OF all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imitate almost every disease; and are seldom alike in two different persons, or even in the same person at different times. Proteus-like, they are continually changing shape; and upon every fresh attack, the patient thinks he feels symptoms which he never experienced before. Nor do they only affect the body; the mind likewise suffers, and is often thereby rendered extremely weak and peevish. The low spirits, timorousness, melancholy, and fickleness of temper, which generally attend nervous disorders, induce many to believe, that they are entirely diseases of the mind; but this change of temper is rather a consequence, than the cause of nervous diseases.
CAUSES. - Every thing that tends to relax or weaken the body, disposes it to nervous diseases, as indolence, excessive venery, drinking too much tea, or other weak watery liquors, frequent bleeding, purging, vomiting, &c. Whatever hurts the digestion, or prevents the proper assimilation of the food, has likewise this effect; as long fasting, excess in eating or drinking; the use of windy, crude, or unwholesome aliments, an unfavourable posture of the body, &c.
NERVOUS disorders often proceed from intense application to study. Indeed few studious persons are entirely free from them. Nor is this at all to be wondered at; intense thinking not only preys upon the spirits, but prevents the person from taking proper exercise, by which means the digestion is impaired, the nourishment prevented, the solids relaxed, and the whole mass of humours vitiated. Grief and disappointment likewise produce the same effects. I have known more nervous patients, who dated the commencement of their disorders from the loss of a husband, a favourite child, or from some disappointment in life, than from any other cause. In a word, whatever weakens the body, or depresses the spirits, may occasion nervous disorders, as unwholesome air, want of great fatigue, disagreeable apprehensions, anxiety vexation, &c.
SYMPTOMS -We shall only mention some of the most general symptoms of these disorders, as it would be both an useless and an endless task to enumerate the whole. They generally begin with windy inflations or distentions of the stornach and intestines, the appetite and digestion are usually bad; yet sometirnes there is an uncommon craving for food, and a quick digestion. The food often turns sour on the stomach; and the patient is troubled with vomiting of clear water, tough phleghm, or a blackish coloured liquor resembling the grounds of coffee. Excruciating pains are often felt about the navel, attended with a rumbling or murmuring noise in the bowels. The body is sometimes loose, but more commonly bound, which occasions a retention of wind and great uneasiness.
THE urine is sometimes in small quantity, at other times very copious and quite clear. There is a great straitness of the breast, with difficulty of breathing; violent palpitations of the heart; suddden flushings of heat in various parts of the body; at other times a sense of cold, as if water were poured on them; flying pains in the arms and limbs; pains in the back and belly, resembling those occasioned by gravel; the pulse very variable, sometimes uncommonly slow, and at other times very quick; yawning, the hiccup, frequent sighing, and a sense of suffocation, as if from a ball or lump in the throat; alternate fits of crying and convulsive laughing; the sleep is unsound and seldom seldom refreshing; and the patient is often troubled with the night-mare.
AS the disease increases, the patient is molested with head-achs, cramps, and fixed pains in various parts of the body; the eyes are clouded, and often affected with pain and dryness; there is a noise in the ears, and often a dulness of hearing; in short, the whole animal functions are impaired. The mind is disturbed on the most trivial occasions, and is hurried into the most perverse commotions, inquietudes, terror, sadness, anger, diffidence, &c. The patient is apt to entertain wild imaginations and fancies; the memory becomes weak, and the judgment fails.
NOTHING is more characteristic of this disease than constant dread of death. This renders those unhappy persons who labour under it peevish, fickle, impatient, and apt to run from one physician to another; which is one reason why they seldom reap any benefit from medicine, as they have not sufficient resolution to persist in any one course till it has time to produce its proper effects. They are likewise apt to imagine that they labour under diseases from which they are quite free; and are very angry if any one attempts to set them right, or laugh them out of their ridiculous notions.
REGIMEN. - Persons afflicted with nervous diseases ought never to fast long. Their food should be solid and nourishing, but of easy digestion. Fat meats, and heavy sauces, are hurtful. All excess should be carefully avoided. They ought never to eat more at a time than they can easily digest; but if they feel themseIves weak and faint between meals, they ought to eat a bit of bread, and drink a glass of wine. Heavy suppers are to be avoided. Though wine in excess enfeebles the body, and impairs the faculties of the mind, yet taken in moderation, it strengthens the stomach, and promotes digestion. Wine and water is a very proper drink at meals: but if wine sours on the stornach, or the patient is much troubled with wind, brandy and water will answer better. Every thing that is windy or hard of digestion must be avoided. All weak and warm liquors are hurtful, as tea, coffee, punch, &c. People may find a ternporary relief in the use of these, but they always increase the malady, as they weaken the stomach and hurt digestion. Above all things, drams are to be avoided. Whatever immediate ease the patient may feel from the use of ardent spirits, they are sure to aggravate the malady, and prove certain poisons at last. These cautions are the more necessary, as most nervous people are peculiarly fond of tea, and ardent spirits; to the use of which many of them fall victims.
EXERCISE in nervous disorders is superior to all medicines. Riding on horseback is generally esteemed the best, as it gives motion to the whole body, without fatiguing it. I have known some patients however, with whom walking agreed better, and others who were most benefited by riding in a carriage. Every one ought to use that which he finds most beneficial. Long sea voyages have an excellent effect; and to those who can afford to take them, and have sufficient resolution, we would by all means recommend this course. Even change of place, and the sight of new objects, by diverting the mind, have a great tendency to remove these complaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journeys near home.
