HYDROGEN (Ferri Redactum). Dose—One to two grains.

CARBONATE OF IRON (Ferri Carbonas). Dose—One to three grains.

CITRATE OF IRON (Ferri Citras). Dose—One to three grains.

PYROPHOSPHATE OF IRON (Ferri Pyrophosphas). Dose—One to three grains.

TINCTURE OF MURIATE OF IRON (Tinctura Ferri Chloridi). Dose—Three to twenty drops.

DR. PIERCE'S FAVORITE PRESCRIPTION. The Favorite Prescription, in addition to those properties already described, likewise combines tonic properties. In consequence of the never ceasing activities of the bodily organs, the system requires support, something to permanently exalt its actions. In all cases of debility, the Favorite Prescription tranquilizes the nerves, tones up the organs and increases their vigor, and strengthens the system. Directions for use accompany every bottle.

DR. PIERCE'S GOLDEN MEDICAL DISCOVERY. In addition to the alterative properties combined in this compound, it possesses important tonic qualities. While the Favorite Prescription exerts a tonic influence upon the digestive and nutritive functions, the Golden Medical Discovery acts upon the excretory glands. Besides, it tends to retard unusual waste and expenditure. This latter remedy tones, sustains, and, at the same time regulates the functions. While increasing the discharge of noxious elements accumulated in the system, it promptly arrests the wastes arising from debility, and the unusual breaking down of the cells incident to quick decline. It stimulates the liver to secrete, changes the sallow complexion, and transforms the listless invalid into a vigorous and healthy being. At the same time, it checks the rapid disorganization of the tissues and their putrescent change, while it sustains the vital processes. It is, therefore, and indispensable remedy in the treatment of many diseases.

* * * * *



CHAPTER III.

BATHS AND MOTION AS REMEDIAL AGENTS.

The remedial effects of bathing are generally underrated. This want of appreciation is more often due to the improper manner in which it is performed than to an insufficiency of curative virtues. The term bathing not only implies a cleaning of the body or certain portions of it, but also the application of water in such a manner as to influence the nervous system, and regulate the functions of the secretory organs. Cleanliness, while it preserves health and promotes recovery, has reference only to the hygienic influences of water and not to its curative effects. There are several kinds of baths, the names of which indicate their character, manner of application, or the part of the body to which they are applied. Among others, we have Cold, Cool, Temperate, Tepid, Warm, Hot, Hot Air, Russian, Turkish, Vapor, Electric, Sea, Shower, Sponge, Douche, Foot, Sitz, Head, Medicated, Alkaline, Acid, Iodine, and Sulphur Baths. Temperature influences the properties of any bath; thus the sponge, sitz, and alkaline baths may be employed warm or cold, according to the effect desired.

THE COLD BATH, used at a temperature of from 40 deg. to 60 deg. Fahr., is powerfully sedative, and is employed for its tonic effects. If the vital powers are low, or the individual remains in it too long (two or three minutes should be the limit), the reaction is slow and its effects injurious. While it is highly invigorating to robust persons, those who have a low standard of vitality should be cautions in its employment. A local bath may be followed by beneficial results, when a general bath would be inadmissible. For these reasons we advise the general use of the

COOL BATH, at a temperature of from 60 deg. to 75 deg. Fahr. If, in any instance, the reaction is slow, we recommend the

TEMPERATE BATH, at a temperature of from 75 deg. to 80 deg. Fahr. The time of remaining in the bath should be regulated by the strength of the invalid. As a rule, it should not exceed three minutes, and the colder the water the less time should the patient be immersed. Immediately after emerging from any bath, the body should be thoroughly dried and rubbed with a moderately coarse towel until a glow is experienced and reaction is fully established. The attempt to toughen children by exposing them to low temperatures of either air or water, cannot be too emphatically condemned. This caution, however, does not apply to the employment of moderately cool water for ablutions. The cold or cool bath should be taken in the early part of the day, but never during digestion. Whenever reaction does not follow bathing, artificial means must be resorted to, as stimulating drinks, dry warmth, or exercise.

THE TEPID BATH, the temperature of which is from 85 deg. to 92 deg. Fahr., is generally used for cleansing the body. It is prescribed in fevers and inflammatory affections for its cooling effects. It is usually medicated with some acid or alkali. The latter unites with the oily secretion of the skin and forms a soapy compound easily removed by the water. The temperature should be regulated according to the vitality of the patient; and the bath may be repeated two or three times a day. It removes superfluous heat, and keeps the skin in a condition favorable for excretion.

THE WARM BATH, at a temperature varying from 92 deg. to 98 deg. Fahr., is always agreeable and refreshing. It equalizes the circulation and softens the skin, by removing all impurities. It moderates pain and soothes the whole system. It does not weaken or debilitate the person, but is in every way beneficial. It is an efficient, remedial agent in many chronic diseases, convulsions, spasmodic affections of the bowels, rupture, rheumatism, and derangement of the urino-genital organs. It should be employed immediately before going to bed unless urgent symptoms demand it at other times. It may be medicated or not, as circumstances require, but should always be taken in a warm room.

THE HOT BATH at a temperature of from 98 deg. to 110 deg. Fahr. is a powerful stimulant. It excites the nerves, and through them the entire system. It causes a sense of heat and a constriction of the secretory organs; but perspiration, languor, and torpor soon follow. In the sudden retrocession of cutaneous diseases, it restores the eruptions to the surface and gives speedy relief. The hot bath may be applied locally when circumstances require.

THE RUSSIAN BATH consists in the application of hot vapor, at a temperature varying from 112 deg. to 200 deg. Fahr. The patient is first subjected to a moderately warm temperature, which is gradually increased as he becomes inured to it, the head being surrounded with cloths wet in cold water. Upon emerging from it, the bather is plunged into cold water or receives a cool, shower bath. In rheumatic and cutaneous diseases, chronic inflammations, and nervous affections, the Russian bath is an effective remedy.

THE TURKISH BATH is a, dry, hot-air bath. The bather passes from one apartment to another, each one being of a higher temperature than the preceding. He undergoes a thorough shampooing, and, although the person may be scrupulously clean, he will be astonished at the amount of effete matter removed by this process. The bather then returns through the various apartments, and, upon emerging from that of the lowest temperature, he experiences a delightful sensation of vigor and elasticity.

As a hygienic agent, the hot-air bath has been' constantly growing in favor. Its value is now recognized by all physicians throughout the world. The judicious use of the Turkish bath serves to secure perfect equalization of the circulation. Glandular activity is increased, elasticity and power given to the muscles, and a permanent, stimulating and tonic influence imparted to the system, a condition at once conducive to the enjoyment and prolongation of life. Dr. Erasmus Wilson, of England, says, in a paper read before the London Medical Association: "The inhabitant of a large city would live as healthy, immured within city walls, as amid the fields and meadows of the country. His bath would be to him in the place of a country house or horse—it would give him air, exercise, freshness, health, and life."

"The bath that cleanses the inward as well as the outward man; that is applicable to every age; that is adapted to make health healthier, and alleviate disease, whatever its stage or severity, deserves to be adopted as a national institution, and merits the advocacy of all medical men; of those whose especial duty it is to teach how health may be preserved, and how disease may be averted."

The hot, dry atmosphere of the Turkish bath promotes rapid evaporation from the surface of the body, and it is well known that rapid evaporation from the surface is a cooling process. A person's finger may be frozen in one minute's time, by throwing upon it a constant, fine spray of rhigolene or sulphuric ether. The rapid evaporation of the light fluid congeals the liquids of the tissues and a film of ice is rapidly formed upon the part. In a less intense degree the same cooling process is carried on over the whole surface of a person, when in the hot room, or sudatorium, of the Turkish bath. The evaporation from the surface is so rapid that one can hardly appreciate the profuseness of the perspiration going on. The evaporation from the surface so rapidly carries off the heat from the body that one finds himself able, with little or no inconvenience, to remain in a room heated to from 180 deg. to 200 deg. or even 220 deg. Fahr.

