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V



Treatment of Diseases

A SHORT TREATISE TO SECURE ADVANCEMENT IN THE SCIENCE OF MEDICINE.

W. G. HEARNE,

137    .A. Xi 33 IE IR» T S T IR, IE IE T ,

( Opposite Fitzroy Gardens)

EAST MELBOURNE.

MELBOURNE :

Sands & McDougall, Printers, Collins Street West.

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TREATMENT OF DISEASES.

Ladies and Gentlemen,—I have decided to address you on the above subject, which is of the utmost importance ; but, in order to effectually explain why I do so, it is necessary that I trouble you with some extracts from Hayter’s Statistics for 1878-9 ; and, although they only refer to Victoria, nevertheless they are indicative of what is being done, or left undone, by medical treatment in every part of the world.

It is recorded in the statistics alluded to, that, “ during the year ending 1878, 12,702 deaths occurred,” of which number 11,471 died prematurely from disease; 894 from accident, murder and manslaughter, &c.; but only 337 died the easy and natural death of old age. The average age attained did not exceed 26 years 10 months, and 53 per cent, of the deaths occurred before the age of 25.

Here is food for reflection ; 21 years are passed before manhood is attained, and the majority of persons are not comfortably settled in life before the age of 25 ; yet it is a fact that more that one-half die before they reach that age. The next item is, if possible, more significant still: 12 out of every 100 children died before the age of one year. These are serious and fearful facts, and demand careful inquiry as to why so many die at such an early age. Some persons argue that those who die young are happier out of the world, but such a view is dangerous, and to be condemned ; for, as the world is in existence, and as it is in the natural order of events that children shall be born, we should, from a sense of duty, do what we can to alleviate that suffering which always precedes, and, if not relieved, results in death.

It will be readily conceded that our chief desire is to live on happily to old age in the enjoyment of good health, free from unnecessary pain and suffering. We must, therefore, inquire into and follow those laws which our great and glorious Creator has instituted for our especial benefit.

The human body is perfectly and beautifully finished ; the various portions have each their own particular functions to perform in re-arranging and conveying such elements of nutrition as are required, and removing that which is effete. It is supplied with all that is necessary to enable life to be sustained with thorough enjoyment for the full period of three score and ten years, but every part must be kept sound and perfect. If one part deteriorate or become diseased in any way, the whole machinery of the system may be thrown out of gear, and will eventually suffer more or less in proportion to the nature, extent, and locality of the primary deterioration ; hence the necessity for the prompt administration of such medicines as have a curative power only.

The different diseases are first known, through the agency of the nerves, by symptoms peculiar to each. Intellect, through the instrumentality of the brain, enables us to seek out and use the proper remedies.

A 2


The effects of the various medicines on the human system have been, and are at the present time, subjects of great dispute among all classes. There are upwards of 1,700 different medicines administered by British allopathic doctors, sometimes alone, but most generally combined in various ways, according to the particular ideas of those who prescribe them, and without regard to any fixed rule or order. There are also a large number of homoeopathic medicines, and over 400 distinctly different patent medicines, which are at the present time being largely consumed. Much difference of opinion exists with regard to the effects of these medicines, both on the part of medical men and the general public. Many argue in favour of allopathic treatment; others in favour of the homoeopathic ; some rely on the represented efficacy of the various patent medicines ; but still the grim fact remains that more than one-half of the population die before they attain the age of 25 years. This fact alone, bearing in mind the great amount of attendant suffering, calls loudly for such steps to be taken as will clearly prove to all what is the proper treatment for each disease, and what the exact effect of each medicine administered.

It is perfectly plain that there is a right and a wrong way of treating every disease, and it is equally plain that it would be advisable to prove which is right, in such an unmistakable manner that further doubt could not exist, and thus the large number of premature deaths at present occurring, together with the great amount of attendant suffering, may be prevented.

Eighteen years ago I determined to make this question of the value and effects of medicines in curing disease my special study. In pursuance of this object I proceeded by most carefully investigating the properties, both chemically and therapeutically, of every medicine recognized by medical practitioners, noting results, recording the exact effects of each dose administered, and studying such in conjunction with the chemical nature of the various medicines under consideration, gradually proving the truth or falsity of the conflicting statements recorded of their effects, and thus freeing them from the uncertainties and mysteries by which they were surrounded, until I ultimately grasped truths. I proved conclusively that many medicines, which are, at the present time, most generally administered, failed to afford relief in, and some positively aggravate, the diseases they are recommended for the treatment of. Others afford relief of a temporary or palliative nature, but without distinctly controlling or curing the disease. Many of the most valuable medicines in existence I found so combined with others, that their good effects were, to a great extent, neutralized and lost. But it was evident to me that much more remained to be done, as several diseases of frequent occurrence did not yield to any of those medicines known and recommended for their treatment. I therefore continued the searching investigation until, one by one, my efforts were so far successful that I am now prepared to prove that, out of the 11,471 deaths from disease recorded and previously alluded to, 7,221 could have been saved, if promptly and skilfully treated with their own appropriate remedies. It was with the object of proving what I have stated, that, some time since, I offered to compete with any legally qualified doctor under such circumstances that conclusive proof would have been obtained; and, in doing so, I was not prompted by any spirit of antagonism to the medical professsion, but by a desire to prove by results that which, in the treatment of disease, could not be done by argument alone or mere representation. I was further hopeful that, if my offer had been accepted in the same spirit in which it was made, facts would have been placed on record, through the combined efforts of both, which would have simplified the treatment of disease generally, and gone far towards preventing, in the future, the administration of any medicine to suffering patients but that which had a proved curative power over the disease from which they suffered.

Believing Honor to be the most suitable reward for successful efforts to arrest disease, I offered to compete for that alone, in December, 1879, upon the following terms :—

1st.—Each competitor shall pay half the expense of investigation.

2nd.—The competition shall be for honors.

3rd.—Each competitor shall have under his care for medical treatment an average of one thousand persons for not less than six months. If the total average death-rate be under five in two thousand for six months, the competition shall be extended for a further period of six months, and he, under whose care there shall have been the smallest average death-rate during the period of competition, shall be declared the winner of the first honor.

4th.—In competition for first honor, deaths from disease only to be counted; deaths occurring as the result of violence, accidental or otherwise, not to be counted.

5th.—Each competitor shall take as nearly as possible the following number of diseases to cure, and he, who shall secure the greatest average amount of success in treating them, shall be declared the winner of the second honor. This competition shall commence immediately upon the conclusion of the competition for first honor :—

5 cases of small-pox (if such should occur)

100 cases typhus fever 100 cases erysipelas 100 cases enteric fever 100 cases diphtheria 100 cases neuralgia too cases hooping-cough 100 cases croup 100 cases rheumatic fever 100 cases bronchial catarrh too cases enlargement of the liver too cases suppurative nephritis 100 cases bronchitis 100 cases pneumonia 100 cases asthma 100 cases pleurisy 100 cases dysentery 100 cases diarrhcea 100 cases constipation 50 cases scarlet fever 50 cases varicella 50 cases pyæmia 50 cases measles 50 cases puerperal fever 50 cases encephalitis 50 cases meningitis 50 cases pericarditis 50 cases inflammation of the brain 50 cases chronic rheumatism 50 cases endocarditis


50 cases gastritis

SO cases dyspepsia

50 cases enteritis

50 cases hepatitis

50 cases peritonitis    •

50 cases cystitis 25 cases English cholera 25 cases febricula 25 cases acute gout 25 cases syphilis 25 cases chronic gout 25 cases diabetes 25 cases chlorosis 25 cases ancemia 25 cases anasarca 25 cases cynanche maligna 25 cases simple continued fever 25 cases infantile convulsions 25 cases pulmonary phthisis 25 cases ulcerative stomatitis 25 cases apoplexy 25 cases schlerotitis 25 cases ophthalmia 25 cases cancrum oris 25 cases splenitis 25 cases jaundice 25 cases urticaria 25 cases erythema 10 cases of any disease not enumerated above.


6th.—Those who place their health’s welfare in the hands of either competitor will be required to strictly follow his advice, and give notice if removing from one place to another, with full address of future residence. Notices of removal, or neglect to follow directions, to be forwarded from one competitor to the other without delay, and weekly returns of diseases treated shall be exchanged.

7th.—Each competitor shall choose one gentleman to act on his behalf in council; but should the two so appointed be unable to agree, or should either of the competitors be dissatisfied with their decision at conclusion of competitions for first or second honor respectively, then each competitor shall choose five other gentlemen, and the twelve so chosen shall elect one more to form a full council of thirteen. The said full council of thirteen shall closely scrutinise, consider, and decide all matters connected with the competition, and their decision shall be final. No gentleman in any way identified with any system of medical treatment shall be chosen a member of the said council of two, or full council of thirteen.

Many persons, however, observed to me that it was hardly to be expected that such an arduous undertaking would be entered into without the inducement of some substantial reward in addition to that of honor; therefore, after waiting a reasonable length of time, but receiving no response, I, on the 4th January, 1880, announced my willingness to compete for £2,000 upon the same terms as previously announced, but with the addition of one clause to the effect that “Each competitor pay into his bank ¿1,000 for competition, the total amount of ¿2,000, less expense of judging, to be paid over to whomsoever be adjudged the winner of the first honor,” and, as a guarantee of good faith, I placed ¿1,000 in the Geelong Branch of the Bank of Victoria, for competition.

Up to the present time, however, I have not received any intimation of willingness to compete in response to cither offer. I have, therefore, decided to demonstrate to the satisfaction of the most sceptical, that the present large death-rate, and the very great amount of suffering at present existing, can be prevented by prompt and skilful medical treatment, and for this purpose I have removed to Melbourne, so that I may take the various diseases for treatment in the densest of the population.

Every disease should be diagnosed and classed, as slight or severe, by some impartial authority, before treatment, to prevent the cure being afterwards discredited ; and, as we have no impartial authority at present except standard works on disease, I have quoted, as an addendum, symptoms of those diseases most fatal and distressing to human life ; and, I venture to hope, few will hesitate to permit me, from this time, to register the cure of such diseases as I have quoted the symptoms of, when I assure them I will not do so without their special and distinct permission, and then only for the purpose of so demonstrating those important facts I have alluded to, that further doubt cannot exist in the public mind.

I purpose treating diseases under two separate arrangements, similar to those particularized in the proposed competition, so that, by a comparison of the results I achieve with the statistics of the colony, I may illustrate and prove the magnitude and importance of the question at issue.

The first arrangement will be by enrolling 1,000 persons of both sexes and all ages. These I undertake to supply with the medicines necessary for the treatment of any disease from which they may suffer during a period of 12 months.

The second arrangement will comprise the treatment of any disease from which persons who have not included themselves in the first arrangement may be suffering.

I am now prepared to undertake such cases as are placed under my care for medical treatment, either by the first or second arrangement just described.

W. G. IIEARNE,

No. 137, Albert-street,

(Opposite Fitzroy Gardens),

East Melbourne.

EXTRACTS FROM HAYTER’S STATISTICS OF VICTORIA.

Deaths at each Age, 1878. (Page in.)

Age.

Number of Deaths.

Percentage of Deaths.

Under 5 years...............

5,018

39'Si

5 years to 10 years ............

596

469

!° IS .» ............

318

2-50

15 .. 25 .. .............

840

6-6i

Total under 25..............

6,772

53 31

25 years and upwards .. ......

5.93°

46'69

Total ............

12,702

100*00

“The total number who died under 1 year of age was 3,262 ; and as the births numbered 26,581, it follows that 1 infant died to every 8 births, or 12‘27 infants to every 100 births.” (Page 114.)

“The average age at death in 1878 was 26 years and 10 months.” (Page 117.)

Deaths in Urban and Country Districts, 1878. (Page 107.)

Estimated Mean Population.

Deaths, 1878.

Districts.

Total Number.

Number per 1,000 of the population.

Melbourne and Suburbs ... Towns outside Melbourne

256,477

5,160

20*12

and Suburbs ......

198,385

3,868

19-50

Country Districts......

414,178

3,674

8-87

Total ... ...

869,040

12,702

14-62

Number of Deaths.

Causes of Death.

24% years. 1853 —1877.

Year.

1878.

Diseases, &c.

Small-Pox ...............

21

Chicken-Pox...............

40

_

Measles... ... ... ... ... ...

3.839

5

Scarlatina ... ... ...... ...

8,487

136

Diphtheria ...............

7,161

336

Quinsy......... .........

567

26

Croup ... ...............

3,373

331

Whooping Cough ......... ...

3,814

291

Typhoid Fever, &c....... ... ...

10,076

532

Erysipelas ...............

931

41

Metria...... ............

604

49

Carbuncle, Boil, &c. ... ... ... ...

54

Influenza, Coryza, Catarrh .........

821

l8

Dysentery ...... ... ......

12,049

197

Diarrhoea ...............

16,139

877

Cholera...... ... ... ... ...

1,121

72

Ague ..................

83

5

Remittent Fever ............

653

22

Rheumatism ...............

1,117

79

Miasmatic Diseases not classed ......

37°

36

Venereal Diseases ............

628

34

Privation ...............

377

3i

Want of Breast-Milk............

1,755

122

Purpura and Scurvy............

255

7

Alcoholism ...............

1,627

64

Other Dietic Diseases............

25

2

Thrush............ ... ...

907

32

Wonns, &c. ...

56

2

Hydatids ...............

399

37

Other Parasitic Diseases ... ... ...

17

2

Gout ..................

138

13

Dropsy ... ...... ... ...

1,904

53

Cancer ... ............

3,536

3*4

Tumor.........

336

28

Polypus.........

8

I

Noma.........

58 '

4

Mortification .

357

8

Other Diathetic Diseases ...

167

Scrofula.........

941

26

Tabes Mesenterica ... ...

2,028

87

1,124

Phthisis... ......

i8,sn

Hydrocephalus......

3,813

I34

Other Tubercular Diseases ... ..

676

34

273

Cephalitis (Inflammation of the Brain) ...

3,907

Number of Deaths.

Causes of Death.

24 years. 1853 — 1877.

Year.

1878.

Diseases, &c.—Continued. Apoplexy ...............

4,266

£

Paralysis ...............

2,061

Insanity..................

254

I

Chorea..................

34

3

Epilepsy ...............

95°

67

Convulsions ... ... ... ... ...

9.032

318

Other Diseases of the Nervous System ...

6,oS6

267

Pericarditis ... ... ... ... ...

633

34

Aneurism ...............

1,308

68

Other Diseases of the Circulatory System ...

9,007

622

Laryngitis ... ... ...... ...

742

56

Bronchitis ...............

7,198

413

Pleurisy..................

1,317

93

Pneumonia ... ... ...... ...

9,790

545

Congestion of the Lungs, Pulmonary Apoplexy

2,000

605

186

Asthma... ... ... ... ... ...

31

Other Diseases of the Respiratory System ...

1,340

74

Gastritis..................

2,230

180

Enteritis ... ... ... ... ...

4,555

185

Peritonitis ......... ......

1,383

67

Ascites..................

397

15

Ulceration of Intestines ... ... ...

354

H

Hernia ... ... ... ... ... ...

349

21

Ileus ... ... ...... ... ...

671

48

Intussusception... ... ... ... ...

152

6

Stricture of Intestines............

6l

6

Fistula ... ... ... ... ... ...

36

3

Stomach Diseases, undefined.........

1,131

81

Pancreas Disease .........' ...

12

I

Hepatitis ... ... ... ... ...

2,002

73

Jaundice, Gall-stone ... ... ... ... Liver Disease, undefined .........

754

47

3,238

25'

Spleen Disease...............

77

7

Nephritis ...............

306

20

Ischuria... ... ... ... ... ...

54

4

Nephria... ... ... ... ... ...

687

115

Diabetes ...............

1S6

13

Stone, Gravel...............

81

7

Cystitis..................