A COOL dry air is proper, as it braces and invigorates the whole body. Few things tend more to relax and enervate than hot air, especially that which is rendered so by great fires, or stoves in small apartments. But when the stomach or bowels are weak, the body ought to be well guarded against cold, especially in winter, by wearing a thin flannel waist-coat next the skin. This will keep up an equal perspiration, and defend the alimentary canal from many impressions to which it would otherwise be subject, upon every sudden change from warm to cold weather. Rubbing the body frequently with a flesh brush, or a coarse linen cloth, is likewise beneficial, as it promotes the circulation, perspiration, &c. Persons who have weak nerves ought to rise early, and take exercise before breakfast, as lying too long a-bed cannot fail to relax the solids. They ought likewise to be diverted, and to be kept as easy and cheerful as possible. There is not any thing which hurts the nervous system, or weakens the digestive powers, more than fear, grief, or anxiety.
MEDICINES. - Though nervous diseases are seldom radically cured, yet their symptoms may sometimes be alleviated, and the patient's life rendered, at least, more comfortable, by proper medicines.
WHEN the patient is costive, he ought to take a little rhubarb, or some other mild purgative, and should never suffer his body to be long bound. All strong and violent purgatives are however to be avoided, as aloes, jalap, &c. I have generally seen an infusion of senna and rhubarb in brandy answer very well. This may be made of any strength, and taken in such quantity as the patient finds necessary. When digestion is bad, or the stomach relaxed and weak, the following infusion of Peruvian bark and other bitters may be used with advantage.
TAKE of Peruvian bark an ounce, gentian root, orange-peel, and coriander-seed, of each half an ounce; let these ingredients be all bruised in a rnortar, and infused in a bottle of brandy or whisky, for the space of five or six days. A table-spoonful of the strained liquor may be taken in half a glass of water, an hour before breakfast, dinner, and supper.
FEW things tend more to strengthen the nervous system than cold bathing. This practice, if duly persisted in, will produce very extraordinary effects; but when the liver or other viscera are obstructed, or otherwise unsound, the cold bath is improper. It is therefore to be used with very great caution. The most proper seasons for it are summer and autumn. It will be sufficient, especially for persons of a spare habit, to go into the cold bath three or four times a-week. If the patient be weakened by it, or feels chilly for a long time after coming out, it is improper.
IN a patient affected with wind, I have always observed the greatest benefit from the acid elixir of vitriol. It may be taken in the quantity of fifteen, twenty, or thirty drops, twice or thrice a-day in a glass of water. This both expels wind, strengthens the stomach, and promotes digestion.
OPIATES are generally extolled in these maladies; but as they only palliate the symptoms, and generally afterwards increase the disease, we would advise people to be extremely sparing in the use of them, lest habit render them at last absolutely necessary.
IT would be an easy matter to enumerate many medicines which have been extolled for relieving nervous disorders; but whoever wishes for a thorough cure must expect it from regimen alone; we shall therefore omit mentioning more medicines, and again recommend the strictest attention to DIET, AIR, EXERCISE and AMUSEMENTS.
MELANCHOLY is that state of alienation or weakness of mind which renders people incapable of enjoying the pleasures, or performing the duties of life. It is a degree of insanity, and often terminates in absolute madness.
CAUSES. - It may proceed from a hereditary disposition; intense thinking, especially where the mind is long occupied about one object; violent passions or affections of the mind, as love, fear, joy, grief, overweaning pride, and such like. It may also be occasioned by excessive venery, narcotic or stupefactive poisons; a sedentary life; solitude; the suppression of custornary evacuations; acute fevers, or other diseases. Violent anger will change melancholy into madness; and excessive cold, especially of the lower extremities, Will force the blood into the brain, and produce all the symptoms of madness. It may likewise proceed from the use of aliment that is hard of digestion, or which cannot be easily assimilated; from a callous state of the integuments of the brain, or dryness of the brain itself. To all which we may add gloomy or mistaken notions of religion.
SYMPTOMS. - When persons begin to be melancholy, they are timorous; watchful; fond of solitude, fretful; fickle; captious and inquisitive; solicitous about trifles; sometimes niggardly, and at other times prodigal. The body is generally bound; the urine thin, and in small quantity; the stomach and bowels inflated with wind; the complexion pale; the pulse slow and weak. The functions of the mind are also greatly perverted, in so much that the patient often imagines himself dead, or changed into some other animal. Some have imagined their bodies were made of glass, or other brittle substances, and were afraid to move, lest they should be broken to pieces. The unhappy patient, in this case, unless carefully watched, is apt to put an end to his own miserable life.
WHEN the disease is owing to an obstruction of customary evacuations, or any bodily disorder, it is easier cured than when it proceeds from affections of the mind, or an hereditary taint. A discharge of blood from the nose, looseness, scabby eruptions, the bleeding piles, or the menses, carry off this disease.
REGIMEN - The diet should consist chiefly of vegetables of a cooling and opening quality. Animal food, especially salted or smoke-dried fish or flesh ought to be avoided. All kinds of shell-fish are bad. Aliments prepared with onions, garlic, or any thing that generates thick blood are likewise improper. All kind of fruits that are wholesome may be eat with advantage . Boerhaave gives an instance of a patient who, by a long use of whey, water, and garden-fruit, recovered, after having evacuated a great quantity of black-couloured matter.
STRONG liuors of every kind ought to be avoided as poison. The most proper drink is water, whey, or very small beer. Tea and coffee are improper. If honey agrees with the patient, it may be eat freely, or his drink may be sweetened with it. Infusions of balm-leaves, penny-royal, the roots of wild valerian, or the flowers of the lime-tree may be drank freely, either by themselves, or sweetened with honey, as the patient shall chuse.
THE patient ought to take as much exercise in the open air as he can bear. This helps to dissolve the viscid humours, it removes obstructions, promotes the perspiration, and all the other secretions. Every kind of madness is attended with a diminished perspiration; all means ought therefore to be used to promote that necessary and salutary discharge. Nothing can have a more direct tendency to increase the disease than confining the patient to a close apartment. Were he forced to ride, or walk a certain number of rniles every day, it would tend greatly to alleviate his disorder; but it would have still a better effect if he were obliged to labour a piece of ground. By digging, hoeing, planting, sowing, &c. both the body and mind would be exercised. A long journey, or a voyage, especially towards a warmer climate, with agreeable companions, has often very happy effects. A plan of this kind, with a strict attention to diet, is a much more rational method of cure, than confining the patient within doors and plying him with medicines.