As a hygienic measure to be regularly or occasionally employed by persons in fair health, the Turkish or hot dry-air bath is far superior to the Russian or vapor-bath. (1.) It produces more profuse perspiration, and is therefore more depurating, or cleansing, in its effects. (2.) It does not relax the system, but rather produces a tonic effect, and fewer precautions are, therefore, necessary to guard against taking cold after employing it. (3.) The Turkish bath can be better ventilated than the Russian. While the air is heated to a high temperature, it can be readily kept pure by constant changes. In the Turkish hot-rooms, or sudatorium, of the Invalids' Hotel and Surgical Institute, provision is made for bringing underneath the floors a current of fresh air from without. This column of fresh air is carried under the centre of each room where it escapes from the conductor, is warmed, and rises into the room, from which extraction of air is constantly going on through registers opening into tubes, communicating with large ventilated shafts which are kept hot, summer and winter, to insure a draught through them. In this manner, thorough ventilation of our Turkish hot-rooms is insured.

The Turkish bath not only combines a most agreeable luxury with a decidedly invigorating and tonic influence, but also, by its stimulating power, induces proper glandular and cellular activity, producing a healthy condition.

Sallowness, tan, and freckles, the result of local or general increase of the pigment granules of the skin, soon disappear under the stimulating influence and regular use of the Turkish bath, which causes rapid development of new and transparent cells. The colored granules are thus gradually replaced and the skin assumes a beautiful clearness and purity of appearance, which transcends immeasurably the unhealthy hue that follows the frequent employment of the various cosmetics.

The value of an agent which thus improves the general health, insures immunity from coughs, colds, and other diseases, and at the same time produces a healthy and permanent beauty of complexion, is at once apparent. The purity of person, perfect circulation, increase of healthy nutrition and glandular activity produced by the Turkish bath, serve to make it of the most lasting utility.

The eminent Dr. Madden has said, and his experience is confirmed by every regular patron of the bath, that, "Wherever the Turkish bath was a national institution the hair of the women was peculiarly luxurious and beautiful. I can vouch for it that the use of the bath rendered the complexion more delicate and brilliant; that the eyes became clearer and brighter; all the personal charms were enhanced. I can recommend no hygienic measure more beneficial or effectual in preserving the health and an attractive personal appearance."

Pimples, blotches, eruptions, and other disfigurations of the skin are removed by the frequent use of the Turkish bath, leaving the integument smooth and soft.



HOW THE TURKISH BATH IS ADMINISTERED AT THE INVALID'S HOTEL AND SURGICAL INSTITUTE. The hot-rooms, of which there are two, are exactly similar in every respect except as regards temperature. The first room has a temperature of from 110 deg. to 120 deg. Fahr. The bather is supplied by the attendant every few minutes with copious draughts of cool water. Gradually the relaxing influence of the elevated temperature manifests itself. The capillaries slowly dilate, the veins enlarge under its gentle stimulus, and small points of perspiration appear upon the surface, which assumes a slight, rosy blush. A delightful calm, a feeling of perfect rest and luxurious ease is imparted to the senses. From this room, after an appropriate interval, the bather enters the second room, in which the atmosphere is higher by from 20 deg. to 30 deg., and it may be made still higher, its regulation requiring but an instant.



A thorough sweating occurs while the subject remains in these rooms, during a period of from ten to forty minutes. The secretions of the skin, at first impure and loaded with the debris of dead cells and extraneous matter, gradually become purer, and clearer, until, finally, all trace of color disappears and the pearly drops of sweat come full and free. Soon the attendant appears and leads the way to the shampooing-room, where, lying upon a warm marble slab, massage is applied most thoroughly to every portion of the body.

By the massage, shampooing, or rubbing, the superficial veins are thoroughly emptied of their contents, the muscles are given elasticity and tone, and glandular activity is promoted. Innumerable dead epithelial cells, together with other impurities, are rolled off in flakes under the skillful manipulation of the attendant.

After a thorough shampooing, the shower bath is applied, to secure a contraction of the capillaries and a diminution of the perspiration.

THE SPIRIT VAPOR-BATH is very effective when employed in the earlier stages of acute, febrile, inflammatory, and painful diseases. In many forms of chronic diseases the administration of a spirit vapor-bath once in from three to fifteen days, is a valuable adjunct to the treatment of these affections. It exerts an exceedingly beneficial influence upon the entire system, and, when habitually employed, may ward off disease.

The body should be moistened with an alkaline solution before the administration of a spirit vapor-bath. After the perspiration which it occasions has subsided, which will usually be in from three to four hours, sponge the body with a mixture of the following ingredients: water, three gills; alcohol, one gill; salt, one teaspoonful. By this method the patient experiences none of the unpleasant effects which generally follow the employment of diaphoretics. Various kinds of apparatus have been devised to facilitate the application of the spirit vapor-baths. Most of them are cumbersome and expensive, and, consequently, are seldom used except in hospitals or sanitariums.

The following method described by Dr. J. King, may be advantageously employed.

"The patient is undressed, ready for getting into bed, having removed the clothing worn through the day and put on a night shirt or other clothing to be worn while sweating, and during the night, if the bath is taken at bed-time. He is then seated on a high Windsor or wooden-bottomed chair, or instead thereof, a bench or board may be placed on a common open-bottomed chair, care being taken that the bottom is so covered that the flame will not burn him. After seating himself, a large coverlet or blanket is thrown around him from behind, covering the back of his head and body, as well as the chair, and another must be passed around him in front, which last is to be pinned at the neck, loosely, so that he can raise it and cover his face, or remove it down from the face from time to time as occasion demands during the operation of the bath. The blankets must reach down to the floor, and cover each other at the side, so as to retain the vapor. This having been done, a saucer or tin vessel, into which is put one or two tablespoonfuls of whiskey, brandy, alcohol, or any liquor that will burn, is then placed upon the floor, directly under the centre of the bottom of the chair, raising a part of the blanket from behind to place it there; then light a piece of paper, apply the flame to the liquor, and as soon as it kindles let down the part of the blanket which has been raised, and allow the liquor to burn until it is consumed, watching it from time to time to see that the blankets are not burned. As soon as consumed, put more liquor into the saucer, about as much as before, and again set it on fire, being careful to put no liquor into the saucer while the flame exists, as there would be danger of setting fire to the blanket, and producing injury to the patient. Continue this until the patient perspires freely, which, in a majority of cases, will be in five or ten minutes."

"If, during the operation the patient feels faint or thirsty, cold water must be sprinkled or dashed in his face, or he may drink one or two swallows of it,—and in some cases the head may be bathed with cold water. As soon as free perspiration is produced, wrap the blankets around him, place him in bed, and cover him up warm, giving him about a pint of either some good store tea, ginger, or some diaphoretic herb tea to drink, as warm as he can take it. After two or three hours, remove the covering, piece by piece, at intervals of twenty or twenty-five minutes each, that he may gradually cease perspiring."

The above method may be improved by using an ordinary hoop skirt, ten to twelve inches below the bottom of which is suspended a larger and stronger hoop. The upper and smaller hoops should rest upon the patient's shoulders. A woolen blanket, large enough to reach and rest upon the floor, and envelop the whole person, is thrown over the hoops. Unless the bath is employed to diminish the quantity of fluids in the body (as in dropsy), the patient may drink some simple, diaphoretic infusion, to hasten or facilitate perspiration. When he perspires freely, small quantities of cold water may be frequently given. "There is little or no danger of taking cold after this process, if ordinary precaution is observed, and it is easy, agreeable, safe, and effectual."

"Occasionally we will meet with patients, upon whom it is almost impossible to produce the slightest moisture, much less perspiration. The skin of such persons is generally dry and harsh, communicating an unpleasant sensation to the touch. In most instances the skin may be restored to its normal condition, by adopting the following course: 1st. Anoint the whole surface of the body and limbs with olive oil every night upon retiring to bed. 2nd. Every morning wash the whole surface with a warm, weak, alkaline solution, employing considerable friction while drying. 3rd. Every two weeks administer a spirit vapor-bath. A perseverance in this course for a few months will accomplish the desired result."

Frequent reference to spirit vapor-baths will be made by the author of this work, in speaking of those diseases in which its employment will prove beneficial.

SEA BATHING is an excellent, remedial agent in chronic disorders, particularly in those of an atonic character, such as nervous prostration, dyspepsia, and general debility.

Much of the benefit attributed to this mode of bathing is undoubtedly due to other influences, such as pure air, exercise, change of scenery, diet, and associations which surround the patient during his sojourn at the sea-shore.

