drowsiness, and redness of the face, it should be considered a premonitory symptom of apoplexy, and the preventive means already recommended for that disease should be immediately resorted to.;

Whatever will produce rigours, or slight shivering of the body, as a cold key to the back, sprinkling the face with cold water, &c., will often speedily check the flow of blood from the nose and other parts of the body.

Such as are subject to this complaint ought to be particular in keeping their feet warm, and in obviating plethora by moderate exercise and spare diet, and the frequent use of the Epsom or Rochelle salt. The application of cold to the forehead by means of a napkin, for ten minutes every morning and evening, is a good preventive.

Practical Remarks. - When a discharge of blood takes place from the nostrils, we should not have recourse to means of stopping it, without duly considering whether it be an operation of nature, or the consequence of diseased vessels. If the system of blood-vessels be evidently in a plethoric state, the object of practice is to take care that the body be not too much reduced by it. When it occurs in young and healthy subjects, and particularly when preceded by head-ache or drowsiness, there can be no doubt of its proving beneficial. In elderly people in a state of health, it is generally salutary. In inflammatory fever it is always bencficial, and even in typhus fever it should not be hastily checked, unless the system be in a state of direct debility, and evidently sinking. When the consequence of suppression of the menstrual evacuation, remedies should be employed to increase the circulation in the lower extremities; and if the person be of a sanguineous habit, abstraction of blood from a vein in the leg or foot often succeeds in bringing on the uterine secretion.

OF BLOOD DISCHARGED FROM THE BLADDER. When blood is discharged with the urine in a plethoric habit, the loss of blood from the arm, and the use of the Purgative Mixture (B), p. 113., are proper. The saline purgatives are in this case inadmissible, on account of their rendering the urine more irritating. The diet should be low, unless the patient be much reduced, or the discharge of blood be the consequence of ulceration of the kidneys or bladder.

When it is occasioned by the mechanical action of a stone in the bladder, or gravel in the kidneys or ureters, it will require the treatment recommended for those complaints. When ulceration is the cause (which is known from its being attended with a discharge of matter), the rectified oil of turpentine, in the dose of twelve drops, in marsh-mallow root tea, has generally a very happy effect. The buchu leaves, and the Canada balsam, with

gum arabic, in these affections, have also proved particularly serviceable, as the following:

Practical Remarks. The treatment of a discharge of blood from the urinary passages must be regulated by the state of the constitution; for, like that from the nose, it may be of an active or a passive kind. In case of debility, which is generally attendant on ulceration of the kidneys and bladder, the buchu leaves are a valuable medicine: but if the system be in a plethoric state, the loss of blood from the arm, the use of castor oil, the Antimonial Febrifuge Powder, p. 86., and the warm vapour bath, are proper. In all cases, a mucilaginous drink, as linseed tea, decoction of the marshmallow root, or of pearl-barley, should be adopted.

OF BOILS. The effects of boils on the constitution being generally beneficial, their suppuration should be promoted (if the situation will admit of it), either by the application of the Gum Plaster, spread on leather, or the Emollient Cataplasm, p. 122, or, if indolent, the Suppurative Poultice, p. 122., and the Stimulating Fomentation, p. 123., occasionally. After they break, they require only to be kept clean, and defended from the external air by a mild poultice, or diachylon plaster, or spermaceti ointment spread on lint. The Aperient Pills, p. 89., should be taken about twice a week, for at least one month: and if, after the operation of the pills, the patient should be much reduced, the Stomachic Mixture (A), p. 114., will have a good effect in strengthening the system, as well as correcting the habit.

When boils occur in a weakly constitution, the treatment recommended for indigestion will succeed better than purgatives and alteratives by improving the general health. The inflammation producing boils commences in the cellular substance beneath the skin. In elderly and irritable subjects this inflammation often terminates in sloughing or mortification; which, in vitiated habits, sometimes spreads through the cellular substance, when it is termed carbuncle. In this case the strength of the patient must be supported by Peruvian bark, wine, and a generous diet. Solution of acetate of morphine, in the quantity of four drops, administered in each dose of the Peruvian bark, by

allaying general irritation, is a valuable medicine.

Besides the application of the emollient poultice, p. 122., the inflamed skin should be washed twice a day with rectified spirit of wine. Practical Remarks. A boil being the consequence of an unhealthy condition of the constitution, the application of a lotion and leeches to disperse it is improper, unless it be situated in a place where suppuration would be attended with an unpleasant consequence, as the eyelids, the ear, &c. It may be considered as indicating the use of an alterative and an aperient medicine. OF BOILS OF THE GUMS. CAUSES. Boils of the gums are the consequences of a fit of the tooth-ache, cold, external violence, and a partial disease of the jaw-bone and decayed teeth.

TREATMENT. When a boil arises from the irritation of a carious tooth, its extraction is necessary; and when from other causes, suppuration may be promoted by the application of a roasted fig; and after the matter is evacuated, the mouth should be frequently rinsed out with the Astringent Gargle, p. 108., or the tincture of the rhatany root, diluted with water, as directed under the head of Prepared Areca Charcoal, p. 155.

Partial inflammation of the gums terminating in suppuration or boils is a very common complaint: and it is worthy of notice, that when they are allowed to suppurate, the interval of recurrence is much longer.