230

26

Other Diseases of the Urinary Organs ...

907

81

Ovarian Dropsy ... ... ... ...

89

5

Other Diseases of the Generative Organs ...

338

18

Arthritis ...............

120

5

Ostitis, Periostitis ............

30

4

Causes of Death.

Number

24 K years. 1853 — 1877.

f Deaths.

Year.

1878.

Diseases, &c.—Continued.

Other Diseases of the Locomotive System ...

445

19

Phlegmon, Whitlow......... ...

47

2

Ulcer ... ... ... ... ... ...

153

II

Other Diseases of the Skin ... ... ...

314

15

Premature Birth ... ... ... ...

4,440

277

Cyanosis ............ ..

286

21

Spina Bifida ...............

204

8

Other Malformations............

597

34

Teething ...............

6,560

119

Paramenia ...............

7S

5

Childbirth ...............

2,349

149

Old Age ... ... ... ... ...

3,253

337

Atrophy and Debility ... ... ... ...

*7,54«

700

Fractures, Contusions, &c..........

6,346

303

Wounds (accident) ............

446

23

Burns and Scalds ............

i,93°

83

Sunstroke ...............

354

25

Struck by Lightning............

31

2

Poison (accident) ...... ... ...

33°

14

Snake or Insect Bite............

63

6

Drowning (accident)............

4,157

227

Suffocation ... ... ...

1,389

62

Other or Unspecified Accidents ......

3,744

12

Murder and Manslaughter .........

440

19

Wounds (suicide) ............

453

6

Poison (suicide) ............

280

10

Drowning (suicide) ............

284

15

Hanging (suicide) ............

398

20

Suicide by other means .........

55

30

Judicial Hanging ............

7«

6

Causes not specified............

1,57°

3i

Deaths from all causes, 1878.........

12,702

The foregoing quotations are from the last Victorian Year-Book of Statistics published, a copy of which is in nearly every public library for reference. The Year-Book containing the Statistics of Victoria for 1879-80 will not be published till about October of this year; but the Government Statist has kindly furnished me with the following information:—During 1879, 51 '34 (more than half) of the deaths occurred before the age of 25.

DISEASES.

It will be observed that the various diseases, with their definitions, symptoms, &c., are arranged, for convenience of comparison, in similar order to that adopted in the list of “Causes of Death,” just quoted from the Government Statistics.

SMALL-POX.

Definition, &c.—Small-pox in man is the product of a specific morbid poison, which is reproduced and multiplied during the course of the malady. It is contained in the contents of the pustules and in the cutaneous and pulmonary excreta of small-pox patients. After a period of incubation of about 9 days in cases of inoculated, and 12 to 13 days by ordinary infection, a remittent fever is established, followed by an eruption on the skin, and sometimes on the mucous surfaces. The eruption on the skin runs a course of about 11 days, and in its progress passes through the stages of papule, lasting from 24 to 48 hours ; vesicle, 4 days; pustule, 3 days ; scab, 3 days. When the eruption is fully out, or at its height, the febrile phenomena, which had remitted, return, and give rise to what is termed the secondary fever. The occasionally succeeding morbid conditions are inflammation of the various tissues of the lungs, of the urinary organs, and, lastly, of the areolar tissue of the body generally, which may become the seat of an endless number of abscesses. The disease runs a definite course, and, as a rule, exhausts the susceptibility of the constitution to another attack.

The occurrence of fever preceding the secondary action of the poison, or the appearance of the eruption, has scarcely an exception, and, indeed, in some instances it has been of so severe a character as to have destroyed the patient at the first onset. The remission or subsidence of the fever is constant in mild cases, but in the severer forms of confluent small-pox it sometimes runs on, and is constant.

When the eruption in small-pox is of the “distinct variety," its first appearance consists of a number of small red papules, about the size of a pin’s head, more or less numerous, but separate and distinct from one another, and scarcely salient. They commence with a circumscribed hyperocmia of the true skin, extending into the subcutaneous tissue. The cells of the rete malpighii swell up, the papilla: elongate, and the red spot of skin becomes a sharply-defined nodule, perfectly solid, and having a flattened top. (‘ ‘ Niemeyer. ”) On the second or third day, a small vesicle, which gradually enlarges, bound down and depressed in the centre, or umbilicatcd, forms on the apex of each pimple, by elevation of the outer layer of the epidermis, and contains a clear whey-coloured fluid. This vesicular stage lasts about 4 days, when the vesicle maturates or “ ripens ” into a pustule. This process is so gradual, that, if you examine the pustule closely about the fifth or sixth day, you may see, at least in many, two colours, viz., a central whitish disc of lymph set in, or surrounded by, a circle of yellowish puriform matter. “ In truth, there is in the centre a vesicle, which is distinct from the pus, so that you may puncture the ■vesicular portion, and empty its contents, without letting out any of the pus ;

or you may puncture the part containing the pus, and let that out, without evacuating the contents of the vesicle. The vesicles have even, by careful dissection, been taken out entire.” (“Watson.”) While the maturation of the vesicle into a pustule is going on, a damask red areola forms around each pustule ; and as the vesicle fills, the whole face swells, and often to so great a degree that the eyelids are closed. When the maturation is complete, the “bride,” which bound down the centre of the vesicle, ruptures, and the pustule becomes spheroidal or acuminated. About the eighth day of the eruption a dark spot is seen on the top of each pustule. At that spot the cuticle ruptures, allowing matter to exude, which concretes into a scab or crust; and during this process the pustule shrivels and dries up. The crust is detached between the eleventh and fourteenth days, leaving the cutis beneath of a dark reddish-brown hue, a discolouration which lasts many days, or even weeks. On the face, however, the pustule often penetrates or burrows, so as to cause ulceration of the rete mucosum, leaving a permanent cicatrix in the form of a depression or “pit.” The cicatrix thus formed, though at first of a reddish-brown, ultimately becomes of a dead white colour. The small-pox eruption does not appear over the whole body at once, but appears in three successive crops. The first crop covers the face, neck, and upper extremities ; the second, the trunk ; while the third appears on the lower extremities. There is usually an interval of several hours between each crop ; and the later the papules are in appearing on the trunk and lower extremities than on the face and neck, by so much the later they are in maturing, and in disappearing from those parts. When the eruption on the face is declining, that upon the extremities liaa scarcely arrived at its height, so that the hands and feet are then considerably swollen.

The number of pustules sometimes does not exceed 5 or 6 over the whole body ; but more commonly they number from one to three hundred, and occasionally amount to several thousands.

The pustule is subject to many irregularities, both as to its form and course, which give rise to two very marked varieties of the disease—viz., the confluent and the horn small-pox.

The confluent small-pox differs from the distinct small-pox in the papules being small, less prominent, and so numerous that even on the first appearance of the eruption there is hardly any distinct separation between them. The vesicles which form on their apices appear earlier, and their diameters increase more irregularly than in the distinct forms, and often they run one into the other. The eruptive stage is usually shorter, and spreads over the body more rapidly, the contents of the vesicles become purulent sooner, and their confluence on the face makes it look “ as if it were covered with one large bladder of matter.”

The horn small-pox is by much the mildest form of the disease. The pustule in this variety passes through the stages of papule and of vesicle, but on the fifth or sixth day of the eruption, instead of maturating, the pustule shrivels, desiccates, and crusts, and the disease terminates three or more days earlier than in the usual course, and without the occurrence of any secondary fever.

The primary fever commences with a chill or repeated rigors, followed by the sensation of great heat; and the thermometer rising rapidly may indicate a temperature of 104° to 106° Fahr., attaining its maximum when the eruption can be felt. The face is suffused with redness, and the carotids pulsate strongly. There is usually much thirst, loss of appetite, and pains in the limbs. The tongue is coated, and the secretions of the mouth are slimy. During the fever, and prior to the expression of the eruption, there is one symptom of great importance in small-pox, as especially pointing to what is about to happen—that is, the pain in the back. It is a peculiar and striking symptom, and more intense than in any other form of fever. On the evening of the third or morning of the fourth day, after the commencing of chill, the fever is usually at its height; and on the fourth day, sometimes sooner, and but seldom later, the eruption appears and the fever remits. A peculiar faint And sickly odor, of a “greasy, disagreeable” kind, and quite stti generis, •emanates from the small-pox patient during the period of maturation of the pustules.

Small-Pox after Vaccination.—Varioloid, or Modified Small-Pox.—It has been noticed that during the epidemic prevalence of small-pox, cases occurred in a very modified form : such as the occurrence of variolous fever without the eruption, or the occurrence of small-pox in which the eruption continued vesicular, and lastly, the occurrence of small-pox in which the vesicle dried up instead of becoming a mature pustule. Modern pathology now regards these varieties as the result of the modifying influence of vaccination, and they may now be all described and classed under the common name, varioloid.

Since vaccination has been generally practised it has now and then seemed apparent that “the protective power of vaccination becomes gradually weaker, and at length dies out in the individual.” Some of the phenomena, which the practice of vaccination itself has made known to us, tend to establish the doctrine of a gradual impairment of vaccine protection, due to lapse of time, and as a result of physiological changes in the healthy body. It has been shown, from a careful analysis of cases, that the lesser protectedness of certain vaccinated persons bears at least some proportion to the number of years which have elapsed since vaccination.—AUken.

CHICKEN-POX.

Definition, &c.—The disease consists of a specific eruption, in a series of new crops, usually appearing for several days in succession, so that dried and fresh vesicles are often alongside of each other on the breast, back, face, and extremities, preceded by fever. The disease may be protracted for a fortnight or longer.

This disease derives an importance, which it does not of itself possess, in consequence of its resemblance to small-pox, with the modified form of which it has been considered by some to be identical. It is for the most part peculiar to childhood and early adult age. Its infectious origin may generally be traced ; and, that it is communicable, has been proved by inoculation. The febrile affection is of a mild character, and though for a few hours it may seem severe, yet it seldom passes into a stage so severe as to have the tongue of a brown and coated appearance.

Nevertheless there is general discomfort, gastric derangement, loss of appetite, and headache. The eruption has three stages—that of papule, of vesicle, and of incrustation. After the fever has lasted from 24 to 72 hours, a number of red papula; appear, which become vesicular, and perhaps in a few points pustular, on the first day. On the second day the vesicles are filled with a whitish or straw-colored lymph. On the third and fourth days they attain their greatest magnitude, when they become acuminated, and shortly afterwards they burst and shrivel, except those which contain purulent matter, and have much inflammation around their base. Pus, indeed, is so rarely found, that when it does appear it may be secondary to some local excitement of inflammation surrounding a vesicle. On the fifth day they begin to crust,, and in four or five days more the crust falls off, leaving for a time red spots on the skin, generally without, but sometimes with, a “pit ” or depression. The eruption is not at first universal over the body, but usually consists of a series of crops, which succeed each other at intervals of 24 hours, and die away in the order of their occurrence. The first crop usually appears on the breast and back, where it is also generally most abundant, and afterwards on the face and extremities ; but the face sometimes remains quite free.—Aitken.

MEASLES.

Definition, &c.—A purely contagious disease, in which an eruption occurs in crops of a crimson rash, consisting of slightly elevated minute dots, about the size of millet seeds, and having a small papular centre, scarcely perceptible to the touch, and without any sensation of hardness. Several of these may unite in irregular circular forms, or crescents, or they may be isolated. The eruption is preceded by catarrhal symptoms affecting the conjunctivas and air passages for about 4 days, and accompanied with fever. The cutaneous eruption is one of the great characteristics of the disease; its color is of a pinkish-red or deep raspberry hue, and in rare instances, as in the morbilli tiigri, is livid or black, from extravasation of blood in the cutis. In severe cases, especially if the patient be of tender age, the eruption assumes a papular form, and when at its height occasionally a vesicular form. The eruption does not at once cover the whole body, but occurs in three crops, each of which follows the other at an interval of about 24 hours. The course of measles, then, in its most simple, uncomplicated form, is that on the third or fourlh day of the primary fever, which is continuous, the first crop of the eruption appears on the face, especially about the mouth and eyes, spreading to the neck, the breast, and upper extremities. On the following day the second crop covers the trunk, and on the third day the third crop appears on the lower extremities, so that the whole body is covered with the eruption, which is then at its height.

If the eruption suddenly disappears, or “goes in,” it is apt to be attended by other dangerous results—diarrhoea, dyspncea, coma, convulsions—all which unfavorable signs may again disappear on the reappearance of the eruption.

When the disease is expressed, its commencement may be marked by violent shivering, or merely by chilliness, characteristic of catarrhal fever. The inflammation of the mucous membrane of the eyes and nasal fossa:, indicated by more or less constant sneezing, generally commences either witli or before the primary fever, and consequently precedes the eruption by some days. There is increased frequency of pulse, and the local symptoms are very decided. The eyes burn and shun the light, which causes them to fill rapidly with tears. There is pain over the frontal sinus, and the nasal passages are stuffed up from the swollen mucous membrane in apposition, and the nose discharges a limpid salty secretion which stiffens linen. This inflammation for a few hours may be confined to fixed spots, and is marked by itching at the mucous orifices; then it becomes diffuse, and quickly changes to mucinous discharge, for a profuse watery discharge from the eyes and nostrils shortly follows, technically termed “ coryza.” It does not always happen, however, that the functions of the mucous membrane are disordered as well as the cutaneous surface. There are cases in which no catarrhal symptoms exist such cases occur during epidemics of the disease, and are but few in number.’ On the other hand, there are cases where the eruption is limited, very indistinct, or altogether absent, and which unmistakably result from infection with measles-poison. One of the most serious complications of measles is catarrhal pneumonia. Children, as a rule, in uncomplicated cases, are not anxious to seek their beds, even with a temperature of 104 deg. Fahr. ; but in cases of pneumonia, with the same temperature, they desire to lie down at once. Inflammation of the bronchial membrane is denoted by the expectoration of a thick viscid mucus, or of pus, and which may or may not be streaked with blood ; while the mucous or sonorous rattle will point out the peculiar seat and extent of the mischief. If the substance of the lungs be inflamed, the breathing is more difficult, cough more troublesome, and the countenance livid ; but the loud mucous rattle which accompanies it seldom allows us to hear crepitation, or to determine the absence of respiration in any given portion of the lung. If the pleura be inflamed, we have, in addition to the cough, severe pain in the side, and an impossibility of filling the chest with air, except in a very limited degree.

In strumous patients, measles may end in the development of miliary tubercles in the lungs ; increasing cough, emaciation, and a harsh dry skin being the symptoms of such an untoward result. Croup sometimes supervenes, and is not unfrequently preceded by diphtheritic inflammation of the fauces. The mucous membrane of the mouth and fauces, in most of the severe cases, inflames; but the inflammation differs from that of the eyes and nose in not being accompanied by any discharge. The early symptoms of the disease are seldom severe, and greatly resemble those of an ordinary acute catarrh; so much so that, in the absence of any epidemic of measles, they could not be otherwise recognized. They are shivering, alternated with heat, frequent pulse, headache, derangement of the bowels, sometimes accompanied by nausea and vomiting.

The diagnostic symptoms between measles and scarlet fever are numerous. In scarlet fever the exanthematous patches are large, but in measles they are not larger than flea-bites, and when most confluent the clusters are small, sometimes forming crescentic patches. The color is also different, being of a bright-red in scarlet fever, while in measles it partakes more of a pinkish-red or raspberry hue. The affections of the mucous membranes are also different in the two diseases. In scarlatina the tonsils are almost always greatly enlarged and ulcerated, while in measles they are little or not at all affected. In scarlatina the eyes arc free from coryza, while in measles this is the most prominent symptom. The tertiary actions of the poisons are also different, being in scarlatina, inflammatory affections of the joints, and dropsy; while in measles, they are inflammations of the lungs, or pleura.—Aitken.

SCARLET FEVER—Syn., SCARLATINA.