At first, the duration of a sea-bath should not exceed three or five minutes, but it may be gradually prolonged to fifteen or twenty minutes. If the patient is very feeble, one or two baths a week are sufficient, and the most robust person should never take more than one a day. They should always be taken in the earlier portion of the day, before breakfast if possible, and never during digestion.

Before entering this bath, a moderate degree of exercise should always be taken, enough to arouse the vital energies, but not to produce fatigue. Suitably dressed, the patient plunges into the water, in which he remains during the prescribed time. Immediately after emerging from the bath, the patient should be thoroughly dried and dressed and then moderate exercise should be taken to induce reaction. If the reaction is slow, a mild stimulant may be taken and the duration of the bath must be diminished the next time. When sea-bathing is beneficial improvement is soon manifested. The blood becomes richer, the whole system is strengthened and the functions are performed with more regularity. To the rich, sea-bathing is a luxury, but it is a remedy beyond the reach of the poorer classes unless they live near the sea-shore.

THE SHOWER BATH produces a shock to the nervous system by suddenly coming in contact with the skin. Numerous streams of cold water fall upon the neck, shoulders, and body of the patient who stands beneath the hose or reservoir. When the patient is plethoric, feeble, or nervous, or when some internal organ is diseased, the cold, shower bath should not be employed. In simple debility unaccompanied by inflammation or symptoms of internal congestion, its use proves advantageous. By moderating the force of the shower, and substituting tepid water, the most delicate persons can endure it and profit thereby. The usual means for inducing a good reaction, friction, and exercise, should be employed.

THE DOUCHE BATH consists of a stream of water, dashed or thrown upon the patient from a moderate height or distance, with considerable force. The size, temperature, and force of the stream may be modified to suit the exigencies of the case. It is locally employed as a remedy for sprains, weak or stiff joints, old swellings, etc. The cold, douche bath is more powerful than the shower bath and should be given with the same precautions which govern the application of the latter.

THE SPONGE BATH admits of extensive employment in both acute and chronic diseases, and its simplicity renders it of untold value. It consists in a general or local application of water (medicated or not) at any desired temperature. The quantity may be great or small to suit the requirements of the case. If it is applied in acute diseases at a temperature agreeable to the patient, it is exceedingly grateful and may be repeated as often as necessary. It may be rendered alkaline by the addition of some compound of soda, in the proportion of a teaspoonful to a quart of water. A portion of the body may be bathed at a time, and quickly dried, thus avoiding any exposure to cold. It removes excessive animal heat, relaxes the capillaries, equalizes the circulation, and produces comfort, tranquility, and sleep.

Nothing is more conducive to the health and comfort of laboring men in summer than a daily bath, and it is a matter of regret that there are so few conveniences for the purpose in most homes, especially those in the country. Farmers in particular need bathing facilities, and yet in most cases they are almost entirely without them. For their benefit we will describe a device which we can recommend to all who want a cheap, convenient, and easily managed apparatus for sponge bathing in the bed-room.

The articles required are a piece of rubber-cloth a yard and a quarter square, four slats, two inches wide and three feet long, notched at the ends so as to lock together in the form of a square, and a large sponge. The slats are placed upon the floor and the rubber cloth is spread over them (there is no need of fastening it to the slats), forming a shallow square vessel a yard wide. In this the bather stands and applies the water with a sponge from a basin or bowl on a stand placed conveniently near. There need be no danger of wetting the carpet, or spoiling the furniture.

When the bath is finished, gather three corners of the rubber cloth in the left hand, take the fourth corner in the right in such a way as to form a spout when lifted or held over the slop-jar or bucket. The water may be poured out in a moment, when the cloth should be spread over the back of a chair to dry, and the slats unlocked and set away in a closet.

THE FOOT BATH is frequently employed, as a means of causing diaphoresis, in colds, attacks of acute diseases, and also to draw the blood from the head or some internal organ. It is a powerful auxiliary in the treatment of those chronic diseases in which inflammation, congestion, and a feeble circulation are prominent symptoms. The water should be as hot as it can be borne and the temperature kept up by additions of hot water. It may be made stimulating by the addition of salt, mustard, ginger, or cayenne pepper.

THE SITZ BATH. A tub is so arranged that the patient can sit down in it while bathing. In this manner the lower part of the abdomen, hips, and upper part of the thighs, are immersed in whatever fluid the bath is composed of. It is applicable in diseases of the pelvic organs, and may be hot, warm, cool, cold, or medicated, according to the effect desired.

The bath tub should be large enough to permit a thorough rubbing and kneading of the diseased parts, and the patient may remain in it from ten to thirty minutes. The clothing may be wholly or partially removed, as agreeable to the individual. A warm, sitz bath is an effective, remedial adjunct in menstrual suppression and in painful menstruation, gravel, spasmodic and acute inflammatory affections generally. The cold, sitz bath is used as a tonic in cases of relaxed tissues of the pelvis, in debility of the urino-genital organs, in piles, prolapsus of the rectum, and in constipation.

THE HEAD BATH. A shallow basin contains the fluid for the bath; and the patient, assuming a recumbent position, immerses a portion of the head, generally the back part. The temperature may be warm, cool, or cold, as desired.

MEDICATED BATHS are infusions of vegetable or other substances in water. They are sometimes applied with the sponge, though generally the patient is immersed. The temperature at which they are usually employed is that of the tepid bath. The nature and strength of the medication depends upon the character of the disease for which it is employed.

THE ALKALINE BATH is prepared by dissolving half a pound of carbonate of soda in sixty gallons of water. It is useful in those diseases in which the fluids of the body are abnormally acid, as in rheumatism.

THE ACID BATH is prepared by adding two pounds of muriatic or hydrochloric acid to sixty gallons of water. A much smaller quantity of the acid is sometimes used, and in some instances vinegar is substituted.

Scott's Acid Bath is composed of nitro-muriatic acid (aqua regia) and water. It should be prepared in a wooden tub, and a sufficient quantity of acid used to give the water a sour taste. It is extensively used in India as a remedy for disorders of the liver.

THE IODINE BATH is composed of the following ingredients: tincture of iodine, two drachms; iodide of potassium, four drachms; water, forty gallons. It should be prepared in a wooden tub. It reddens the skin. For children, a much weaker solution must be employed. Its use is generally restricted to scrofulous and tubercular affections.

THE SULPHUR BATH is prepared by dissolving eight ounces of sulphuret of potassium and two ounces of dilute sulphuric acid in sixty gallons of water. The acid may be omitted.

A SULPHUR VAPOR-BATH is often employed in cities where the necessary apparatus can be procured. It may be improvised by placing sulphur on a shovel over hot coals. The patient should be prepared as in the spirit vapor-bath, and burning sulphur substituted for the liquor. The patient is then enveloped in the fumes of sulphurous oxide. Heating a mixture of sulphur and sulphuric acid, produces the same result. If the gas is inhaled in large quantities it causes irritation of the respiratory passages, and suffocation. It is therefore necessary that the coverings should be securely fastened at the neck, and that the room be one which can be quickly filled with pure air This bath is used in cutaneous, rheumatic, and syphilitic disorders.

FOMENTATIONS consist of the general or local application of woolen cloths wrung out of hot water. They should not be so light as to be ineffectual, nor so heavy as to be burdensome. They should not be wet enough to drip, nor applied so as to expose the body to the surrounding air. A fresh cloth should be ready for application before the first one is removed, and the change quickly effected. Fomentations are effectual in relieving congestion and inflammation.

THE WET SHEET PACK. As this remedial appliance will be frequently recommended in the pages following, its mode of application is here described. Take a pail half filled with cold water, gather together one end of a common cotton sheet, and immerse it, allowing it to remain while preparing the bed, which may be done as follows: remove all the bed-clothes except a coverlet and the pillows, then spread upon it, in the following order, two ordinary comforters, one woolen blanket, one woolen sheet, (or two woolen sheets if a woolen blanket is not at hand); then wring out one-half or two-thirds of the water from the wet sheet, spread it smoothly upon the blanket, and the patient being undressed, places himself on the sheet, with his arms extended, while an assistant wraps him closely and tightly with it, as quickly as possible. Each arm may be thus covered by the wet sheet, or may lie outside of it, and be covered by wet towels, prepared in the same manner as the sheet. Then quickly and tightly cover with the blankets and comforters, tucking snugly from head to foot. The head should also be covered with a wet towel, and a bottle of warm water placed to the feet, or near enough to keep them warm.