OF BURNS AND SCALDS. Slight burns or scalds may in general be cured by the Anodyne Liniment (A or B), p. 124., or Anodyne Lotion (A), p. 125. If the person be of a plethoric habit of body, or if the system become feverish, however trifling the accident may be, it will be most prudent to empty the bowels, with either the Aperient Mixture (B), p. 112, or the Rochelle or Epsom Salt, and to keep the system quiet by the Saline Mixture (B), p. 114. After the operation of the aperient medicine, five or six drops of the solution of acetate of morphine may be added to each dose of the saline mixture, particularly in case of much pain, or if the mischief be extensive. A low diet is necessary till the inflammatory symptoms have subsided, when the usual mode of living may be gradually resumed.

This treatment should be adopted, although the injury may not be very extensive; for if the constitution should be in an unhealthy state, it may produce considerable mischief. From inattention to this constitutional treatment, the most trifling accidents are often productive of the most serious consequences.

The immersion of the part in cold water, as soon as possible after the accident, affords instantaneous relief, and by keeping it a few hours in that situation, the mischief is certainly much

diminished. The Discutient Liniment (D), p. 124, in many instances, I have known to prove very beneficial.

When the injury is extensive or deep, mortification or sloughing will probably ensue, the result of which will depend on the state of the constitution. The advice, therefore, of a skilful surgeon should be resorted to in the first instance.

In very weakly constitutions, or in leucophlegmatic habits, the Stimulant Liniment, as the Discutient, p. 124, and even a mild tonic medicine, as the following, with a gentle aperient, will be more proper than a cooling application and saline

mixture.

Take of Infusion of Roses,
Tincture of Cascarilla,

Solution of Acetate of Morphine,

6 ounces.
4 drachms.

10 drops.

Mix.-Three table-spoonsful to be taken three times a day.

PRACTICAL REMARKS. -This short account of burns and scalds points out the propriety of attending to the constitution as well as the local injury. Experience has taught me, that the most trifling accident in a bad constitution often produces the most serious mischief.

OF BRUISES AND SPRAINS. In cases of sprains, the prevention of inflammation should be attempted by the application of leeches, and afterwards the Discutient Lotion (B), p. 126; to which may be added, in case of much pain, half an ounce of laudanum. The Aperient Mixture (B), p. 112, should be taken occasionally, and the Saline Mixture (B), p. 114, if fever intervene. If leeches cannot be readily procured, and the inflammation runs high, the loss of eight or ten ounces of blood from the arm will be proper. A low diet should be strictly observed till the first or inflammatory symptoms have subsided.

Superficial bruises may generally be cured by the Soap or Cajeput Liniment, or the Discutient Lotion (A), p. 126, with the use of the Epsom Salt or Aperient Mixture (A), p. 111; but if the part has sustained much injury, mortification may probably ensue, which in an elderly person may terminate unfavourably; such a case should therefore be referred to a surgeon.

The treatment of bruises and sprains, like burns and scalds, must be regulated by the state of the constitution. In an inflammatory habit, the slightest accident is sometimes productive of the most serious consequences; and in elderly people, or leucophlegmatic habits, the inflammation frequently terminates suddenly in gangrene; it is therefore judicious practice always, in the first instance, to guard against mischief. The directions given for the prevention of sympathetic fever in cases of burns and scalds, are applicable to bruises and sprains.

OF CANCER. - This disease is divided into two stages; occult or scirrhous, and open or ulcerative. During the first stage, the object is to allay irritation, and to bring the absorbent vessels of the part into action; and for this purpose abstraction of blood from the part, about twice a month, by leeches, and the application of the Discutient Plaster (C), p. 130, with attention to the bowels and stomach, I have found to succeed in numerous cases. A hare skin applied over the tumour, with the hairy side next the skin, is also useful in protecting the part from the pressure of the stays, &c.

Should there be appearances indicating visceral obstruction, a grain of calomel should also be administered every or every other night (formed into a pill), and continued for ten days or a fortnight. (See INDIGESTION.)

The tincture of iodine, in the dose of twenty or thirty drops twice a day, in a glass of the decoction of marshmallow root, has lately been highly extolled as a remedy for scirrhous tumours; and in the 79th Number of the Monthly Gazette of Health, a remarkable case of this disease appears, in which it was administered with complete success.

In diseases like the present, it is of great consequence to allay the general nervous inquietude of the habit. Hence the mind, as a most powerful agent in disturbing the nervous system, should be kept in a tranquil and steady frame. Anodyne and nervous medicines will accordingly, with such patients, be highly useful.

Equally with the use of medicines, the regulation of diet claims an important consideration, in regard to which we must take into the account the former habits of the patient and the state of constitution. If the constitution be not much reduced, vegetables should form the principal part of the regimen; while the best beverage will be distilled water, being free from any chemical combination that might irritate, or produce disturbance in the system, and the meat (which should be taken only once a day) should be fresh, and as little roasted or boiled as possible. But if the habit be much debilitated, a more generous diet will be necessary; for too low a regimen, by increasing general nervousness, may aggravate the disease.

When ulceration has taken place, attention should be directed to the declining health of the patient, under its ravages. To counteract the decomposing process, and suspend the ulceration by keeping up the vitality of the parts, the surface of the sore should be sprinkled with the phosphate of iron, combined with an anodyne, as the following: