BLACKWELL FAMILY ELIZABETH BLACKWELL Subject File Medical PapersFrom Dialogues of Plato. Jovett 5. volumes. Oxford. 1892 ROCK HOUSE, EXMOUTH PLACE, HASTINGS. Cephalus the aged host, says, "old age has a great sense of calm and freedom. Regrets and complaints are to be attributed to men's characters & tempers, not to old age" Hope says Pindar, cherishes the soul of him " who lives in justice & holiness and is the nurse of his age, and the companion of his journey." How admirable are his words. Peace of mind is the greatest advantage given by the possession of wealth" "Medicine does not consider the interest of Medicine, but the interest of the body" SocratesI heard a few days ago from a man intently acquainted with Jameson for years that during his career as a medical man he could not have believed to its S.P.A - Most unsatisfactory - from Dr B Jan 21:1900 Pasteur & Serum-Therapy Dr Lataud & Prof Boucher Harvey Dr Wall Hyderabad Chloroform Commission Dr Arnold Experiments with Drugs Dr Dudgeon Demonstrations before Students Stephen Townesend Scientific Morality Dr Oldfield Preventive Medicine, Brain Surgery, and Inoculation are to be included but are not yet arranged. Telegraphic Address, "Bohn, London." G. Bell & Sons Publishers 5, York Street, Covent Garden, London, W.C. It is a good omen, that you will give the Trust a good repository. I shall be really glad to collect together safely, copies of all our books and papers - and I shall give some copies of "Scientific Method." I have not settled to come to London until October 25th. When the quarterly Trust meeting is to takeI am just sending out, with my Secretary's help, the reprints of the Tsar's receipt, which the Daily Chronicle has sent one down, to the fifty-religious bodies of this town, with a note begging them to support the effort for International peace. If any responses come back to me, it may be possible to get Diseases of females. Structural or functional - Chlorosis generally produced by absent or disordered menstruation - treatments - electricity, & warm hip baths, iron, & hygiene - Chlorosis may be complicated with disease of many organs - in Phthisis the circulation is increased, the pulse not being quickened in simple chlorosis - it is a disease of the circulations which must be remedied before emmenagogues are administered - the bowels should be kept open - Aloes & ipecac, with rhubarb for tonic, or colonical for absorbent laxative - digitalis 10 gH with nitre 20 gH to promote secretion. Amenorrhea - retained or suppressed menstruation - menstruation caused by the development of an [?] - absence or disease of ovaries may prevent it - use general hygiene means, not emmenagogues to bring it on - closure of the passage may require a surgical operation, guard against peritoneal inflammation - warm hip bath useful at the menstrual period - guard against unacknowledged pregnancy. Dysmenorrhea, should be treated with hygienic means in the intervals - exercise, simple food, bathing - at the period, warm baths, anodynes Menorrhagia, may be difficult to distinguish from abortion, when complicated with hemorrhage - absence of coagula, mark it. there may be a membrane, whole or in shreds - in plethoric patients, the period should be preceeded by bleeding or leeches to the parts, - blister to sacrum, cold injections with acetate of lead - ergot - some advise cautherides - acetate of ammonia - camphor - Vicarious menstruation & general means - warm hip bath electricity to the uterine region - Cessation - about 45 - mortality not greater than among males at the same age - Keep the bowels freely open - Leucorrhea - vaginal or uterine - forever most common in those who have borne children - must not be too suddenly suppressed if of long standing - irritation to be avoided - blister to sacrum, astringent injections - the uterine forin marked by its' periodicity - tonics or emmenagogues needed - Parturition After 280 days - 3 Stages - 24 hours - Class 1 {Natural labour - {head presentations Class 2 {Unnatural labour {Tedious labour - Powerless labour - {Obstructed labour - Distortion of pelvis - {Malposition & presentation - Plural births - Monsters - Class 3 {Complex labour {Prolapse of funis - Retention of Placenta - Flooding - {Convulsions - Lacerations - Inversion of uterus - Natural labour. Head 4 positions - may change - 1st stage cutting pain - 2nd bearing down - Support perineum - ensure contractions - remove placenta - feel pulse - horizontal position for a week - Tedious labour Prolonged in first stage - not injurious - Indications for ergot - 1 pains causlessly feeble - 2 as uteri soft & dilatible - 3 no obstacle - 4 head or breech presentation - 5 no head or general irritability - Powerless labour In second stage, dangerous to mother & child - use force for, unless the greater danger of the mother require the perforator & [?] which are quicker - cleanse & poultice the parts - Obstructed labour From rigidity, cancer, tumors, hernia &c - gentle means - or knife, or Caesarian section - Deformed Pelvis - 3 inches, the forceps - 1 1/2 perforation - less, Casarian section - Induction of formative labour - When the passage will not allow the birth of a child at full term - by oblique rupture of membranes or ergot - separate membranes - [?] uteri - Version Object to substitute head for other presentation - to bring down feet - to hasten labour - 1st saves child - 2nd gives control of labour - immediately after rupture of membranes - introduce hand during pain, also turn -Vectis To change mal position - or hasten delivery - needed, room, dilatation, pains - used as a lever or tractor - Forceps 4 objects - 1 when malposition arrests if at brim or of civility - 2 to supply uterine actions - 3 save another from prolonged labor 4 save child - Craniotomy - When forceps cannot be used, but bones can be extracted - perforate the bone, not suture - Mal-position & presentation Face, assistance generally unnecessary - Breech, the head & shoulders need some assistance - danger from pressure on funis - Footling - same - [?] dangerous, turn, or use crotchet - Complex labour. Prolapse of cord, return, or turn - Retained placenta - from inertia, ergot spasmodic, gentle continued effort - Hemorrhage - cold application, drink, enema, douche, ergot, compression of aorta, introduction of hand - Convulsion, hysteric antispasmodics - epileptic & apoplectic, active antiphlogistic treatment - Fistula, catheter, cautery, suture, closure of vagina, plug - Purpural fever - 1 Peritonitis - 2 Inflam of apendages - 3 Hysteritis - 4 U phlebitis - 5 Inflam of U absorbents - 9 days after delivery - rigor, pain, heat, quicker pulse, secretion of milk stopped - Bleeding leeches, poultice, opium, mercury blisters, hip [?] [?] - leeches & [?], friction, tonics - Longitudinal 4 - 4 1/2 Transverse 3 1/2 - 4 Materia Medica Dr Lee Lecture 2nd The circumstances which modify the action of medicines, are ,1st Age. In early life the nervous system is highly susceptible, much more so proportionally than advanced life, that a drop of laudanum will kill a young infant children are much more liable to convulsive deceases, and to suffer from surgical operations, thus a harelip or cleft palate, should never be operated on, in very early life- a burn, which seemed of little consequence, will suddenly send the child into a comatose state ending in death. Another important circumstance in relation to children, is the exceeding delicacy of their mucous membranes, which can be easily acted on by corrosive substances, hence antimony, mercury (&c?) are improper. In old age, the exhaustion of vital energy produces torpor in the various organs- constipation is common, and the more powerful action of cathartics by enemata(?) is requisite. The most stimulating remedies are suited to this age ; the turpentines & balsams, as balsam of cop(?) are valubale. 