After the first shock of the chill is over, the pack is very pleasant and refreshing, and the patient should go to sleep, if possible. The ordinary time for a patient to remain in a pack is about sixty minutes. Thirty or forty minutes is sufficient, if he is in a feeble condition. Never wring the sheet out of warm water, for one of its principal benefits comes from the vigorous reaction induced by its cold temperature. After remaining in the pack from thirty to sixty minutes, allow the patient to stand on his feet, if he is able, and have the whole surface of his body bathed. Rub briskly, and dry with towels, or by throwing over the body a dry sheet and then rubbing him. The dry sheet retains the bodily warmth and is more comfortable, but interferes with the completeness and vigor of the rubbing of the body. Be sure and establish full reaction, which may be known by the warmth of the surface. Frequently, when the patient is released from the pack, and is being bathed, rolls of scales, scurf, and skin-debris come off, thus giving palpable evidence of the utility of the pack in freeing the myriads of pores of the skin of effete matter. It is efficient in fevers, and for breaking up colds, and is a very valuable, remedial agent in most chronic diseases, assisting in removing causes which depress the bodily functions.

MOTION IS A REMEDIAL AGENT.

The stability of the planetary system depends upon the converted motion of its parts. So in the human system, motion is a fundamental principle which underlies every vital process. Health consists in normal, functional activity. The human system is the arena of various kinds of motions, both of fluids and of solids, and life and health depend upon these physiological movements. There are the movements incident to respiration, the expansion and contraction of the walls of the chest, bringing the oxygen of the air into contact with the blood as it circulates through the lungs. Corresponding with the movements of the chest are the motions of the abdominal walls, which promote the functions of the organs of the abdominal cavity.

There are motions of the heart and arteries, which urge the blood out to the extremities and diffuse it through every part of the system, and also motion of the blood in the capillaries, by which the blood is circulated through the tissues, that the latter may be built up from its nutritive constituents. Then there is the motion of the vital current in the veins returning towards the heart, and urged forward by the muscular and pump-like action of the chest and abdominal walls. The peristaltic motions of the stomach and bowels urge onward digesting materials, exposing them successively to different solvents and aiding the absorption of nutritive matter. No less essential to life and health are numerous other minute operations or motions, on which vital power in all its manifestations of muscular and nervous energy depends. Many other motions are consequent upon decay, growth, and repair. Oxygen, carbonic acid, watery vapors, and other gaseous matter are constantly being exchanged between the system and atmosphere. Then, the human system being a complex, chemical laboratory, there are motions consequent upon chemical action, constantly going on within it.

Muscular motion, under the direction of the will, is also absolutely necessary for the maintenance of good health.

Animal heat and muscular and nervous power are dependent upon motions of the minutest particles composing the body. The body is composed of fluid and semi-fluid matter, permitting great freedom of motion. Health requires that there shall be a constant change of place, an active transmission of material to and from vital organs and parts, through the medium of blood-vessels, as well as outside such vessels; that is, motion of interstitial fluids.

NATURE'S MODE OF SUSTAINING HEALTH. The act of transforming latent, non-vital force which exists pent-up in food, as heat is in coal, into vital energy, requires the simultaneous elimination from the system of a like amount of worn-out matter. Assimilation of nutritive materials is impossible, unless a like amount of matter be eliminated from the system. Muscular and nervous energy are dependent upon activities which cause waste. Not only is this true in a general way, but it is also true that the energy produced by the operations of the vital system has a strict relation to the wasting products—that full energy is only attained by perfected waste. Use, waste, and power, then, sustain definite and dependent or corresponding relations, since waste is as essential to health as is supply.

Without waste, disturbance is at once produced in the system similar to that resulting from the introduction of foreign matter. These disturbances constitute disease. The more obvious effects of lack of waste and elimination are mechanical. The circulation is loaded with effete and useless matter, the vessels being thereby weakened and distended, and the circulation retarded. The capillaries become clogged and vital action is diminished. Local congestions, inflammations, effusions, morbid growths, and other pathological results follow.

Deranged or suppressed action characterizes, and, indeed, constitutes all departures from health which we call disease. Suffering indicates action, but action which is perverted into wrong channels, or action in one part at the expense of motion in other parts, constituting a disturbance in the equilibrium of forces, from which the system suffers.

VALUE OR MECHANICAL MOVEMENTS AND MANIPULATIONS FOR THE TREATMENT OF CHRONIC DISEASES. To correct and restore deranged movements, thereby producing normal, functional activity of every organ and part of the system, must therefore be the chief object of the physician. All remedies, of whatever school or nature, imply motion, and depend for their efficacy upon their ability to excite motion in some one or more elements, organs, or parts of the system.

While we do not wish to detract from the real merits of medicine as a curative agent, yet we must admit that the remedial power of motion, transmitted either manually or mechanically, is founded upon rational and physiological principles. All systems of medicine, however much they may differ superficially, propose, as the chief end to be attained by the administration of medicine, or by other treatment, that motions identical with physiological activity should be incited or promoted. How best to accomplish this result, and with least cost to vitality, is an important consideration. Bearing in mind the conservation of forces, that energy or power is as indestructible as matter, that it may be changed into other forms but never lost, it is plain that mechanical force may be applied to the living system and transformed into vital energy; that chemical action, animal heat, and magnetism may represent in the system the mechanical force transmitted to the body. Keeping in view the transformable nature of force, and the need that our systems have of auxiliary power in different departments, when normal activity is impaired by disease, we can readily understand how undoubted, curative effects result from either the manual or the mechanical administration of motion.

RUBBING is a process universally employed by physicians of every school for the relief of a great diversity of distressing symptoms, is instinctively resorted to by sympathizers and attendants upon the sick, and constitutes one of the chief duties of the nurse. Uncivilized people resort to this process as their principal remedy in all forms of disease.

The difficulty in administering motion as a remedial agent by manual effort, such as rubbing, kneading, oscillating, flexing, and extending the limbs, lies in the impossibility of supplying the amount, intensity, and variety of movement required to make it most effective. The power of the arm and the strength of the operator are exhausted before the desired effect is produced. Inventive genius has at last overcome the obstacles to the successful and perfect administration of motion as a curative agent. We have now a series of machines propelled by mechanical power, by the use of which we rub, knead, manipulate, and apply in succession a great variety of movements to all parts of the body. These machines transmit motion to the body from inexhaustible sources, never tire, but are ever ready for new, remedial conquests. The movements administered by their use, while entirely under the control of the patient, are never disagreeable, and are far more rapid and intense than can possibly be given by the hands. By the application of short, quick movements of from twelve to fifteen hundred vibrations a minute, deep-seated organs and parts are reached, to which motion is transmitted and in which vital energy is thereby generated. The hands have not the power, by kneading, manipulating, or rubbing to impress the system except in a very mild degree, and deep-seated organs and parts are scarcely influenced by the comparatively slow movements thus administered. Among the most important, mechanical inventions devised for administering motion as a remedial agent, is one which has received the name of the manipulator.

THE MANIPULATOR. With this machine motion can be applied to any organ or part of the system, and intensity of the application regulated to a nicety. The rapidity of motion necessary to produce active exhilaration of any part of the body is easily secured by the use of the manipulator, but is far beyond the power of the hands. The degree of circulation given to the fluids, both inside and outside of the vessels, and of energy imparted to the organs and parts operated upon by the manipulator, is also unapproachable by the application of manual power.

EFFECTS UPON THE CIRCULATION AND NUTRITION. The influence of motion on these functions is as follows: The contents of the blood-vessels are moved onward by the pressure and motion transmitted by the manipulator, all backward movement of the blood being prevented by the valves of the veins and by the propelling power of the heart and arteries. Fluids outside these vessels pass through their walls, to take the place of the stagnant blood that has been moved onward. Other blood flows into the part, and thus active and healthy circulation is induced, and nutritive material, capable of affording vital support is also brought to refresh the local part.

We have found mechanical movements especially effectual in paralysis, neuralgia, sleeplessness, and other nervous affections; in derangements of the liver, constipation, and dyspepsia; in displacements of the uterus, and congestion, and inflammation of the pelvic organs.

For a complete description of the mechanical movements and the machinery employed in the treatment of diseases at the Invalids' Hotel and Surgical Institute, the reader is referred to the appendix to this work.

