an irritating medicine, such as tartar emetic. It will be found in practice, that frequent emetics, from their tendency to weaken the stomach, are inadmissible; but the occasional exhibition of a few grains of ipecacuanha, with chalk, may safely be directed: B Pulveris ipecacuanhæ, gr. iij. Cretæ præparatæ, gr. vj. Misce. 2. When the disease has subsisted for any length of time, the mild narcotics are decidedly useful. Dr. Butter* recommends very strongly the extr. conii, which may be given according to the following form:— B Extracti conii, gr. iij. Syrupi rhæados, 3j. Misce. Fiat haustus ter indies sumendus. Other practitioners have found advantage from hyoscyamus, and the lactuca virosa. Opium for the most part confines the bowels, and makes the child feverish. 3. Expectorant medicines, of several kinds, have been tried, and occasionally have proved singularly beneficial. Dr. Richard Pearson† has spoken in high terms of the combined influence of an expectorant (the vinum ipecacuanha) with an anodyne and absorbent. He strongly recommends the follow ing formula: B Soda subcarbonatis, gr. xxiv. Vini ipecacuanhæ, 3j. Tincturæ opii, mvj. Syrupi, 3iij. Aquæ pure, 3j. Misce. Sumat partem sextam sexta quaque hora. 4. Stimulant embrocations enjoy a high reputation for the relief of hooping-cough. They should be applied not only to the chest, but along the course of the spine; and the milder kinds may be repeated frequently during the day. Tartarized antimony, and the oleum succini, are among the most approved * Treatise on the Kin-Cough. + Medico-Chirurgical Transactions, vol. i. page 23. ingredients in such applications. They may be prepared for use in the following manner : B Antimonii tartarizati, ij. Solve antim. tartariz. in aqua rosa, dein adjice tincturam. Linimenti saponis compositi, 3jss. Olei succini, 3ss. Misce. 5. An open state of the bowels is almost essential to the favourable progress of the disease. An occasional dose of rhubarb is very necessary, and much advantage is derived from its combination with the carbonate of potash or soda. Dr. R. Pearson has observed, that the slimy fluid brought up by vomiting has often a sour smell. 6. In the latter stages of hooping-cough, where it becomes combined with symptoms of marasmus, I have seen great benefit derived from small alterative doses of calomel (a grain twice a day with a little sugar), and to this may be united very advantageously a few grains of scammony. 7. In all severe cases, when the cough is accompanied with permanent dyspnoea, much heat of skin, and other febrile symptoms, general or local blood-letting ought never to be omitted. It is frequently necessary to repeat the evacuation of blood two or three times before the symptoms yield. When the child complains of much head-ache, it will be right to apply a few leeches to the head. It has been observed, that the severity of the hoop has been by this means diminished. 8. When the disease proves very tedious and obstinate, resisting all the common modes of relief, and exhausting the patient by its continuance, we presume that it has rooted itself in the system by the force of habit; and to break in upon this, change of air has long been found eminently beneficial. It is often the only thing that gives the patient a chance for life. But it must be remembered in what circumstances it is applicable, and should never be advised where symptoms of bronchial inflammation are present, which a free exposure to cold air would in all probability aggravate. CHAP. IV. SYNCOPE AND PALPITATION. Functional Disturbances of the Heart's action. Of Syncope. Its Causes and Mode of Treatment. Of Palpitation. Its several Causes. Diagnosis of Nervous Palpitation from Organic Disease of the Heart. Treatment of the Nervous Palpitation. THE heart is liable to various disturbances of its function, independent of organic disease. We have seen, for instance, in fever, how its movements are accelerated. In some cases of pressure upon the cerebral substance, the motions of the heart are retarded. The same effect is produced by digitalis. There are two functional disturbances of the heart's action so frequent, and so important in practice, as to have been considered by all nosologists entitled to rank as distinct diseases. The first is temporary cessation of the heart's action, called by pathologists syncope: the other is increase of the heart's action, often with irregularity;-this is called palpitation. To these two conditions of disease my attention will be directed in this chapter. I. SYNCOPE. Syncope, or fainting, consists in the temporary suspension of the functions of the heart, and consequently of every other function of the body. Though commonly considered as an affection of the heart, it is in strict pathology a disease of the brain and nervous system. Phenomena of the fainting fit.