Definition, &c.—A febrile disease, the product of a specific poison, which is reproduced during the progress of the affection. On the second day of the illness, or sometimes later, a scarlet efflorescence generally appears on the fauces and pharynx, and on the neck and face, which spreads over the whole body, and commonly terminates in desquamation from the fifth to the seventh day. The fever is accompanied with an affection of the kidneys, often with severe disease of the throat, and is sometimes followed by dropsy.

There are several forms of the eruption, such as smooth, papulose, phlyctanoid or vesicular; these are all evanescent after death.

In the smooth eruption the surface of the inflamed skin presents no inequality either to the sight or touch.

The scarlatina papulosa has an eruption in which the papillae of the skin are enlarged, by inflammatory exudations at circumscribed spots, and the appearance is that of roughness, or “goose-skinned.” The third form is accompanied by numbers of vesicles of various size, filled with serum, or with limpid or cloudy yellow liquid, which ultimately shrivel up and desquamate.

Whatever the ultimate form of the eruption may be, its first appearance is by innumerable small bright-red puncta, dots, or macula.-, separated by interstices of healthy skin. These puncta or maculae are at first very minute points all over the affected parts of the skin, but they quickly become confluent, so that in a few hours the redness becomes general over the parts attacked. The papillte of the tongue are singularly elongated and enlarged, and stand up salient and erect, and of a deep scarlet color, above the thick, white, creamy mucous fur which coats the lingual membrane; and hence the term “strawberry tongue,” from the supposed resemblance to the exterior of a strawberry.

The sore throat, or inflammation of the faucial membrane, though not so constant an affection as that of the skin, yet, when it does exist, it is often of much longer duration. This inflammation, at first punctated, then diffused, usually runs into ulceration, and the character of the ulcer is so completely in unison with the state of the constitution as to enable us, according as it is slight or severe, to divide scarlatina into two great varieties—the “anginose" and the “ malignantThe first form is marked by a greatly enlarged or swollen state of the tonsils, which are of a vivid or bright-red color; and, when ulceration takes place, the ulcers are seldom deep. In malignant cases the tonsils are much less tumefied and enlarged, but much more loaded with blood, and of a deeper, and sometimes of a livid color. The ulcers, also, are deep and formidable, and are slow to heal.

The dropsy which sometimes occurs after scarlet fever usually commences between the fifteenth and twenty-third days of the disease, and almost uniformly not till after all the other symptoms have subsided. The patient is liable to it during desquamation, and for a considerable time afterwards. This disease in the two years 1863 and 1864 destroyed in England alone more than 60,000 persons.—Ailkcn.

DIPHTHERIA.

Definition, &c.—A specific disease with membranous exudation on a mucous surface, generally of the mouth, fauces, and air passages, or occasionally on a wound. In some cases a remarkable series of nervous phenomena are apt to supervene, characterized by progressive paralysis and sometimes by fatal syncope. The disease is contagious, and apt to be epidemic. It terminated the life of the celebrated Washington, and of the Empress Josephine. The prodromata which forbode an attack of diphtheria may be set down as general malaise, morbidly diminished appetite, slight fever, and glandular swelling. Some general constitutional disturbance supervenes very gradually and insidiously, such as feelings of depression, prostration, muscular debility and headache. There is a sense of stiffness about the neck and throat, and the drowsiness which often attends the accession of an attack of diphtheria, may lead the patient to fancy he has caught a slight cold in the throat while indulging in a short sleep. The mucous membrane covering a tonsil, the arches of the palate, the posterior surface of the soft palate, or the uvula, may be the primary seat of the characteristic local exudation. At first there is redness and swelling, and the normal mucous secretion is so altered in its physical properties that it adheres by its own increased viscidity to the mucous membrane. A white or grey patch now forms on the membrane, which indicates the presence of a layer of lymph on the reddened surface. Sometimes the particles of the lymphy exudation are so thin, soft, and separated from each other, that the term membrane can scarcely be correctly applied to it. At other times it is tough, elastic, and as much as an eighth of an inch in thickness. In the one case the lymph resembles cream in consistence, in the other it resembles wash leather, and between the two extremes we meet with all intermediate conditions as regards consistence and tenacity. Vegetable growths, as the oidium of muguet (“Vogel”), occur in the pellicle of diphtheria from time to time, and have been reported by some as a constant occurrence. It is, however, by no means so, and the accidental existence of such vegetable growths is no evidence that epiphytes have any essential connection with cases of diphtheria. (“Jenner.”) However mild a case of diphtheria may appear to be, no case is unattended with danger. The great danger during the first week and towards its end, is from extension of the exudative process to the larynx ; and the least laryngeal quality in the respiration is suggestive of danger.—A Men.

QUINSY—Syn., CYNANCI-IE TONSILARIS.

Definition, &c.—Acute inflammation of the tonsils, which may or may not lead to suppuration.

Inflammation of the tonsils is usually preceded by some shivering and fever, succeeded in a few hours by the sensation of a sore throat, attended with a continual dull aching when the throat is at rest. The voice is altered, being thick and nasal. There is a constant flow of saliva, and a frequent desire to clear the throat of the viscid mucus which adheres to it. These symptoms, combined with feverishness and loss of appetite, increase in severity, until either resolution takes place, or pus, having been formed, escapes. It is often very difficult to examine the throat, because the patient is unable to open his mouth widely. Should a view be obtained, one or both tonsils will be seen to be red and swollen. Although all the soft structures are swollen and cedematous, only one tonsil is generally affected at a time; but it is not uncommon for the inflammation as it subsides in one tonsil to attack the opposite side. The tongue is covered with a thick clammy fur, and the breath is very offensive. The sub-maxillary glands are usually sympathetically enlarged. —A Men.

CROUP.

Definition, &c.—A non-infectious inflammation of the mucous membrane of the trachea, differing from other inflammations of such tissue in the presence of plastic exudation, indicated by accelerated, difficult, wheezing, or shrill respiration, short, dry, constant barking cough, voice altered by hoarseness, with spasm of the interior laryngeal muscles. The disease occurs in children, and may terminate fatally, either in suffocation or exhaustion of the vital powers. As the disease draws towards a close the paroxysms become more frequent, cough more severe, and with less sound, pulse more rapid, suffocation more imminent, and the extremities cold and livid. The final close of the disease (if not arrested) is often by convulsions, sometimes almost tetanic.—Ait ken.

B

WHOOPING COUGH.

Definition, &c.—An infectious and (sometimes epidemic) specific disease, preceded and accompanied by fever of variable intensity, attended in the first instance by catarrh, and subsequently by paroxysmal fits of convulsive coughing. A sensation of tickling or prickling in the larynx and trachea is the warning which young children recognize and dread as the harbinger of a paroxysm, and which suggests to them the necessity of seizing something for support during the fit of coughing which almost immediately commences. In the expiratory efforts the air is expelled with great violence, and so repeatedly and irresistibly that the lungs are ultimately almost emptied of air. A sudden inspiration now necessarily follows, the air being drawn through the glottis by the gasping patient with a force and velocity which gives rise to a shrill, sonorous sound, not unlike the crowing of a cock. The anxious and distressing inspirations are scarcely completed when the convulsive expirations of the cough are again renewed, and again followed by the gasping and crowing inspirations, till a quantity of mucus is brought up from the lungs, or till the contents of the stomach are ejected by vomiting. It is observed that, in the majority of cases, whooping cough commences like a simple catarrh, alike in children and adults ; afterwards, however, the specific element of the disease predominates and is combined with the catarrhal element.—Aitken.

TYPHUS FEVER.

Definition, &c.—A continued specific fever characterized by an eruption on the skin, of a general dusky mottled rash, appearing generally from the third to the eighth day, at first slightly elevated, and disappearing on pressure, but after the second day of its appearance persistent, and (unless the disease be arrested) remaining persistent for 11 or 12 days. Languor and weariness are prominent from the first, gradually passing into sluggishness of intellect and confusion of thought, stupidity, oblivion, and complete prostration. In still more severe cases, somnolence, stupor, and sometimes coma supervene, when prostration becomes profound. Typhus fever is eminently contagious, and occurs in strongly-marked epidemics. It attacks persons of both sexes and of all ages.

After a longer or shorter duration (generally a few days) of unpleasant sensations, in which general soreness, uneasiness, and fatigue without cause, loss of appetite, and disturbed sleep, are the prominent phenomena, the disease begins and advances gradually. It is not possible in all instances to fix the precise time of the commencement of the attack ; but in the majority of cases the patient is seized with chilliness, which sometimes amounts to a rigor, usually followed by heat of skin, and occasionally by sweating, pains in thé back and limbs, and frontal headache. Loss of appetite and more or less thirst exist from the first ; the tongue is white, large, and pale, but is afterwards covered with a yellow-brown fur, and is sometimes tremulous indicating the early loss of muscular power and control. The bowels may be confined or regular. Nausea with vomiting are often among the earliest symptoms. If sleep is obtained, it is disturbed by dreams, or by the occurrence every few minutes of sudden starts. There is sometimes a tendency to heaviness and drowsiness. The attention cannot be fixed, and the mind ceases to think. The expression of the countenance betokens weariness. The eyes are dull and heavy, sometimes suffused and injected or bloodshot, and a dusky flush overspreads the cheeks. Giddiness and noise in the ears are amongst the earliest and most loudly complained-of symptoms. The debility increases rapidly, so that by the seventh day the patient can rarely leave his bed without some assistance. By this time also the want of control over the muscular movements becomes more decided ; the legs and arms shake when raised, and the tongue trembles when protruded. The impairment of the mental powers manifests itself in a variety of singular ways. Memory becomes deficient—the ideas of time are such that it is always supposed to be prolonged. If an event is impressed upon the patient’s mind, he will remember it, and it alone. This mazy state of the intellect soon passes into delirium, which becomes manifest first between waking and sleeping, then by night, and finally by day and night. When delirium first sets in, the patient is able to correct himself; if he is made to think, he becomes conscious of his mental error; but this power is soon lost, and delirium becomes predominant.

About the fifth to the seventh day of the disease the characteristic eruption appears on the skin in 95 per cent, of the cases. On the first appearance of this eruption it consists of very slightly elevated spots of a dusky pinkish-red color, somewhat like the stains of mulberry juice. Each spot is flattened on the surface, irregular in outline, with no well-defined margin, and fading insensibly into the hue of the surrounding skin. The spots disappear completely on pressure, resuming their distinctive appearances as the pressure of the finger is withdrawn, and they vary in size from a point to three or four lines in diameter. The largest spots appear to be formed by the coalescence of two or more smaller ones; and the shape of the larger spots is more irregular than the smaller ones. After one, two, or three days, these spots undergo a marked change. They no longer remain elevated above the surrounding cuticle. Their hue becomes darker and more dingy than at their first appearance. Their margins become more defined, especially on the posterior surface of the body, and when the finger is firmly pressed on them they grow paler, but do not entirely disappear. Each spot remains visible from its first appearance till the whole rash vanishes—that is, till the termination of the disease. When very numerous, the eruption, viewed as a whole, has not an equal depth of color; some places are much paler than others, and the spots have a dull appearance, as if seen through the cuticle. A mottled aspect is thus sometimes given to the skin. The eruption “comes first on the backs of the wrists, the borders of the axilla, and about the epigastrium, and in many cases it covers the whole trunk, and frequently also the arms and legs.” (“Buchanan.”)

Age seems to exert a considerable influence over the eruption. In 100 typhus patients under 15 years of age, the rash will be absent in 25 ; in 100 typhus patients between 15 and 22 years of age, the rash will be absent in 14. (It will always be present in cases above 22 years of age, unless the disease be checked.) In cases of geat cerebral disturbance the respiration becomes sighing, irregular, spasmodic, or jerking, and then coma is apt to supervene. The “nervous respiration” of Dr. Corrigan, or what is sometimes also called “cerebral respiration,” is denoted by a blowing or hissing sound in breathing, the lips being kept closed, the cheeks are distended, the nostrils dilate with each expiration, and the breath is forced through the closed lips with a puffing, blowing noise. Such breathing is irregular, a long pause being followed by a deep inspiration, and subsequently by short respirations in rapid succession. The air expired has a disagreeable odor, most marked in the advanced stages of severe cases, and has been compared to the ‘ ‘ odor of rotten straw,” to the “smell of mice,” See. The disease, if it prove fatal, generally terminates from the twelfth to the twentieth day, and before death

b 2

the prostration increases to an extreme degree. For a day or two before fatal termination the condition termed coma-vigil may come on; in this condition the patient never sleeps; he lies on his back with his eyelids widely separated, his eyes staring and fixed in vacuity, his mouth partially open, his face pale and expressionless. The breathing is often scarcely perceptible, the pulse rapid and feeble, or unable to be felt; the skin cool, perhaps bathed in perspiration. Life is only known to have ceased by the eye losing its little lustre, and the chest ceasing to effect its slow and feeble movements.—Aitken.

ENTERIC FEVER—Syn., TYPHOID FEVER.

Definition, &c.—A continued fever, associated with an eruption on the skin of rose-colored spots, chiefly on the abdomen, appearing generally from the eighth to the twelfth day, occurring in crops, each spot continuing visible for about 3 days. Languor and feebleness are prominent from the first, attended by headache, abdominal pains, and (early) by spontaneous diarrhoea. With the advance of the disease the diarrhoea increases, the discharges being for the most part liquid, copious, of a yellow colour, devoid of mucus, occasionally containing altered blood. In reaction, the discharges are alkaline, and contain a large proportion of soluble salts and some albumen. As the patient loses strength the stools are passed involuntarily. There are special symptoms also associated with the characteristic lesion of this form of fever, viz., fullness, resonance, and tenderness of the abdomen ; also increased splenic dullness. The specific lesions are enlargement of the mesenteric glands, with deposit in the glands of Peyer, and in the minute solitary glands of the small intestine. It is in childhood and early life that Peyer’s glands are most obvious and their functional activity the greatest; and therefore it is extremely significant to find that “more than one-half of the cases of enteric fever occur between 15 and 25 years of age ; and in very early life the proportion of cases of enteric fever would be greater were it not that many children labouring under this disease are described as cases of ‘ Infantile Remittent Fever.

(“ Murchison.”)

Much has been spoken and written about the identity and non-identity of typhus and enteric (or typhoid) fevers. Proofs of numerous and remarkable differences of a specific kind between these two diseases have been slowly but surely accumulating since the beginning of the present century. The dissections by Prost of Parisian fever-patients in 1804 may be said to have laid the foundations of our knowledge, and to have turned the attention of pathologists in the direction which has led to such definite results. In more than 150 dissections Prost found inflammation, with or without ulceration of the mucous membrane of the intestines. Petit, Serres, Pommer, and Bretonneau followed up the investigation ; but the celebrated treatise of Louis, in 1829, was the first to give a complete and connected view of symptoms as well as of postmortem lesions in the fever ; and although Prost asserted the connection of a certain intestinal lesion with a definite series of symptoms, still it was Louis who described this intestinal lesion, in terms sufficiently precise, and indicated with scientific exactitude the symptoms with which it is concurrent. Enteric fever begins gradually, often indeed so very insidiously, that its commencement is not always able to be fixed, being preceded for days or weeks by indefinite feelings of general illness, mental depression, great dullness and relaxation, loss of appetite, indigestion, restless sleep disturbed by dreams, headache, dizziness, and wandering pains in the limbs usually considered rheumatic. Amongst the earlier symptoms, the most characteristic are the abdominal pains and diarrhoea, which continue to increase. A symptom often very painful is metcorism, or the accumulation of air in the large intestine. This is present in a greater or less degree in one-half of the cases, and when considerable it always marks a grave affection. The symptoms of typhoid fever cannot be said to be fully developed till the characteristic eruption has appeared. The eruption occupies usually the abdomen, thorax, and back, but may be present on the extremities, and may not consist of more than from 6 to 20 spots at one time, but is sometimes, though rarely, so thickly-seated that scarcely an interval of normal cuticle is left between. This successive daily eruption of a few small, very slightly elevated rose-colored spots, disappearing on pressure, each spot continuing visible for 3 or 4 days only, is peculiar to and absolutely diagnostic of typhoid fever. The first crop of the eruption is rarely quite decisive, but as soon as successive crops, even of two or three spots each, appear, all doubt is removed. The disease may always be recognized when there is in the evening hours a persistent elevation of temperature. In children, between I and 5 years of age, the phenomena do not seem to be so easily observed as in adults. The chief symptoms of enteric fever in the child are splenic enlargement, diarrhcea, meteorism, gurgling in the course of the colon, associated with pyrexia, quickened respiration, delirium, and somnolency. The eruption already described, and sudamina, are nearly constant in children after 5 years of age.—Aitkcn.

ERYSIPELAS.

Definition, &C.—Inflammation of the integument tending to spread indefinitely, and which may involve the areolar tissue beneath the skin. In erysipelas a specific poison is absorbed and infects the blood, and after a given period of latency it produces fever. The specific action of the poison, however, is mainly made manifest by a peculiar inflammation of the skin, of a bright scarlet or rose-colored tint, evanescent on pressure, but returning on that pressure being removed, and characterized especially by “diffuseness.” It is especially apt to become complicated with visceral inflammations of membranous structures, such as the brain, the lungs, and the bronchi, or the gastro-intestinal mucous surface.    _ ,

In Scotland the disease is known by the name of the Rose; in England it is sometimes called St. Anthony's Fire.

It may terminate by resolution, by vesication, or by gangrene. If the inflammation terminate in vesication, the cuticle is raised into a number of vesicles of greater or less size, and sometimes into large bullte or bladders containing a yellowish transparent serum. The cuticle at length ruptures, the fluid is discharged, and a crust sometimes forms, which, on falling off, leaves the skin underneath either sound or superficially ulcerated. Should the termination be by gangrene, the skin becomes livid or black, its whole texture more or less disorganized, while the bulla: or phlyctenre which often form in these cases are filled with a bloody serum. The diagnosis of erysipelas is in general easy. For a few hours, perhaps, if a joint be attacked, it may be mistaken for acute rheumatism ; or, if a surface be attacked, it may be confounded for a short time with erythema ; but the intumescence and spread of the disease quickly enable us to decide.

When erysipelatous inflammation affects the face, it may begin either in the skin or in the subjacent areolar tissue. If the areolar tissue be primarily affected, the face at the inflamed part becomes swollen, but the skin suffers no discoloration for some hours. At length, however, the skin inflames, and the part is now red, hot, and painful, as well as swollen, and the disease is fully formed.

A patient having passed through an attack of erysipelas has no security against future attacks, and many persons suffer repeatedy. Malignant forms of pneumonia will result from communication with erysipelatous cases; and such forms of pneumonia may convey erysipelas to others having open sores or wounds. Erysipelas is at all periods of life “a dangerous and deceitful disease,” and, when it fixes on the face or scalp, it is one of the most serious diseases to which an aged person especially is liable.—Aitken.

PYAEMIA.

Definition, &c.—A febrile affection generally sequent on wounds, suppurative inflammation of bone, the puerperal state, or surgical operations, resulting in the formation of secondary abscesses in the internal visceral organs (most frequently in the lungs, the liver, kidneys, spleen, and brain), and also in the joints and connective tissue.

When pymmia commences the expression of the countenance is anxious, the face pallid or flushed alternately ; mental depression, with sleeplessness and restlessness, prevails; the eyes lose their lustre, and the features become pinched and careworn. The conjunctiva: and skin assume a “dusky,” “ sallow,” “ leaden,” “icteric,” or “yellowish” tinge, but much less bright than the golden hue of true jaundice.—Aitken.

PUERPERAL FEVER.

Definition, &c. —A continued fever, communicable by contagion, occurring in connection with childbirth, and often associated with extensive local lesions, especially of the uterine system.

True epidemic puerperal fever is characterized by great depression of the powers of life. Increase of body-temperature followed by rigors from the third to the fifth day after delivery are the earliest indications. Consequent upon these phenomena there is generally tenderness over the whole surface of the abdomen, or limited to the lower half. Thirst is distressing; and not unfrequently nausea and vomiting occur. As a rale, the lochial discharge is suppressed or altered as to its character, and sometimes also the flow of milk ceases. Symptoms of great prostration are constant, and the countenance expresses great anguish, with sunken features and circumscribed lividness around the eyes. Diarrhoea is apt to occur, and the abdomen becomes distended. The phenomena of puerperal fever originate in a vitiation of the fluids; and the various forms of puerperal fever depend on this one cause of vitiated blood, and are readily deducible from it. Any fluid matter in a state of putrefaction, communicated by linen, by a catheter, by a sponge, by small particles of placenta, or even by the ambient atmosphere impregnated with foul substances, may produce puerperal fever.—Aitken.

METRITIS.

Definition, &c.—Inflammation of the uterus.

An attack of acute metritis is commonly ushered in by a rigor followed by increased rapidity of the pulse, flushed countenance, and hot skin. The patient complains of acute pain and tenderness in the hypogastrium. The pain extends backwards to the loins, and shoots into each ovarian region and down the thighs. There is an abiding sense of weight and bearing-down, and the desire to pass water is almost constant, while micturition is often extremely painful. The intestinal mucous membrane sympathises also in the disturbance, and often there is violent tenesmus with a catarrhal or dysenteric affection of the rectum. The catamenia, if present at the time, are probably suddenly suppressed, and the vagina is hot and dry. Frequently the sympathetic fever is accompanied by frontal headache, nausea, and vomiting, and in susceptible subjects, by a variety of hysterical symptoms. The hysterical symptoms are sometimes so prominent during an attack of acute metritis, that, unless great care be taken, the local condition may be overlooked.

The most severe and perilous cases occur in connection with the puerperal state.

It is worthy of remark that in some cases very little hypogastric tenderness is complained of throughout the attack. —Priestly.

INFLUENZA.

Definition, &c.—A specific catarrhal inflammation of the mucous membrane of the air passages, with severe constitutional disturbance. Chills occur, and great sensibility to cold exists over the surface of the skin ; the eyes become injected and tend to fill with tears, the nostrils discharging an acrid fluid, attended with fixed and intense pain in the head, mostly frontal over the eyes, sometimes also attended with giddiness. The nights are sleepless, with delirium or lethargy; cough prevails, with yellow expectoration, most troublesome at night.

The symptoms of influenza assume a variety of different forms. Thus, catarrh often exists without the fever, and, in a smaller number of cases, the fever without the catarrh.—Aitken.

DYSENTERY.

Definition, &c.—An infectious febrile disease, accompanied by tormina (griping), followed by straining, and scanty mucous or bloody stools, which contain little or no foecal matter.

Dysentery has at all times proved one of the most severe scourges of our fleets on foreign stations, of our armies in the field, and during campaigns even in temperate regions. It is sometimes so prevalent that it exceeds the number of sick from all other diseases put together. It helped to destroy the British army in Holland in 1748. It decimated the French, Prussian, and Austrian armies in 1792. It was a chief cause of death in the ill-fated Walcheren Expedition in 1809, and it cut down the garrisSn of Mantua in 1811 and 1812.—Aitken.

DIARRHCEA.

Definition, &c.—A frequent discharge of loose or fluid alvine evacuations, without tormina (griping), or tenesmus.—Aitken.

ENGLISH CHOLERA.

Definition, &c.—An acute catarrhal inflammation of the mucous membrane of the stomach which extends into the intestines, attended with nausea, retching, and vomiting, followed by severe watery purging. The vomiting and purging occur in rapid succession, and recur again and again, either simultaneously or in close alternation, constituting the prominent and distinctive features of simple cholera. Intense thirst is excited from the large loss of fluid. Spasm or cramp often attends the act of vomiting, and there are apt to be painful contractions of the muscles, especially of the calf of the leg and feet, and of the abdominal muscles. These irregular muscular movements amount sometimes to general convulsions, and add greatly to the sufferings of the patient, who becomes anxious and restless, with a feeling of depression and exhaustion proportionate to the violence and continuance of the vomiting, the purging, and the cramp; the pulse rapid, small, and feeble.—A it ken.

MALIGNANT CHOLERA.—Syn., ASIATIC CHOLERA.

Definition, &c.—A disease essentially specific, existing at all seasons of the year among human beings inhabiting certain parts of India, and capable of being propagated or disseminated over the surface of the earth. The seizure is characterized in many cases by premonitory diarrhoea, sudden muscular debility, tremors, vertigo, occasional nausea, and spasmodic griping pains in the bowels, depression of the functions of respiration and circulation, and a sense of faintness and oppression in the praecordial region. A copious purging of serous fluid, alkaline when passed, in appearance resembling rice-water, and sometimes containing blood, is succeeded or accompanied by vomiting and burning heat at the stomach, coldness and dampness of the whole surface of the body, coldness and lividness of the lips and tongue, cold breath, a craving thirst, a feeble rapid pulse, difficult and oppressed respiration, with extreme restlessness, suppressed urinary secretion, a sunken and appalling countenance, and a peculiarly suppressed voice. These symptoms are accompanied by spasms which affect the fingers, the toes, the arms, and the legs. Under conditions favorable to its development, malignant cholera often becomes epidemic.— A it ken.

AGUE—Syn., INTERMITTENT FEVER.

Symptoms.—The disease may be sudden in its attack, and without previous illness ; but, more commonly, it is preceded by general indisposition, headache, weariness, pain in the limbs, thirst, loss of appetite, white tongue and frequent pulse. These prodromes are accompanied with well-marked exacerbations and remissions of fever, displaying a periodic tendency. After this feverish stale has lasted from four days to a fortnight, the patient is seized with severe rigor, and the ague is manifested.

The febrile paroxysm, or fit of intermittent fever, has three stages—a cold stage, a hot stage, and a sweating stage ; but sometimes only the two former. The duration of the cold stage is from a few minutes to five or six hours. The patient experiences a sensation of coldness of the extremities, then of the back, and, lastly, of the whole body. The coldness increasing, the teeth begin to chatter, and this tremor extends to every muscle, till the whole body shakes with rigor. The patient often suffers from nausea and vomiting, and the latter symptom is speedily followed by the hot stage. As the heat returns, so also does the color ; and the body, especially the face, becomes pretematurally swollen and red. The heart and arteries beat with unusual violence, and headache, with a frequent full pulse, is present. The mean duration of this stage is from 3 to 8 hours. At its close a gentle moisture breaks out, first on the forehead, and thence extends till the patient lies in a general sweat, sometimes so profuse as to soak the bed and linen as completely as if they had been dipped m water. After the sweat has continued to flow for some time, the fever gradually abates, and (a sense of exhaustion excepted) the patient feels restored

to health. Sometimes he continues pale, debilitated, and incapable of all exertion, till, on the recurrence of the paroxysm, the symptoms just described are repeated.    _

The varieties of intermittent fever are distinguished from each other by the interval of time which elapses between each paroxysm. For instance, when the paroxysm returns every 24 hours it is termed a quotidian, when every 48 hours, a tertian, and when every 72 hours, a quartan.Aitken.

REMITTENT FEVER.

Definition.—The fever is malarious, characterized by irregular repeated exacerbations and remissions. There is great intensity of headache, the pain darting with a sense of tension across the forehead. It is accompanied by functional disturbance of the liver.—Aitken.

ACUTE RHEUMATISM—Syn., RHEUMATIC FEVER.

Definition, &c.—A specific febrile disorder expressed by inflammation ot a peculiar and non-suppurative kind in the fibrous tissues. Many joints may be affected at the same time or in succession. The various local phenomena of the disease have a tendency to shift from part to' part, most remote from each other. The febrile state is accompanied by profuse acid excretions from the skin, and by a highly-fibrinous condition of the blood.

Acute rheumatism expresses itself by a severe inflammation of the feet, of the hands, or of the larger joints, as the wrist, ankle, knee, hip, elbow, and shoulder-joint, and this is usually accompanied by severe inflammatory fever. In some cases the heart or pericardium, or the membranes of the brain, may become the seat of rheumatic inflammation.

The local symptoms which accompany the inflammation of the articulations are pain, heat, redness, and tumefaction. The pain is generally active and severe, although in a few cases it is latent—that is, the patient is at ease, unless the joint or limb be moved. At first the pains may wander capriciously from limb to limb, and produce more or less temporary stiffness. It has many degrees of intensity, being in a few instances trifling, but more commonly atrocious and agonizing. RedSess, though not universally present, is nevertheless the rule, and the affected joint is surrounded by a rose-colored blush, evanescent on the slightest pressure, yet returning on its removal. The symptoms which indicate cardiac mischief are pains or soreness all over the chest, increased on pressing between the intercostal spaces, and also on taking a deep breath. The patient is restless, his countenance anxious, and occasionally he coughs. If acute rheumatism be severe and neglected, the patient may die in 3 or 4 days of this secondary cardiac affection ; or, if the patient survive, the pericardial surfaces either become adherent, or the valves of the heart permanently diseased.—Aitken.

CHRONIC RHEUMATISM.

Definition, &c.—Chronic pain, stiffness and swelling of various joints.

This is one of the most common forms of rheumatic disease. The knee, ankle, hip, elbow, or shoulder-joint are those which usually suffer. The soreness, stiffness, and pain generally extends from the joint along the fibrous structures to a greater or less extent, the limb thus becoming the seat of severe pain. The joints of the hands are often also liable to be affected, and those of

the fingers are generally most deformed, the joints being liable in extreme cases to dislocation, when the fingers are drawn more or less out of their normal position. The pain in chronic rheumatism is often latent, unless the part be moved, and then the agony is severe. In many cases it is quiescent during the day, but extremely acute during the night, and has a great tendency to shift from joint to joint.—Aitken.

PURPURA.

Definition, &c.—A disease not unusually attended by fever, characterized by purple spots of effused blood, which are not effaced by pressure, and are of small size, except where they run together in patches.

Various symptoms denoting general disorder of the constitution may precede the appearance of the petechia;. The purple spots appear first on the legs, and afterwards, without any certain order, on the thighs, arms, and trunk of the body, and their presence is attended with much weakness and great depression of spirits.—Aitkai.

SCURVY.

Definition.—A chronic morbid state, characterized by sponginess of the gums and the occurrence of livid patches under the skin of considerable extent, which are usually harder to the touch than the surrounding tissue. It is ushered in by debility, lassitude, lowness of spirits, attended by fetor of the breath, and the gums swell by irritation till they overhang the teeth in palmated excrescences. The phenomena are brought about by a deficient supply of the organic vegetable acids, or of the salts of fresh vegetables.— Aitken.

THRUSH.—Syn., APHTHA, VESICULAR STOMATITIS.

Definition, &c.—Vesicular or follicular inflammation or aphtha of the mouth.

This disease usually commences as a simple stomatitis ; but very soon small round transparent greyish or white vesicles appear, and at the base of each is an elevated marginal ring, which is pale and firm. Fluid soon escapes from the ruptured vesicle, and an ulcer forms, which spreads, bounded by a red circle and an elevated border. The whole surface of the mouth exhibits unusual redness, with here and there cord-like exudation in irregular patches. The skin is commonly hot and dry; thirst is considerable; swallowing seems to give pain, and diarrhoea may ensue. In some forms of the affection, microscopical parasitic plants occur. The parasite usually found in the mouth is the oidium albicans, or so-called thrush fungus.Aitken.

ACUTE GOUT.

Definition, &c.—A specific febrile disorder, characterized by non-suppurative inflammation, with considerable redness of certain joints, chiefly of the hands and feet, and, especially in the first attack, of the great toe, and attended by excess of uric acid in the blood. The constitutional affection tends to culminate in a paroxysm, or “ fit of the gout, ” at longer or shorter intervals, when various joints, textures, or parts of the body are apt to become affected.