2nd Sex. Many circumstances in the female organization, should be considered in administernig medicines - the mobility of system & nervous excitabilty, under the same precaution necessary as in infancy- a delicate women should not be dosed like an Irishman; enquiry should always be made as to the presence of menstruation; during its continuance the nervous system is unusually excited, & the pelvie viscera particularly susceptible, powerful remedies should be avoided at this time, as hysteria, or unnatural affection of the menstrual function may result. The same care is necesssay, during the period of pregnancy, abortion having frequently resulted from the use of powerful medicine. During lactation, the intimate connection between mother & child must be remembered , as medicine administered to the former, will injuriously affect the latter- the mammary glands being unusually active, all moral & physical influences tend to that centre- it is known that (?)ling nursed, have swallowed laudanum, & thus acted on the child. The change of life also calls for care- every function seems disturbed at that time- hysteria, menorrhagia, are easily induced. 3rd. Temperament- A man of delicate or highly nervous organization, must be treated on totally different principles from one whose whole power seems to (lie ?) hismuscles - a modern french writer rejecting the antient doctrine of prevailing humors, bases the different temperaments, on the predominant activity of certain organs - thus we have the nervous, sanguine, muscular, and relaxed - in the first where the brain & nervous system is disproportionately large & active, bleeding is generally injurious, and an anodyne is frequently useful as an accompaniment to other medicines - on the contrary in the sanguine temperament where the lungs & arterial system are largely developed, bleeding may generally be employed with benefit or impunity. In cases where the muscular fibre wants vigor & the whole system seems relaxed, tonics & stimulants are valuable. 4th Constitutional power - 5th Idiosyncrasy, certain medicines, commonly taken, may be constantly rejected by some, or produce unusual or injurious effects. 6th Habit, enquiry should be made whether the patient is accustomed to take medicines - in general, the system is more susceptible to their action, when they have not been used; there is however a great difference in this respect, in different medicines - this narcotics by continued use lose their effect, the dose has to be progressively increased, while emetics, saline cathartics, act more readily on repetition, 1 [?] of salts may be decreased in successive doses, till two [?] act as powerfully as eight - this difference between vegetable & mineral need & [?], is supposed to proceed from the fact, that the stomach in time required the power of digesting the vegetable medicines thereby converting them into food instead of physic. Habits of intemperance, necessitate the use of stimulants in almost all diseases. 7th Climate the common use of mercury in tropical climates, is being changed to quinine. 8th Diet if an rapid & powerful effect is to be produced, medicine should be given on an empty stomach, but if the substance is corrosive as antimony, food should first be taken. 9th Time - a powerful cathartic should not be given at bedtime, but one as [?] of slow operation a diaphoretic at night, a diuretic in the morning, a narcotic may be stimulant in the morning & sedative at night. 10th - The cause, period & seat of the disease must be considered - a purely inflammatory fever where bleeding is required, is rare - most fevers are caused by a poison in the blood, which must be eliminated, this is done by increasing the secretions, & supporting the patient. Bleeding which may be proper in the commencement of disease, may be injurious at a later period. Nervous affections seldom bear bleeding, but opium & other narcotics may be given in unusually large quantities, they seem to expend their force upon the disease. The repetition of medicine is important to keep up the effect produced otherwise reaction occurring, the disease may be increased thus a costing application if not continued may increase the heat. The purity & freshness of medicines are important. Lecture 3rd. Medicines are applied to various parts; most commonly taken into the stomach they are absorbed by the veins, carried into the circulation, & thus reach the desired part. By the rectum, when gastritis forbids the ordinary method, when rapid & powerful action is required, or the neighboring organs to be affected a smaller quantity than usual is to be employed & retained by a cloth or pressure, till after a few times the rectum acquired the habit of absorption. Medicines applied to the skin produce very rapid effects, when the cuticle is denuded, by a blister, ammonia or boiling water three times the amount taken by the stomach is to be laid on the part. The most rapid action is produced by those agents that can be inhaled, & thus enter the blood through the lungs - the loose spongy texture of the organ, & the great extent of surface presented, produce this rapidity of action. The physiology of absorption is explained on the principle of endosmosis & exosmosis, by which rarer fluids permeate membranes separating them from denser fluids - this explained why the same substance may act as cathartic or diuretic, if concentrated the serum of the blood is carried through the absorbents into the intestinal canal, but if diluted so as to be of less specific gravity, the reverse takes place. Errhines or sternutatories are another mode of application. Serous membranes are sometimes injected, though great danger attends the operation - an ovarian tumour has been thus cured - the contents being discharged, a strong solution of sulphate of zinc was thrown in - the inflammation following produced adhesion, & care followed. Some late European writers speak of powerful effects following the absorption of medicines by the mouth, one grain of antimony dissolved on the tongue producing powerful emesis, and mercury absorbed producing its constitutional effects - doubtful - Direct venous injection is another method most medicines act by absorption, sympathetic action is the exception - the rapid poisoning of animals which is said to prone, the latter mode, if carefully watched, will be found to allow sufficient time for complete absorption. During the cholera of [1??] Dr Lee treated many hundreds in thehospital, in 12 cases he injected several pints of artificial serum, the benefit was rapid & striking for a short time, but transitory, only one recovered. The modus operandi of medicines varies - We make an external application for the local effect merely, whether excitant or sedative; we make it also for its constitutional effect as in narcotic poisoning, in collapse, the cutis vera having intimate connexion with ill parts of the body. Opinions have greatly varied as to the action of internal remedies. The mechanical vital & chemical theories alternating, the latter is now generally adopted - a decomposition of medicines takes place in the stomach, thus in opium, the gum sugar, lignine [lignin] &e are digested for food, while the active principle set free, is absorbed into the blood, this active principle in time, is probably digested - this absorption proved by placing a portion of medicine on the skin, it presently disappears & is found in the blood & secretions - the kidneys are the chief organs for eliminating medical substances, most odorous substances however pass off by the lungs - alcohol is partly nutritive, it is decomposed. It is an important distinction that binary compounds pass undecomposed through the blood into the urine, while ternary & quaternary are decomposed - thus nitrate of potash is found in the urine, while other compounds as citrate of potash, & vegetable remedies are decomposed. Many medicines act revulsively thus a cathartic will relieve the head by drowning excitement to the intestinal canal. Parry attributes their effect exclusively to this mode of action. Medicines not only excite & depress, but also change the action of parts - this altertive [alternative?] power is an important fact. Lecture 4th. Pathology. In order to understand Pathology, which is the history of disease, a knowledge is presupposed of anatomy the description of structure, and Physiology the description of function - The term laws of nature, calculated to mislead, a law, is nothing but a manifestation of certain phenomena, under given circumstances, thus the modern discovery of the microscope, that every organized structure originated in a germ or cell, is called the