When palsy is produced by the action of a poison, as lead, &c., or by the dry belly-ache, to which painters and labourers in lead mines are very liable, the occasional use of the Purgative Pill (B), p. 117, will be necessary. (See COLIC, p. 303, and STIMULANTS, p. 45.) In this species of palsy, mercurial friction (as the Stimulating Liniment (A), page 124), galvanism, and electricity are important remedies. I must do Mr. Mahomed, of Brighton, the justice to say, that in these cases I have witnessed more extraordinary and speedy cures from his system of shampooing than from any other topical treatment. This gentleman, by a long practice in such cases, is so convinced of the necessity of maintaining a regular state of the bowels, and of emptying them occasionally by a brisk cathartic, that he never fails to give directions for these purposes. In an early number of the Gazette of Health, I have noticed the good effects of the vomic nut in cases of palsy. This article is a powerful poison, and probably has had a beneficial influence in bringing paralysed nerves into action, by exciting a disposition in the muscular system to convulsive motions, or by occasioning slight convulsions which may re-establish the natural connection between the affected nerves, and the muscles through which they ramify; for it has been observed, that when such effects are not produced by it, the paralytic affection is rather increased than otherwise. (See STRYCHNINE, p. 166.) If the digestive organs should require invigorating, two teaspoonsful of the volatile aromatic tincture of bark may be taken two or three times a day in a wine-glass of water. The objects of this tincture are to accelerate the circulation, prevent the production or accumulation of air in the stomach or intestines, and to increase the peristaltic motion; and if it should excite considerable appetite, it should not be gratified by full meals; for in such case, by producing plethora, it would prove very injurious. If the bowels should be very sluggish, the Purgative Clyster, p. 103, may be employed. It is of importance to distinguish palsy of a part of the body, arising from slight effusion of blood in or on some portion of the brain, from the species termed partial palsy, the consequence of compression of the trunk or branch of a nerve, or from morbid structure; as some of the remedies applicable to the latter (as electricity, galvanism, &c.) might prove highly injurious in the former, by occasioning an undue determination of blood to the head. Dissection has satisfactorily proved, that a slight effusion of blood in various parts of the brain has paralysed one leg, or one arm, the nerves of the tongue, or of one half of the face, without affecting any other part of the nervous system. Some practitioners suppose, that when there is considerable and continued palsy, there must necessarily exist some pressure or organic disease of the brain. That the cause frequently exists in the brain, there is no doubt; but "the number of cases," says Mr. Abernethy, "in which the paralytic affection is merely nervous, and independent of visible disease, is, in my opinion, very considerable." The instances which have been related warrant this conclusion, and show such cases to be more frequent than is generally supposed. When there is organic disease of the brain, the case is very hopeless; and probably no considerable alleviation of the symptoms will take place, by attention to the state of the digestive organs. In dubious cases,—and such, on the first examination of them, the majority of these instances will probably be,—it seems right to try the effect of correcting disorder of the digestive organs, with a view to alleviate nervous irritation, before we proceed to those severer methods, which the belief of the existence of organic or vascular disease in the brain would induce us to institute. For if blood-letting and counterirritation be employed, in order to diminish vascular action; or if mercury be used to some extent, in order to induce the absorption of deposited substance; these measures must aggravate that disorder of the general health, upon which, in many instances, the nervous affection depends. After noticing the great advantage paralytic patients have derived from a chylopoietic treatment, Mr. Abernethy observes, "It is right, however, to mention, that in some cases to which I have attended, I have been foiled in my endeavours to correct, by the simple measures which I have related in the introductory remarks, the disorders of the digestive organs; probably because their derangement depended on some established disease of the brain. "In other cases, when the functions of the digestive organs had been partially restored, the nervous and muscular affections were mitigated, but not cured. I have also met with one instance, in which the bowels became moderately correct in their functions, without any evident amendment in the state of the limbs; and I have known two instances of persons, who were suddenly seized with paralysis of the lower extremities, apparently dependant on general nervous disorder, in which the digestive organs scarcely seemed affected." Palsy of one side of the body is sometimes occasioned by compression or debility of the cervical portion of the spinal marrow, in which case there is no affection of the tongue, the eyes, or of the head. In the treatment of such a case, a blister should be applied to the nape of the neck, the bowels should be kept in a regular state by an aromatic purgative, and the circulation in the extremities promoted by electric sparks, or the mustard poultice. If the system be plethoric, abstraction of blood will be proper. — (See APOPLEXY.) Sumach has lately been recommended as a remedy for palsy. A grain of the powder is directed to be taken in any convenient vehicle twice a day, and to be gradually increased to three or four grains. From the account given of it by Dr. Alderson, it appears to have effected more in the cure of palsy than has ever been ascribed to any other remedy, and such as justly entitles it to the attention of the medical profession. Being a powerful poi son, it should be given with great caution. In one of the cases, the dose was increased to ninety grains night and morning; and in some it appears that even two grains produced pain in the stomach and bowels, and considerably deranged the nervous system. Dr. Gales, of Paris, and Mr. Green, of Great Marlborough Street, London, have lately found sulphurous fumigation very beneficial in paralytic complaints, and cases of local nervous debility. They advise the body to be exposed to the fumes for a short time every day. The inhalation of vital air to the extent of three gallons daily, I have lately found very beneficial in general and partial palsy, not occasioned by