When gout has become fully developed, and has assumed its specific inflammatory character, it produces all the fonns of articular inflammation which have been described in rheumatism, and these inflammations attack nearly the same parts, as the bones, cartilages, synovial membranes, bursae, ligaments, muscles, tendons, and aponeuroses. These inflammations have little to distinguish them from rheumatism, except the singular pathological phenomenon of a tendency to the deposition of the urate of soda. The urate of soda is deposited first in a white fluid state, like a mixture of chalk and water; after a time this fluid portion becomes absorbed, leaving concretions consisting of little more than bundles of crystals of urate of soda. The concretions afterwards harden, and form what, from their color and appearance, have been termed chalk-stones.

It is now generally believed that gout is hereditary ; and in many instances it is so, whether the intemperate habits of ancestors arc followed out, or whether the mode of living be abstemious. The power of hereditary transmission to induce gout has been illustrated in a most interesting way by Spencer Wells in his treatise on this disease. He shows that the children born prior to the development of gout in their parents were free from the affection in after-life, but that those children born subsequently to the development of gout in the same parents became afterwards gouty. The potent influence of hereditary predisposition in regard to gout is now known to betray itself even amongst some of the laboring classes, and in the upper classes in a still greater proportion. On the other hand again, it is certain that an unusually large proportion of non-hereditary cases are met with among the indolent and luxurious inhabitants of large metropolitan towns. A belief in the prophylactic virtue of labor and moderate living probably instigated the abrupt reply of Abernethy to the question, “What is the cure for gout?” when he said, “Live on sixpence a day, and earn it.” Sydenham, himself a great sufferer, thus describes an acute attack or fit :—“ It comes on suddenly, giving scarce any sign of its approach, except that the patient has been afflicted for some weeks before with a bad digestion, crudities of the stomach, and much flatulence and heaviness, which gradually increase till at length the fit begins. The patient goes to bed, and sleeps quietly till about two in the morning, when he is awakened by a pain, which usually seizes the great toe, but sometimes the heel, the calf of the leg, or the ankle. The pain resembles that of a dislocated bone, and is attended with a sensation as if water just warm were poured upon the member; and these symptoms are immediately succeeded by a chilliness, shivering, and slight fever. The chilliness and shivering abate in proportion as the pain increases, which is mild in the beginning, but gradually becomes more violent every hour, and comes to its height towards evening, adapting itself to the numerous bones of the tarsus and metatarsus, the ligaments whereof it affects so as sometimes to resemble a tension or laceration, sometimes the gnawing of a dog, and sometimes a weight and coarctation or contraction of the membranes of the parts affected, which become so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking quickly therein ; and hence the night is not only passed in pain, but likewise with a restless removal of the part affected from one place to another, and a continual change of its posture.”

In some cases the attacks are so frequent that the patient can scarcely be said to be free from gout the whole year round ; but much in all this depends on the habits and constitution of the individual. The disease tends to acquire a chronic character, and in aggravated cases it attacks both feet, the hands, wrists, elbows, knees, and other parts.—A ¡then.

CHRONIC GOUT.

Definition, &c.—A persistent constitutional affection, characterized by stiffness and swelling of various joints, with deposit of urate of soda.

The nature of chronic gout does not differ from acute gout, except as regards its chronicity, which is shown by the frequency of the attacks, and by other persistent and permanent signs of a gouty constitution. The dyspepsia is especially persistent; and although distinct paroxysms are accompanied by less pain and fever than in acute gout, they last for weeks or months, and several joints are affected at once or in succession. The chalky deposit described as a characteristic lesion, in and about the joints, are most common in cases of chronic gout. The swelling and redness of part develop very slowly. The redness is generally less intense, and the swelling more diffuse and cedamatous than in acute gout.

The term “retrocedent gout” is “ applied to cases ofgout in which some internal organ becomes affected on the disappearance of the disease from the joints, and is referable either to acute or chronic gout." The organs most frequently affected are the stomach, brain, and heart. Gout in the stomach may be either of a spasmodic or inflammatory character. The spasmodic is the most frequent. The patient is seized with violent pains in the stomach, with faintness, coldness of the extremities, and a quick, small, and scarcely perceptible pulse, accompanied with much flatulence, acidity, or vomiting. If, on the contrary, the attack be of an inflammatory character, the pain is perhaps equally great, but is increased on pressure, and there is more reaction, some fever, a fuller pulse, with vomiting, and sometimes with hcematemesis, and perhaps obstinate constipation.

Gout affecting the encephalon may sometimes present the phenomena of an apoplectic seizure, or be indicated by severe circumscribed headache, giddiness, and vomiting.

Gout affecting the heart may induce irregular and feeble action of that organ, associated with disturbed circulation, dyspnoea, and fainting.

Gout affeclitig the spinal canal may induce sudden paraplegia.—Aitken.

DROPSY.

Definition, &c.—Dropsy is a contraction for Hydropsy, and signifies the accumulation of a watery fluid in one or more of the serous cavities; or a diffusion of watery fluid through the areolar tissue of the body, or its organs ; or a combination of all these conditions.

Dropsy is never a primary affection, or substantive disease, but only a symptom of disease, and always dependent on some antecedent morbid condition. Dropsies receive different names according to their situation. Thus, “a collection of serum effused into the cavity of the peritoneum” is-usually called Ascites ; dropsy of the brain or head, where the ventricles are distended with watery fluid, is called Hydrocephcilus; dropsy of the chest, Hydrothorax ; dropsy of the pericardium, Hydropericardium ; dropsy of the eye, Hydrophthalmia; dropsy of the tunica vaginalis testis is termed Hydrocele; dropsy of the areolar tissue of a part is termed CEdema, and is a lesion common to the areolar tissue of internal organs, as well as to the subcutaneous areolar tissue of the body generally. Hence there is atdetna of the lungs and of the liver, and when fluid effusion exists in the tissue of these organs, they are said to be (Edematous. When (Edema of the subcutaneons areolar tissue is general over the body, this dropsy receives the name of Anasarca ; and the combination of Anasarca with dropsy of one or more of the large serous sacs is usually named general dropsy.Aitken.

NOMA.

Definition, &c.— Ulcerative inflammation of the mouth. Noma generally commences at the edges of the gums, opposite the incisors of the lower jaw. At these points the gums appear white, become spongy, and separate from the teeth. Ulceration begins and extends along the gums until the jaws are implicated; and as the disease advances the cheeks and lips begin to swell, so as to form a tense indurated tumefaction. The breath becomes intolerably fetid, and there is generally enlargement, with tenderness of the sub-maxillary glands.—Aitken.

SCROFULA.

Definition, &C.—A constitutional disease, resulting either in the deposit of tubercle or in specific forms of inflammation or ulceration.

The diseases with which the name of scrofula is associated are manifested by certain forms of nutritive disorder. Many of these are characterized by the growth of a peculiar substance in the tissue of some organs to which the name of tubercle has been given. These growths occur in the tissue of the alimentary canal; in the peritoneum, arachnoid, or pleura; in the lungs, liver, spleen, or kidney ; in the tissue of the lymphatic glands, especially the cervical, inguinal, and mesenteric glands ; and sometimes in the pancreas and the tonsils. In cases where the tendency to the growth of tubercles is hereditary, the operation of agents from without act as stimuli or excitants to the growth of them.

The development of tubercles, wherever found, is undoubtedly a local lesion which indicates a constitutional disease. It has been hitherto the custom to name the local lesions as the disease, rather than to describe the constitutional state. Thus, when the Lesions have been most marked in the bones and glands, the name of scrofula has been given to the condition; when the lungs are the site of the deposits, phthisis or consumption is the name by which the condition is familiar; and when in the glands of the mesentery, it has been called tabes mesenterica. Scrofula is the name of the constitutional disease under which all these affections are now comprehended.

The changes in the general system by which the scrofulous cachexia is brought about are apparent in the physical condition of the patient, and in the exercise of some of the vital functions especially connected with nutrition.

The prominent symptoms of the form of dyspepsia most common in established phthisis relate to difficulty in the assimilation of fatty matters. The patient acquires a remarkable distaste for all fats ; and he suffers much from acid eructations after taking food. The dislike for fat was present in 71 per cent, of cases of confirmed phthisis, and had existed through life in 48 per cent. Such an intense dislike to an important element of a mixed diet indicates a deficiency on the part of a patient to digest it. Coincident with the development of such symptoms emaciation usually becomes apparent.

The mucous membranes generally are very susceptible to disordered action. Discharges from the nose, ears, or eyes are not uncommon; the tonsils enlarge, and the air-passages inflame from the slightest causes. The physical powers are generally feebly developed, and incapable of sustained exercise. The muscles of the limbs, though full, are soft, flabby, and weak, and have neither the form nor the firmness of health. The general circulation is feeble, the weak pulse and cold extremities indicating the debility. Inflammation in any tissue in a scrofulous subject generally assumes a slow chronic type, accompanied with little pain or heat, and suppurating parts heal very slowly.— Aitken.

TABES MESENTERICA.

Tabes mesenterica is known by a hard and swelled abdomen, contrasting forcibly with wasted limbs, and a pallid, drawn countenance, which is so marked in its expression as to be easily recognized. It is generally confined to children under io years of age. As in tubercles of the lungs, so here, the deposits may exist in the glands for a long time without exciting inflammation j but as they are situated in the course of the lacteal vessels which absorb food, they interfere with that process from the first, and produce emaciation.

PULMONARY PHTHISIS.

Definition, &c.—Lesions commencing with lobular indurations of the lungs, which end in disintegration of the new material and of the textures involved in the induration with the formation of caverns, and with or without the deposit or growth of miliary tubercles.—Aitken.

By the term Phthisis or consumption has been understood from the earliest times a disease characterized by wasting or emaciation of the body. Premonitory symptoms generally occur indicative of diminished general health, and of deteriorated constitutional vigor. In many cases it is observable in young persons that they dislike fatty substances, are capricious with regard to food, become thin, pale, weak, and liable to dyspepsia. In adult persons the premonitory symptoms are most commonly lassitude, diminution of appetite, with or without indigestion, and a sensible falling-off in flesh. The first symptom of gradually-developed phthisis is cough, at first so slight as scarcely to attract attention, and attributed to transient exposure to cold, or tickling in the throat. It may be observed, however, to be persistent, and of a dry, hacking character. Sometimes the cough is accompanied with pains in the shoulders, tightness in the chest, slight dyspnoea on exertion, together with all the other symptoms described as premonitory. After a variable time expectoration follows the cough; at first consisting of transparent, frothy mucus in small quantity, but soon becoming opaque and purulent, and often streaked with a little blood. The cough and expectoration now become gradually increased, and all the other symptoms Which have preceded or accompanied them are intensified ; the failing appetite is more marked, the quickened pulse and feverish excitement more evident, and the general weakness, falling-off in flesh, pallor, and languor make progress. A period sooner or later arrives when on careful percussion a sensible dullness may be detected under one clavicle. On auscultation over this dullness, either there is increased harshness of the breath-sound on taking a deep inspiration with prolonged expiration, or a slight crepitation may be discovered during some parts of the inspiratory act. Increased vocal resonance also is present over the dull portion of lung. The area over which dullness can be detected by percussion gradually extends from • the apex downwards, until it occupies one-third, one-half, or even a greater portion of the lung. Dullness may appear at the summit of the other lung, and all the signs observed on the one side may follow on the opposite one. The crepitation on inspiration also extends, and, at first very fine, gradually becomes larger and coarser, until a loud mucous rattle is established. The vocal resonance, which at first is only slightly increased, becomes louder and louder, until at length decided broncophony is produced. During the occurrence of these changes in the physical signs, the cough becomes more frequent and prolonged, especially early in the morning, the expectoration is more abundant, and at length consists of dense, purulent masses, some of which sink in water. These also may from time to time be streaked with blood, or even slight hremorrhage from the lungs may occur. There is now generally visible emaciation of the body, considerable debility, indisposition to take exercise, dyspncea on exertion, and especially on going up an ascent. The tongue is red, often glazed, and occasionally anaemic. There is anorexia and nausea, or the appetite is much diminished and very capricious. The night sweats are often distressing; there is thirst, quick pulse, and, not unfrequently, marked fever at night; sometimes diarrhoea may supervene.

The further progress of phthisis is now characterized by the formation of excavations in the lungs, which are distinguished by loud, moist rattles, passing into gurgling or splashing sounds, if the cavities be large and contain fluid, or by loud bronchial blowing, and rarely amphoric breathing if they be dry. Percussion, with the mouth open, sometimes elicits a clear tone over such cavities; at others a peculiar chinking or cracked-pot sound. Together with the signs of a dried cavity are frequently coarse creaking sounds, indicating the existence of chronic adhesions. At the same time dullness, and the other signs audible in the second stage of the disease, are more or less extended over one or both lungs. The cough is now very harassing and prolonged, and often so violent as to occasion vomiting, and it disturbs sleep at night. There is more or less dyspnoea, and occasionally, if the lung be extensively diseased, orthopnoea. The expectoration is greatly increased, consisting of nummular masses of dense, purulent matter, often containing portions of infiltrated lung, which rapidly sink in water. Sometimes it is greenish, ichorous, and of offensive odor. In very chronic cases, on the other hand, with dry cavities, the expectoration is trifling, and brought up with considerable difficulty. Htemoptysis is now a more common symptom, and may vary in amount from a few teaspoonsful to 20 ozs., or even more. Such attacks invariably cause great alarm, and produce exhaustion in proportion to the amount of blood lost. As the disease extends and the cavities enlarge, the strength of the patient declines, the appetite is lost, and it becomes difficult to eat anything. Hectic fever appears, there is a pink blush on the cheeks, rapid pulse, occasional rigors, profuse sweating at night, and extreme emaciation.

Acute Phthisis.—The diagnosis of this form of the disease is exceedingly difficult, as all the symptoms and signs are identical with those of an acute inflammation of the lungs. It is only by careful observation of the premonitory symptoms, the existence of a marked hereditary taint, or the amount of emaciation as compared with the extent of local disease, the continuity of the fever, and the rapid formation of cavities, that we are at length able to pronounce with confidence as to the presence of acute phthisis. As the disease progresses the excessive exhaustion and breaking down of the lungs establish the nature of the affection, while its rapid progress and the continued fever too certainly indicate its acute nature.—Bennett.

CHRONIC HYDROCEPHALUS.

This disease is a dropsy occurring within the cranial cavity. The fluid may be collected in the sac of the arachnoid or in the ventricles of the brain, beneath the arachnoid membrane. The affection may be congenital or acquired. The quantity of fluid varies from a few ounces to a few pounds. As a necessary consequence of the accumulation of fluid, the ventricular cavities are considerably enlarged, the openings through which they communicate are considerably dilated, although in some instances, from the pouring out of lymph, these apertures sometimes get closed, and the fluid may therefore accumulate in one part more than another, producing an unsymmetrical enlargement of the head.

Symptoms.—When the disease is congenital, signs of cerebral disturbance manifest themselves very soon after birth. There may be either strabismus and rolling of the eyes alone, soon followed by gradual enlargement of the head, or convulsions, recurring pretty frequently, may set in. “ In twelve out of forty-five cases, fits, returning frequently, had existed for some weeks before the head was observed to increase in size; in six, the enlargement of the head succeeded to an attack resembling acute hydrocephalus; and in four other instances it had been preceded by some well-marked indication of cerebral disturbance. In the remaining twenty-three cases no distinct cerebral symptoms preceded the enlargement of the head.”—West.