law of cell life, but is simply the will of the Creator, exercised in that way. There are two Kingdoms of Nature, the organic & inorganic, distinguished in various ways - by the existence in the former of organs, structure destines to accomplish a particular function - by origin, the one coming into existence & developing by successive cells, the other increasing by accretion - by size, every organic substance has a type, which admits of variations, but is the medicine standard - by chemical formation, the elements of inorganic bodies are 55 in number, but in the animal & vegetable kingdoms they are not more than 15 - by nitrogen, which is found exclusively in organized products, and much more abundantly in animals than vegetables, indeed the peculiar smell like burnt hair, which is owing to the presences of nitrogen, will generally distinguish the animal from the vegetable product, when otherwise owing to the close interlinking of the two Kingdoms, it would be impossible - it is also worthy of notice that the opposite portions of plants, the seed, & the poisonous parts, contain most nitrogen - by vital change, the interstitial growth, through which the entire body is changed in five years or less - by the liquid & solid constituents, the diminished proportion of the former, seeming in organized bodies to be the chief cause of natural death, the long life of trees owing probably to the smaller proportion of fluid, necessary to their existence. Many theories of life, more interesting than instructive have successively arisen. Aristotle supposed an intelligent principle presiding over the formation of each organ the chemical theorists of modern time, have still constantly to employ the term vital, & express an antecedent energy, which no material theory can avoid - a simple expression may serve our purpose, when an assemblage of organic elements, is acted on by chemical & other forces, the resulting manifestation of phenomena, we term life - many actions of the body, may be explained on purely chemical principles, thus respiration in aerating the blood, producing carbonic acid in the lungs, absorption by endosmosis, secretion, secretion, digestion, animal heat which undoubtedly is generated in every part of the body by the changes constantly occurring; sight & hearing also may be caused by physical changes, as the instruments can be imitated by the mechanist. Locomotion, sensation and volition are also peculiar to organized bodies - it is doubtful whether organic compounds can be produced thus urea & other substances brought as examples, though found in animals are really inorganic compounds. The proportion of fluid in animal bodies is very great, an adult mummy quite dry, weighed 7 lbs - The most important elements in animal bodies, are albumen, fibrine, caseine, constituting proteine, and gelatine, the secondary, are such as urea, cholesterine, peposine &e. Materia Medica - Lectura 5th. Amongst the circumstances which modify the action of medicines, is their date of aggregation - in general the more complete the division of particles, the more rapid & powerfultheir action - Homeopathic plan of separating the active principle, not the natural plan. The common method of administering medicines is to combine the chief substance or basis with others, to render its operation quicker, or milder, to make it pleasanter - substances of similar effects are combined for more powerful action, or different substances are united to produce different effects, thus Digitalis & Potash, the former to operate on the secreting vessels of the kidneys, the latter on the absorbents of the intestinal canal. The climate and cultivation have a great effect upon medicines - the natives of tropical climates cannot have all their principles developed in a colder temperature - rhubarb cultivated in our climate has not the same extractive matter - our climate produces sufficient astringents, tonics (with the exception of bark) and diaphoretics, for medical purposes, but but narcotics have to be imported, and cathartics, ours being too drastic. The time of gathering is important - Rule is to take them when the juices are most abundant - Annuals, before flowering - Biennials in the Fall of the second year - Bark in the Spring or fall - Leaves before flowering - Aromatics while in flower - light, heat, & atmosphere affect them, therefore they should be dried in the shade, & preserved in tin cases. The rule for proportioning a child's doses, is to add 12 to the age & divide the product by the age - but there are exceptions as castor oil. Medicine may be administered in powder, where the intimate union of the elements is necessary to their power or safe action - thus in ipecacuanha, the emetia should be combined with the sugar, resin &e or it is severe in action, thus jalap & sometimes bark are best administered in powder - insoluble substances should not be given in powder - medicines should not be ground very fine if their action depends on extraction or volatile parts - but compound substances depending on combination should be fine. Some substances are employed to unite others more closely, thus Potash is to unite the Opium & [?] in Dover's Powders. Pills are employed where we wish give a small dose, that shall be conveyed to the lower portion the canal, or shall act slowly as an alterative - substances of great specific gravity are not suited to this form - nor large amounts of medicines, nor deliquescent nor nor efflorescent substances, mixture oils nor balsams. The best recipient is the conserve of roses, because it remains moist long - 5 gr of vegetable & 8 of mineral substances usually form a pill. Lozenges, are suitable to irritations of the throat; the ingredients should be well mixed, & powder rubbed over - unpleasant substances not to be used. An electuary a semi-solid - a suppository a medicated substance introduced into the rectum, to act on lower organs, or alloy pain &e - Liquids are given in draughts, to be taken at once - mixtures - enemata - injections - inhalations dry, suffitus - moist halitus - External applications are blisters, cerates, plasters, linaments, lotions, ointments, baths, brachi- pedi- manuluvia - Medicines applied to the skin by the [iatraleptic?] epidermic or endermic method - plasters most commonly formed with some preparation of the oxides of lead, & an oily acid - resin may excoriate - the object of a plaster is mechanical or medicinal, it may be stimulating, sedative, rubefacient or alterative - for support the least irritation & most adhesive substances should be used, as [?] [?], goldbeater's skin - cholodium for burns an excellent application, excluding air without producing heat. Ointments are fatty substances medicated - Liniments are more fluid - A lotion or embrocation, is a wash. A cataplasm or poultice is a pulpy application, stimulant, antiseptic, emollient, refrigerant - Blisters. Lecture 6th - Classification. 1st Alimentary Canal - Emetics, Cathartics, Anthelmintics 2 Respiratory Organs - Expectorants 3 Glandular Organs - Errhines, Sialagogues, Diuretics, Antilithics, Diaphoratics 4 Nervous System - Narcotics, Tetanics, Antispasmodics 5 Reproductive Organs - Emmenagogues, Parturifacients 6 Various organs - Stimulants, Tonics, Astringents, Sedatives, Refrigerants, Revellents, Alteratives 7 Chemical Agents - Antacids, Antalkalies, Disinfectants 8 Mechanical Agents - Demulcents, Diluents Emetics, are substances which evacuate the contents of the stomach in health, independently of nauseous flavor, or quantity. In the act of vom-iting, the first effect is sedative, the pulse reduces, with languor, coldness, nausea, the next is stimulant, colour returns, circulation quickened, diaphoresis produced - vomiting is a reflex act; the impression made on the stomach is transmitted by the par vagum to the medulla oblongata, which returns the force producing emesis - the abdominal muscles chiefly concerned in the act, the stomach contracts somewhat - the diaphragm loose - an irritation in any part of the body sufficiently affecting the medulla oblongata will produce vomiting. The action of emetics is direct & indirect - the first class as sulphate of zinc or copper, acts immediately on application to the stomach - the second class must be digested & pass into the circulation before action - In cases of poisoning an emetic of direct action which will produce local inflammation must not be given, but the stomach pump be used, or ipecac mixed with tartar emetic - During vomiting the circulation & secretions are increased - in Jaundice, the compression is valuable in emptying the engorged biliary ducts - they are the best expectorants, promoting the secretion & expulsion of mucus. The saliva act the quickest & may be used where evacuation of the stomach is the chief object - but of a powerful impression on the nervous or circulatory systems, is desired to break up diseased actions as in fevers, the indirect are better - Idiosyncrasies sometimes forbid their use, also pregnancy, not from their violent action, but the mechanical difficulty; also hernia & prolapsus uteri, & some say apoplexy - the emetic should be mixed in 5 or 6 spoonoful of water & one given every 10 or 15 minutes - drink 1/2 a tumbler after each emesis, too much drink impedes free actious. Night is the best time to take an emetic as sleep is [?] quieted afterwards. The effects to be produced by emetics are 1st evacuation - in some forms of dyopepsia, morbid gastric secretion require them. 2nd pressure - as in the portal congestion of feaer. 3rd to reduce arterial action - as in hemorrhage - in hemoptysis, ipecac is almost a specipie. 4th for relaxation - as in dislocations, where antimony is very serviceable. 5th to promote secretion in the skin, lungs, or liver. 6th to agitate the whole system - the alteration revulsive, purgative - emetics in small quantities followed by gruel will prove purgative. 9th depletion from increased secretion & the removal of food. 10 in irritation of the stomach when the caulk is present & remove it. Chamomile tea is a suitable drink, with emetics-instead of excessive vomiting, laudaunum, or warm flax seed tea may be given ,or a mustard plaster to the pit of the stomach, or an enema of 60 drops laudaunum in 2 1/3 of starch. Lecture 7 th Pathology Medicine has been called an uncertain service it is true for it has no fixed data to form a basis. The numberical method of Lowes, will not apply to epidemics, whose types vary constantly. Pathalogical anatomy the most certain branch this anatomy of the solids is almost exhausted, the fluids now receiving attention. In organic elements are said to unite in binary, the organic in [teruary?] & quaternary compounds. Proteins is the important element of albumen fibraise & caseine, the first two contain phosphorus & sulphor, the last sulphor. These princples are found in vegetables as well as animals, these two kingdoms therefore furnish food to man, but not the [vegetable] mineral. A man consumed 16 1/2 of carbon 32 1/2 oxygen a day, variety is essential in food, that all elements may be obtained. Albumen is formed in the serum of the blood united with soda & other salds in hair & nails. Fibraise, forms the buffy coat of the blood, the coloring particles having rapidly sunk in [?] & chyle seems to be vitalized albumen. Caseine coagulated rapidly by pepsine. Golatine found in the skin, tendonds, membranes, also chondrine, not nutritive. Elaine, stearine, & margarine, procured from fat. Hematodine and globudine, are other consituents of animal bodies. they are all found in the chyle. During the last year a french chemis has discovered the office of the pancreatic fluid, viz to unite with oily substances in the stomach & form a substance which is readily to [?] up by the lacteals, for nutrition of the brain &c. the secondary compounds are such as lactic acid, urea, bile. The fluids are contained in vessels, they form the chief portion of the human body_a body of 140 lbs, being dried, weighs 7. There are 6 classes of fluids, 1st those produced by digestion, chyme & chyle_ 2 the circulating, lymph & blood_3 perspiration. 4 those contained in the follicles. 5 in the larger glands. A solid is a substance whose particles adhere, so as not to be seperated by their own weight. The solids of the body are bone, muscle, ligament, vessels, nerves, ganghoius, follicles, glands, membranes, celular membranes, viscera. The membranes are simple or compound, 1st as mucous, serous, 2nd serofibrous_ Lecture_ 8th Emetics are divided into direct & indirect. There are 4 direct Ammonia, Sulphate of zinc, the blood to the head - it in common with the alkalies, thins the mucous secretions - it is useful, grain in small quantities before antimony, in the catarrh of typhoid fever - also in chronic bronchitis. Sulphate of zinc, has in common with all metallic substances, a styptic taste - it is safer than copper - it is valuable in narcotic poisoning - maybe combined with ipecac. Its emetic effect may be produced by enema. Sulphate of copper, may be used in the same cases, but is very poisonous. Mustard is very valuable as an emetic in narcotic poisoning - its volatile oil, is best produced by the chemical actions of water, good in intoxication or poisoning from alcohol; a stream of cold water on the head, very beneficial. Indirect emetics. Tartar emetic - a double salt - poisonous to vegetables & animals - substances poisonous to the latter are always to the former; produces peculiar pustules, like smallpox. It is a valuable alterative in chronic disease - the nausea is peculiar - invaluable in constitutional diseases - in fever, in the commencement of inflammatory disease, of inflammation of the lungs; the system should be kept under a nauseating influence - care must be taken in giving it to children - never under two years; it is best combined with ipecac - 3 gr to 20, in 5 or 6 spoonfuls of water, sweetened. Lecture - 9th. Disease is irregular action, or change of structure or function - Pathology investigates the nature of diseases - causes are extrinsic or intrinsic - are uncertain - may be divided into predisposing & exciting. There is a conservative power in the system, by which the stomach vomits, the eye waters, when an irritating power is present - Predisposing causes of disease, 1st heat - the powerful heat of tropical climates stimulates the glandular secretions, less oxygen existing in the atmosphere, less carbon is burnt in the lungs - the nervous system is also excited, hence the typhoid form which disease takes. 2nd Gold is a sedative, if no reaction follows, the blood thickens, the globules adhering to the vessels - cold is a most important curative agent - friction & the mechanical action of the douche aid - reaction will follow if the body is not exhausted, or disease does not present. Lecture - 10th. Ipecacuanha, is mild in sparation, from the number of substances combined with the active principle emetia - it is peculiarly irritant to the lungs, & yet is almost a specific in asthma - it is more suitable than antimony, where we do not wish to affect the nervous system strongly, in delicate organizations; and where a cathartic effect is not desired as ipecac is less apt to extend its action downwards. It is generally combined with antimony - good thus in phlegmasia dolens - ipecac valuable in dysentery - in haemoptysis & uterine hemorrhage - in constipation, it may be given occasionally - hygiene means better, medicine is always an evil, though sometimes a necessary evil. Violets contain a principle analagous to emetia - excellent as an expectorant or slight laxative for children. 1 lb to 2 pt water, 7 lb sugar. No valuable native emetics - Lobelia dangerous - Gillenia trifoliata, the best - Squill acrid, not suitable for an emetic, may be joined with ipecac. Hives syrup consists of antimony, squills, snake root, with water & sugar, should not be given frequently. A narcotic principle renders a substance unfit for an emetic. Lecture - 11th. The cause of disease, must have a relation to peculiar dispositions - thus in epidemics many escape who are exposed, & escape at one time but not at another - fear predisposes to disease - Hereditary disease may be divided into 3 classes. 1st where there is no participation on the part of the parents, 2nd hydrocephalus, imperfect developement naevi, aneurisms from anastomosis, fractures, - 2nd where there is sympathy with the Mother, as in syphilis, smallpox - 3rd from one or both parents, as in tubercular disease - Children are generally born healthy, but a peculiar diathesis is often inherited, which requires a strong exciting cause to produce active disease - ill health of parents, causing a cachectic state of body, frequently produces scrofula in the child - internal & external malformations are often transmitted - Different ages are subject to different diseases. The great nervous susceptibility of childhood to convulsive disease & inflammation of the brain reckets, scrofula from checked or imperfect developement - in cities one half the population die under 5 years - in adult life the preservative & recuperatives powers the most active - at puberty congestive disorders from the greater size & activity of the venous system, hypochondriasis & tendencies to insanity - later the arterial system is effected. After 40 as old age approaches, disease of the urinary organs, the heart, the mind, dropsy, apoplexy, houghing & The sanguine temperament is liable to inflammatious hemorrhagies - The bilious temperament, to eruptive & hepatic, & gastrocutine affections - Symphatic to catarrhal affections, scrofula, chronic discharges - The nervous to cerebral affections - hysteria &e - Lecture 12th - Cathartics. Cathartics, are substances which evacuate the contents of the alimentary canal - There are two natural motions in the tube, the vermicular, & peristaltic, has mucous follicles & glands entering into its structure, is supplied with nerves of organic life, is directly connectedwith important organs & has 15 or 16 square feet of surface - stomach 90 square inches, small intestines 1500, large ditto 500. Cathartics differ in the part on which they act, partly from their degree of solubility, partly from their specific affinity, or the peculiar susceptibilities of the intestine. The characters of the discharges vary with the different substances employed, laxatives as manna, olive & castor oil simply evacuate the contents of the alimentary canal, mercury procured black or dark yellow from the bile - if stimulating, watery discharges as hydragogues - stimulant substances may produce mucous evacuations as cayenne pepper lobelia - We have laxatives, purgatives, & drastic cathartics - Their uses are various - to evacuate, when morbid secretions are exist, or costiveness - retained secretions are very debilitating in sickness, being absorbed & pervading the system - to deplete, by discharging the serum of the blood, none of the red globules, & little of the albumen, also modify the chyle - promote absorption, by lessening the circulation which is in an inverse ratio to absorption, by revulsion, as a drop of croton oil on the tongue in apoplexy & determination of blood to the head - they are useful in all diseases but inflammations of the alimentary canal - they may promote the secretion of bile by their mechanical effect in increasing the peristaltic motion - by combination the operation may be rendered milder - emetics or bitters increase their activity - aromatics remedy their griping nature, thus anise or a spoonful of ginger with salts & senna - carbonic acid in some form, acts as a sedative before the administration of cathartics - an empty stomach promotes their action, also drink, as barley water or gruel - in general, they should not be given at night the recumbent position & diminished susceptibility are adverse - Hypercatharsis may be checked by 20 or 30 drops of laudanum given in starch injection, or by the mouth - a mustard plaster to the stomach & mustard water to the feet. Cathartics are cooling or heating - the first will not produce inflammation, the effect they produce relives itself, cannot kill with a saline cathartic. They are indicated when the tongue is furred, of any colour, especially if the breath is foul, also when rough, fissured or cracked, pale or flabby with loss of appetite. The bilious temperament bears purging better than the sanguine or nervous. Menstruation contraindicates, & in general pregnancy - idiosyncracies sometimes prevent their use. Children bear purging badly - the old need the stimulating cathartics. The nature of the evacuation should be noted. Lecture - 13th. Depletion by cathartics is very weakening - similar to repeated bleeding but less rapid in its effect - Exercise is local & general in its effects - all the actions of the capillary vessels are promoted by it as secretion, nutrition, absorption - it is exhausting, when reaction, is not equal to or greater than action - by inactivity, secretions, as urea, that should be thrown off, are retained in the blood. Sleep, too much, or too little is equally a cause of disease - in sleep the functions of relation cease, while those of organic life continue - The second class of the causes of disease, are the moral faculties - pleasurable emotions are centrifugal in their tendencies, diffusing the blood equally through the body - the depressing emotions are centripetal, causing congestion in important organs. Lecture 14 - Cathartics. Cathartics may be divided into groups - 1st Laxatives - manna, magnesia, sulphur, tamarinds, prunes, sugar, fixed oils - These are not irritant in their effects - are suitable in inflammations of the intestinal canal, hernia, prolapsus ani, piles, after surgical operations. 2nd Saline cathartics, producing exhalation, watery evacuations - they are generally similar in effect, & about the same in dose - from 32-31 - crem or tartar however may in very large doses produce inflammation - good in fevers, inflammations, plethora. 3 Milder acrids, as senna, aloes, rhubarb - not very irritant in their action - senna made overnight oxidises & becomes very acrid. 4 Drastic purgatives - will produce inflammation & death - they are acrid poisons - jalap, scammony, croton oil, elaterium, colocynth - they are united with soap, or blended together - are good in torpid conditions of the system, in dropsy - but not, where there is irritation of the mucous membrane, as in colic, ileus, intussusception - (colic, warm water injections). 1st class - the dry or fresh fruits, tamarinds, raisins, figs, prunes, owe their laxative properties, to the saccharine & acidulous elements - prunes are the most valuable, in costiveness; electuary of senna particularly good - Tamarinds may be given with warm water or whey - Sulphur may be combined with salines - objection, the odor, it produces has a specific alterative action in the skin - Oils are not digested - Castor oil has a specific affinity for mucous membrane - does not produce costiveness by repetition but gains power, so that an ounce may be reduced to a teaspoonful - Magnesia only acts when it meets with acids - there is danger of its remaining in the bowels - chalk mixture good in diarrhea, because the lime uniting with acid, becomes astringent, balcined better than carbonate, as the latter distends the abdomen with carbonic acid.Lecture 15. Causes of disease - Mechanical, injuries, tight lacing, caluli, worms, hardened fecal matter - always suspect the latter, when the disease is mysterious, & pass the hand over the region of the colon - hysteria often caused by it. Chemical, burns, poisons irritant, narcotic, narcotics aired, septic- almost every disease can be produced by a poisoned agent. Endemic & Epidemic. Lecture 16 - Cathartics. Epsom Salts increased the peristaltic motion of the whole canal - in administering salts & senna coffee, dilute sulphuric acid, infusion of roses, will disguise the taste. Sulphate of soda, with Rhubarb & Magnesia, is a safe & mild cathartic. The vegetable acids, disguise the taste of all the salines. Their mode of action & dose, are about the same from 1/2 [?] to 1 [?]