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of the breathing and convulsive hiccup; in batlı, he should be well rubbed with warm the remissions, the pulse and respiration are flannels, and put to bed; opiate frictions natural, the heat of the body is commonly are particularly recommended, as the medinot increased, the face is generally pale, cine can, in this way, be introduced into with a cold sweat upon it; the extremities the system more readily, and without in. are generally cold, and there is frequently creasing the frequency of the spasms, which a cold sweat over the wliole body, some frequently occur during the efforts of deg. times, however, when the spasms are very lutition; the combination of opium with frequent and violent, the polse becomes æther is also of great service; the diet full and frequent, the face is flushed, and a should consist of milk and broths, and if warm sweat is diffused over the whole the nonrislıment cannot be received by the body: it is a very remarkable circumstance month, it should be thrown up by clyster, that neither the mental nor natural func. If the disease have arisen in consequence of tions are considerably affected, there is the partial division of a nerve, it should be seldom delirium, or confusion of thought, cut through ; and if from a wound, it should the appetite remains good, the urine is be dilated, and filled with stimulating applisometimes suppressed, or is voided with cations; as lint, moistened with the oleum difficulty and pain, and there is costiveness. terebinthinæ, and we must avoid exposure It is remarked by Dr. Blane, that the con. of the part to a current of cold air: the valsive twitchings are sometimes even ac- pain under the ensiform cartilage, and the companied with pleasure,
spasms in general, will most commonly be This disease often proves fatal before the relieved by applying cloths dipped in æther, fourth day; after that period there is gene- and by gentle and uniform pressure on the rally less danger, but, although there may parts suffering from spasm, by means of be some abatement of its violence, it is apt bandages, on which the æther should be to return with renovated force; a favour. poured occasionally, guarding, however, able termination of it is sometimes at- against the cold produced by the too spee. tended with a sensation of stupor, or for- dy evaporation of the æther. The trismus micatio, and a sense of itching; more fre- of infants is a disease most frequent in warm quently, however, it goes off, without any climates, it generally attacks infants, within evident crisis ; the danger will, therefore, the first fortnight after birthi, inore gebe determined by the violence of the at: nerally, however, before they are nine tack, and frequent recurrence of the spasms days old; as it, in our opinion, very freand general convulsions.
quently proceeds from a retention of the The removal of this disease must be at- meconium in the primæ viæ, it will be tempted by administering opinm in mode. highly proper, in the tirst instance, to exhirate but frequent doses, and where the bit gentle laxatives, afierwards wine and deglutition is performed with any difficulty, antispasmodics, and if we do not sneceed it should be thrown in by clyster; wind by these means, it will be advisable to try is a most valuable auxiliary, but it should. the cold bath, and the reinedies above be taken in large quantities, and it will recommended. be more serviceable when given in com. Epilepsy may be distinguished from other bination with opium ; bark is recom- species of convulsions by the sopor, and by mended, but it does not appear to have the abolition of the sensation of external answered the sanguine expectations that impressions ; from apoplexy, by the increas. were to be wished for; mercury is often of ed action of the muscles; front hysteria, by service, provided it is posled so far as to the absence of the globus hystericus, and affect the mouth; the warm bath, or a by its not being attended with the fear of bath composed of milk or oil, has been death. The symptomatic epilepsy is more recommended, and fras sometimes succeed- easily cured than the idiopathic; the later ed, when employed in combination with in life epileptic fits are experienced, the opium, the heat of the bath is ordered to more dangerous they may, in general, be be lowered or raised, so as to afford the esteemed, as the cause may be supposed to sensation of gentle and comfortable warmth; have been acquired by the patient's lrabits the most powerful remedy, however, ap. of life, or by the decay of some internal pears to be immersion in the cold bathi, in part: hereditary epilepsy is scarcely ever the paroxysm of convulsion, taking care to cured; the longer the continuance of the have some warm blankets in readiness, and complaint has been, and the more violent immediately the patient is taken out of the and frequent the convulsions are, the more dangerous is the disease, particularly if the time, administer aloetic cathartics; after vital functions be much affected; some- the plethoric state of the system is removed, times, although not very frequently, a sin. the cnre of the disease will be effected by gle violent paroxysm cuts off the patient : antispasmodics: when the disease seems to epilepsy sometimes goes off at the age of arise in consequence of a debilitated state puberty, or on the appearance of the men- of the system, it must be strengthened by ses; an intermittent fever, or a cntaneous cold-bathing, exercise, change of air, a eruption often removes the disease. nourishing diet, tonics, and anti-spasino.