The gradually increasing head soon attracts notice. The fontanelles enlarge, and the anterior one is seen often to pulsate, and grow tense and prominent; and at such times there is heat of the head, and the child is more restless than usual. The sutures of the head widen, and the head by degrees assumes a globular shape. The forehead is round and prominent. On applying the hand over the opened sutures and fontanelles, a distinct sensation of fluctuation is perceptible. The hair grows very scantily on the head, on which very large distended veins are seen to ramify. The face is small, and contrasts remarkably with the large size of the head, and looks triangular, with the apex of the triangle at the chin.—Ramskill.

INFLAMMATION OF THE BRAIN.

Encephalitis.—Definition.—Inflammation of the brain, or of its membranes.

Meningitis.—Definition.—Inflammation of the immediate coverings of the brain, the dura mater, pia mater, and arachnoid.

The general symptoms of the first stage of encephalitis may be but feebly marked, unless meningitis predominates.

There is usually, in the first instance, some heat of head and of surface generally, face pale, pulse low and irregular, some loss of intellectual vigor, failure of memory, confusion of ideas, irritability of temper, and a consciousness of weakness—these symptoms becoming gradually persistent, accompanied with headache and vomiting. The patient is sullen, and his faculties become obscured. There may be convulsions, followed by coma, and partial paralysis, with rigidity, ending fatally (if the disease be not arrested) in from a few days to 2 or 3 weeks. Intemperance in alcoholic fluids is a frequent cause of this, as well as of every other disease of the brain. The disease is sometimes brought about idiopathically, by exposure to the sun’s rays in very hot summer weather, especially in tropical climates.

The premonitory symptoms of meningitis are closely allied to those of encephalitis. “ The most common are slight but increasing pains of the head, sensorial disturbance, irritability of temper, or restlessness, with some general malaise.

Rigors quickly supervene, or simple chilliness; convulsions may supplant the rigors, especially in children ; such, however, are by no means common in the adult. The fever is commonly high, pulse hard, sharp, and frequent; respirations irregular, performed with a sigh, and often with a moan.

Niemeyer observes that in scarcely any other disease of the brain is the fever of a similar character and equal in severity to that of meningitis, and consequently it is of great importance in diagnosis.

If the frequency of the pulse subside after the disease has lasted for some time—if it fall from 120 or 140 beats to 60 or 80, while the symptoms of fever and the functional disturbance of the brain increase—the evidence is almost pathognomonic of meningitis. The headache of fever is supplanted by acuteand intense pain ; the face flushes and turns pale alternately; the eyeballs; stare, and the conjunctiva; become injected. Vomiting is frequent, without epigastric pain or tenderness, and often without nausea. The functional disturbance of the brain is partly of the character of irritation, and partly of depression, or of complete paralysis. The temper is extremely irritable. There is marked somnolence, or wakefulness, and the two sometimes alternate for several days. The most marked feature is delirium, commencing early, and of a furious character, the patient screaming and gesticulating in the wildest manner; expression of countenance savage, and malignant.—A Men.

APOPLEXY.

Definition, &c.—A disease essentially characterized by the sudden loss, more or less complete, of volition, perception, sensation, and motion, depending on sudden pressure upon the brain, originating within the cranium.

The literal meaning of the term apoplexy conveys the idea of a sudden stroke; and it has been common or usual to apply the term to the phenomena produced by—

“ 1st—Congestion of the brain, or what is commonly called determination of blood to the head—congestive apoplexy.

“2nd—Haemorrhage, or extravasation of blood into the substance of the hemispheres, or cerebellum, into the ventricles, or into the arachnoid cavity—sanguineous apoplexy.

“3rd—Sudden serous effusion, in large quantity, commonly called serous apoplexy.

This disease was well known in the Greek and Roman schools of medicine, and is of too frequent occurrence, and of too striking a character, to have escaped observation, even in the rudest ages of society. Patients have died with undoubted apoplectic symptoms, when nothing has been found but congestion of the vessels of the scalp, of the membranes of the brain, and of the brain itself, but without the extravasation of a particle of blood. Mord generally, however, a greater or less quantity of blood has been effused, either into the cavity of the arachnoid, into the substance of the brain, or into some of the ventricular cavities. Thus it is that the lesions found in cases which die of undoubted apoplectic symptoms vary much.

Cerebral hoemorrhage generally takes place from the smaller arteries or capillaries of the brain, and there is generally structural disease of the arterial walls, as well as a morbid condition of the brain-substance surrounding the diseased vessels, combined with increased pressure of blood from some temporary cause—temporary plethora—such as occurs during prolonged and luxurious meals.    -

The appearance of the blood effused into the membranes of the brain varies according to the time which elapses before the patient dies. If that event takes place in a few hours after the attack, the blood is still fluid, or is found in black clots, while the membranes, except being infiltrated with blood, are as yet healthy. The substance of the brain, likewise, has no other appearance

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of disease than that of being flattened, from the presence of the extravasated blood. Again, if the patient has survived a week, the blood is found coagulated, and the serum set free ; but the presence of the clot has caused inflammation, so that the walls of the cavity are not only discolored, but more decidedly softened, and are softer in proportion as they are nearer the clot. If life be prolonged till the fifteenth day, the serosity is absorbed, but the walls of the cavity are still of a deep red. About the seventeenth day Virchow has discovered blood-crystals, or hoematoid-crystals, in the cavity. It appears that these crystals do not form from clotted blood until the blood-corpuscles have become ruptured by endosmosis. Their contents then escape, and crystallize as the solution gradually becomes concentrated.—Beale.

Symptoms of Apoplexy from Congestion.—The face, scalp, and conjunctiva: are increased in vascularity ; the skin generally is of a dusky venous hue, and the surface is warm. There is fullness of the jugular veins, with increased pulsation in the carotids. The tongue is foul, and nausea prevails, with constipated bowels. Respiration and the pulse are both labored, and the extremities are cold. Such are some of the general symptoms which indicate the approach of an attack of the congestive form of apoplexy. The activity and power of the intellect are diminished. General confusion of thought prevails, with deficient memory. Any attempt at mental exercise increases the expression of these signs; so does the recumbent position and emotional disturbance. There is a general tendency to inaction of body as well as of mind —“ a not-to-be-disturbed ” sort of desire is experienced.

These precursory symptoms having generally been more intense for a few minutes or hours, an attack takes place, distinctly apoplectic. The seizure commonly occurs during some muscular exertion, such as lifting a heavy weight, pulling on a pair of boots, blowing the nose, straining at defcecation, or the like ; or even upon a simple change of posture, such as stooping, or suddenly assuming the erect attitude.

In the congestive form of apoplexy, if active and judicious measures of treatment are employed, the recovery may be rapid and complete ; but if this is not the case, there is a liability to a more aggravated form.

An attack of apoplexy from hoemorrhage is generally sudden, and rapid in its development. The patient, if standing, generally falls instantaneously, often with a cry as if knocked down, and this constitutes the “stroke of apoplexy,” commonly so called.

Among the most frequent causes of apoplexy, especially in some constitutions, is an intemperate use of fermented and spirituous liquors.—A Men.

PARALYSIS.

Definition, &c.—Palsy or paralysis are terms commonly restricted to those affections where voluntary motion is lost, in which the motor fibres are no longer acted upon by volition.

Palsy of a part is a very constant symptom of structural disease of the brain or of the spinal cord, but it occasionally occurs from a diseased state of a nerve-trunk itself. Palsy may affect a whole limb, or merely a part of one, and it is also limited to the muscles of certain regions.

Hemiplegia.—Definition, &c.—A form of paralysis affecting one lateral half of the body. It is one of the commonest forms of paralysis, and one to which the name of ‘'paralytic stroke” is commonly applied.

The paralysis may be either complete or incomplete, as regards motor power. Consciousness may or may not be perfectly retained ; and whether it is so or not, the patient, when seized, falls to the ground, because the power of maintaining his equilibrium is destroyed by the failure of the antagonizing muscles of one-half of the body. The affected arm and leg lie as if lifeless on the side, all power of motion in them being destroyed. Stimulation, however, of the extremities of the sentient nerves, by slight titillation with the fingers, sometimes gives rise to active movements. The combined effect of such stimulation and the resulting movements is to cause considerable pain. These excited motions, to which the name of “ reflex actions ” has been given, •occur, almost exclusively, in the lower extremities. Other involuntary movements of the paralyzed limbs occur simultaneously with the action of yawning, or result from emotions of surprise, joy, pleasure, grief, laughter, crying.

The protrusion of the tongue is characteristic in hemiplegia. It is pushed out towards the side affected, and, on being retracted, it is drawn towards the healthy side. Imperfect articulation exists in hemiplegia, and, where the power of speech is wholly lost, or utterance is limited to monosyllables, the sign denotes, with other symptoms, extensive lesion of the brain, superficial as well as deep.

The slow accession of paralysis, following symptoms of irritation, indicates a gradual morbid change, such as from exudations slowly taking place.

An important feature in paralysis is the condition of the muscles, as to whether they are rigid or relaxed. Rigidity, whether supervening or occurring simultaneously with the paralysis, indicates irritative disease within the cranium. In cases where the rigid condition of the muscles does not come on till after a long period of paralysis, and after the muscles are perhaps wasted from atrophy, such a condition indicates loss of substance in the brain, and that the cicatrix is undergoing contraction.

Paraplegia.—Definition, &c.—A form of paralysis affecting the lower half of the body, in which both legs, and perhaps also some of the muscles of the bladder and rectum, are paralyzed, sometimes caused by inflammation of the substance of the spinal cord. Cases of “reflex paralysis ” are also known to occur in the upper parts of the body—e.g., paralysis of the optic nerve is sometimes due to injury of the frontal nerve ; paralysis of the auditory nerve is sometimes due to neuralgia of the face ; local palsy, as of the eye, the neck, the trunk, the bladder, or rectum, is sometimes due to teething, worms, or other sources of irritation of the sensitive nerves.—Aitken.

CHOREA—Syn., ST. VITUS’S DANCE.

Definition, &c.—An irregular convulsive action of the voluntary muscles, of a clonic kind, especially of the face and extremities. The movements are either entirely withdrawn from the control of volition, or but little under the direction of the will.

The history of this disease is a sad picture of superstition. As late as the close of the fifteenth century it does not appear to have been studied by physicians, but was supposed to depend on supernatural causes, or what was termed “demoniacal possession.”

Chorea principally consists in singular and involuntary movements of one or more limbs, which prevent the patient from being able to lay hold with certainty of any given thing, or to carry that object, be it a spoon or a glass, with any certainty to his mouth, or to any other place. These symptoms are developed so gradually that in most cases the disease .is not recognized till it has made some progress. The symptoms reach a certain point of intensity, and remain at such a point for a variable period. Premonitory symptoms are

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neither frequent nor characteristic ; but a certain susceptibility to nervous disturbance, and irascibility of temper, are not uncommon. General ill-health is not unfrequent. The commencement of the symptpms is often at first insidious, but more commonly gradual, and sometimes sudden. They consist at first simply of restlessness, or of hurried, and somewhat clumsy movements. The left side and the upper limbs are frequently affected first; but subsequently the whole body is involved. The lower limbs are generally as much affected as the upper, and the patient can with difficulty walk in a straight line, or, if he does, it is always by a series of movements which tend towards the object, counteracted by another series which altogether diverge from it—his feet turning in and out, upwards and downwards, in every possible direction. The muscles of the face and neck are sometimes seized with this species of convulsion, when the head is not only tossed about, and the mouth contorted info the most singular grimaces, but it may require two or three persons to feed the patient—one or more to hold, and another to watch the proper moment to pop the food into the mouth.

When the disease is slowly ushered in, it is.more obstinate and enduring than when it is suddenly developed. If of long duration, the accuracy of judgment becomes impaired, and disorders of the intellect are apt to follow.— Aitken.

EPILEPSY.

Definition, &c.—A complex nervous state in which, as a rule, a sudden and complete loss of consciousness prevails, associated with convulsions. The expression of the epileptic state varies from the most severe paroxysm to simple vertigo, a momentary suspension of consciousness, a fixity of gaze, a totter of step, and a confusion which appears and disappears almost instantaneously, and which only the patient can recognize.

The interest and importance which attaches to epilepsy cannot be better expressed than has been done by Sir Thomas Watson. He writes that it “ is scarcely less terrible to witness when it occurs in its severer forms than Manus or hydrophobia ; but it is not attended with the same urgent and immediate peril to life. Yet it is, upon the whole, productive of even more distress and misery, and is liable to terminate in even worse than death ; a disease not painful probably in itself; seldom immediately fatal ; often recovered from altogether; yet apt in many cases to end in fatuity or insanity ; and carrying perpetual anxiety and dismay into those families which it has once visited.”

Epilepsy may be grave or slight. The attack often occurs without any previous warning ; many patients, however, on the approach of the fit, have vertigo or headache ; some swelling of the veins, or throbbing of the arteries of the head ; while others again have ocular spectra, or affections of the other senses. In the adult, whether the warning symptoms be or be not present, the attack usually commences by the patient uttering a cry, losing on the instant all consciousness, and falling down in convulsions, his mouth covered with foam.—Aitken. “The more immediate or directly precursory symptom of this event is a momentary and death-like paleness of the face at the time of the fall, which is immediately followed by the flushed face.”—Trousseau.

The convulsions vary from the most trifling and transitory convulsive movement, to the most frightful, terrific, and long-continued struggles.

In mild cases only one limb is convulsed; or only the face, the lip, or the eye. Esquirol gives the case of a lady whose fits were so slight that, although often seized on horseback, she never fell oft'. In a few seconds she recovered, and resumed the conversation by finishing the sentence she was expressing. In this case, however, the epileptic cry and the convulsed eye denoted the true nature of the attack.

In severe forms of epilepsy the convulsions are more formidable ; the hair stands on end, the forehead is wrinkled, and the brow is knit. If the eyelid be opened, the eye is seen to be injected, sometimes convulsively agitated, at other times in a state of strabismus, and sometimes fixed ; more commonly the eyelid is quivering, and half open, so as to show the white of the lower portion of the conjunctiva;. The face is red, or livid and swollen, the teeth generally clenched, and the lips covered with foam. Sometimes, however, the mouth is open and the tongue thrust forward ; and should the masseter muscles now act spasmodically, it may be bitten through, or otherwise much injured, and the foam consequently mixed with blood. The force with which the jaw closes is so great that teeth have been known to be broken and the jaw luxated. The limbs also are violently convulsed, thrown about in every direction, and with such power that it often requires three or four persons to prevent the patient seriously hurting himself. In these convulsions, also, the hands are strongly clenched, and the body is often arched backwards ; when, on the muscles relaxing, the patient may fall to the ground with great force. While the limbs and trunk are thus powerfully agitated, the muscles of the chest are often spasmodically fixed, so as hardly to permit the acts of respiration. When the paroxysm has reached its crisis, the muscles relax, the convulsions subside, the respiration becomes more free, the pulse more regular, and the countenance more natural; and at length the patient falls into a heavy sleep, from which he awakes sometimes in good health, but more often shaken, exhausted, and suffering from severe headache, which lasts some hours, or even days. In neither case has he the slightest consciousness or remembrance of what has passed. In other instances the termination of one paroxysm is but the beginning of another, and the succession is occasionally so continued, that the attack, with short intermissions, may last 24 or 48 hours, or even longer.

Fright is considered a very common cause, but errors in diet, excess of any kind, blows on the head, structural or functional disease of the brain, are all powerful and remote causes. (“ Aitken.”) “ Hereditary predisposition plays an unmistakable part in the production of epilepsy. Its existence or presence is demonstrable in nearly one-third of all the cases.” (“ Niemeyer.”) The duration of the disease before treatment is commenced has an obvious influence over its curability. “A single paroxysm often leaves the patient in a worse condition than that in which it found him ; but this is not perceptible to an ordinary observer until the alteration has been rendered apparent by repeated fits and repeated small additions to the permanent injury. The friends of the patient remark that his memory is enfeebled in proportion to the number of the attacks; that his mental power and intelligence decline, and too often he sinks into hopeless fatuity, utter imbecility, or confirmed insanity.” (“Watson.”)    ,

“ Every successive attack strengthens the habit, but every arrest or postponement of a seizure is so much gained in favor of the patient, not only by avoiding the pain and the risk of the isolated paroxysm, but still more by diminishing his future liability to the disease.” (“ Sieveking.”)

INFANTILE CONVULSIONS.

Definition, &C.—Convulsive seizures, consisting of contraction of muscles by rapid shortening of the muscular fibres, followed by alternating movements of contraction and relaxation, independent of the will, which is as powerless to suspend or moderate as to excite them.

Convulsions may occur from the time of birth until the end of the seventh or eighth year, and arise—

(i.) During the progress of acute diseases of the brain or spinal marrow.

(2.) As the expression or premonitory beginning of many very different diseases, for example—epilepsy, chorea, tetanus, blood poisoning, scarlet fever, measles, &c., the high fever heat of such diseases as pneumonia, and other inflammatory diseases of childhood, irritation of peripheral nerves from teething, intestinal worms, indigestion, painful injuries of the skin, like burns, or from application of blisters, or sinapisms.

(3.) Convulsions occur as the expression of hereditary predisposition.

(4.) Convulsions also occur as the result of terror, insufficient feeding, or bad food ; or in those who have lost large quantities of blood from hoemorrhage, or who had profuse diarrhoea persisting for a long time.

The symptoms of infantile convulsions are best described by Trousseau, as follows :—“The child may utter a cry, lose consciousness, become rigid as a deal board, and ultimately commence to struggle with a fixed chest and suspended respiration. The face, pale at first, becomes red and livid, and the eyes fill with tears, which run over the cheeks, and the veins of the neck are turgid, and project like knotted cords. The clonic spasrns then set in, characterized by disorderly and involuntary contractions of many muscles, the limbs are alternately flexed and extended ; the fingers and toes successively bent and stretched out, separated from or approximated to one another, but most frequently in a state of forcible flexion ; the thumb is adducted and hidden by the fingers. The head is drawn backwards or is bent forwards; and sometimes it is pulled laterally by irregular and jerking rotatory movements. The muscles of the face share in the general convulsions ; the eyes are the seat of jerking movements, and roll in their sockets ; they are generally drawn up under the upper eyelid ; more rarely they are pulled downwards, and there is strabismus convergens. The labial commissures are dragged upwards and outwards,—hence the distorted face is sometimes frightful to beholders ; and then, on each convulsive shock, the air passes through the kind of funnel formed by the corners of the half-opened buccal orifice, making a suction noise, accompanied by a flow of frothy, and sometimes of bloody saliva. The tongue is apt to be protruded, and may be bitten, and so lacerated by the teeth.” A repetition of fits may be anticipated, when the sleep is not sound, after the first fit has subsided. There are localized convulsions to be recognized, such as partial convulsions of one half of the body, of the muscles of the face, of the muscles of the eye, also partial spasms of the pharynx, larynx, and muscles of respiration.—Aitken.

PERICARDITIS.

Definition, &c.—An inflammation of the fibro-serous membrane containing the heart.

The normal pericardium is a membranous bag containing the heart, fixed at the base to the upper part of the diaphragm.

Symptoms.—Decided evidence of local trouble in the chest, especially pain more or less severe in the region of the heart, acute, sometimes extending to the shoulder and down the left arm, and increased by pressure upwards against the diaphragm, accompanied by disturbance of the heart’s action, a sensation of constriction over the whole chest, by urgent distress, and by an incapacity to take a long breath. From these causes the patient is restless and anxious ; this anxious expression of countenance is often peculiar and striking from the first. Dyspnoea may exist in proportion to the distension of the sac with fluid pressing on the lungs. In some instances these symptoms are most insidious in their approach. When acute pericarditis is not the result of rheumatism, the symptoms are often most obscure.

The most characteristic physical sign of pericarditis is a double frottement or friction-sound. This sound closely resembles a rasping murmur. It has been named a “ to-and-fro ” sound by Sir Thomas Watson, and is usually limited to the region of the heart. In diagnosis, however, it is necessary to bear in mind that, during the progress of a case, friction-sound may be absent. The amount of fluid effusion has much to do with this. A really considerable effusion of fluid generally at first muffles, then renders barely audible, and finally removes the sound. Like the heart’s sounds, the friction-sound continues audible longest, and is recovered soonest towards the base. Again, the presence of friction-sound is not necessarily a proof of the existence of pericarditis. It is only when the murmur accurately coincides with the development of symptoms, or where it corroborates and explains the symptoms and the other physical signs already existing, in such a manner as to leave no doubt of its nature, that we are justified in assuming that a friction murmur over the heart is pathognomonic of acute pericarditis. “Areally refined and intellectual diagnosis,” and not one founded on the mere aural recognition of acoustic characters, is necessary to guard against serious mistakes. Increased extent of dulness in percussion, and marked prominence over the cardiac region, are also two characteristic signs.

A valuable distinctive sign of pericardial effusion, when contrasted with pleuritic effusion, is, that when the left side is dull in front and resonant behind, it is a pericardial, and not a pleuritic effusion. When the fluid increases, the pulse becomes feebler, and more disposed to falter and to flutter ; it becomes irregular and excited, and often the patient is so fixed in one position that he fears to move lest he may aggravate by exertion the dyspnoea and action of the heart from which he suffers so intensely. The jugular veins not unfrequently become distended ; a significant sign is thus furnished of the greatness of the obstruction which exists to the thoracic circulation. CEdema and great coldness of the extremities are also apt to supervene.—Aitken.

ENDOCARDITIS.

Definition, &C.—An inflammation of the lining serous membrane of the heart, covering the valves and lining the chambers of that organ.—Aitken.

There can be no doubt that the great majority of cases of endocarditis arises in the course of acute articular rheumatism, and all the more readily the greater the number of joints attacked—Bamberger.

The parts most often affected in endocarditis are those which are especially prone to strain and frict ion from the constant action of the heart.

Symptoms.—A more extensive, forcible, and abrupt impulse of the heart than natural, combined with endocardial murmurs, of a soft, low pitch tone and blowing sound, in a febrile state of the system, and with cardiac uneasiness, are signs suggestive of the probability of endocarditis ; but a careful study of the development, order of occurrence, and combination of the general symptoms and physical signs, can alone convert that probability into a certainty. The patient is observed to prefer to lie on his back, and he may perhaps incline to toss about with his arms. No special sensation of dyspnoea is complained of so long as the cardiac orifices are not seriously obstructed, and no obstruction exists in the lungs from pneumonia or bronchitis. Discomfort and uneasiness at the heart are most common symptoms, and more or less palpitation may be present. Its impulse is almost always more extended and stronger than natural at the commencement, till infiltration of tissue takes place, when the pulse and force of the heart become small and soft. Iu nearly every case of endocarditis there is considerable general illness, which differs from, and is superadded to, that due to simple rheumatic inflammation of the joints, and is such as to call attention to the state of the heart. The symptoms are often exceedingly insidious in their origin and progress, and the disease is rarely simple, being generally combined with pericarditis.

The heart’s sounds undergo modifications as soon as the tissues of the valves become changed in texture, substance, and shape, by the inflammation.

As in pericarditis, it is important to recognize the friction-sound pathognomonic of its existence, apart from any endocardial murmur with which it might be confounded ; so in endocarditis it is, if possible, still more important to detect endocardial murmurs when masked by pericarditis, for the grazing sounds of the latter disease may altogether mask those of the valve murmurs. The principles on which the diagnosis is to be effected are involved in the facts that friction-sounds of pericaiditis are limited to the heart’s region; while the sounds of the heart, and the murmurs which attend the lesions of its valves, are propagated in certain determinate directions ; and while they are heard in maximum intensity at certain points, more or less defined, they may be detected by following the line of propagation at points beyond the mere limits or region of the heart itself. For this purpose the murmurs of endocarditis must be looked for beyond the region of the heart; and if a systolic mitral murmur is heard extending an inch and a half beyond the nipple, it is most probably due to mitral regurgitation.Sebsou, Aitken.

LARYNGITIS.

Definition, &c.—Inflammation of the lining membrane of the larynx.

The disease may commence as a slight catarrh, and may gradually take the form of acute inflammation, or it may from the first be ushered in by rigors, and rapidly followed by fever and elevation of temperature. Locally, a sense of uneasiness in the throat, generally referred to the pomum Adami, is soon followed by a feeling of constriction and strangulation. Vocalization, cough, and respiration are all more or less modified. The voice is at first hoarse, but as the disease advances it becomes completely aphonic. The cough is at first clear and shrill, then harsh and croupy. In a well-marked case, the brassy tone peculiar to the disease terminates in a hissing noise, and begins similarly by a hissing inspiration in a muffled manner, because the lips of the glottis, being thickened, irregular, and rough, cannot be sufficiently closed to begin a sharp sound. (Hyde Salter.) As to the respiration, there is a peculiar noise, like a loud whisper, which accompanies both inspiration and expiration. Inspiration is from the first laborious and wheezing ; afterwards it is very much lengthened and stridulous, and starts sharp from the conclusion of the previous expiration.—Aitken.

BRONCHITIS.

Definition, &c.—Inflammation of the air-passages leading to the pulmonary vesicles, characterized in the acute form by hoarseness, cough, heat, and soreness of the chest anteriorly. The natural mucous secretion is at first arrested, but subsequently it becomes increased in amount, and altered in quality. If the disease progresses, all the phenomena due to deficient oxygenation of the blood are aggravated, the cyanosis deepens, the facial anxiety is extreme and distressing, the surface is livid and damp, words are spoken with great difficulty, the dyspnoea is intense, and all the respiratory muscles are forcibly working ; the patient is unable to lie down, though completely worn out, a frequent short moist cough, coming on in spells, replaces the ceaseless hack, and expectoration becomes free, the sputa being brought up during or after each fit, frothy and aerated throughout, or spongy at the top, ropy, and adhering together as a single mass when turned out of the vessel. As death approaches the pulse usually becomes more rapid, and is large and compressible, and then small and thready.

Chronic Bronchitis is frequently a remnant from the acute form (when not quickly cured); but sometimes a frequently relapsing and protracted catarrh (commonly called cough), recurring once or twice a year, commences the chronic affection, till at last the symptoms and the catarrh are more or less constant all the year round. With respect to the effects of the cough on the constitution, the patient may suffer little in his general health, and often feels he would be well if he could get rid of “the cough.” In other cases he loses flesh, ejecting every meal from the violence of the cough ; or he sinks into a state of marasmus simulating phthisis. —Aitken.

PLEURISY.

Definition, &c.—Inflammation of the serous membrane that lines the cavity and covers the viscera of the chest. Pleurisy may be acute or chronic. The acute form of the disease may. be preceded by fever, but often no such antecedent is present. Its local symptoms, however, in most cases are strongly marked, the patient suffering with severe continued pain in the affected side of “ a dragging shooting character,” which is greatly exasperated by coughing or forced inspirations, so that the lungs can only be imperfectly filled with air. The seat of the pain, however extensive the inflammation, is generally limited to one point. Coughing and sneezing are especially painful. Pulse hard and quick. Another form develops in a latent and slow way, without inflammatory fever, and without pain, shortness of breath being the only source of distress to the patient, but who ultimately seeks advice on account of failing strength, and having become pale and thin.—Aitkcn.

PNEUMONIA.

Definition, &c.—Inflammation of the lungs, generally preceded by some antecedent fever; by shivering more or less violent, and often by bronchitis. In some cases failure of the appetite, general weakness, and wandering pains in the limbs and chest, precede any definite attack by several days. The disease being set up, the patient is restless and uneasy; respiration difficult and hurried, from 30 to 50 in a minute; cough frequent, and expectoration streaked with blood ; but, notwithstanding this symptom, he seldom, unless the pleura is affected, suffers pain, which consequently increases the danger.

The aged, however, seldom complain of difficulty of breathing during the progress of the disease, whatever may be the frequency of the respiration ; so that it is incumbent to count the movements of the chest in old people to avoid all sources of error. Pulse full and frequent, 100 to 120; countenance livid ; nostrils dilated ; the tongue and lips more or less livid, the former of which is coated with a white or yellow mucus ; the patient inclines to lie on his back, supported by pillows.

There are many instances, however, where the course is widely different, and in which the patient, though evidently distressed by impeded respiration, has yet moments of cheerfulness, gets up, and may even walk about; but (unless the disease be arrested), he may suddenly die, seized with a severe paroxysm of dyspnoea or of coughing. The disease is attended with extreme danger to aged persons and to drunkards.—Aitken.

PULMONARY APOPLEXY.

Definition, &c.—An extravasation of blood by capillary haemorrhage into the air-cells, terminal bronchi, and interstices of elastic tissue, by which the air-cells of the lung are entwined.

The symptoms of pulmonary apoplexy have various degrees. The effusion may be slight, and the patient recover ; or it may be extensive, and the patient survive some days ; or it may be so sudden and considerable as to cause the immediate death of the patient.

The first degree of pulmonary apoplexy may be determined during life. If in a case of chronic heart-disease, and especially of the valves, there occurs a sudden difficulty of breathing which may threaten suffocation, some expectoration of blood, some mucous rhoncus, and cough, and a total inability for a time to lie down, the formation of one or more htemorrhagic infarctions may be inferred.

In pulmonary apoplexy of the second degree, the symptoms which have been described exist, but in greater severity, so that the patient is more oppressed in his breathing; he is obliged to be supported by pillows, and his head often falls forward, while his face is purple, and his pulse small and frequent; yet, however formidable these symptoms are, life is still capable of co-existing with them for some time.—Aitken.

ASTHMA.

Definition, &c.—A disease which culminates in paroxysmal attacks of difficult breathing. The dyspnoea is immediately dependent on more or less extensive contraction of the bronchial tubes, and due to tonic spasm of their circular fibres. The breathing is accompanied by a wheezing sound and a sense of constriction in the thorax ; the lungs undergo dilatation of the air-cells, which dilatation does not much interfere with their normal action when free from attack. It produces emphysema in the same way that bronchitis does, and leads to hypertrophy and dilatation of the right side of the heart. There appears to be no period of life at which asthma may not make its appearance, from the earliest infancy to old age. When it has once expressed itself, it seldom fails of recurring, though the intervals between the paroxysms are of very uncertain duration. In severe cases the fits will return periodically every ten days, or a fortnight, and in still more severe cases they will recur every night or early morning, at exactly the same hour. The stomach and bowels are extremely liable to disorder ; colic-like pains, flatulence, and loss of appetite are not uncommon. On inspecting the chest of a patient labouring under a severe paroxysm of asthma, the upper part seems almost motionless, while the inferior portions are acting within a very confined range. The whole of the lungs, but particularly the posterior portion, are labouring with a loud and deep sibilous, sonorous wheeze, accompanied with a mucous rattle ; percussion shows that the lungs are distended with air, and should an air-cell have burst, a rubbing sound will be heard, denoting the effusion of air into the cellular substance of the lung. In extremely severe cases, when remedial

measures are not taken to subdue the constitutional affection, the nights may be passed by the patient in a state of great distress, sometimes so severe that he almost anticipates death before morning. The characteristic wheezing of a paroxysm generally commences while the patient is yet asleep, and as the difficulty of breathing increases, he gradually or partially awakes, and sits up in bed “in a miserable half-consciousness of his condition.” A temporary abatement occurs, and sleep may again overpower him, to be again awoke, and again to sit up. By-and-by the struggle ceases between sleep and the full expression of the paroxysm, the dyspnoea increases, so that he can lie back no more, he throws himself forward, plants his elbows on his knees, and, with fixed head and elevated shoulders, labours for his breath like a dying man, the expression is anxious and distressing, the eyes wide opened, strained, turgid, and suffused.—Ailken.