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CHAPTER IV.

HYGIENIC TREATMENT OF THE SICK.

There are two essentials requisite to the successful treatment of the sick: (1.) Medical skill; (2.) Good nursing. The former is necessary in order that the condition of the patient be fully understood, and the proper means be employed to effect his recovery. The latter is essential, in order that all influences favoring the production and development of disease may be removed, the tendencies to restoration be promoted by every possible means, and the directions of the physician be properly observed.

Success in the treatment of the sick requires good nursing. Without it, the most skillful physicians fail to effect a cure; with it, the most unqualified may succeed. If certain hygienic agencies are essential to the maintenance of health, how much more necessary it is that they be employed in sickness! If certain conditions cause disease, how great the necessity is that such conditions be obviated and hygienic ones substituted!

Notwithstanding the importance of good nursing, in the rural districts it is frequently difficult to find a professional nurse, or, if one can be obtained, it is often impossible for the invalid to procure such services, on account of the expense which must necessarily be incurred. Hence, this office usually devolves upon some relative who is considered to be the best qualified for the position; or, as is often the case, necessity demands that the patient be left to a change of nurses. A woman is generally selected for this important position. Her soft hand and soothing voice, her kindly, sympathetic, and provident nature, together with her scrupulous cleanliness, render her man's equal, if not his superior, in the capacity of nurse. There are circumstances, however, in which the services of a man are indispensable; hence the necessity that all should be qualified to care for the sick.

A nurse should be attentive to the requirements of physician and patient, for she sustains an intimate relation to both. She should observe the directions of the physician, and faithfully perform them. She should note all the symptoms of the patient, and do everything in her power to promote comfort and recovery. She should anticipate the wishes, and not cause the patient to ask for everything which is desired. So far as practicable, let the wishes be gratified. The senses of the sick often become morbidly acute, and those things which in health would pass unnoticed, in sickness are so magnified as to occasion annoyance and vexation. Sick persons are not all alike, and the peculiarities of each must be studied separately. The nurse must be kind, but firm, and not yield to such whims of the patient as may be detrimental to recovery; neither must she arouse dislike or anger by opposition, but endeavor to win the patient from all delusions. The feelings of the patient should never be trifled with, for idealities become realities.

The nurse should possess an inexhaustible store of patience. Disease affects the mind of the patient and fills it with strange delusions. The sick are often querulous, fretful, and unreasonable, and should be treated with kindness, forbearance, and sympathy. The nurse should always be cheerful, look on the bright side of every circumstance, animate them with encouragement, and inspire them with hope. Hope is one of the best of tonics. It stimulates the flagging, vital energies, and imparts new life to the weak and exhausted forces. Gloom, sadness, and despondency depress the vital forces and lead to death. We have seen patients rapidly sinking, who had given up all hope, and were quietly awaiting the coming of death, snatched, as it were, from its grasp, and restored to health, by words of cheer and encouragement.

The nurse should possess moral principles, which alone can win the confidence of the patient. She should have judgment, circumspection, intelligence, forethought, alacrity, carefulness, and neatness. In a word she should exercise common sense.

We deem it but justice to say a word in behalf of the nurse. She, too, is a human being, subject to disease, and, unless hygienic conditions be observed, will soon be stricken low by its presence. She must be relieved occasionally and get rest, or she cannot long withstand the combined influence of fatigue and disease. Her office is an arduous one at best, and the long, weary hours of night-watching should be compensated by exercise in the open air, as well as by sleep during the day. Unless this be done, the system will become exhausted, and sleep will intrude itself upon her at the time when the greatest diligence is required for the welfare of the patient, when the vital powers are at their lowest ebb. She should be supplied with plenty of suitable food during the night, to sustain her and to serve as a safeguard against the invasion of disease. She should be treated with kindness and respect, else her disposition may become morose and reflect itself upon the patient, causing peevishness and despondency.

THE SICK-ROOM should be as comfortable, cheerful, and pleasant, as circumstances will allow. Let the room be large and airy, and furnished with a stove, or better still, a fireplace. All articles of clothing and furniture, not necessary to the comfort of the patient, should be removed from the room, and in malignant or contagious diseases the carpets, even, should not be permitted to remain. The surroundings beget happiness or gloom, in proportion as they are pleasant or disagreeable. A tidy attendant, a few flowers and books, wonderfully enhance the cheerfulness of the room. Permit no unnecessary accumulation of bottles, or any thing that can in any way render the room unpleasant. Medicines, drink, or nourishment should never be left uncovered in the sick-room, since they quickly absorb the gaseous emanations from the patient, and become unfit for the purpose which they were intended to serve. Their presence gives the room an untidy appearance, suggestive of filth and slovenliness, and imparts to the patient a feeling of loathing and disgust for articles of diet.

THE BED should not be of feathers, on account of their undue warmth, which causes a sensation of languor throughout the system. A husk or sea-grass mattress, or even a straw bed, covered with a cotton quilt, is far preferable. The bedding should be changed frequently. It is better that the bed should be away from the wall, so as to admit of greater freedom of movement about it.

PURE AIR. The air in the sick-room should be kept as pure as possible. That which is so necessary in health, is indispensable in sickness. The importance, therefore, of a perfect and free ventilation of the sick-room cannot be too thoroughly impressed; and yet to properly secure this end, may call forth a considerable amount of ingenuity on the part of the nurse. A window should be open, but the current of air must not be allowed to blow directly upon the patient. One window may be raised from the bottom and another lowered from the top. This will permit the entrance of pure air from without, and the exit of the vitiated air from within. The patient, if sufficiently covered in bed, is not liable to take cold from a proper ventilation of the room. Especially is this true, when the bodily temperature is raised by febrile or inflammatory affections. The temperature of a room is no indication of the purity of the air. It is a prevalent, but mistaken notion, that when a room is cold, the air must be pure. Cold air is as readily contaminated with impurities as warm air, therefore, it is not sufficient that the room be kept cool, but the air should be frequently changed. During convalescence, great care is necessary to protect the patient from taking cold. Air which is admitted into the sick-room should not be contaminated by passing over foul drains, privies, or other sources of infection, since, instead of invigorating, it depresses the physical forces and generates disease.

LIGHT is as necessary to health as is pure air. Banish either for any continuous period of time, and serious results follow. The strong, robust man, when deprived of light, soon degenerates into a feeble, sickly being, and finally dies.

According to the investigations of the Massachusetts Medical Society, it was found that absence of sunlight, together with moisture, not only favor the development of tubercular consumption, but act as an exciting cause. It is well known that persons living in shaded dwellings often suffer from forms of disease which resist all treatment until proper admission of light is secured.

The physician to the Emperor of Russia found upon examination that patients confined in well lighted wards, were four times as liable to recover as were those in poorly lighted rooms. Children reared away from the sunlight are apt to be deformed and idiotic, while those partially deformed have been restored by being admitted to the light.

Patients sometimes wish to have their rooms darkened, because the light is painful to their weak and sensitive eyes. It is far better to shade the eyes and admit the sunlight into the room, since its rays cause chemical changes to take place, which favor the return of health. Many invalids can ascribe their recovery to the influence of a sun bath. There are, however, conditions in which the patients should be screened from the light. In such cases a little arrangement of the curtains or shutters will accomplish all that is to be desired.

Patients convalescing from acute, or suffering from chronic diseases, should receive the influence of light in the open air, and be in it several hours every day. Light and pure air stimulate a healthful development, induce cheerfulness, hope, and recovery, while darkness begets gloom, sadness, despondency, disease, and ultimately death.

WARMTH is essential to the well-being of the patient, and it is necessary that a proper temperature be maintained in the room. Except in very warm weather, a little fire should be kept in the room, and at the same time fresh air should be admitted from without, and a uniform temperature thus preserved. This arrangement is especially necessary in localities where great variations in temperature are experienced during the day and night.