MEDICINE. - In the cure of this disease particular attention must be paid to the mind. When the patient is in a low state, his mind ought to be soothed and diverted with a variety of amusements, as entertaining stories, pastimes, music, &c. This seems to have been the method of curing rnelancholy among the Jews, as we learn from the story of King Saul; and indeed it is a very rational one. Nothing can remove dieases of the mind so effectually as applications to the mind itself, the most efficacious of which is music. The patient's company ought likewise to consult of such persons as are agreeabIe to him. People in this state are apt to conceive unaccountable aversions against particular
persons; and the very sight of such persons is sufficient to distract their minds, and throw them into the utmost perturbation.
WHEN the patient is high, evacuations are necessary. In this case he must be bled, and have his body kept open by purging medicines, as manna, rhubarb, cream of tartar, or the soluble tartar. l have seen the last have very happy effects. It may be taken in the dose of half an ounce, dissolved in water-gruel, every day, for sundry weeks, or even for months, if necessary. More or less may be given according as it operates. Vomits have
likewise a good effect; but they must be pretty strong, otherwise they will not operate.
WHATEVER increases the evacuation of urine or promotes perspiration, has a tendency to rermove this disease. Both these secretions may be promoted by the use of nitre and vinegar. Half a drachm of purified nitre may be given three or four times a-day in any manner that is most agreeable to the patient; and an ounce and a half of distilled vinegar may be daily mixed with his drink. Dr. Locker seems to think vinegar the best medicine that can be given in this disease.
CAMPHIRE and musk have likewise been used in this case with advantage. Ten or twelve grains of camphire may be rubbed in a mortar with half a drachm of nitre, and taken twice a-day, or oftener, if the stomach will bear it. If it will not sit upon the stomach in this form, it may be made into pills with gum asafoetida and Russian castor, and taken in the quantity above directed. If musk is to be administered, a scruple or twenty-five grains of it may be made into a bolus with a little honey or common syrup, and taken twice or thrice a-day. We do not mean that all these medicines should be administered at once; but whichever of them is given, must be duly persisted in, and where one fails another may be tried.
AS it is very difficult to induce patients in this disease to take medicines, we shall mention a few outward applications which sometimes do good; the principal of these are issues, setons, and warm bathing. Issues may be made in any part of the body, but they generally have the best effect near the spine. The discharge from these may be greatly promoted by dressing them with the mild blistering ointment, and keeping what are commonly called the orrice pease in them. The most proper place for a seton is between the shoulder blades; and it ought to be upwards and downwards, or in the direction of the spine.
OF THE PALSY.
THE palsy is a loss or diminution of sense or motion, or of both, in one or more parts of the body. Of all the affections called nervous, this is the most suddenly fatal. It is more or less dangerous, according to the importance of the part affected. A palsy of the heart, lungs, or any part necessary to life, is mortal. When it affects the stomach, the intestines, or the bladder, it is highly dangerous. If the face be affected, the case is bad, as it shews that the disease proceeds from the brain. When the part affected feels cold, is insensible, or wastes away, or when the judgment and memory begin to fail, there is small hope of a cure.
CAUSES. - The immediate cause of palsy is any thing that prevents the regular exertion of the nervous power upon any particular rnuscle or part of the body. The occasional and predisposing causes are various, as drunkness; wounds of the brain, or spinal marrow; pressure upon the brain or nerves; very cold or damp air; the supression of customary evacuations; sudden fear; want of exercise; or whatever greatly relaxes the system, as drinking much tea, or coffee, &c. Many people imagine, that tea has no tendency to hurt the nerves, and that drinking the same quantity of warm water would be equally pernicious. This however seems to be a mistake. Many persons drink three or four cups of warm milk and water daily, without feeling any bad consequences; yet the same quantity of tea will make their hands shake for twenty-four hours. That tea affects the nerves is likewise evident from its preventing sleep, occasioning giddiness, dimness of the sight, sickness, &c. The palsy may likewise proceed from wounds of the nerves themselves, from the poisonous fumes of metals or minerals, as mercury, lead, arsenic,
IN young persons of a full habit, the palsy must be treated in the same manner as the sanguine apoplexy. The patient must be bled, blistered, and have his body opened by sharp clysters or purgative medicines. But, in old age, or when the disease proceeds from relaxation or debility, which is generally the case, a quite contrary course must be pursued. The diet must be warm and invigorating, seasoned with spicy and aromatic vegetables, as mustard, horse-radish, &c. The drink may be generous wine, mustard, whey, or brandy and water. Friction with the flesh brush, or a warm hand, is extremely proper, especially on the parts affected. Blistering-plasters may likewise be applied to the affected parts with advantage. When this cannot be done, they may be rubbed with the volatile linement, or the nerve ointment of the Edinbuirgh dispensatory. One of the best external applications is electricity. The shocks should be received on the part affected; and they ought daily to be repeated for several weeks.
VOMITS are very beneficial in this kind of palsy, and ought frequently to be administered. Cephalic snuff, or any thing that makes the patient sneeze, is likewise of use. Some pretend to have found great benefit from rubbing the parts affected with nettles; but this does not seem to be any way preferable to blistering. If the tongue is affected, the patient may gargle his mouth frequently with brandy and mustard, or he may hold a bit of sugar in his mouth wet with the palsy-drops or compound spirits of lavender. The wild valerian-root is a very proper medicine in this case. It may either be taken in an infusion with sage leaves, or half a drachm of it in powder may be given in a glass of wine three times a-day. If the patient cannot use the valerian, he may take of sal volatile oleosum, compound spirits of lavender, and tincture of castor, each half an ounce. Mix these together, and take forty or fifty drops in a glass of wine, three or four times a-day. A table-spoonful of mustard-seed taken frequently is a very good medicine. The patient ought likewise to chew cinnamon-bark, ginger, or other warm spiceries.
