HEALTH OF LONDON DURING THE WEEK THE deaths registered in the metropolitan districts, in the week ending estimated at 1-55 per cent. annually, is 1252. As compared with deaths registered weekly in last December, the present return exhibits an increase of nearly 100. The mortality from bronchitis has increased in two weeks from 78 deaths to 103, while that from pneumonia has increased from 69 to 95; the averages of the two diseases in the same week of ten previous years are 57 and 104. From phthisis there were 129 deaths, which is slightly under the corrected average. From small-pox there were only 8; in the ten corresponding week of 1840-9, this epidemic ranged from 5 to 86. Hooping-cough, which was fatal to 23 children, is also under the usual number. Measles, scarlatina, and typhus, produce nearly the ordinary amount of mortality; but all the five epidemics, with the exception of measles, are now much less fatal than in the same week of last year. From diarrhoea there were only 8 deaths; but 6, which is rather more than usual, occurred from dysentery. TO CORRESPONDENTS. gist's at a reasonable expense. ACID (Newcastle-on-Tyne).—Desist from using the instrument. Take a warm bath twice a week, or foment the part; omit all medical treatment. Write to us, and say where a private note will meet you. QUERIST.-At fourteen or fifteen years of age. To your second query, No. We doubt the object of your question.-Virtue ! J. J. (Glamorganshire)-Cleanliness; attention to the bowels ; temper- ADOLESCENS (Surrey.-We must know much more of your case previous APPRENTICE.-"Nervous Debility" is a very convenient term, and is to correct the excess or misdirection of our passions and affections, and to prevent their morbid influence on the body. The practice of this science is the noblest office of the physician; compared to it the mere prescribing of drugs is secondary, and yet how frequently is the moral management of a patient overlooked! Your case demands more of this control and proper direction, and less physic. NOTICE. All communications for the Editor must be addressed, pre-paid, J. S. (Camberwell).—MORAL MEDICINE is that science which teaches us to his house, No. 25, LLOYD SQUARE, PENTONVILLE. It is indispensable that letters requiring a private answer contain a postage stamp, or stamped envelope, whereon is written the address of the applicant. Invalids resident in the country, and others desiring the opinion of the Editor, who are unable to consult him personally, carr have, on application, a series of questions proposed to them, and by attention on their part, in giving answers thereto, the necessity of a personal interview, in many instances, may be avoided without detriment to the successful issue of the required treatment. Notes of every case submitted to the Editor will be recorded in his private case-book for the facility of reference at any future period. WE particularly request Correspondents who do not attach their proper names to their communications, to avoid all such signatures "a Subscriber," - "Constant Reader," Well-Wisher," &c. Where the correct name is not given, it will insure the identity of the "answer" to the query proposed to us, if our correspondents add the name of the town or street from which they write: thus-O. P. Q. (Bath)-DELTA, (Manchester Square). JOHN (Barnsbury Road).-Your question is answered in detail in the first paper on Indigestion, &c., published in No. I. of the PEOPLE'S MEDICAL JOURNAL. H. J. J———N N▬▬▬8 (Peter Street).-Call in Lloyd Square on Sunday morn B. ing. The book you name is the property of one of the "worthies" alluded to in the letter of " VICTIM," published in the PEOPLE'S ME-T. DICAL JOURNAL of last week. CHEMICUS.-We are obliged by your note. We have known much mis- THE MEDICAL DIRECTORY.-We well know the “quackish” propensities B. C. (Stepney Causeway).-Take of the compound infusion of horse- TAYLOR (Ware).-Until you get rid of the cause, so long will yon be annoyed by the worms. Tape worm is more frequently an effect than a cause; as long as the stomach and intestines generate diseased secretions, so long will worms be fostered and nourished; like other parasites, they revel in unclean things. Oil of turpentine, and the male fern root, are excellent "expellers," but there their virtues end. We cannot spare space to go into the required treatment of your case in this column. H. (Rochdale).-Take, tincture of the sesqui-chloride of iron, three M. B. (Nun's Street, Derby).-Take, compound extract of colocynth, and Printed by CHARLES ADAMS, at his Printing Office, 8, St. James's Walk, in the Parish of DYSPEPSIA.-INDIGESTION. NERVOUSNESS, &c. No. IV. (Continued from page 19.) THE TREATMENT OF INDIGESTION. ONE PENNY, affect the cause of the constipation and of the acidity? To cure disease, we must attack the enemy in his lair, and totally vanquish him; we do but temporary good in patching up, or varnishing over, the inroads he makes in his repeated assaults. After this preamble, it will not excite surprise if we endeavour to instruct our readers how they may preserve health, rather than teach them how to cure disease; when, however, the means to be adopted are so simple and safe as to be left to the discretion of the patient, we shall not withhold the information. In the treatment of indigestion, we have two indications of cure to follow : first, to palliate the exciting distress, and, secondly, to prevent a recurrence So that we may avoid all ambiguity and confusion, we shall, in describing the means by which these indications may be fulfilled, consider the treatment of each symptom separately. Acidity on the stomach, as is well known, may be temporarily counteracted by the use of an alkali, as soda, chalk, or magnesia; to each of these, in some cases, there is an objection; the constant use of soda exerts a baneful effect, not only on the stomach itself, but also on the whole frame; it acts powerfully in diminishing the nutritive properties of the blood, rendering it thin, watery, and deficient in the rich red particles. We remember a case attended by Dr. Cumin, of Glasgow, of a lady who was in the constant habit of taking carbo nate of soda, who observed each time she pricked her finger in sewing, that the blood which escaped was almost colourless; a violent attack of inflammation rendered bleeding from the arm necessary, and the result was such a perfect fainting, that animation was with the greatest difficulty restored. Persons who are habituated to the use of soda, entail upon themselves continual debility, even if they relieve the acidity. Chalk and magnesia when long persevered in, are apt to form balls or calculi in some parts of the intestines, and thus produce a very troublesome obstruction, if not colic; under judicious management, these antacids are of great value—it is their abuse, not use, that can be injurious. The greatest benefit may be derived in some cases by the employment of lime water or Seltzer water, and in others soap is the most valuable remedy; when combined with a small proportion of opium, it not only neutralises the acidity, but alleviates the pain. If the acidity be accompanied by "water-brash," the trisnitrate of bismuth is serviceable; occasionally some of the aromatics are required, as ginger, cubebs, nutmegs, anise, &c.; and Dr. Mason Good says, "speedy and effectual relief may be obtained by the simple and pleasant remedy of eating six or eight almonds." It will now be seen that several remedies will produce one effect, namely, the cessation of the acidity; to select for each individual case that which will attain this end the more readily, without exciting any opposing peculiarity, must be the result alone of tact and experience, not mere chance. WE fear we shall, in this essay, fall short of realising the anticipations of such E Flatulence, giving rise to painful distension of the stomach and distress to the neighbouring parts, is frequently encouraged and increased by the improper efforts of the invalid to expel the wind, in the expectation of obtaining relief by its escape; we have now under treatment a patient, who, on his first visit, in describing this symptom, said he was constantly exciting "belching," and, as a proof of the facility with which he accomplished his object, he repeatedly struck his chest violently, and each blow was followed by a welltoned report; such practice is decidedly injurious, as it offers to the stomach a constant impulse to continue this irregular and unnatural process. When we have reason to suppose that the flatulency is caused by some undigested fermenting substance, which may be lurking in the stomach, an emetic will sometimes afford immediate relief, and in this manner worms have at times been thrown up, as well as morsels of undigested fruit, or other materials, as plum-stones, or the fragments of a pear or apple. We have, however, more frequently to attribute the continual generation of wind to the inability of the stomach to digest its contents, and want of tone in its muscular coats; and permanent relief, in such cases, can only be obtained by perfectly re-invigor ating that organ. As palliatives, innumerable remedies are in vogue, which vary in their several effects according to the variety of the idiosyncrasy, or the actual state of the stomach; amongst those which may be considered as domestic remedies we may name, thyme, rosemary, peppermint, pennyroyal, coriander, dill, ginger, cloves, capsicum, &c. When the circulation is weak, and pain is entirely absent from the stomach, some slightly stimulating remedy may be employed with advantage-as camphor, the aromatic spirits of ammonia, or a small quantity of hot brandy and water. If the subject of flatulence be of a nervous or hysteric temperament, some of the fetid gums will give great relief. Distension of the stomach from flatulence frequently gives rise to alarming symptoms in old people, producing spasms, sometimes convulsions, and apoplexy. In such cases the stomach loses, to a great extent, its contractility and susceptibility, and thus the usual remedies prove inert; it will, therefore, be necessary to apply a mustard poultice to the stomach, whilst we give internally a strong infusion of mustard-seeds, or the tincture of horse-radish, in camphor mixture. We shall allude to the food which should be taken when this symptom is least urgent, when we come to speak of the diet for dyspeptics. Nausea and vomiting, when excited by crudities or offensive substances lodged in the stomach, are frequently best relieved by a full discharge of its contents, either by encouraging the vomiting, when it does occur, by repeated draughts of tepid water, or by an emetic, so as to remove the cause of the distress, and thoroughly wash out the stomach. It may happen that there is constant nausea, without the ability to vomit, and then a gentle emetic, either of sulphate of zinc or mustard-which does not create the same degree of nausea as antimony or ipecacuanha-may be used with much benefit. When the vomiting occurs, as it more frequently does, from irritability of the stomach, which renders it unable to bear the stimulus of the most simple food, it will be prudent to administer, with extreme care, a proper dose of opium, or hydrocyanic acid; from the latter we have found the greatest benefit in these cases in which the food is ejected, in its original crude state, immediately after it has been swallowed; effervescing draughts, or soda water, sometimes allay the uneasiness, but if they do not quickly effect this, their use should not be persisted in. If the stomach be overloaded with bile, an emetic should be given without delay, and the bowels excited to action by an aperient speedy in its operation, as the tartrate of potash, combined with some warm tincture. After the full emetic effect has been obtained, we should endeavour to restore the proper tone to the stomach by an aromatic cordial draught, containing, if requisite, ten or fifteen drops of laudanum. When the sickness proceeds from a chronic debility of the stomach, as well as strengthening the whole system by diet, exercise, and moral means, it will be useful to employ the lighter and warmer bitter tonics, as an infusion of orange peel, cascarilla, or calumbo. So long as the dyspeptic invalid suffers from want of tone and deficient nervous energy in the stomach, so long will he be liable to a return of sickness; the means to be adopted to regain this great desideratum will be explained hereafter. We come now to speak of the alleviation of pain induced by indigestion. When pain is a symptom which does not yield to the treatment already recited, we may with reason attribute its continuance to some degree of irritation or inflammation in the stomach, and it will then be necessary to have recourse to those means which are employed to subdue inflammation generally. When the pain is acute, darting, and increased on pressure, eight or ten leeches should be applied to the region of the stomach, and afterwards warm fomentations freely used. When the pain is dull, obtuse, and deep-seated, only increased by firm and long-continued pressure, we have ordered with great benefit the tartar emetic ointment to be rubbed in every night, so as to produce a good crop of pustules around the pit of the stomach. If the pain be severe, but irregular, returning now and then like a spasm, a large mustard poultice may be applied with advantage; and as this remedy is perfectly innocent, it may be repeated two or three times until it produces the desired end. Of opiates it is useless to speak, as so many contingencies must be considered before they can be employed, that a professional man alone can judge of their expediency. In our next we shall speak of the general treatment of indigestion, dietetics, &c. DISEASES OF THE CHEST. IIUMID CATARRH, OR COUGH WITH EXPECTORATION. (Continued from page 21.) HUMID CATARRH, or cough with expectoration, is produced by those causes which incite other forms of cold: it may succeed to a dry cough, and is a frequent result of disordered or weakened digestion, disease of the liver, syphilis, or the imprudent and rheumatism, and sometimes it is produced by inhaling irriuse of mercury; it is also an occasional attendant upon gout tating or noxious effluvia. The aged and weak are seldom free "winter cough; " and from a periodical attack in the form of a persons who are addicted to intoxicating beverages, irregularities, and excesses, frequently suffer this severe penalty for their Humid, or mucus catarrh, in its acute form, more generally attacks persons of a bilious temperament, and usually becomes chronic-that is, constant and devoid of immediately urgent symptoms, - in those of a lymphatic or scrofulous habit. Unlike many other diseases, the predisposition is increased by each invasion, and one attack is frequently followed by another; indeed, many individuals are affected several times in the course of a year, they get a cold upon a cold, and are scarcely ever exempt from catarrh, follies. In numerous instances, the disease when chronic presents all the general, and some of the functional symptoms of consumption of the lungs, and becomes the cause of considerable anxiety to the friends of the invalid. It is a too common custom with some medical practitioners who are so wanting in candour as to assert that consumption is curable, to call every affection of the chest by that name, when, in truth, the existing disease may be far less formidable, and, to some extent, free from danger so that, under ordinary treatment, the patient gets well, the practitioner gets fame, and the case is dotted down in a book as another victory won from the enemy, consumption. I am daily consulted in cases which I am assured are consumptive, but which, on examination, I find to be mucus catarrh of long standing; and the ease with which the symptoms are relieved, and the cure ultimately obtained, is positive evidence of the less dangerous nature of the complaint. THE SYMPTOMS. The symptoms, being tolerably familiar to every one, need not detain us long in description, were it not that " cough" of every degree is popularly considered as one and the same complaint, and consequently treated alike in all cases: such a course is fraught with uncertainty and risk, that may be avoided when the character of the disease is correctly distinguished, and the treatment adapted to the peculiar state and cause of the affection, on The earliest symptoms are those of common cold, with a tickling or feeling of roughness at the back part of the throat, and at the commencement of the windpipe; the cough comes in paroxysms, attended with difficulty of breathing, and tightness or pain across the chest; there is hoarseness or huskiness of the voice, and in some cases the patient can scarcely speak above a whisper. The expectoration is at first a thin, colourless, glairy fluid, "frothy on the surface, and underneath like the white of an egg diluted with water:" after a time it is of a thicker consistence, and puts on the well-known appearance of phlegm; it accumulates rapidly in the air-passages, and induces a constant irritation and inclination to void it by cough; the windpipe becomes sore, and every breath of cold air adds to the pain, and aggravates the other symptoms. As well as these pulmonary symptoms, there is some con siderable disturbance of the general health: the pulse is accelerated, and the surface of the body is alternately flushed with heat, or damp and chill with cold perspiration; the spirits are depressed, the patient is languid and indolent, and the eyes betoken dulness and want of expression. As the disease progresses, the tightness across the chest becomes more oppressive, the cough is aggravated by the least exertion, particularly by walking fast or going up stairs: its frequency renders the chest tender and sore, or, as patients sometimes describe it, "raw"; occasionally there are sharp darting pains across the breast; or pain closely resembling that of rheumatism, if it be not actually rheumatism, is experienced in the muscles of the chest, the shoulders, and between the blade-bones; the appetite is precarious, and the patient gradually loses strength. All these symptoms are generally more violent towards evening, and during the night. When the expectoration is profuse, the patient is seized with a fit of coughing so soon as he is in the horizontal position; in some instances the cough is severe in the morning, and returns with violence three or four times during the day, the expectoration is then thin, frothy, and abundant, but the attack is usually of short duration. In humid catarrh of old people, the expectoration is thick and viscid, and the cough exhausting and prolonged: young children and debilitated persons suffer acutely from this form of cough, on account of their inability to use sufficient force and exertion to clear the tubes of accumulated mucus; in such cases, the air contained within the bronchial passages may be distinctly heard gurgling and wheezing, as it becomes obstructed by the increased After the disease has existed for some days, or when the catarrh is chronic, the expectoration becomes thicker, more ropy, and less in quantity, and, as it decreases in quantity, so it becomes thicker; it is also usually changed in appearance, and is of a yellow, greenish yellow, grey, sometimes darker, or even bluish-black colour. secretion. The expectoration in catarrh is essentially mucus, although in some instances it assumes a purulent aspect. The difference between mucus and purulent expectoration is of considerable importance, as one denotes merely a disordered condition of a natural secretion, and is the result of catarrh and bronchitis; whilst the other-purulent expectoration-is the result, for the most part, of disease and disorganisation of structure, and as such, is the sign and product of the ulceration of the lungs, and of consumptive tubercles. Mucus is a viscid fluid, resembling in its healthy state, the white of an egg, but capable of undergoing in disease the changes I have just named; it has a slightly saline taste, and acquires apparent fluidity in water; it is of less specific gravity than water, and floats on the surface; it is soluble in dilute sulphuric acid, and is blackened by the concentrated acid. Pus is a yellow fluid, somewhat like cream; it is found in abscesses, and is formed upon the surface of what are called healthy