The normal temperature of the body ranges from 98 deg. to 99 deg. Fahr. The minimum occurs from 2 to 6 A.M.; the maximum, from 1 to 6 P.M. The deviation of a few degrees from this standard indicates disease, and the greater the deviation, the greater is its severity. During the early stages of acute diseases, the animal heat is generally increased, and should be allayed by bathing, and cooling or acidulated drinks. In the latter stages, the temperature becomes diminished and the condition of the system is favorable to congestions, which are most likely to occur between the hours of 2 and 6 A.M., when the vital powers are lowest. The patient then becomes feeble, his extremities grow cold, and he has what is termed a "sinking spell," and perhaps dies. It is during these hours that additional covering, the application of hot bricks to the feet, and bottles of hot water to the limbs and body, friction upon the surface, stimulating drinks, and increased vigilance on the part of the nurse will often save the patient's life. But, unfortunately, at these hours the nurse is apt to get sleepy and inattentive, the demands of the patient go unheeded, and a sacrifice of life is the result.

Persons suffering from chronic diseases, or those in feeble health, should preserve their vital energies by dressing warmly, by wearing flannels next to the skin, and by carefully protecting the feet from cold and moisture.

CLEANLINESS cannot be too thoroughly impressed upon the minds of those who have the care of the sick. Filthiness is productive of disease and favorable to its development. Bathing at least once a day, with pure, soft water and toilet-soap, is strongly urged, and as this is designed for cleanliness, the temperature of the bath should be made agreeable to the patient.

THE CLOTHING AND BEDDING OF THE PATIENT in acute diseases, should be changed frequently and thoroughly aired, if not washed. As soon as removed, these articles should be taken from the room, replaced by others well aired and warmed. The hands and face of the patient should be bathed frequently, the hair combed, the teeth brushed, the nails cleaned, the lips moistened, and everything about him kept clean and tidy. These observances, although in themselves trifling, promote comfort and cheerfulness, and contribute largely to the recovery of the sick. All excretions from the patient should be buried, and not committed to privies to communicate disease to those who frequent them.

THE DIET contains a very important relation to health. During the process of acute disease, the appetite is generally much impaired, if not entirely absent. It should then be the study of the nurse to devise such articles of nourishment as will be acceptable to the patient and suitable to the condition. The food should be light, nutritious, and easy of digestion.

Each individual disease requires a diet adapted to its peculiarities. Those of an inflammatory character require an unstimulating diet, as gruel, barley-water, toast, etc. An exhausted or enfeebled condition of the brain, unattended by irritability, demands a stimulating diet, as beef, eggs, fish, Graham bread, oysters, etc. In wasting diseases, in which the temperature of the system is low, beef, fatty substances, rich milk, sweet cream, and other carbonaceous articles of diet are recommended. In the various forms of chronic ailments, the diet must be varied according to the nature of the disease and the peculiarities of the patient. Deranged digestion is generally an accompaniment of chronic disease. A return to normal digestion should be encouraged by selecting appropriate articles of food, paying due regard to its quantity and quality, as well as to the manner and time of eating. The appearance of food, and the manner in which it is offered, have much to do with its acceptance, or rejection by the patient. Let the nourishment be presented in a nice, clean dish, of a size and shape appropriate to the quantity. More food than can be eaten by the patient should not be placed before him at one time, since a great quantity excites disgust and loathing. In taking nourishment, drink, or medicine, the patient, if feeble, should not be obliged to change his position.

MILK is one of the most important foods in fevers and acute diseases attended with great prostration, and in which the digestive powers are enfeebled. It contains within itself all the elements of nutrition.

BEEF TEA furnishes an excellent nourishment for the sick, but there are few, even among professional nurses who know how to properly prepare it. We give three good recipes. One method is to chip up lean beef, put it in a porcelain or tin saucepan, cover it with cold water, and bring it up to just below the boiling point, at which temperature retain it for ten minutes, then season and serve. Another method is similar to the foregoing, with this difference, that the juices of the meat are squeezed through a piece of muslin or crash, making the tea richer. Another way, which we consider preferable to either of the above, is to take lean beef, cut it into fine bits, put them in a tightly covered vessel, which is placed in a kettle of water kept boiling. Thus the whole strength of the juice will be obtained from the meat without losing any of its properties. It can be seasoned to the taste, and reduced with water to suit the needs of the patient.

SLEEP is "Nature's grand restorer, a balm to all mankind; the best comforter of that sad heart whom fortune's spite assails." It is necessary in health, and doubly so in sickness. During sleep, the vital energies recuperate, the forces are less rapidly expended, and the strength increases. It is the great source of rest and refreshment. Often a day's rest in bed, free from the cares and anxieties of an active life, is sufficient to ward off the approach of disease. If quiet and rest are essential to recuperation in health, their necessity in disease must be apparent. Life frequently depends on tranquility and repose, and the least noise or confusion disturbs the sufferer and diminishes the chances of recovery. Nothing annoys sick or nervous persons more than whispering and the rustling of newspapers. If conversation be necessary, let the tones be modified, but never whisper. In sickness, when the vital forces are low, the more natural rest and sleep the patient obtains, the greater is the prospect for recovery. As a rule, a patient should never be awakened when sleeping quietly, not even to take medicine, unless in extreme cases. If the patient does not sleep, the cause should be ascertained and the appropriate remedies employed; if it arise from rush of blood to the head, cooling lotions should be applied, and warmth to the feet; if, from restlessness or general irritability, a sponge bath, followed by friction should be administered; if the wakefulness is due to noise or confusion, quiet is the remedy. When these means fail, anodynes, or nervines, should be employed. Lying on the side instead of on the back should be practiced. Patients afflicted with chronic diseases, on rising, should take a cold bath, dry the surface quickly with a coarse towel, followed by friction with the hand. Great benefit may be derived by following these suggestions when the nature of the disease is not such as to forbid it.

EXERCISE and rest necessarily alternate with each other. Exercise, so necessary to health, in many forms of disease greatly contributes to recovery. It sends the sluggish blood coursing through the veins and arteries with increased force and rapidity, so that it reaches every part of the system, supplying it with nourishment. It increases the waste of old material and creates a demand for new.

Convalescing patients, or those suffering from chronic diseases, whenever the weather will permit, should take exercise every day in the open air. This should be done with regularity. The amount of exercise must be regulated by the strength of the patient; never take so much as to produce fatigue, but, as the strength increases, the exercise may be increased proportionately. Some interesting employment, commensurate with the patient's strength, should be instituted, so that the mind may be agreeably occupied with the body.

When unable to take active exercise, the invalid, properly protected by sufficient clothing, should ride in a carriage or boat, and each day a new route should be chosen, so that a change of scenery may be observed, thus arousing new trains of thought, which will be exhilarating and prove beneficial to him.

SEXUAL INFLUENCES. During the progress of disease or convalescence, entire continence must be observed. It is then necessary that all of the vital energies should be employed in effecting a recovery from disease, without having the additional tax imposed of overcoming the debilitating effects of sexual expenditure. This holds true with regard to all diseases, and especially those of the nervous system and genitourinary organs.

VISITING THE SICK may be productive of good or evil results. Mental impressions made upon the sick exert a powerful influence upon the termination of disease. The chances of recovery are in proportion to the elevation or depression of spirits. Pleasant, cheerful associations animate the patient, inspire hope, arouse the vital energies, and aid in his recovery; while disagreeable and melancholy associations beget sadness and despondency, discourage the patient, depress the vital powers, enfeeble the body, and retard recovery.

Unless persons who visit the sick can carry with them joy, hope, mirth, and animation, they had better stay away. This applies equally in acute and chronic diseases. It does not matter what a visitor may think with regard to the patient's recovery, an unfavorable opinion should never find expression in the sick-room. Life hangs upon a brittle thread, and often that frail support is hope. Cheer the sick by words of encouragement, and the hold on life will be strengthened; discourage, by uttering such expressions as, "How bad you look!" "Why, how you have failed since I saw you last!" "I would have another doctor; one who knows something!" "You can't live long if you don't get help!" etc., and the tie which binds them to earth is snapped asunder. The visitor becomes a murderer! Let all persons be guided by this rule: Never go into the sick-room without carrying with you a few rays of sunshine!

If the patient is very weak the visitor may injure him by staying too long. The length of the visit should be graduated according to the strength of the invalid. Never let the sufferer be wearied by too frequent or too lengthy visits, nor by having too many visitors at once. Above all things, do not confine your visitations to Sunday. Many do this and give themselves credit for an extra amount of piety on account of it, when, if they would scrutinize their motives more carefully, they would see that it was but a contemptible resort to save time. The sick are often grossly neglected during the week only to be visited to death upon Sunday.