EXERCISE is of the utmost importance in the palsy; but the patient must beware of a cold, damp, and moist air. He ought to wear flannel next his skin; and, if possible, should remove into a warmer climate.
OF THE EPILEPSY, OR FALLING SICKNESS.
THE epilepsy is a sudden deprivation of all the senses, wherein the patient falls suddenly down, and is effected with violent convulsive motions. Children, especially those who are delicately brought up, are most subject to it. It more frequently attacks men than women, and is very difficult to cure. When the epilepsy attacks children, there is reason to hope it may go off about the time of puberty. When it attacks any person after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expected. If the fit continues only for a short space, and returns seldom, there is reason to hope; but if it continues long and returns frequently, the prospect is bad. It is a very unfavourable symptom when the patient is seized with the fits in his sleep.
CAUSES. - The epilepsy is sometimes hereditary. It may likewise proceed from frights of the mother when with child; from blows, bruises or wounds on the head; a collection of water, blood, or serous humours in the brain; a polypus; tumours or concretions within the skull; excessive drinking; intense study; excess of venery; worms; teething; suppression of customary evacuations; too great emptiness or repletion; violent passions or affections of the mind, as fear, joy, &c. hysteric affections; contagion received into the body, as the infection of the small-pox, measles, &c.
SYMPTOMS - An epileptic fit is generally preceded by unusual weariness; pain of the head,; dullness; giddiness; noise in the ears; dimness of sight; palpitation of the heart; disturbed sleep; difficult breathing; the bowels are inflated with wind; the urine is in great quantity, but thin; the complexion is pale; the extremities are cold, and the patient often feels, as it were, a stream of cold air ascending towards his head.
IN the fit, the patient generally makes an unusual noise; his thumbs are drawn in towards the palms of the hands; his eyes are distorted; he starts, and foams at the mouth; his extremities are bent or twisted various ways; he often discharges his seed, urine, and faeces involuntarfly; and is quite destitute of all sense and reason. After the fit is over, his senses gradually return, and he complains of a kind of stupor, weariness, and pain of his head; but has no remembrance of what happened to him during the fit.
THE fits are sometimes excited by violent affections of the mind, a debauch of liquor, excessive heat, cold, or the like.
THIS disease, from the difficulty of investigating its causes, and its strange symptoms, was formerly attributed to the wrath of the gods, or the agency of evil spirits. In modern times it has often, by the vulgar, been imputed to witchcraft or fascination. It depends however as much upon natural causes as any other malady; and its cure may often be effected by persisting in the use of proper means.
REGIMEN. - Epileptic patients ought, if possible, to breathe a pure and free air. Their diet should be light but nourishing. They ought to drink nothing strong, to avoid swines flesh, water-fowl, and likewise all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves cheerful, carefully guarding all violent passions, as anger fear, excessive joy, and the like.
EXERCISE is likewise of great use; but the patient must be careful to avoid all extremes either of heat or cold, all dangerous situations, as standing upon precipices, riding deep waters, and such like.
MEDICINE. - The intentions of cure must vary according to the cause of the disease. If the patient be of a sanguine temperament, and there be reason to fear an obstruction in the brain, bleeding and other evacuations will be necessary. When the disease is occassoned by the stoppage of customary evacuations, these, if possible, must be restored; if this cannot be done, others may be substituted in their place. Issues or setons, in this case, have often a very good effect. When there is reason to believe that the disease proceeds from worms, proper medicines must be used to kill, or carry off these vermin. When the disease proceeds from teething, the body should he kept open by emollient clysters, the feet frequently bathed in warm water, and, if the fits prove obstinate, a blistering-plaster may be put betwixt the shoulders. The same method is to be followed when epileptic fits precede the eruption of the small-pox, or measles, &c.
WHEN the disease is hereditary, or proceeds from a wrong formation of the brain, a cure is not to be expected. When it is owing to a debility, or too great an irritability of the nervous system, such medicines as tend to brace and strengthen the nerves may be used, as the Peruvian bark, and steel; or the anti-epileptic electuaries, recommended by Fuller and Mead. See Appendix, Electuary for the Epilepsy
THE flowers of zinc have of late been highly extolled for the cure of the epilepsy. Though this medicine will not be found to answer the expectations which have been raised concerning it, yet in obstinate epileptic cases it deserves a trial. The dose is from one to three or four grains, which may be taken either in pills, or a bolus, as the patient inclines. The best method is to begin with a single grain four or five times a-day, and gradually to increase the dose as far as the patient can bear it. I have known this medicine, when duly persisted in, prove beneficial.
MUSK has sometimes been found to succeed in the epilepsy. Ten or twelve grains of it with the same quantity of factious cinnabar, may be made up into a bolus, and taken every night and morning.
SOMETIMES the epilepsy has been cured by electricity.
CONVULSION FITS proceed from the same causes, and must be treated in the same manner as the epilepsy.
THERE is one particular species of convulsion fits which commonly goes by the name of St. Vitus's dance, wherein the patient is agitated with strange motions and gesticulations, which by the common people are generally believed to be the effects of witchcraft. This disease may be cured by repeated bleedings and purges; and afterwards using the medicines prescribed above for the epilepsy, viz. the Peruvian bark, and snake-root, &c. Chalybeate-waters are found to be beneficial in this case. The cold bath is likewise of singular service, and ought never to be neglected when the patient can bear it.
OF THE HICCUP.
THE hiccup is a spasmodic or convulsive affection of the stomach and midriff, arising from any cause that irritates their nervous fibres.