Treatment. Blood-letting will sometimes dics; the most suitable tonics are, bark, be of service in the paroxysm, if the disease oxide of arsenic, ammoniate of copper, sul. has not been of long continuance, and the phate of copper, oxide of zinc and chalypatient is in a plethoric state; in general, beates: the antispasmodics in most general however, it is more advisable pot to take use are, oil of cajeput (melaleuca leucadenaway blood, but to trust to less debilitating dron), æther, musk, digitalis, stramonium, remedies ; immediately the patient is at. belladonna or hyoscyamus, lunar caustic and tacked with a fit, we must endeavour, as far opium, which last is most assuredly the best as possible, to prevent his receiving any in. and most efficacious antispasınodic, it should jury from the violent agitation of his body, be administered in doses, proportioned to he ought, therefore, to be put into a bed, the age and constitution of the patient, a with his head raised, and to have any pres- short time before the expected return of sure, occasioned by ligatures about his neck, the paroxysm, the opium must be repeated instantly removed; stimulants shonld be at proper intervals, and it will be necessary applied to the nostrils, as errhines, or vola- to increase the dose in a gradual manner, in tiles, as the spiritus ammoniæ compositus, proportion to the violence or frequent re. the spiritus ammoniæ succinatus, &c. and currence of the fits : whatever antispasmo. the spine should be rubbed with the æther, dic is employed, it will be indispensably re. or with the linimentum ammoniæ fortius, or quisite never to allow its effects to cease on oil of turpentine, and they will be more the system, and to continue its use for serviceable, if combined with stimulants, as months, or even a year or two after the vio. the oil of amber, or the tincture of cantha- lence of the disease is overcome, and the rides; it will be proper to administer opiates, fits have ceased, in order to establish a new and other anti-spasmodics, by clyster, par- habit in the system, and it should, on no acticularly musk, and valerian. In the inter- count, be left off all at once, but the dose missions we are to attempt the radical cnre should be gradually diminished, as the fits of the disease; when the disease is sympto- are very apt to return, on the disconmatic of some primary affection, we must, tinuance of the medicine, with increased by a particular attention to the attending violence and danger: it will not be improsymptoms, endeavour to discover the na. per to remark, that antispasmodics are emture of that affection; and if we succeed ployed with most advantage, a short time in removing the primary affection, by the previous to the expected recurrence of the proper means adapted to its cause, the epi. paroxysm, and when the fits recur during leptic attacks will cease of course; the aura sleep, a full dose of an opiate should be epileptica has been removed by a tight given at bed-time ; the application of a bandage being made round the limb, just cataplasm, formed chiefly of tobacco, to above the part from which that sensation the scrobiculus cordis, about half an hour appears to proceed; we must direct the pa- before the expected return of the patient to carefully avoid the occasional roxysm, has sometimes prevented it, and causes which are within his reach, and the this practice, repeated several successive predisposition must be corrected, as far as days, at the expected periods, has destroyed lies in our power. When the disease is the diseased catenation, and effected a peridiopathic, and appears to depend upon a manent cure: if the disease appears to plethoric state of the system, that must be arise from sympathy, some instrument of removed or prevented by moderate exer- terror should be kept in readiness, as the cise, an abstemious diet, and issues, or se actual cautery, or something that will in. tons, if the disease appear to arise from any spire horror, which will very frequently suppressed discharge, in particnlar the hæ- prevent the fits: should derangement of morrbois, leeches should be applied to the the primæ viæ, worms, dentition, or any hæmorrboidal vessels, fomentations sbould other obvious exciting cause, be the means be employed, and we should, at the same of occasioning the disease, it must be re