-A dimness comes before the eyes; a deadly paleness overspreads the checks; the patient falls down; the pulse fails; respiration is at a stand; sensation and all mental phenomena cease. In some cases, indeed, the patient, though incapable of speaking, retains enough of perception and sensation to be conscious of his own disorder, and of what is passing around him. The disease brings with it its own cure. The horizontal position to which it reduces the body quickly renews the supply of blood to the heart, and the fit of syncope is over. In a few cases, recovery is accompanied with a confusion of ideas, vertigo, and headache. Much more frequently it is described as being attended with very painful feelings. Vomiting frequently occurs during the state of faintishness, especially in that brought on by copious bleeding. By exciting the circulation, vomiting contributes essentially to the recovery of the patient. Fainting, viewed in the light of a disease, must always from its very nature terminate favourably. I shall have occasion, indeed, in a subsequent chapter, to speak of death by syncope, that is, of a sudden and permanent check given to the heart's action; but to such a state, the term fainting, in its common acceptation, is obviously inapplicable. Nosologists have attempted to distinguish different degrees of swooning, to which they have applied the terms of leipothymia, leipopsychia, echysis, syncope, and apopsychia; but there are certainly no real grounds in nature for any such distinctions. Syncope may be considered, in a pathological point of view, as arising from two different sources,-imperfect supply of blood to the heart, and defect of nervous power: and in one or both of these ways it will be easy to understand the operation of the several predisposing and exciting causes of fainting, which systematic writers have enumerated. Predisposition.-A predisposition to fainting is given by original delicacy of organization. Hence it is so much more frequent among women than men. Weakness of constitution, the result of long illnesses, or of scanty nourishment, may be viewed in the same light. In convalescents from typhoid fevers, the exertion of getting out of bed is often followed by a fit of syncope. Exciting causes.-The most common exciting causes of a fainting fit in persons otherwise in good health are, violent and long-continued exertion, long continuance in the erect position, violent and protracted pain, excessive evacuations, whether of blood or by purging, external heat, the sudden operation of a depressing passion, and, in very delicate habits of body, certain objects of dread and antipathy. Treatment. The treatment applicable to the state of syncope is very obvious and simple, and, excepting in the case of syncope from flooding, rarely, if ever, demands the exercise of professional skill. The horizontal posture, a free current of cold air, sprinkling a little cold water over the face, and hartshorn held to the nostrils, will be sufficient to re-excite the circulation in common cases. In those severe cases which are the consequence of excessive evacuations of blood, the most powerful stimulants (ether and brandy) are often required, and an unremitting perseverance in them can alone ensure the safety of the patient. II. PALPITATION. There are few sensations better known, and which create at the same time more uneasiness, than that to which the term palpitation is popularly applied; and it is not therefore surprising that pathologists should have directed so large a share of their attention towards it. By some it has been advanced to the rank of an idiopathic affection, and considered in the light of a convulsion. By others, and certainly with more justice, it is viewed merely as a symptom, arising from various causes, sometimes quite unimportant, but sometimes indicating, in conjunction with other symptoms, disease in different parts. A few observations on the nature and sources of palpitation may be of some assistance to the student, with a view to the diagnosis of disease and the administration of remedies. it In a state of health, and even in many forms of disease, such as fever, the movements of the heart take place imperceptibly. When they are, from any cause, so far increased in violence as to become perceptible to the individual, he is said to have palpitation. Such irregular action may be either sharp and strong, when it is called throbbing of the heart; or may be soft and feeble, when it is called a fluttering. The sensations of the patient are obviously to be ascribed to the rebound of the heart against the inside of the chest. With a view to practice, a distinction is to be drawn between permanent and occasional palpitation. The former is always, or nearly always, the result of organic disease existing within the chest, more especially of the enlarged or hypertrophied condition of the heart. The latter also may sometimes indicate structural derangement, but it is far more commonly the evidence merely of sympathetic disturbance in the action of the heart. To that variety of palpitation which occurs with perfect integrity of the heart's structure, the term nervous has been usually appropriated, and to it I confine my attention for the present. Causes of palpitation.-1. Every one must be sensible of the influence of strong emotions and passions of the mind |