IT may proceed from excess in eating or drinking; from a hurt of the stomach; poisons; inflammations or scirrhous tumours of the stomach, intestines, bladder, midriff, or the rest of the viscera. In gangrenes, acute and malignant fevers, a hiccup is often the forerunner of death.
WHEN the hiccup proceeds from the use of aliment that is flatulent, or hard of digestion, a draught of generous wine, or a dram of any spirituous liquor, will generally remove it. If poison be the cause, plenty of milk and oil must be drank, as has been formerly recommended. When it proceeds from an inflammation of the stomach, &c. it is very dangerous. In this case the cooling regimen ought to be strictly observed, The patient must be bled, and take frequently a few drops of the sweet spirits of nitre in a cup of wine-whey. His stomach should likewise be fomented with cloths dipped in warm water; or have bladders filled with warm milk and water applied to it.
WHEN the hiccup proceeds from a gangrene or mortification, the Peruvian bark, with other antiseptics, are the only medicines which have a chance to succeed. When it is a primary disease, and proceeds from a foul stomach, loaded either with a pituitous or a bilious humour, a gentle vomit and purge, if the patient be able to bear them, will be of service. If it arises from flatulencies, the carminative medicines, directed for the heart-burn, must be used.
WHEN the hiccup proves very obstinate, recourse must be had to the most powerful aromatic and antispasmodic medicines. The principal of these is musk; fifteen or twenty grains of which may be made into a bolus, and repeated occasionally. Opiates are likewise of service, but they must be used with caution. A bit of sugar dipped in compound spirits of lavender, or the volatile aromatic tincture, may be taken frequently. External applications are sometimes also beneficial; as the stomach plaster, or a cataplasm of the Venice treacle of the Edinburgh or London dispensatory, applied to the region of the stomach.
I LATELY attended a patient who had almost a constant hiccup for above nine weeks. It was frequently stopped by the use of musk, opium, wine, and other cordial and antispasmodic medicines, but always returned. Nothing however gave the patient so much ease as brisk small beer. By drinking freely of this, the hiccup was often kept off for several days, which was more than could be done by the most powerful medicines. The patient was at length seized with a vomiting of blood, which soon put an end to his life. Upon opening the body, a large scirrhous tumour was found near the pylorus or right orifice of the stomach.
CRAMP OF THE STOMACH.
THIS disease often seizes people suddenly, is very dangerous, and requires immediate assistance. It is most incident to persons in the decline of life, especially the nervous, gouty, hysteric, and hypochondriac.
IF the patient has any inclination to vomit, he ought to take some draughts of warm water, or weak camomile-tea, to cleanse his stomach. After this, if he has been costive, a laxative clyster may be given. He ought then to take laudanum. The best way of administering it is in a clyster. Sixty or seventy drops of liquid laudanum may be given in a clyster of warm water. This is much more certain than laudanum given by the mouth, which is often vomited, and in some cases increases the pain and spasms in the stomach.
IF the pain and cramps return with great violence, after the effects of the anodyne clyster are over, another, with an equal or a larger quantity of opium, may be given; and every four or five hours a bolus, with ten or twelve grains of musk, and half a drachm of the Venice treacle.
IN the mean time, the stomach ought to be fomented with cloths dipped in warm water, or bladders filled with warm milk and water, should be constantly applied to it. I have often seen these produce the most happy effects. The anodyne balsam may also be rubbed on the part affected; and an anti-hysteric plaster worn upon it, for some time after the cramps are removed, to prevent their return.
IN very violent and lasting pains of the stomach, some blood ought to be let, unless the weakness of the patient forbids it. When the pain or cramps proceed from a suppression of the menses, bleeding is of use. If they be owing to the gout, recourse must be had to spirits, or some of the warm cordial waters. Blistering-plasters ought likewise, in this case, to be applied to the ancles. I have often seen violent cramps and pains of the stomach removed by covering it with a large plaster of Venice treacle.
OF THE NIGHT-MARE.
IN this disease the patient, in time of sleep, imagines he feels an uncommon oppression of weight about his breast or stomach, which he can by no means shake off. He groans, and sometimes cries out, though he oftener attempts to speak in vain. Sometimes he imagines himself encgaged with an enemy, and in danger of being killed, attempts to run away, but finds he cannot. Sometimes he fancies himself in a house that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dashed to pieces suddenly awakes him.
THIS disorder has been supposed to proceed from too much blood; from a stagnation of blood in the brain and lungs; &c. But it is rather a nervous affection, and arises chiefly from indigestion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the night-mare. Nothing tends more to produce it than heavy suppers, especially when ate late, or the patient goes to bed soon after. Wind is likewise a very frequent cause of this disease; for which reason those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that oppresses the mind, ought also to be avoided.
AS persons afflicted with the night-mare generally moan, or make some noise in the fit, they should be waked, or spoken to by such as hear them, as the uneasiness generally goes off as soon as the patient is awake. Dr. Whytt says, he generally found a dram of brandy taken at bed-time, prevent this disease. That, however, is a bad custom, and, in time, loses its effect. We would rather have the patient depend upon the use of food of easy digestion, cheerfulness, exercise through the day, and a light supper taken early, than to accustom himself to drams. A glass of peppermint-water will often promote digestion as much as a glass of brandy, and is much safer. After a person of weak digestion, however, has ate flatulent food, a dram may be necessary; in this case we would recommend it as the most proper medicine.
PERSONS who are young, and full of blood, if troubled with the night-mare, ought to take a purge frequently, and use a spare diet.
PEOPLE of weak nerves or delicate constitutions are liable to swoonings or fainting fits. These indeed are seldom dangerous when duly attended to; but when wholly neglected, or improperly treated, they often prove hurtful, and sometimes fatal.