THE USE OF TOBACCO AND OPIUM. The recovery of the sick is often delayed, sometimes entirely prevented, by the habitual use of tobacco or opium. In acute diseases, the appetite for tobacco is usually destroyed by the force of the disease, and its use is, of necessity, discontinued; but in chronic ailments, the appetite remains unchanged, and the patient continues his indulgence greatly to the aggravation of the malady.

The use of tobacco is a pernicious habit in whatever form it is introduced into the system. Its active principle, Nicotin, which is an energetic poison, exerts its specific effect on the nervous system, tending to stimulate it to an unnatural degree of activity, the final result of which is weakness, or even paralysis. The horse, under the action of whip and spur, may exhibit great spirit and rapid movements, but urge him beyond his strength with these agents, and you inflict a lasting injury. Withhold the stimulants, and the drooping head and moping pace indicate the sad reaction which has taken place. This illustrates the evils of habitually exciting the nerves by the use of tobacco, opium, narcotic or other drugs. Under their action, the tone of the system is greatly impaired, and it responds more feebly to the influence of curative agents. Tobacco itself, when its use becomes habitual and excessive, gives rise to the most unpleasant and dangerous pathological conditions. Oppressive torpor, weakness or loss of intellect, softening of the brain, paralysis, nervous debility, dyspepsia, functional derangement of the heart, and diseases of the liver and kidneys are not uncommon consequences of the excessive employment of this plant. A sense of faintness, nausea, giddiness, dryness of the throat, tremblings, feelings of fear, disquietude, and general nervous prostration must frequently warn persons addicted to this habit that they are sapping the very foundation of health. Under the continued operation of a poison, inducing such symptoms as these, what chance is there for remedies to accomplish their specific action? With the system already thoroughly charged with an influence antagonistic to their own, and which is sure to neutralize their effect, what good can medicine do?

Dr. King says, "A patient under treatment should give up the use of tobacco, or his physician should assume no responsibility in his case, further than to do the best he can for him." In our own extensive experience in the treatment of chronic diseases, we have often found it necessary to resort to the same restriction.

The opium habit, to which allusion has also been made, is open to the same objections, and must be abandoned by all who would seek recovery.

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PART IV.

DISEASES AND THEIR REMEDIAL TREATMENT.



INTRODUCTION.

Knowledge which is conducive to self-preservation is of primary importance. That great educator, profound thinker, and vigorous writer, Herbert Spencer, has pertinently said that, "As vigorous health and its accompanying high spirits, are larger elements of happiness than any other things whatever, the teaching how to maintain them is a teaching that yields to no other whatever. And therefore we assert that such a course of physiology as is needful for the comprehension of its general truths and their bearings on daily conduct is an all-essential part of a rational education."

Believing that the diffusion of knowledge for the prevention of disease is quite as noble a work as the alleviation of physical suffering by medical skill, we have devoted a large portion of this volume to the subjects of physiology and hygiene. These we have endeavored to present in as familiar a style as possible, that they may be understood by every reader. Freely as we have received light upon these subjects have we endeavored to reflect it again, in hopes that a popular presentation of these matters made plain and easy of comprehension to all people, may lead the masses into greater enjoyment of life—the result of a better preservation of health. This we do in part as a public acknowledgment of our obligations to society, to whom every professional man is a debtor. He belongs to it, is a part of its common stock, and should give as well as receive advantages, return as well as accept benefits. We know of no better way to signify our appreciation of the public confidence and patronage, so generously accorded to us, than to offer this volume to the people at a price less than the actual cost for an edition of ordinary size. This we do as a token of the cordial reciprocation of their good will. In giving to the people wholesome advice, by which they may be enabled to ward off disease and thus preserve the health of multitudes, we believe we shall receive their hearty approval, as well as the approbation of our own conscience, both of which are certainly munificent rewards. We believe that good deeds are always rewarded, and that the physician who prevents sickness manifests a genuine and earnest devotion to the common interests of humanity.

We have no respect for the motives of those medical men who would withhold that information from the people which will direct the masses how to take care of themselves, and thereby prevent much sickness and suffering. Nor is the diffusion of such knowledge antagonistic to the best interests of the true and competent physician. The necessity for his invaluable services can no more be set aside by popularizing physiological, hygienic, and medical truths, than we can dispense with those of the minister and lawyer by the inculcation of the principles of morality in our public schools. The common schools do not lessen the necessity for colleges or universities, but rather contribute to their prosperity. Nor are we so presumptuous as to anticipate that we could possibly make this volume so instructive as to render "every man his own physician." No man can with advantage be his own lawyer, carpenter, tailor, and printer; much less can he hope to artfully repair his own constitution when shattered by grave maladies, which not only impair the physical functions, but weaken and derange the mental faculties. What physician presumes to prescribe for himself, when suddenly prostrated by serious illness? He very sensibly submits to the treatment of another, because he realizes that sickness impairs his judgment, and morbid sensations mislead and unfit him for the exercise of his skill. If this is true of the physician, with how much greater force does it apply to the unprofessional! If a sick sea-captain is unfit to stand at the helm and direct his ship, how utterly incompetent must the raw sailor be when similarly disqualified! Nor is the physician as competent to treat those near and dear to him, when they are suffering from dangerous illness, as another medical man not similarly situated, whose judgment is not liable to be misled by intense anxiety and affectionate sympathy.

Notwithstanding all these facts, however, a knowledge on the part of the unprofessional, of something more than physiology and hygiene, and appertaining more closely to medicine proper, will many times prove valuable.

In the first stage of many acute affections which, if unheeded, gradually assume a threatening aspect, endangering life and demanding the services of the most skilled physician to avert fatal results, the early administration of some common domestic remedy, such as a cathartic, or a diaphoretic herb, associated with a warm bath, a spirit vapor-bath, or a hot foot-bath, will very often obviate the necessity for calling a family physician, and frequently save days and weeks of sickness and suffering.

So, likewise, are there numerous, acute diseases of a milder character which are easily and unmistakably recognized without the possession of great medical knowledge, and which readily yield to plain, simple, medical treatment which is within the ready reach of all who strive to acquaint themselves with the rudiments of medical science. But in sudden and painful attacks of acute disease, life may be suddenly and unexpectedly jeopardized, and immediate relief prove necessary. While under these circumstances the prompt application of such domestic treatment as good common-sense may dictate, guided by a knowledge of those first principles of medical learning which we shall hereafter endeavor to make plain, may result in speedy and happy relief, yet at the same time there should be no delay in summoning a competent physician to the bedside of the sufferer.

Then, and not the least important, there are the various chronic or lingering diseases, from all of which few individuals indeed, who pass the meridian of life, entirely escape. In this class of ailments there is generally no immediate danger, and, therefore, time may be taken by the invalid for studying his disease and employing those remedies which are best suited for its removal. Or, if of a dangerous or complicated character, and, therefore, not so readily understood, he may consult either personally or by letter, some learned and well-known physician, who makes a specialty of the treatment of such cases, and whose large experience enables him to excel therein.

In consideration, therefore, of the foregoing facts, we deem it most profitable for our readers that Part Fourth of this volume should be arranged in the following manner:

The milder forms of uncomplicated, acute diseases, which may be readily and unmistakably recognized, and successfully managed without professional aid, will receive that attention which is necessary to give the reader a correct idea of them, and their proper remedial treatment.

We shall devote only such attention to the severe and hazardous forms of acute diseases as is necessary in order to consider their initial stage, with their proper treatment, not attempting to trace their numerous complications, or portray the many pathological conditions which are liable to be developed. For, even by devoting much space to the latter, we could not expect to qualify our unprofessional readers for successfully treating such obscure and dangerous conditions.

We shall devote the largest amount of space to a careful and thorough consideration of those chronic diseases, which, by a little study, may be readily recognized and understood by the masses, and for the cure of which we shall suggest such hygienic treatment and domestic remedies as may be safely employed by all who are in quest of relief. In the more dangerous, obscure, or complicated forms of chronic diseases, the correct diagnosis and successful treatment of which tax all the skill possessed by the experienced specialist, the invalid will not be misled into the dangerous policy of relying upon his own judgment and treatment, but will be counseled not to postpone until too late, the employment of a skillful physician.