sores; it is composed of globules of a whitish fluid contained in a transparent liquid; it does not coagulate by heat; it is heavier than water, and sinks when deposited in it. The duration and importance of humid catarrh is variable, and depends on the state of the individual at the period of its attack; of itself it is not necessarily a dangerous disease, but when the invalid is labouring under other complaints, or is enfeebled by previous illness, it may prove fatal in a few hours. If neglected, the bronchial membranes readily inflame, and cause acute bronchitis; if the subject has weak or irritable lungs, the worst consequences may be apprehended, inflammation of the lungs or of the pleura-pleurisy-may ensue, blood may be coughed up, and the end may be the development of pulmonary consuniption. I believe I am within the mark when I say that ten cases out of every twelve of consumption may be traced to a neglected cold and cough, by which the latent disease is called into dangerous activity. By long continuance, a cough which is lightly thought of or scarcely heeded, will impair the strength, waste the body, and perhaps bring on disease of the heart, or otherwise so affect the vital functions as to place the life of the patient in jeopardy. When, however, the subject is strong and healthy, without predisposition to disease, a cough may, in some rare cases, continue for years without materially interrupting the health, being, nevertheless, a sad drawback on the comfort and repose of the individual. I may remark that in general far less serious results follow a mucus cough that comes on in paroxysms, although most distressing at the time, than when the cough is less severe, but constant. THE TREATMENT. the head, pursued, perhaps, with more activity: before other remeMucus catarrh demands the same general treatment as cold in dies are employed, itwill be prudent to act gently upon the bowels by to promote the more certain action of other medicines. We a mild purgative, so as to lessen the liability to inflammation, and must then endeavour to remove the accumulated mucus, and restrain its excessive secretion by preparations of those expectorant drugs that cause the separation and discharge of the viscid phlegm with which the air-passages are loaded. The best expectorant for this purpose is ipecacuan, which, when the symptoms are acute, may be given in such a dose as will act as an emetic, or at least tinent it has been the practice to use tartar emetic (antimony) with maintain a nauseating effect for some short time. On the Conthe same intent, and in some cases recorded by Laennec and Rasori, the most heroic doses appear to have been prescribed with much success: I consider, however, that the debility consequent upon its excessive use is greater than the urgency of the symptoms in ordinary humid catarrh demands; in acute bronchitis, antimony in full doses is invaluable. The lobelia inflata is a most valuable remedy, but requires the greatest watchfulness during its exhibition, as it is apt to induce vertigo and derangement of the stomach. Squills are very useful, and when conjoined with acid, as they are in the oxymel and vinegar of squills, their efficacy is increased. I subjoin two or three prescriptions from which benefit may be anticipated in this form of cough. so as to soothe the irritated mucous surface;-liquorice may be used for the same purpose. fusely at the least touch of the knife. tumour, was then divided, and thus the entire front of the disease was laid bare. It was firm in texture, and so exceedingly vascular, that it bled proAfter a little further dissection, it was The diet should be plain and nutritive, and consist chiefly soon apparent, that the deep-seated connexions of the tumour were such as to of light puddings, with a very small proportion of animal food. render its removal next to impossible. On the one side it was firmly incorAll spirituous and fermented liquors must be strongly prohibited. porated with the rectus and vastus internus; on the other, with the adductor Strong coffee, made by infusion, not by boiling, is the best morn-muscles; and a portion of it seemed to be prolonged upwards towards the pelvis. Thus, scarcely any part of its circumference could be detached. ing and evening beverage. Moreover, in attempting to do this, a very large artery was divided, and bled profusely before it could be secured. The operation was then given up, but not before so much blood had been lost, that fears were entertained lest the patient should die on the table. At the time that we attend to the local affection-the cough -we must not neglect the general health; we should endeavour to give tone and vigour to the system, so as to gain for it a power of endurance and resistance to cold; the clothing should be warm and always uniform; sudden and unprepared-for exposure to cold should be avoided, and during convalescence daily exercise in a bracing atmosphere should be persisted in. When the catarrh becomes chronic, especially in old people, with a viscid secretion expectorated with great difficulty, and laborious breathing, we