THE general causes of swoonings are sudden transitions from cold to heat; breathing air that is deprived of its proper spring or elasticity; great fatigue; excessive weakness; loss of blood; long fasting; fear, grief, and other violent passions, or affections of the mind.
IT is well known, that persons who have been long exposed to cold, often faint or fall into a swoon, upon coming into the house, especially if they drink hot liquor, or sit near a large fire. This might easily be prevented by people taking care not to go into a warm room immediately after they have been exposed to the cold air, to approach the fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature.
WHEN any one, in consequence of neglecting these precautions, falls into a swoon, he ought immediately to be removed to a cooler apartment, to have ligatures applied above his knees and elbows, and to have his hands and face sprinkled with vinegar or cold water. He should likewise be made to smell to vinegar, and should have a spoonful or two of water, if he can swallow, with about a third part of vinegar mixed with it, poured into his mouth. If these should not remove the complaint, it will be necessary to bleed the patient, and afterwards to give him a clyster.
AS air that is breathed frequently, loses its elasticity or spring, it is no wonder if persons who respire in it often fall into a swoon or fainting fit. They are, in this case, deprived of the very principle of life. Hence it is that fainting fits are so frequent in all crowded assemblies, especially in hot seasons. Such fits however must be considered as a kind of temporary death; and to the weak and delicate, they sometimes prove fatal. They ought therefore with the utmost care to be guarded against. The method of doing this is obvious. Let assembly rooms, and all other places of public resort, be large and well ventilated; and let the weak and delicate avoid such places, particularly in warm seasons.
A PERSON who faints, in such a situation, ought immediately to be carried into the open air; his temples should be rubbed with strong vinegar or brandy, and volatile spirits or salts held to his nose. He should be laid upon his back with his head low, and have a little wine, or some other cordial, as soon as he is able to swallow it, poured into his mouth. If the person has been subject to hysteric fits, castor or asafoetida should be applied to the nose, or burnt feathers, horn, or leather, &c.
WHEN fainting fits proceed from mere weakness or exhaustion, which is often the case after great fatigue, long fasting, loss of blood, or the like, the patient must be supported with generous cordials. as jellies, wines, spirituous liquors, &c. These however must be given at first in very small quantities, and increased gradually as the patient is able to bear them. He ought to be allowed to lie quite still and easy upon his back, with his head low, and should have fresh air admitted into his chamber. His food should consist of nourishing broths, sago-gruel with wine, new milk, and other things of a light and cordial nature. These things are to be given out of the fit. All that can be done in the fit is to let him smell to a bottle of Hungary-water, eau de luce, or spirits of hartshorn, and to rub his temples with warm brandy, or to lay a compress dipped in it to the pit of the stomach.
IN fainting fits that proceed from fear, grief, or other violent passions or affections of the mind, the patient must be very cautiously managed. He should be suffered to remain at rest, and only made to smell to some vinegar. After he is come to himself he may drink freely of warm lemonade, or balm tea, with some orange or lemon-peel in it. It will likewise be proper, if the fainting fits have been long and severe, to clean the bowels by throwing in an emollient clyster.
IT is common in fainting fits, from whatever cause they proceed, to bleed the patient. This practice may be very proper in strong persons of a full habit; but in those who are weak and delicate, or subject to nervous disorders, it is dangerous. The proper method with such people is to expose them to the free air, and to use cordial and stimulating medicines, as volatile salts, Hungary-water, spirits of lavender, tincture of castor, and the like.
OF FLATULENCIES, OR WIND.
ALL nervous patients, without exception, are afflicted with wind or flatulencies in the stomach and bowels, which arise chiefly from the want of tone or vigour in these organs. Crude flatulent aliment, as green peas, beans, coleworts, cabbages, and such like, may increase this complaint; but strong and healthy people are seldom troubled with wind, unless they either overload their stomachs, or drink liquors that are in a fermenting state, and consequently full of elastic air. While therefore the matter of flatulence proceeds from our aliments, the cause which makes air separate from them in such quantity as to occasion complaints, is almost always a fault of the bowels themselves, which are too weak either to prevent the product of elastic air, or to expel it after it is produced.
TO relieve this complaint, medicines ought to be used as have a tendency to expel wind, and by strengthening the alimentary canal to prevent its being produced there. Many nervous people find great benefit from eating a dry biscuit, especially when the stomach is empty. I look upon this as one of the best carminative medicines; and would recommend it in all complaints of the stomach, arising from flatulence, indigestion, &c.
THE list of medicines for expelling wind is very numerous; they often however disappoint the expectations of both the physician and his patient. The most celebrated among the class of carminatives are juniper berries; the roots of ginger and zedoary; the seeds of anise, caraway, and coriander; gum asafoetida and opium; the warm waters, tinctures, and spirits, as the aromatic water, the tincture of woodfoot, the volatile aromatic spirit, aether, &c.
DR. WHYTT says, he found no medicines more efficacious in expelling wind than aether and laudanum. He generally gave the laudanum in a mixture with peppermint-water and tincture of castor, or sweet spirits of nitre. Sometimes, in place of this, he gave opium in pills with asafoetida. He observes that the good effects of opiates are equally conspicuous, whether the flatulence be contained in the stomach or intestines; whereas these warm medicines, commonly called carminatives, do not often give immediate relief, except when the wind is in the stomach.
WITH regard to aether, the Doctor says, he has often seen very good effiects from it in flatulent complaints, where other medicines failed. The dose is a tea-spoonful mixed with two table-spoonfuls of water. Though the patient may begin with this quantity, it will be necessary to increase the dose gradually as the stomach can bear it. Aether is now given in considerable greater doses than it was in Dr. Whytt's time. In gouty cases he observes that aether, a glass of French brandy, or of the aromatic water; or ginger, either taken in substance or infused in boiling water, are among the best medicines for expelling wind.