The apportionment of space which is made in considering the various diseases and their different stages, as well as the course which the people are advised to pursue under the different circumstances of affliction, is not always in accordance with the plans and recommendations which have been made by others who have written works on domestic medicine. Most of these authors have attempted, by lengthy disquisitions, to teach their readers how to treat themselves without the services of a physician, even in the most hazardous forms of disease. In such dangerous maladies as typhoid, typhus, yellow, and scarlet fevers, typhoid pneumonia, and many others, in which life is imminently imperiled, such instruction and advice is decidedly reprehensible, as it may lead to the most serious consequences. We are confident, therefore, that the manner of disposing of the different subjects which are discussed in the succeeding chapters, and the course of action which is advised, will commend themselves to our readers as being such as are calculated to promote and subserve their best interests.

MEDICAL DIAGNOSIS.

Skill in the art of healing is indicated in three ways: (1.) by ascertaining the symptoms, seat, and nature of the disease, which is termed diagnosis; (2.) by foretelling the probable termination, which is termed prognosis; (3.) by the employment of efficacious and appropriate remedies, which is called treatment. Of these three requisites to a prosperous issue, nothing so distinguishes the expert and accomplished physician from the mere pretender as his ready ability to interpret correctly, the location, extent, and character of an affection from its symptoms. By medical diagnosis, then, is understood the discrimination between diseases by certain symptoms which are distinguishing signs. Every malady is accompanied by its characteristic indications, some of which are diagnostic, i.e., they particularize the affection and distinguish it from all others.

Medical diagnosis is both a science and an art; a science when the causes and symptoms of a disease are understood, and an art when this knowledge can be applied to determine its location and exact nature. Science presents the general principles of practice; art detects among the characteristic symptoms the differential signs, and applies the remedy. Da Costa aptly remarks: "No one aspiring to become a skillful observer can trust exclusively to the light reflected from the writings of others; he must carry the torch in his own hands, and himself look into every recess."

The critical investigation of symptoms, with the view of ascertaining their signs, is essential to successful practice. Without closely observing them, we cannot accurately trace out the diagnosis, and a failure to detect the right disease is apt to be followed by the use of wrong medicines.

General diagnosis considers the surroundings of the patient as well as the actual manifestations of the disease. It takes into account the diathesis, i.e., the predisposition to certain diseases in consequence of peculiarities of constitution. We recognize constitutional tendencies, which may be indicated by the contour of the body, its growth, stature, and temperament, since all these facts greatly modify the treatment. Likewise the sex, age, climate, habits, occupation, previous diseases, as well as the present condition, must be taken into account.

Auscultation, as practiced in detecting disease, consists in listening to the sounds which can be heard in the chest.

Percussion consists in striking upon a part with the view of appreciating the sound which results. The part may be struck directly with the tips of the fingers, but more generally one or more fingers of the other hand are interposed between the points of the fingers and the part to be percussed, that they, instead of the naked chest, may receive the blow; or, instead of the fingers, a flat piece of bone or ivory, called a pleximeter, is placed upon the chest to receive the blow.

Latterly, improved instruments greatly assist the practitioner of medicine in perfecting this art. The microscope assists the eye, and helps to reveal the appearance and character of the excretions, detecting morbid degenerations; chemistry discloses the composition of the urine, which also indicates the morbid alterations occurring in the system; by percussion we can determine the condition of an internal organ, from the sound given when the external surface is percussed; the ear, with the aid of the stethoscope, detects the strange murmurs of respiration, the fainter, more unnatural pulsations of life, and the obscurer workings of disease; with the spirometer we determine the breathing capacity of the lungs, and thus ascertain the extent of the inroads made by disease; the dynamometer records the lifting ability of the patient; the thermometer indicates the morbid variation in the bodily temperature; various instruments inform us of the structural changes causing alterations in the specific gravity of fluids, e.g., the urinometer indicates those occurring in the urine; and thus, as the facilities for correct diagnosis increase, the art of distinguishing and classifying diseases becomes more perfect, and their treatment more certain. While physiology treats of all the natural functions, pathology treats of lesions and altered conditions.



By the term symptoms we mean the evidence of some morbid effect or change occurring in the human body, and it requires close observation and well-instructed experience to convert these symptoms into diagnostic signs. Suppose "Old Probabilities" (as we commonly designate the invaluable Signal Department) hangs out his warning tokens all along our lake borders and ocean coasts; our sailors behold the fluttering symbols indicating an approaching storm, but if no one understood their meaning, a fearful disaster might follow. But if these signals are understood, a safe harbor is sought and the mariner is protected. So disease may hang out all her signals of distress, in order that they may be seen, but unless correctly interpreted, and a remedial harbor is sought, these symptoms are of little practical value.

Undoubtedly the reason why so many symptom-doctors blunder is because they prescribe according to the apparent symptoms, without any real reference to the nature of the affection. They fail to discover how far a symptom points out the seat, and also the progress of a disease. They do not distinguish the relative importance of the different symptoms. The practical purpose of all science is to skillfully apply knowledge to salutary and profitable uses. The patient himself may carefully note the indications, but it is only the expert physician who can tell the import of each symptom.

Symptoms are within every one's observation, but only the physician knows the nature and value of signs. We have read an anecdote of Galen, who was a distinguished physician in his day, which illustrates the distinction between sign and symptom. Once, when dangerously ill, he overheard two of his friends in attendance upon him recount his symptoms, such as "Redness of the face, a dejected, haggard, and inflamed appearance," etc. He cried out to them to adopt every necessary measure forthwith, as he was threatened with delirium. The two friends saw the symptoms well enough; but it was only Galen himself, though the patient, who was able to deduce the sign of delirium—that is, he alone was able to translate those symptoms into signs. To determine the value of symptoms, as signs of disease, requires close observation.

INTERPRETATION OF SYMPTOMS.

We shall refer to a few symptoms which any unprofessional reader may readily observe and understand.

POSITION OF PATIENT. When a patient is disposed to lie upon his back continually during the progress of an acute disease, it is a sign of muscular debility. If he manifests no desire to change his position, or cannot do so, and becomes tremulous at the least effort, it indicates general prostration. When this position is assumed, during the progress of continued fever, and is accompanied by involuntary twitching of the muscles, picking of the bed-clothes, etc., then danger is imminent and the patient is sinking. Fever, resulting from local inflammation, does not produce muscular prostration, and the patient seldom or never assumes the supine position. If this inflammation is in the extremities, those parts are elevated, in order to lessen the pressure of the blood, which a dependent, position increases.

For example, let us change the scene, and introduce a patient with head and shoulders elevated, who prefers to sit up, and who places his hands behind him and leans back, or leans forward resting his arms and head upon a chair. The next week he is worse, and no longer tries to lie in bed, but sits up all the time; note the anxious expression of countenance, the difficult or hurried breathing, the dry and hacking cough, and observe that the least exertion increases the difficulty of respiration and causes palpitation of the heart. These plain symptoms signify thoracic effusion, the collection of water about the lungs.

THE COUNTENANCE displays diagnostic symptoms of disease. In simple, acute fevers, the eyes and face are red and the respiration is hurried; but in acute, sympathetic fever, these signs are wanting. We cannot forget the pale, sharp, contracted, and pinched features of those patients whose nostrils contract and expand alternately with the acts of respiration. How hard it was for them to breathe. The contraction and expansion of the nostrils indicate active congestion of the lungs.

As a general rule, chronic inflammation of the stomach, duodenum, liver, and adjacent organs, imparts a gloomy expression to the countenance, at the same time the eye is dull, the skin dusky or yellow, and the motions are slow. But in lung diseases, the spirits are buoyant, the skin is fair, and the cheeks flushed with fever and distinctly circumscribed with white, for delicacy and contrast, almost exceed the hues of health in beauty. Note, too, the pearly lustre and sparkling light of the eye, the quivering motion of the lips and chin, all signs of pulmonary disease.

THE STORY OF SEXUAL ABUSE is plainly told by the downcast countenance, the inability to look a person fairly in the face, the peculiar lifting of the upper lip and the furtive glance of the eye. The state of the mind and of the nervous system corroborates this evidence, for there seems to be a desire to escape from conversation and to elude society. The mind seems engrossed and abstracted, the individual appears absorbed in a constant meditation, he is forgetful and loses nearly all interest in the ordinary affairs of life. The whole appearance of a patient, suffering from spermatorrhea, is perfectly understood by the experienced physician, for the facial expressions, state of mind, and movements of the body, all unconsciously betray, and unitedly proclaim his condition.