may employ warnier and more pungent expectorants than those I have before named; such as the stimulant gum resins, ammoniacum, benzoin, and styrax; garlic is occasionally of very great utility, Friction to the chest, by means of a flesh-brush, or what answers equally well, a coarse towel, should be used night and morning; and the application of a slightly stimulating embrocation is invariably productive of benefit. might have been expected from the operation. He soon rallied, and the Notwithstanding the profuse hæmorrhage, the patient suffered less than wound began to granulate. On the sixth day it was discovered, that the tumour was beginning to slough. The sloughing increased with such rapidity, that, by the eighteenth day, the entire tumour had perished, and become detached from its connexions; so that Mr. Lawrence drew out the disease en masse from its bed in the thigh. On careful examination of the disease thus removed, the femoral vessels were found running through the centre of it. This circumstance accounts for a symptom which we have not hitherto mentioned, namely, the considerable swelling of the whole limb after the oper The large excavation in the thigh left after the separation of the slough, has been filled up by healthy granulations, and the patient has left the hospital with the perfect use of the limb, and with every prospect that there will be no ation. return of the disease. The chief practical point deducible from this case is the caution with which we ought to estimate the connexions and extent of a tumour by its looseness and mobility. In this instance, there was no reason to suppose In that form of mucus cough which is attended with irrita- that the tumour had such deep connexions as would prevent its complete rebility of the system, and thin frothy expectoration, I have pre-of the growth by sloughing is a most rare occurrence. moval; but it proved otherwise. The subsequent spontaneous detachment scribed the tincture of hops, with the oxymel of squills, with good effect: I am averse to opium, and rely chiefly upon hyos- ON THE DISEASES OF WOMEN & CHILDREN. ciamus and conium when there is occasion to employ a narcotic: prussic-acid is an invaluable remedy from its power to diminish general sensibility without affecting the functions of respiration and circulation; I need not add that it requires the greatest cau tion in its administration. (To be continued in our next.) SPONTANEOUS SEPARATION of a large TUMOUR FROM THE THIGH, AFTER to the close. THE following very remarkable case has recently been discharged from the hospital, a perfect cure. We are, therefore, enabled to give a complete report of the many interesting points belonging to it from the commencement Evan Davies, a thoroughly robust and healthy-looking man, about 46 years of age, was admitted into "Henry" Ward, Bartholomew's Hospital, under the care of Mr. Lawrence, on the 4th of October, 1849. He had a large tumour on the front of the right thigh, just above the middle. It was of a nearly spherical shape, between four and five inches in diameter, uniform on the surface, compact and elastic to the feel. It was, evidently, deeply imbedded in the thigh. As one might expect of a tumour so situated, it could be moved very little independently of its surrounding connexions; at the same time, there was no reason for believing that it was in any way fixed to the bone. The superincumbent skin was quite healthy, and so was all the We gathered from him the following history. About nine months ago, while engaged in the execution of his duty as a constable, he was kicked on that part of the thigh where the disease subsequently appeared, The kick was so severe that he was compelled to remain at rest for a few days, and apply leeches to the affected part. Not till two months, or thereabouts, after this injury, did he perceive any trace of the tumour. Various means were then tried with a view to disperse it, and amongst others a thorough salivation; but the lump steadily progressed in size, and became gradually more painful, especially after unusual exercise. Under these circumstances, he determined to come up to London for the benefit of the best surgical advice, and had rest of the limb. the good fortune to fall under the care of Mr. Lawrence. Mr. Lawrence, after maturely considering all the circumstances of this case, recommended the man to submit to an operation for the removal of the tumour, and on these grounds:-1. The disease could be got rid of in no other and was progressing in size; 2. Its nature, though uncertain, was way, in all probability innocent; 3, Its mobility and connexions were such as to justify the hope that it might be entirely removed; 4. The patient was in the best possible health. Accordingly, on the 23rd of October, with the approbation of all his colleagues, Mr. Lawrence undertook the operation, the patient being under the influence of chloroform. A free crucial incision was made through the integument. The sartorius muscle, which crossed over the No. II. (Continued from page 18.) THE influence which this function in return, exerts over the |