WHEN the care of flatulent patients is such as makes it improper to give them warm medicines inwardly, the Doctor recommends external applications, which are sometimes of advantage. Equal parts of the anti-hysteric and stomach plaster may be spread upon a piece of soft leather, of such size as to cover the greatest part of the belly. This should be kept on for a considerable time, provided the patient be able to bear it; if it should give great uneasiness, it may be taken off, and the following liniment used in its stead.
TAKE of Bates's anodyne balsam an ounce; of the expressed oil of mace half an ounce; oil of mint two drachms. Let these ingredients be mixed together, and about a table-spoonful well rubbed on the parts at bed-time.
FOR strengthening the stomach and bowels, and consequently for lessening the production of flatulence, the Doctor recommends the Peruvian bark, bitters, chalybeates, and exercise. In flatulent cases, he thinks some nutmeg or ginger should be added to the tincture of the bark and bitters, and that the aromatic powder should be joined with the filings of iron.
WHEN windy complaints are attended with costiveness, which is often the case, few things will be found to answer better than four or five of the following pills taken every night at bed-time.
TAKE of asafoetida two drachms; succotrine aloes, salt of iron, and powdered ginger, of each one drachm; as much of the elixir proprietatis as will be sufficient to form them into pills.
ON the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm or two scruples of the Japonic confection, given every other evening, will have very good effects.
IN those flatulent complaints which come on about the time the menses cease, repeated small bleedings often give more relief than any other remedy.
WITH regard to diet, the Doctor observes, that tea, and likewise all flatulent aliments, are to be avoided; and that for drink, water with a little brandy or rum is not only preferable to malt liquor, but, in most cases, also to wine.
AS Dr. Whytt has paid great attention to this subject, and as his sentiments upon it in a great measure agree with mine, I have taken the liberty to adopt them; and should only add to his observations, that exercise is in my opinion, superior to all medicine, both for preventing the production and likewise for expelling of flatulencies. These effects, however, are not to be expected from sauntering about or lolling in a carriage, but from labour, or such active amusements as give exercise to every part of the body.
OF LOW SPIRITS.
ALL who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise and amusements, are the most likely means to remove this complaint. It is greatly increased by solitude and indulging gloomy ideas; but may often be relieved by cheerful company and sprightly amusements.
WHEN low spirits are owing to a weak relaxed state of the stomach and bowels, an infusion of the Peruvian bark with cinnamon or nutmeg will be proper. Steel joined with aromatics may likewise in this case be used with advantage; but riding, and a proper diet, are most to be depended on.
WHEN they arise from a foulness of the stomach and intestines, or obstruction in the hypochondriac viscera, aloetic purges will be proper. I have sometimes known the Harrowgate sulphur-water of service in this case.
WHEN low spirits proceed from a suppression of the menstrual or of the hemorrhoidal flux, these evacuations may either be restored, or some others substituted in their place, as issues, setons, or the like. Dr. Whytt observes, that nothing has such sudden good effects in this case as bleeding.
WHEN low spirits have been brought on by long continued grief, anxiety, or other distress of mind, agreeable company, variety of amusements, and change of place, especially travelling into foreign countries, will afford the most certain relief.
PERSONS afflicted with low spirits should avoid all kind of excess, especially of venery and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful; but when taken to excess they weaken the stomach, vitiate the humours, and depress the spirits. This caution is the more necessary, as the unfortunate and melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction.
OF HYSTERIC AFFECTIONS.
THESE likewise belong to the numerous tribe of nervous diseases, which may be justly reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons a hysteric fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid humour, or the like. A sudden suppression of the menses often gives rise to hysteric fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments.
SOMETIMES the hysteric fit resembles a swoon or fainting fit, during which the patient lies as in a sleep, only the breathing is so low as scarce to be perceived. At other times the patient is affected with catchings and strong convulsions. The symptoms which precede hysterical fits are likewise various in different persons. Sometimes the fits come on with coldness of the extremities, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting; afterwards it rises into the gullet, and occasions a degree of suffocation, to which quick breathing, palpitation of the heart, giddiness of the head, dimness of the sight, loss of hearing, with convulsive motions of the extremities and other parts of the body, succeed. The hysteric paroxysm is often introduced by an immoderate fit of laughter, and sometimes it goes off by crying. Indeed there is not much difference between the laughing and crying of an highly hysteric lady.
OUR aim in the treatment of this disease must be to shorten the fit or paroxysm when present, and to prevent its return. The longer the fits continue, and the more frequently they return, the disease becomes the more obstinate. Their strength is increased by habit, and they induce so great a relaxation of the system, that it is with difficulty removed.
IT is customary, during the hysteric fit or paroxysm, to bleed the patient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper, but in weak and delicate constitutions, or where the disease has been of long standing, or arises from inanimation, it is not safe. The best course in such cases is to rouse the patient by strong smells, as burnt feathers, asafoetida, or spirits of hartshorn, held to the nose. Hot bricks may also be applied to the soles of the feet, and the legs, arms, and belly may be strongly rubbed with a warm cloth. But the best application is to put the feet and legs into warm water. This is peculiarly proper when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafoetida will be proper and, as soon as the patient can swallow, two table-spoonfuls of a solution of asafoetida, or of some cordial julep, may be given.
THE radical cure of this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly promoted by a proper attention to diet. A milk and vegetable diet, when duly persisted in, will often perform a cure. If, however, the patient has been accustomed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most proper drink is water with a small quantity of spirits. A cool dry air is the best. Cold bathing and every thing that braces the nerves, and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body is hurtful. It is of the greatest importance to have the mind kept constantly easy and cheerful, and, if possible, to have it always engaged in some agreeable and interesting pursuit.