GASTRITIS.

Definition', Sec.—Inflammation of the stomach, characterized in the acute form by burning pain in the pit of the stomach, increased on pressure and after swallowing food ; constant vomiting, accompanied by a sensation of sinking and great prostration of strength ; quick, hard, and wiry pulse ; and excessive thirst.

Chronic Gastritis differs only from the above in the symptoms coming on more gradually, and with less severity.

As exciting causes must be mentioned irritants of all kinds, including those whose action is purely mechanical, but especially the mineral and vegetable acrid poisons. The simplest and most frequent form of inflammation of the stomach is that which is brought about by errors or excess in eating or drinking.

ENTERITIS.

Definition, &c.—Inflammation of the small intestines.—Ailken.

The symptoms may creep on insidiously, or show themselves in sudden intensity, and consist mainly, in the earlier stages, in more or less severe abdominal pain (resembling the pain of peritonitis in its being increased by pressure and by movement, but differing from it in being associated with colic), obstinate constipation, nausea and vomiting, and marked febrile disturbance. Tormina are often at the onset very agonising, being then probably due in some measure to the spasmodic movements of the inflamed bowel ; sometimes they are scarcely recognisable, and frequently, like pain, cease comparatively early. The affected part, which is mostly in the small intestine, and which may vary in length from an inch or two to one or two feet or more, is, as a rule, much dilated. The inflamed tract usually presents fairly well-defined limits, terminating abruptly, below—in pale and healthy, but contracted and nearly empty bowel, above—in bowel, which may also be healthy, but is dilated like the diseased portion, and filled like it with foecal contents.

Enteritis is a disease which is almost always complicated with some other grave lesion, on which indeed it depends, as strangulated hernia, or intussusception, or whenever a gall-stone or other foreign body of sufficient size becomes fixed in its passage along the intestine. But even in the uncomplicated form of the disease, the symptoms are liable to considerable variety; the variations depending mainly on the degree of intensity of the inflammation and its extent, and on the situation of the affected portion of bowel. If the lower or larger intestines are attacked by the disease, diarrhoea or dysentery very frequently occurs. The temperature of the skin is usually in the first

instance more or less elevated, and its surface dry; but even then perspirations are apt to break out, especially during the paroxysms of colicky pain : subsequently, however, the temperature falls, the extremities and face become cold and pale, or livid, with sometimes a faint tinge of jaundice, and all parts of the surface bathed in profuse cold perspiration.—Bristowe.

PERITONITIS.

Definition, &c.—An inflammation of the serous membrane lining the cavity of the abdomen, and covering the viscera contained in that cavity.

Peritonitis may be acute or chronic, partial or general. The invasion is often sudden, but the attack may come on slowly and covertly. In the acute sthenic form there are generally rigors, followed by heat and flushings, lassitude, thirst, nausea, and pain in the abdomen aggravated by pressure, coughing, sneezing, or even the erect position ; indeed, whatever produces weight upon or stretches the membrane of necessity aggravates the suffering. The pain is at first localized, but it soon becomes diffused over the entire abdomen, and is a prominent sign. The patient lies on his back with knees drawn up, and cannot turn on either side without increase of pain. He will say that he experiences a feeling of heat, pricking, cutting, or soreness in his inside. In addition to the pain, there is also great tension and tumefaction of the abdomen. Nausea and even vomiting often come on with the other symptoms. One of the most frequent results is effusion; indeed, the affection cannot assume a well-marked and typical character without one or other of the inflammatory products being thrown out.

Causes.—Mechanical violence, as a kick, a blow, or a penetrating wound ; sudden and great changes of temperature, especially in women at the period of menstruation. As a secondary disease, it is frequently produced by the spread of inflammation from adjacent parts ; rupture of the intestine from ulceration, or the bursting of an abscess, or of an aneurismal tumour into the abdominal cavity.—Aitken, Wardcll.

ASCITES.

Definition, &c.—A collection of serum slowly effused by transudation into the cavity of the peritoneum. When (edema of the sub-cutaneous areolar tissue is general over the body, this dropsy receives the name of anasarca ; and the combination of anasarca with dropsy of one or more of the large serous sacs is usually named general dropsy. Sometimes anasarca accompanies ascites. It is an infiltration of serous fluid amongst the elements of the general con necting or areolar tissue of the body. The fluid is generally limpid and watery, composed merely of the serous part of the blood, while in other instances the fluid is viscid, contains lymph, and the organizable elements characteristic of inflammatory origin. The existence of fluid in the areolar tissue of the trunk or extremities constituting anasarca is determined by the finger leaving a mark or “ pit ” ; and the fluid being thus displaced the part does not recover its original form and fulness for some seconds, and is said “ to pit on pressure.” Dropsy is never a primary affection, or substantive disease, but only a symptom of disease, and always dependent on some antecedent morbid condition. The quantity of fluid contained in the abdomen in cases of ascites varies from a few ounces to many gallons.—Aitken. The symptoms due to ascites alone are very simple and very characteristic of the affection. The accumulation of fluid within the adominal cavity causes the abdomen to enlarge and become tense.—Bristmve. From the weight of the abdomen, the gait of the patient is upright.—Aitken.

Shortness of breath is an early symptom, and it increases with the increase of the dropsy. It is not always noticed by the patient himself, while he remains quiet in the sitting or semi-recumbent posture, but it is much aggravated when the patient lies down, on account of the fluid in the abdomen gravitating towards the chest and compressing the lungs.—/iristowc, Aitken.

The abdomen becomes large, uniformly rounded, but with a tendency to spread or bulge in the flanks as the patient lies on his back. (Edema of the lower extremities and intervening parts is a very general and early accompaniment of adominal dropsy. Sometimes it occurs at so early a period as to be the first symptom of disease which the patient himself recognizes, and indeed it is not very uncommon for ascitic patients to assert that their illness began wilh swelling of the legs.—Bristmve.

HEPATITIS.

Definition, &c.—Inflammation of the liver, occurring sometimes in an insidious form.

Symptoms.—A sense of fulness and weight, or pain, in the right side ; with sympathetic pain, or dull aching and uncomfortable feeling about the right shoulder-blade; disturbance of the digestive organs; and more or less prostration.—Aitken, Reynolds.

JAUNDICE.

Definition, &c.—Jaundice, or Icterus, is a condition attending many diseases involving the liver or biliary passages, known by yellowness of the tissues and of many secretions of the body.—Goodeve.

On posthumous examination, besides the yellowness of the cutis, the serum of the blood is generally found loaded with bile, and perfectly yellow.

The first symptom of jaundice is a yellowness of the white of the eyes, then of the roots of the nails. The yellowness next appears over the face and neck, and ultimately over the trunk and upper and lower extremities. As soon as the eyes are affected, the urine becomes of a deep red color, and stains linen yellow. At the same time that the urine is thus discolored, the stools are often copious and white. The pulse is slow, and the patient complains of a bitter taste in the mouth, much thirst, and an absolute inaptitude for all exertion.— Aitken.

GALL-STONES.

Definition, &c.—Concretions of certain biliary constituents, accumulating generally in the gall-bladder as gall-stones, the passage of which through the duct into the duodenum gives rise to symptoms known as “ gall-stone colic.”

The bile is liable to undergo many morbid changes. The most remarkable of the states of diseased bile is that in which it concretes into a gall-stone. Biliary calculi are often found filling the gall-bladder, and although the liver is frequently found healthy when the gall-bladder contains calculi, yet more commonly its structure is more or less diseased.

The remote causes of gall-stones are too full an animal diet, combined with a sedentary life, or the indulgence of anger or of those other passions which suppress the flow of bile, and perhaps alter its qualities; also those states of indigestion which re-act on the liver.

The formation of gall-stones is unattended with pain, and stones once formed often lie latent for a considerable time in the gall-bladder, without causing any trouble to the patient. At length some cause may force a stone into the cystic duct, when a series of very formidable symptoms arise, and continue till

the calculus has passed into the duodenum. But occasionally calculi of small size may pass without exciting pain or any other symptom.

The attack is generally sudden, the patient being seized with shivering, accompanied by violent and acute piercing, griping, insupportable pain at the pit of the stomach, or rather at the point corresponding to the opening of the duct into the duodenum, and from this point it spreads over the whole abdomen to the right side of the thorax and right shoulder, and darts through the back. This pain occurs in paroxysms varying from a few minutes to a few hours, when it intermits, and after a short interval returns, and this continues until the gall-stone has passed into the intestine. The patient during this trying period suffers from nausea or vomiting so severe that everything is rejected, and the matters thrown up often contain bile and small biliary calculi, which may perhaps more properly be called biliary sediment.—Aitken.

SUPPURATIVE NEPHRITIS.

Definition, &c.—Inflammation, with suppuration of the substance of the kidney.

Symptoms.—When the kidneys are inflamed, more or less pain is felt in the region of these glands. The pain commonly shoots along the ureters, and there is a sense of numbness down the thigh. When one kidney is affected, these symptoms are only felt on that side. There is sickness and vomiting, and more or less fever. When pus is formed, the event may be known by the pus being mixed with the urine.—Aitken.

ISCHURIA RENALIS.—Syn., SUPPRESSION OF URINE.

Definition, &c.—A complete or partial suspension of the functions of the kidneys, by which the quantity of urine is greatly in defect, or its secretion entirely suppressed.

Among the symptoms there may be some pain in the back, or some irritability of the bladder, and an urinous odor of the perspiration. The patient becomes anxious and restless, till at last the brain is oppressed and (if not relieved) he dies comatose.—Aitken.

DIABETES—Syn., DIABETES MELLITUS.

Definition, &c.—A constitutional disease obviously produced through errors in the processes of assimilation, and characterized especially by an excessive discharge of urine, more or less constantly saccharine, excessive thirst, and associated with progressive emaciation of the body.

The onset of the disease is generally insidious and unobserved. There may be a sense of general discomfort, and some emaciation may declare itself, while constant thirst and frequent micturition become well-marked symptoms. The appetite is capricious, but generally excessive and voracious. The skin is harsh and dry. The intestinal excretion of water is lessened; hence the bowels are costive, and the faces dry and hard. In advanced cases the patient becomes greatly emaciated. The emaciation of diabetes is progressive, and the muscles, as well as the adipose tissue, become atrophied. The digestive organs become weak and feeble, the inordinate appetite diminishes, and food is loathed. Nausea is frequent, and a sinking at the pit of the stomach is complained of. A short dry cough becomes frequent, the index of commencing disease of the lungs ; and the patient (unless the disease be arrested) generally sinks from exhaustion, or from coma, or convulsions.—Aitken.

CYSTITIS.

Definition, &c.—Inflammation of the urinary bladder. The mucous membrane of the bladder is liable to the diffuse, the serous, the adhesive, the suppurative, and the ulcerative inflammations, and these may be either 'acute ■or chronic.

The inflammation may extend over the whole cavity of the bladder, or be limited to some portion of it, and the part most frequently inflamed is that near and around the neck. The mucus secreted is at first small in quantity and extremely fluid, but is deposited as the urine cools. At a further stage of the disease it becomes abundant and thickens.

Inflammation of the mucous membrane of the bladder often terminates in suppuration, and pus to a considerable amount may then be passed.

Occasionally, instead of suppuration taking place at its free surface, an abscess forms : in either case ulceration may take place, sometimes superficially and sometimes so burrowing as to perforate the bladder.

Symptoms.—Pain in the lowest part of the abdomen, with a constant desire to pass the urine, which is evacuated in small quantities and with great pain; or there is a total retention of urine, with a strong desire to void it. The rectum is affected, from its connection with the bladder, with tenesmus and the stomach likewise takes part in this disease, being affected with nausea or vomiting.—A ¡then.

ARTHRITIS.

By arthritis, in its simple form, is meant inflammatory disease of an acute or chronic kind of the whole or greater part of the structures that enter into the formation of a joint.

The symptoms of arthritis that are most marked are the pain, heat, swelling and peculiar position of the joint. The pain is often severe, tensive, and throbbing: so acute is it sometimes that the patient screams with a<mny • he cannot bear the bed to be touched, the room to be shaken, or the slightest movement communicated to the limb, any attempt at examination of the joint in such cases being attended with insupportable agony. There are usually nocturnal exacerbations, and the pain is commonly referred with especial severity to one particular spot in the joint; thus it is generally felt at the inner or under side of the knee-joint, and at the outer aspect of the hip. The heat of the diseased joint is considerable, and is often accompanied with more or less superficial redness.—Erichsen.

OSTEITIS.

Osteitis varies in its character, causes, and results, according as it affects the long or the short bones. When affecting the shaft of a long bone it usually occurs as the result of blows or of exposure to cold and wet. When it occurs in the articular ends, or in the short cancellous bones, although often immediately excited by these causes, it is more commonly associated with a strumous habit of body.

Acute osteitis commonly leads to necrosis of the affected bones, and is more frequent in the shafts than in the articular ends of long bones.

Chronic osteitis is that which occurs most commonly from slight traumatic or climatic causes in delicate or strumous children.

The symptoms of chronic osteitis consist of enlargement of the affected bone, with deeply-seated pain and great tenderness in the limb.— Erichsen.

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INDEX.

PAGE

24

33

47

44

42


PACK.

Inflammation of the Peritoneum ..    44

»» >y

Pleura ..

41

yy yy

Stomach ..

43

yy yy

Tonsils ..

17

yy yt

Uterus ..

22

Influenza ..

23

Ischuria.. ..

46

Jaundice ..

45

Laryngitis ..

40

Measles ..

14

Metritis.. ..

22

Nephritis ..

46

Noma .. ..

29

Osteitis ..

47

(Edema (see Dropsy) .. ..

Paralysis ..

34

Pericarditis ..

38

Peritonitis ..

44

Phthisis .. ..

30

Pleurisy ..

41

Pneumonia ..

4L

Puerperal Fever

22

Pulmonary Apoplexy .. ..

42

Purpura ..

26

Pyæmia.. ..

22

Quinsy ..

17


25

15

2d

26 11

7

SO

26

20

l8


18


Ague ..    ..

Apoplexy    ..    .

Arthritis..    ..

Ascites    ..    .

Asthma ..    ..

Anasarca (see Dropsy)

Bronchitis ..

40

Cephalitis ..

32

Chicken-Pox ..

13

Cholera, Asiatic

24

„ English

23

Chorea ^ ..

35

Convulsions ..

37

Croup ..

17

Cystitis .. ..

47

Diabetes ..

46

Diarrhoea ..

23

Diphtheria ..

16

Dropsy .. ..

28

Dysentery ..

23

Endocarditis ..

39

Enteric Fever (Typhoid)

20

Enteritis ..

43

Epilepsy ..

36

Erysipelas ..

21

Gall-stones ..

45

Gastritis.. ..

43

Gout, Acute ..

26

„ Chronic ..

28

Hepatitis ..

45

Hooping Cough ..

18

Hydrocephalus

31

Hydrocele (see Dropsy) ..

Inflammation of the Bladder

47

Bone

47

1 ,,

Brain

32

Bronchial Tubes

40

»j

Heart

39

Intestines

43

>1 yy

Joint

47

t> tt

Kidney

46

t* yy

I^arynx

40

yy yy

Liver

45

yy yy

Lungs

41

yy yy

Pericardium

38

Remittent Fever..    ..    ^    25

Rheumatism, Acute (Rheumatic ^    25

Fever)    ..    ..

Rheumatism, Chronic

Scarlatina    ..    • •

Scrofula ..    ..

■ Scurvy ..    ..    ..

Small-pox ..    ..

Statistics    ..    ..

Tabes Mesenterica ..

Thrush ..    ..    ..

Typhoid Fever (Enteric)

Typhus Fever    ..    ..

Whooping Cough    ..

i oíy ufi

rík)

■ ■ .


*


■ ♦