. The milder acrids, act also on the exhalents, but more on the nervous system than the salines. Senna may rank between jalap & aloes - has a tendency to the pelvic viscera. Lecture - 17th Contagion. Type of disease - periodicity - Acute disease lasting 20 days - Sub acute 40 - Chronic for a longer period. Lecture 18th Cathartics. Rhubarb is peculiar in the astringent power it exerts, after it's cathartic effect - Aloes differs from rhubarb, by it's specific action on the liver. Podophyllum Peltature resembles jalap in it's action. Butternut & Blueflag good indigenous cathartics. Oil of Turpentine aids the operation of castor oil, in enemata - Jalap owes its power to a resinous principle - resin does not dissolve in water. Lecture 19th Cathartics. Scammony too acrid alone - the comp colocynth pill often used. Gamboge acts more on the stomach & upper portion of intestines than the other drastics - Colehicuin too violent for a cathartic . Elaterium valuable in dropsy with cream of tartar & ginger. Lecture 20. Critical days - old idea false. A septennary period impressed on the animal organism - in chrysalis state - hatching of eggs - & every variety of gestation. Lecture 21st Anthelmintics. Every living being has it's parasitic growths. Of hydatids, the acephalocysts are not animal - a sack or cell containing albuminous fluid, developing cells uterinally in the human species. The Echinococcus contains animalcules, found in the liver spleen & mesentery - the Cysticercus, a distinct structure, found in the muscles. 5 species of worms. 1st Ascaris lumbricoides- 6-12 inches in the intestines, particularly the small. 2nd Ascaris vermicularis - Maw or thread worm ½ inch, in the rectum, sometimes stomach. 3rd Tenia Solium, long tape worm. 4th Tenia lata, broad tape worm * [* *5th Tricocephalus in the caecum*] both occupying the up part of the intestines. Worms may produce, epilepsy, chorea, remittent fever, dyspnea, cachexia, foul breath- they cause an abundant secretion of muc[o]us, therefore a cathartic should generally precede an anthelmintic. Anthelmintics 4 divisions. 1st those which poison the worms. 2nd Evacuate without poisoning- 3rd operate mechanically- 4th prevent their formation. The best of the 1st class Spigelia Marylandica- senna, manna, pink root, [savine?] - form an excellent mixture- Jerusalem oak on account of it's volatile oil should not be given in fever. Male Fern ranks next to Pink root in power. In 2nd class are all cathartics, particularly calomel - Jalap & cream of tartar- castor oil, & oil of turpentine. Oil of turpentine, is the best remedy in tape worm, given in emulsion. Tur is not desirable, producing intestinal irritation. Lecture 22nd Pathology. Death - Lecture 23rd. Expectorants. Different classes of substances constitute expectorants- thus in pulmonary inflammation, bleeding would be one - Expectorants are substances which promote secretion & excretion from the pulmonary mucus membrane - Cough should not be checked, when it is nature's effort to remove secretion - thus opium in croup would be bad. Expectorants are direct or indirect- 1st class either pass through stomach blood & lungs, stimulating the mucous membrane, or are inhaled with the breath - All alkaline substances, thin the mucus - but the secretion may be too thin for the air to expel it - as is often the case in old age- Demulcents, act through sympathy - Emetics mechanically- Antiphlogistics as bleeding, warm bath, by relaxing. Inhalants, stimulate the par vagum & pulmonary exhalents, or exert an alterative effect - Vapour of warm water most effectual, acting as a poultice. Lecture 24th - Pathology. Sources of life a trinity- brain, heart, lungs, death may occur at either angle of the triangle - effects antitoded of poisons- patients often starved to death in fever. Lecture 25th Expectorants Inhalations, a better method of taking expectorants than, by the stomach, leaving the digestivepowers impaired. The substances should always be inhaled with water vapour - a quantity not exceeding the dose by the stomach to be used - water not too hot - Chlorine or iodine, may be rendered milder by opium or from 10-15 gtt of conium - They produce irritation in health, & increase the disease for a short time. Tobacco & digitalis are too sedative in their affects. Snake root is contraindicated where depletion is proper, as in inflammation of the mucous membrane. The astringents are useful in catarrhus senilis, where relaxation is the cause. Lecture 27th - Expectorants Sobelia though a bad emetic from its acrid narcotic properties, is almost a specific in spasmodic asthma. should be employed till vomiting is produced- Bloodroot will poison in doses of [?] ½- Assafactida valuable stimulant expectorant- given in emulsion- may combine with ipecac or conium- useful in typhoid pneumonia, inflammatory measles- [?Gurnmouiac] resembles Assafactida in it's properties & uses - not quite so antispasmodic- Galbanum resembles gum [Ammoniae?] - Myrrh with sulphate of zinc, valuable in catarrhus senilis, in Phthisis- the gum resins do not destroy the tone of the stomach, as the stimulant expectorants- Tolu, the balsams are more suitable in chronic, than acute affections of the pulmonary organs, also to the old than young- they are best administered in emulsion- Peru is more stimulating and suitable to external applications- Copaiba, an oleo resin, exerting an alternative effect on the capillaries of the mucous membranes- Creasote valuable to check the [?] of discharges as cancer- receipt for chronic vomiting as in pregnacy, RX Creosote --- gtt. 17 acetic acid--gtt 16 Aqua --------f oz 14 Compound spirit of Juniper f oz i Simple syrup ----- f oz i ____________________________________ In chronic bronchitis the following is an admirable wine RX Tar water ---- pt 2 ale --------------pt ½ Honey ------- gill ½ yeast -------- gill ½ [?Ml.] Ferment in a temperature of 90, for 48 hours- decant, & give from a tablespoonful [?] a [?] or add paregoric or naptha.- Lecture- Diaphoretics. The state of the skin of essential importance. The hot air both stimulates, but does not soothe- it does not exhaust it may be medicated- The vapour bath is not as revulsive as air. The warm water bath is about the temperature of the body - it soothes the nervous system - in both below 50, the body absorbs moisture & weighs more -of equal temperature no effect produced - above 70 exhalents not [?] weight is lost - the pulse is increased by heat - a bath of 110 irritates the nervous system, but does not draw the fluids outward as the warm bath - they may produce tonic, revulsive, or diaphoretic effects the warm bath is good in all inflammations after bleeding. Lecture Diaphoretics Acetate of Ammonia does not excite the arterial system. The same substances that produce diaphoretics may be used as diuretics - 2 classes stimulating & sedatives - diuretics not of much importance- Stimulating as juniper - hydriodate of potash - liquor potassa & salts of potash-mineral acids - salts of soda. Lecture - Diuretics. Diuretics promote the secretion of urine - secretion in some measures vicarous with the action of the skin - A certain amount of urea has to be eliminated the skin cannot exhale sufficient. Direct & indirect diuretics - the direct acting specifically do not undergo decomposition in the stomach, but are conveyed through the blood to the kidneys. Another class act through the stomach. Another stimulate the capillaries. Diuretics evacuate but not powerfully & without debilitating - they depurate the blood from various salts. Direct, are volatile oils - as oil of turpentine, good in dropsy with lenco phlegmatic habit of body. Iodine acts powerfully on the absorbents- may produce unpleasant effect. Liquor Potassa, in small doses, where irritability of stomach exists, as in dyspepsia. Acetate of Potash is the most valuable salt. Cream of tartar, may be united with digitalis. Centhardes useful in incontinence of urine, as with children. Copeiba & Cabbs, valuable in gonorrhea, should be give in large doses at first, that their effect may be felt. Squills combine with mercury. Squills, Calomel gr 2-3, Digitalis gr 1-2. Colchicum, specific in rheumatic gout. Lecture - Diuretics The effects of digitalis not always perceived at first - care necessary. Diurectics from their stimulant action on the kidneys are contraindicated in inflammationNot good in fever, when the action of the skin is required - they are poor evacuants, most valuable in chronic diseases, particularly dropsy - they act by exciting the capillaries - their operation is uncertain, as organic disease is common in dropsy - also antilithic - 3 rules to be observed in their exhibition - 1st keep the skin cool - give them in the daytime - 2nd use diluents freely with them - 3rd give alterative tonics after their exhibition in dropsy. -- Lecture - Antilithic Lithic acid, causes the red gravel