compression of the brain, or the consequence of an apoplectic fit. I often meet with cases of morbid excitement of the brain and nervous system, in consequence of mental or corporeal exertion, to which the name of palsy is generally given. This variety is generally aggravated by stimulating or tonic medicines. The use of the Aperient Mixture, p. 111, to obviate costiveness, the spirit of nitre, as recommended p. 64, and the application of cold water to the head every morning, by means of the shower bath, I have found very beneficial in this complaint. The mind being in general much affected, the directions for its management, given under the head of hypochondriacism, should be likewise observed. When the cause of palsy is not evident, the treatment recommended for indigestion should be adopted. PECTORAL ANGINA. This disease was not noticed, till the late Dr. Heberden published a description of it about forty years ago; and although it is by no means rare, it is little understood by the physicians of the present day. It is evi dently of a spasmodic nature, arising from morbid excitement of the nerves of the heart, and is often the consequence of diseased structure, particularly of the artery destined to convey nourishment to this organ. A paroxysm is generally brought on by bodily exertion or mental agitation. When excited by walking, the fit will often instantaneously cease on standing still; but after the disease has continued some months, it will attack the patient; not only on walking, but also on lying down, with such violence as to oblige him to rise up immediately in order to prevent suffocation. The fit commences with an acute pain beneath the lower part of the breast-bone, attended with a sense of constriction. The pain inclines rather to the left side, and often extends to the left arm, accompanied with great anxiety, difficulty of breathing, and a sense of suffocation. The late Dr. Fothergill observes, that a sharp constrictive pain across the chest is the characteristic symptom of this disease. No age is exempt from it. It attacks men more frequently than women, and particularly the short-necked, the corpulent, and sedentary. ČAUSES. — In young people this disorder probably arises from nervous excitement of the heart; but in elderly people this state is generally accompanied with some organic disease of the heart or the coronary arteries. TREATMENT. The object of practice in the treatment of this disease, is to allay the morbid excitement of the nervous system. If the sanguiferous system be overloaded, or what is termed in a plethoric state, it will be necessary to unload it by abstracting eight or ten ounces of blood from a vein of the arm; and, if there be considerable irritation in the chest, a blister should be applied over the breast-bone. The bowels should be kept open by the occasional use of the Aperient Mixture, p. 111, after which the Nervous Mixture (C), p. 113, may be taken as there directed. If the paroxysm be violent, about thirty drops of ether, and ten of solution of acetate of morphine or laudanum, may also be taken immediately on its attack. The diet should be light, and free from every thing of a stimulating nature, as spices, spirit, and vinous liquors. The patient should be careful not to overload the stomach, or to use any kind of exercise immediately after meals, and to guard against any emotion of the mind. Corpulence being a predisposing cause of the disease, exercise, a spare diet, and the use of laxative medicines, are the best preventives. Dr. Darwin and Dr. Macbride have published several cases of this disease, that were effectually cured by issues alone. If the patient be emaciated, the countenance pallid, and particularly if the legs swell in the evening, thirty drops of the ethereal tincture of steel, in three table-spoonsful of the infusion of buchu leaves, will afford great relief. When thus attended with great debility of the system, it is scarcely necessary to observe, that bleeding or an issue is improper. Sometimes the irritation is of a gouty nature, in which case the remedies recommended for gout will be proper.-(See ANT ARTHRITIC MIXTURE, p. 110, and AMMONIATED TINCTURE OF COLCHICUM SEEDS, p. 149). -- OF PILES, &c. This disease consists in small tumours, situated sometimes externally, and sometimes within the verge of the anus, for the most part attended with a discharge of blood. When there is no discharge, it is termed blind piles; and, when the discharge is only serum, white piles. The malady, at first, is generally local; but, by frequent occurrence, the constitution becomes so habituated to the discharge, as to render it, in some degree, constitutional: in which case it is preceded by headache, stupor, giddiness, and other symptoms of fever, with a sense of tightness or fulness, heat, and itching, and a sense of dragging down towards the anus; or otherwise symptoms of indigestion, as flatulency, acidity in the stomach, &c., often attended with spasms. Sometimes the inflammation of one tumour runs so high as to advance to suppuration, and produce the sinous ulcer termed fistula. CAUSES. Piles may be occasioned by whatever interrupts the free return of blood from the rectum; such as a collection of hard fæces, or an impregnated or enlarged womb. It is sometimes produced by irritation; hence aloes, or the advertised aperient antibilious pills, the basis of which is aloes, are very apt to excite piles by irritating the rectum. The piles are sometimes the effect of relaxation and debility, and, I believe, not unfrequently arise from an inflammatory action in the rectum, and a diminished secretion of mucus from its inner membrane. TREATMENT. Costiveness not only increases the distention of the hæmorrhoidal veins, and the effusion in the surrounding cellular membrane, constituting piles, but is generally the principal cause of the complaint. One dose of an active purgative, by unloading the lower intestines, generally affords considerable relief; but a repetition of it in the course of a few days, frequently increases the irritation. After unloading the bowels, a re-accumulation of faces in the colon and rectum should be prevented by the regular use of a mild dose of an active aperient, so as to produce one or two copious soft motions daily, in conjunction with a remedy, capable of allaying irritation in the rectum. The following composition I have known not only to obviate costiveness, without exciting griping pains in the intestines, but effectually to allay irritation and inflammatory excitement in the rectum : Take of Alcaline Extract of Jalap, 1 drachm. Mix, and divide into twenty-four pills; two or three to be taken once or twice a day. A lavement of cold thin gruel, or cold water, once a day, has been lately much extolled by some French writers, as a remedy |