moved by laxatives, and other remedies times, during the paroxysm, somewhat adapted to its causes, and as the disease so Alushed and turgid, more commonly, howfrequently, in part, arises from the first ever, it is pale and shrunk: asthma is very mentioned canse, occasional emetics and frequently an hereditary disease, it does not gentle cathartics will be proper, in order to very commonly appear before the time of obviate any accumulation of irritating mat. puberty, and chiefly affects the male sex; ter in the stomach and intestines: when the it is most liable to return in hot weather, disease proves obstinate, especially in those this, however, is not always the case: the who are advanced in life, or have been in- paroxysm is often preceded by lassitude, temperate in the use of fermented, spi. torpor, drowsiness, a sense of weight or rituous, or distilled liquors, we have every pain of the head, and symptoms of dys. reason to suspect some derangement in the pepsia. hepatic system; in which case it will be re- Treatment. In the paroxysm, if the paquisite to employ the hydrargyrus, to a
tient be young,
and of a plethoric babit, greater or less extent, in proportion to its blood-letting will be often of service, espeeffects on the disease, and it will, if the pa- cially, if employed in the early periods of tient is not in a very debilitated state, the disease, but if it have been of long consometimes be of essential service to push tinuance, it is generally burtful, but cupping mercury so far as to affect the mouth. A between the shoulders is often of consideratotal change of habit and climate may also ble service; gentle laxatives and clysters frequently be prescribed with great benefit. should be employed, at proper intervals, so
Asthmu. The paroxysms of this disease as to keep the bowels regular; gentle emevery frequently commence during or after tics should on no account be dispensed the first sleep, with a sense of tightness and with, and where a paroxysm is expected to stricture across the chest, and a feeling of occur in the course of the night, an emetic aneasy oppression in the lungs, impeding exhibited in the evening will
generally prerespiration; there is either no cough pre- vent it: antispasmodics should be adminisent, or it is not attended with any expecto- stered, as opium, asafætida, æther, &c.; it ration: the patient, if in a horizontal situa- will be necessary to assist and promote the tion, is immediately under the necessity of expectoration by means of some of the fol. getting into an erect posture, and of flying lowing remedies, either alone, or perhaps a for relief to the open window; the diffi- more preferable manner will be in combiculty of breathing for a time increases, and nation, as milk of ammoniac or of asafæ. both inspiration and expiration are atten- tida, the decoction of seneka, or a solution ded with a wheezing noise, the voice is of spermaceti, with nauseating doses of tarweak, and the exertion of talking is more tar emetic, or with some of the preparations or less painful: after these symptoms have of squills; the carbonate of ammonia, and continued for some hours, a profuse sweat myrrh, are also medicines of considerable sometimes breaks out, the breathing be- efficacy; but squills are, by far, the most comes less laborious, and the cough, which, valuable expectorant of any in the whole at the commencement, was not present, or
materia medica ; a blister should be applied was without any expectoration, now be.
to the chest, the vapour of warm water comes more free, and a more or less copious should be inhaled, and its effects will be insecretion of mucus takes place, and the creased, if the water is impregnated with other symptoms abate, but there is a greater æther; warm pediluvia, or ihe warm bath or less degree of tightness across the chest, should be ordered; the respiration of an and e difficulty of breathing, throughout atmosphere, mixed with hydrogen gas, or the course of the day; towards evening, or
any other innocuous air, which might dilute about midnight, for several successive nights, the oxygenous gas, would be useful in spasthe symptoms suffer au exacerbation, and a modic asthma, by decreasing the sensibility remission takes place towards morning; of the system, and preventing the recor. and after some days, on the expectoration rence of the paroxysms; the respiration of becoming and continuing more copious, the an atmosphere, with an increased propor. paroxysms for a time cease altogether: the tion of oxygen, is recommended in what is pulse is, for the most part, quick, weak, and called the humoral asthma : in the intersmall; and the urine, which, at the com- missions, the remote causes should, as far mencement of the paroxysm, was pale, on
as lies in our power, be carefully avoided; its remission becomes high-coloured, and the use of fermented liquors, and particuuften deposits a sediment; the face is some- larly of distilled spirits, must be strictly in
bibited; the diet should be light, of easy spirits may be added to the fomentations ; digestion, not flatulent, and the food should friction of the abdomen with warm oil, or be taken in moderate quantities, taking care bags filled with hot sand, or bladders filled not to oppress the stomach; but when the with hot water, may be employed also with disease has been of lovg continuance, a great advantage ; blisters or rubefacients, more full diet may be allowed; riding on together with warm pediluvia, will be rehorseback, or in a carriage, and more par- quisite ; antispasmodics should be adminiticularly a sea voyage, should, if convenient, stered internally, and where the disease has be advised, or the patient should change not been preceded by long costiveness, the air, and try different situations, until, opium will be the most efficacious remedy, either by accident or by perseverance, he especially if vomiting prevents the exhibifinds out a situation to live in, in which tlietion of cathartics : where, however, the disdisease is rendered less distressing, or is en. ease has been preceded by costiveness, the tirely removed ; repeated blisters should be hyoscyanuts will be found to be a more applied about the chest, or an issue be made suitable remedy, as along with its narcotic in the neighbourhood: smoking tobacco is it also possesses a gently cathartie quality : useful; and garlic or onions, by way of cathartics must be ordered, and they will sauce, may be also found serviceable. be more efficacious when given in combiBark, chalybeates, and aloes should be had nation; calomel, above all, ought never to recourse to towards the close of the pa. be given alone, its operation is always renroxysm.
dered more certain and easy by combining Colic. commences with an acute pain over it with other cathartics, and the addition the abdomen, the navel is twisted towards of a few drops of some essential oil will, in a thie spine, and the muscles of the abdomen great measure, obviate their griping effects; are spasmodically contracted into separate laxative clysters must be ordered; at first portions, giving it the appearance of a bag they should be mild, and tolerably large; the full of round balls; there is vomiting of a addition of a portion of oil, or of a solution bilious matter, obstinate costiveness, and of Epsom salts, will be an useful auxiliary; generally coldness of the extremities; the and if we do not succeed iu procuring the urive is high coloured, is voided in small evacuation of the intestines by the above quantity, and with some degree of difficulty means, we must have recourse to the injecand pain; the disease is seldom attended tion of the smoke of tobacco, or a more with pyrexia in the first instance. Some certain and efficacious remedy is, a decoctimes, however, an inflammation of that tion of tobacco, in the proportion of half part of the intestine, where the disease is a drachm to four ounces of water, to be situated, supervenes, and aggravates the thrown up as an enema. If all the above disease : when the peristaltic motion of the means prove of no avail, we must have rewhole intestinal canal is inverted, the dis- course to mechanical dilatation, as, by adease is called ileus, which is only to be re- ministering one or two ounces of the by. garded as a more violent degree of colic; drargyrus every hour or two, or a large it is, however, more apt to terminate in en quantity of warm water should be injected teritis, or gangrene.
by means of a large syringe : when every The remoral of this disease will generally purgative, and even all other means that be effected by blood-letting, in the repeti. a'e in most common use, have failed, the tion of wbich we must be guided by the action of the intestines has sometimes been state of the pulse, violence of the attack, effectually excited by throwing cold water and strength of the patient; in' all violent on the lower extremities. attacks of colic, if the patient be in tolera- The Colica Pictonum vel Saturnina, or ble vigour, it will not only be advisable, Colic from Lead, differs from the species but prudent to take away a moderate quan- above described, in not coming on in so tity of blood (except the disease arise in sudden and violent a manner, and also in consequence of lead being received into the its cause, that of lead taken into the body, system), more particularly so if the pulse is under various circumstances, as by exposure full or bard; and there are any symptoms to the action of it, or by drinking cyder, denoting a tendency to enteritis, it will, at or other liquors, impregnated with it; the the same time, be the means of relaxing disease generally commences with slight the spasm, and procuring stools : the warm nneasiness in the bowels, or with a sense of bath should be ordered, or the abdomen weight, or of an aching, rather than an should be fometed, and strong peppers and acute pain, about the navel, wluich is in.
creased after eating; the pain remits, and system must be kept under the influence of is sometimes relieved by pressure upon mercury, in a greater or less degree, accordthe abdomen : this, however, is frequently ing to the violence of the disease, for two not the case. After a time the pain in- or three weeks after every symptom of the creases, becomes permanent, and intole- disease bas disappeared, as it is very apt to rably excruciating; there is retraction of return, and with increased force. As a disthe umbilicns, the integuments of the abdo. position to costiveness often remains, it men, and the intestines are violently con- should be obviated by some of the above tracted, and drawn towards the spine, and cathartics. It sometimes happens that the the spasms are often so obstinate, that it is pain in the bowels shifts suddenly, and atwith the greatest difficulty a clyster can be tacks the head, causing extreme misery : thrown into the rectum ; the pulse is hard in this case nothing affoids so much relief and tense, there is obstinate costiveness, as blisters applied to the back, behind the and often strangnary ; after several attacks ears, and to the temples, successively, acparalysis comes on, chiefly of the upper ex. cording to the urgency or continuance of tremities, although there are numerons cases the pain: opiates may be administered at recorded, in which the lower are affected the same time with advantage. The paraalso, and sometimes it terminates in swel- lytic affections, which are the consequence lings of the joints, and loss of sight; some- of this disease, and the ileus, will be retimes, but more rarely, the disease is snc- moved hy the internal and external employ. ceeded by paralysis after the first attack; ment of Bath waters. the patients cannot rest in bed for the vio. In Diabetes the most prominent symplence of the disease, and they find relief in toms, according to Dr. Rollo, are vora. walking about, if they have sufficient ciousness and keenness of appetite, or a strength : those who liave once laboured frequent craving for food, without the feel under the disease are very liable to relapse, of entire satiation ; a parched mouth, with in which case the disease comes on in a constant spitting of a thick viscid phlegm, more violent manner than before, and the of a mawkish, sweetish, or bitterish taste; recovery is then môre slow, and less com- intense thirst; a whitish tongue, with red plete. In the removal of this violent dis. bright sides; red and swelled gums, with ease, we must, in the first place, restore the teeth feeling as on edge from acids, and the intestines to their natural irritability, loose in their sockets ; head-ach ; a dry hot by the exhibition of a large dose of opium; skin, with flushing of the face; a pulse most we should then administer some cathartic generally about eighty-four or six ; an inmedicine at proper intervals, as the sn!phate crease of clear urine, of a light straw coof magnesia or soda,or the phosphate of soda, lour, having a sweetish taste, resembling dissolved in broth, or some aromatic fluid, sugar, or rather honey and water ; an uncastor or almond, may be given, combined easiness of the stomach and kidneys; a wastwith tincture of senna ; and if the stomach ing of the flesh, a wearioess and disinclination be in a very irritable state, the medicines to motion or exertion, with the feeling of must be exhibited in the form of pills, for weakness; an excoriation, with soreness of which purpose the calomel, joined with ex. the glans, penis, and prepuce, which is tract of jalap or colocynth, and a few drops sometimes swelled, and there is no desire of some essential oil, will be the most suit. of venery: in females there is a peculiar able ; laxative clysters will be necessary, to uneasiness about the meatus urinarins. which may be added some cathartic salt, or The predisposing causes of this disease oil; the pain of the abdomen will be re- are at present obscure, but the disease has lieved by rubbing it with tepid oil, or by been found to occur in those who have in. applying spiced fomentations, or by the dulged in fruits, sweetmeats, pickles, highwarın bath, or by bags of hot sand, and seasoned food, warm, stimulating condi. similar antispasmodics; the application of a ments, wine and fermented liquors, or indullarge blister to the abdomen is, however, a gence even in farinaceous foods, with large much more efficacious remedy. When we quantities of small beer, accompanied by have relieved the urgent symptoms, the great bodily exercise, with or without acdisease will, ou its first attacks, be effectu- tive mental employment; moisture, grief, ally removed by employing mercury inter- vexation or agitation of mind; sudden vapally and externally. Mercury must be riations of temperature may also be regard. pushed so far as to occasion some affection ed as predisposing or exciting causes. The of the mouth as soon as possible, and the proximate cause is supposed to be a mor