deposite - the phosphates, white gravel to the pellicle with prismatic colours - Lithic acid calculi, the most common - the lithic deposite, marks a sthenic, the phosphatic an asthenic condition of system. In treatment, the skin & digestive organs, must be particularly attended to - In the lithic acid diathesis, acids & whatever food may become acid, should be avoided - potash water better than soda, forming more soluble deposites - Litmus test should be used constantly - natural urine is slightly acid - in disease the lateritious deposite is sometimes a valuable critical sign - colchicine & turpentine are useful in the lithic diathesis - For the phosphatic deposite, tonics & mineral acids suitable - hydrochloric & nitric acids, with an astringent as uva ursi - bases with mineral acid more suitable than vegetable acids, as the stomach may decompose the latter & thus produce an alkali - Lecture - Pathology. Congestion produces effusion - stiumlation needed - Croup from inflammation commencing above, checked by nitrate of silver, & stimulant gargles - Lecture - Antilithics. Indications of treatment in the lithic acid diathesis, are 1st to present this formation by diet purgatives, & citrate of potash & antimony - 2nd increase the solvent power of the urine by eating less & drinking more, demulcents, flaxseed tea, barley water - 3rd neutralize the lithic acid by lime water, bicarbonate of potash, largely diluted - 4th to destroy the calculi - but vesical calculi cannot be acted on chemically - Acid antilithics - the mineral preferable - muriatic acid, most congenial to the stomach - 10-20 gH, with demulcent drinks - Alkaline antilithics, allay gastric irritibility & thus present the formation of acids in the stomach - Liquor Potassae, also reaches the kidneys, 10-20 gH, largely diluted, two or three times a day - the litmus test should be used frequently, during the administration of remedies - Carbonate of soda &, potash are preferable from the mildness, the latter being the most powerful & soluble - Ammonia & its carbonate, exert their effects on the stomach - Magnesia should be used with tonics - Some water improves the digestion, 1 pt in 1qt of milk - The state of the general system, should always be attended to - Where much Ammonia exists, betters are very serviceable, those with astringency should be chosen - Lecture - Narcotics. Narcotics diminish the sensibility & irritability of the nervous system, & in moderate doses produce excitement followed by depression & sleep - termed cerebroopinants - Narcotics, Antispasmodics, & Tetanics - The nervous centres, variously affected by the different agents, as opium specifically on cerebrum - kill in different ways, as tetanus from want of relaxation - Narcotics are stimulant in small doses, promoting secretion, depressing from reaction, wehre as Sedatives immediately depress - repeat the dose to keep up a stimulant effect - some are anodyne - duration of excitement, in inverse ratio to the dose - Their 1st effect is on the nerves of the stomach, impairing digestion, producing constipation (except hyoscyamus) the same effects by the skin or veins - disease affects their operation - in gastric irritability or intestinal spasm, digestion & action may be improved, but in atony or inflammation, they are injurious - in diarrhea they are valuable - 2nd effect, by entering the circulation - their action on the capillaries is according to the dose - They act in proportion to the developement of the brain & nervous system, thus care must be used in giving them to children - applied to membranous surfaces, they act according to their absorbing power - do not act by sympathy - In narcotic poisoning, artificial respiration should be kept up, till the poison is thrown from the system - A larger quantity is required by enema - Topical power according to their active principles & solubility - solubility of acetate, hydrochlorate, sulphate of morphia many modifying circumstances - in pregnancy frequently destroys the fœtus - acids promote their action - best antidotes, strong astringents. Their active principle is an alkaloid - vegetable alkaloids exist in combination with an acid, mostly crystalizable & solid, C. H. O. N. -- Lecture - Narcotics. Opium the most valuable article of the Materia Medica - differs from most other narcotic, in being a safe remedy - the sleep if produced is a safeguard - contains alkaloids, neutrals & acids - Morphia the active principle - Narcotine resembles quinine, proving effectual in intermittent fevers. Thebaine resembles Strychnine. Morphia & codeia are the narcotic principles. Narcotina acts on the spinal cord. Thebaine is tonic. The dose cannot be specified, sufficient must be given to produce the desired affect. In disease it expends it's force without leaving unpleasant results. Thus as an anodyne, it will not constipate. Sometimes a full dose can be taken better than a small one , as the salts be borne better than opium in substance. In inflammation bleeding should precede, in disease of the heart care is necessary, in congestion of the liver, combine with calomel. Lactucarium is a substitute for opium but rather feeble. Aconite acountina the most powerful poison known 1/50 gr has caused death by paralysis and congestion, not convulsion - in benumbs is anodyne, where no inflammation exists, a diaphoretic in inflammation. 3 gH of tincture of the root - an external application. [Coninmuconia?] the alkaloid is only, [?] salts - produces pally of the respiratory nerves. Strychnia & conia neutralize each other- two properties- alterative, in tumors & ulcers anodyne. Lecture - Pathology Facts in relation to inflammation - the blood vessels are enlarged- the passage of blood is obstructed - excess of fibriue over globules & it's slow coagulation the cause of the buffy coat. The natural heat of the blood is 95 in disease it may sink, or rise to 114. Lectures - Narcotics Solanum nigrum, not much used - Solanum Dulcamara, a feeble narcotic. Atropa Belladonna - daturia the active principle - produced extravagant delirium like Stramonium - antidotes emetics, astringents- in neuralgia & as a plaster in helping cough. Datura Stramonium - the root leaves of seeds of all these narcotics. datruria the active principle - in asthma, smoked or inhaled - dilates the pupil. Hyoscyamus Niger does not constipate, is used to quiet pain of nervous irritation where opium will not agree. Hop is tonic as well as narcotic. Camphor stimulant & narcotic. Cannabis Indica - inhale for nervous irritability. Lecture - Anasthetic agents - Hyponitrous ether, Sulphuric ether,Chloroform- 3 parts sulphuric ether, with 1 art Chloroform, the best & safest. Chloroform alone is dangerous. breathe from 2-4 minutes - enters the blood - soon exhaled. Lecture - Inflammations Tubercular disease a form of scrofula - Lupus, white swelling Encephaloid tumors, are generally connected with or mark the strumous diathesis, thin skin, cold extremities, chilblains, frequently accompany this diathesis. guard against its development by nutritious diet, bracing air &c- Lecture - Antispasmodics Alcohol, one of the cerebro-stimulants has a strong affinity for albumen, hardening textures, & for water, which it absorbs from the stomach, an admirable stimuli in low fever & uterine hemorrhage is Rx Brandy Cinamon water aa [?] 4 yolk of eggs 2 sugar m- Antispasmodics are nervous stimuli- affecting the nervous much more than the circulatory system, not acting on the brain specially - indirect agents in spasm from irregular nervous influence. Assafoetida is good in hysteria & hooping-cough. Castor - volatile oil the active principle. Used in the same diseases but is less powerful. Amber with laudanum & [?] good in hooding-cough. Coffee promotes digestion. Lecture - Tetanics Tetauics act on the motor track of the spinal cord. They irritate muscular fibre & produce convulsions-are chiefly useful in Paralysis. Strychnia forms salts should be used externally as well as internally- acts in tetanus on homopathic principle 1/12 gr every 9 hours - occasioally omit- efficacious on paraplegia, dyopepsia, amenorrhea - produces an alterative action of the capillaries. Brucia is similar but less powerful. Arucia a valuable nervous stimulant - 5-10 gr of the extract. Emmenagogues- Electricity in chronic cases, after hygiene treatment. Valerian in ammenorrhea with hysteria. Ergot in uterine hemorrhage acts probably through the lower portion of the spinal cord.Lecture - Alterations Alteratives are general agents. All vital stimuli are such. There are three indication of cure in disease, to lessen, promote, or modify or change action. Ateratives fall under the third head. Act without [?] diate perceptible affect, as secretion or excretion. Suitable to chronic disease. They act either on the nervous system, or by changing the blood. Disease is a mode of action not an entity. Alterative treatment must be continued for a considerable period. Rules-1st prepare the system as by bleeding or tonics. 2nd Do not hurry the cure. 3rd Combine the alteratives with the other remedies. 4th Select the right agent. 5th Regulate the diet. 6th Adapt the remedy to the exiting derangement. Lecture Alteratives Mercury - in the metallic stat acts only mechanically as in [intussusecption?] (all its compounds salivate) in the ointment a blue pill, a portion probably becomes oxidised, hence the effect. Corrotive Sublimate. The Nitrates, Acetates & Bicyanide are corrosive. Antedotes Albumen. Milk with Tannic Acid. [Calomel?] & the [Pro?oxide] peculiarly excite vascular action. Mercureal pill, plaster, ointment & powders, are feebly irritant. The soluble salts are violently cathartic. The insoluble mildly so. [Colomel?] is a slow cathartic, is generally combined its use is to increase the effect of hydragogue cathertics, it affect the [brilliary?] secretions, & produce an altertive action. [Mercurealism?], affects the circulation, breathe, gums, & salivary glands. Other drugs with salivate as Digitalis, Prussie acid, Iodine, but not similar constitutional effects. It enters the blood. [Inu?etion] of mercurial ointment & inhalation of Red [bimiabar?] placed on heated iron, most rapidly act on the system. this last application, is, next to the early use of nitrate of silver, the most powerful remedy in Group. To check [mercurialisin?], give saline cathartics, apply chloride of soda, or nitrate of silver locally, a wet compress to meek, & a cool room. Lecture Alteratives Mercury users more indication fever, than any other substance. As an antiphlogistie agent, it checks the effusion of lymph. Bleeding should precede in inflammation. It is not good in rheumatic or scrofulous inflammation. Very injurious in cancerous or scorbutie affections. In inflammation of fibrous membranes where there is a tendency to effusion as [pericarditis?]m & mucous membranes. Dysentary. Valuable in Syphilis. [Coutramideated?] of the Liver. In cutaneous disease-the general principle of treatment of all cutaneous diseases is the same. Lecture - Revulsives Revulsives transfer morbid action to a less important related organ. [Rubifacients?] excite the capillaries. Draw the patients attention from the disease. Mustard depends on its volitile oil which is developed by water. in [bo??a]. [pa?i]. A poultics is more suitible for children, than [sinapsi??s] or blisters. Cayenne Pepper is a permanent stimulant internally. excellent in malignant Scarlet Fever. Oil of Turpentine of great value. A good external application is Sweet oil [?] 10 Oil of Turpentine [?]4 Sulphuric Acid [?] 2 [Epis??astics] produce cuticular Secretion. They are [ru?befacients], inflammatory [?], secretory excitants. The discharge contains 18 p ct Albumen. Indicated where disease is acute but modyfied by autophlogestie treatment. Acute in time, but life low, as in typhoid states. In chronic disease, Contramedicated in acute inflammations before depletion. bleeing and blistering must not go together. 4 modes of action as Derevatives, Evacuants, General Stimulants, Antispasmodics. Lecture - Revultives 6 or 8 hours will produce the full effect. Twice that time on the scalp. In children they should be removed when the skin looks red, in 2 or 3 hours & cabbage lead applied to vesicate. Dry cups of mustard fermentative will prepare for blisters, when the system will not act [Straugury?] treated by fermentation, opiate injections & [demula??] To relieve their irritation, bread & milk [pottice?], lard, [?]water & sweet oil, sometimes with[Caud???]. [?] of [prop?] in fever, unless a local complication require it. bleed before applying in local inflammation - good in spinal irritation. Suppurants - produce pustular [?] more permanent & profound than vestication, less dangerous as the absorption of [Antimouy?], the best, is not like [fontharided?]. Escharotics - the [bestis?] Nitrate of Mercury, which does not spread, like potash. Lecture - Astringent Astringents produce contraction of the living tissue. They act in different ways. Their principle effect is vital, independently of mechanical or chemical action. The pulse in contraction, secretions diminished. Moderate & permanent [str] excitants to organic life. useful in unhealthy discharges of local character, not the result of a general morbid condition. If excitement exists, bleeding should precede. In diarrhea, diabetes, hemorrhagies. Tonic Astringents - Tannin root important. unites with gelatine forming an insoluble compound. the dose can be exactly regulated, it does not offend the stomach. combined with nitras argenti & [hyos??] in the diarrhea of Phthises - a good application to sore nipples. Gallic acid - suitable to chronic discharges. it does not constipate. Witch Hazle, combine narcotic properties. Minerable acids are a apt to irritate from their chemical action which the vegetable substances do not. 30 g of Sulphuric acid with 1 oz lard, considered specific in itch. Alum is in large doses purgative. Nitrate of Silver, unites with Albumen, excluding the air. All the metallic astringents are collyria. the best however is the Nitrate of Silver. All vegetable astringents list given in decoction. Lecture - Sedatives Sedatives depress the energy of the nervous system, without previous excitement. Cyanogen & its compounds are the most powerful. Chloroform dangerous from its direct powerful action. The first affect of sedatives is on the nerves of the stomach, thence to the brain, then the respiration is impeded, impression on the circulation, not commensurate with that of the nerves. 2 classes of Sedative, the direct, acting through the nerves. Indirect through the blood. The [por?nt] sedative properties of the compounds of Cyanogen are developed by water, its hydrogen, Antiphlagistic regimen. Diet, air, Repose mental & bodily. in the great muscular debility of inflammatory fever, more blood is sent to the lungs than they can manage. therefore rest and recumbency is essential. also abstinence is dictated by Nature in the commencement of acute disease. the secretion being diminished. the Oxygen of pure air is the chief nutrient. 20,000 sq inches in the lungs, 72 beats a minute, 2 oz of blood each sent to the lungs each beat. gives 24 hogsheads of blood passing through the lungs in 24 hours. 18 respirations a minute, & 1 pt of air entering in an enspiration gives 54 hogshead, of air entering the lungs in 24 hours. Temperature should be about 60. Mental & moral emotions, not sufficiently appreciated in treatment. Bloodletting - blood a vital stimulus in disease. abstract & lessen excitement if blood could be completely abstracted from an [dis?sed] inflamed part, we could completely arrest the inflammation, for blood is the fuel which feeds the fire of inflammation. The more important the organ, the more necessary to be prompt in bleeding. A hard pulse does not indicated bleeding always the pulse taken alone is no guide. Inflammation of serous membranes & the substance of organs, requiring it most. Greatest tolerance of bleeding in congestion of the brain. 40 oz can be borne, next pleurisy, peritonitis. 15 oz borne in health. children & old people have less tolerance for bleeding. for children when repetition is necessary, leeches should be used. Cups are preferable to leeches where speed is necessary, the quantity can be measured also. leeches can go where cups cannot be applied & tenderness would forbid. Hydrocyanic fluid (& chloroform) will produce local insensibility in dyspepsia, painful, or spasmodic affections, where there is no inflammation.