WHEN hysteric fits are occasioned by sympathy, they may be cured by exciting an opposite passion. This is said to have been the case of a whole school of young ladies in Holland, who were all cured by being told, that the first who was seized should be burnt to death. But this method of cure, to my knowledge, will not always succeed. I would therefore advise, that young ladies who are subject to hysteric fits should not be sent to boarding schools, as the disease may be caught by imitation,
THE proper medicines are those which strengthen the alimentary canal and the whole nervous system, as the preparations of iron, the Peruvian bark, and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a-day. The bark and iron may likewise be taken in substance, provided the stomach can bear them; but they are generally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder.
IF the stomach is loaded with phlegm, vomits will be of use; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there be a tendency to costiveness, it must be removed either by diet, or by taking an opening pill as often as it shall be found necessary.
TO lessen the irritability of the system, antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opium, and castor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is often successful in removing those periodical head-achs to which hysteric and hypochondriac patients are subject. Castor has in some cases been found to procure sleep where opium failed; for which reason Dr. Whytt advises, that they should be joined together. He likewise recommends the anti-hysteric plaster to be applied to the abdomen. Though antispasmodics and anodynes are universally recommended in this disease, yet all the extraordinary cures that I ever knew in hysteric cases were performed by means of tonic and corroborating medicines.
HYSTERIC women are often afflicted with cramps in various parts of the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphire, and the warm bath.
CRAMPS are often prevented or cured by compression. Thus cramps in the legs are prevented, and sometimes removed, by tight bandages, and, when convulsions arise from a flatulent distention, of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong compression upon the abdomen by means of a broad belt. A roll of brimstone held in the hand is frequently used as a remedy for cramps: Though this seems to owe its effect chiefly to imagination; yet, as it sometimes succeeds, it merits a trial. When spasms or convulsive motions arise from sharp humours in the stomach and intestines, no lasting relief can be procured till these are either corrected or expelled. The Peruvian bark has sometimes cured periodic convulsions after other medicines had failed. Some persons afflicted with cramps pretend to reap great benefit from small bundles of rosemary tied all night about their feet, ancles, and knees.
OF HYPOCHONDRIAC AFFECTIONS.
THIS disease generally attacks the indolent, the luxurious, the unfortunate, and the studious. It becomes daily more common in this country, owing no doubt to the increase of luxury and sedentary employments. It has so near a resemblance to the immediately preceding, that many authors consider them as the same disease, and treat them accordingly. They require however a very different regimen; and the symptoms of the latter, though less violent, are more permanent than those of the former.
MEN of a melancholy temperament, whose minds are capable of great attention, and whose passions are not easily moved, are, in the advanced periods of life, most liable to this disease. It is usually brought on by long and serious attention to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous eruptions, long continued evacuations, obstructions in some of the viscera, as the liver, spleen, &c.
HYPOCHONDRIAC persons ought never to fast long, and their food should be solid and nourishing. All acescent, and windy vegetables are to be avoided. Flesh meats agree best with them, and their drink should be old claret, or good madeira. Should these disagree with the stomach, water with a little brandy or rum in it may be drank.
CHEERFULNESS and serenity of mind are by all means to be cultivated. Exercise of every kind is useful. The cold bath is likewise beneficial; and where it does not agree with the patient, frictions with the flesh-brufh or a coarse cloth may be tried. If the patient has it in his power, he ought to travel either by sea or land. A voyage or a long journey, especially towards a warmer climate will be of more service than any medicine.
THE general intentions of cure, in this disease, are to strengthen the alimentary canal, and to promote the secretions. These intentions will be best answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations, may be taken in the same manner as directed in the preceding disease.
IF the patient be costive, it will be necessary to make use of some gentle opening medicine, as pills composed of equal parts of aloes, rhubarb, and asafoetida, with as much of the elixir proprietatis, as is necessary to form the ingredients into pills, Two, three, or four of these may be taken as often as it shall be found needful to keep the body gently open. Such as cannot bear the asafoetida may substitute Spanish soap in its place.
THOUGH a cheerful glass may have good effects in this disease, yet all manner of excess is hurtful. Intense study, and every thing that depresses the spirits, are likewise pernicious.
THOUGH the general symptoms and treatment of nervous disorders were pointed out in the beginning of this chapter; yet, for the behoof of the unhappy persons afflicted with those obstinate and complicated maladies, I have treated several of their capital symptoms under distinct or separate heads. These however are not to be considered as different diseases, but as various modifications of the same disease.They all arise from the same general causes, and require nearly the same method of treatment. There are many other symptoms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I shall therefore omit them altogether, and conclude this chapter with a few general remarks on the most obvious means of preventing or avoiding nervous disorders.
IN all persons afflicted with nervous disorders, there is a great delicacy and sensibility of the whole nervous system, and an uncommon degree of weakness of the organs of digestion. These may be either natural or acquired. When owing to a defect in the constitution, they are hardly to be removed; but may be mitigated by proper care. When induced by diseases, as long or repeated fevers, profuse haemorrhages, or the like, they prove also very obstinate, and will yield only to a course of regimen calculated to restore and invigorate the habit.
BUT nervous affections arise more frequently from causes which it is in a great measure in our own power to avoid, than from diseases, or an original fault in the constitution. Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases.
IT has been already been observed, that grief indulged destroys the appetite and digestion, depresses the spirits, and induces an universal relaxation and debility of the whole system. Instances of this are daily to be seen. The loss of a near relation, or any other misfortune in life, is often sufficient to occasion the most complicated series of nervous symptoms. Such misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and proper exertion of the mind, might be rendered less hurtful. For directions in this matter we must refer the reader to the article GRIEF, in the Chapter on the passions.
THE effects of intense study are pretty similar to those occasioned by grief. It preys upon the animal spirits, and destroys the appetite and digestion. To prevent these effects, studious persons ought, according to the Poet, to toy with their books. They should never study too long at a time; nor attend long to one particular subject, especially if it be of a serious nature. They ought likewise to be attentive to their posture, and should take care frequently to unbend their minds by music, diversions, or going into agreeable company.
WITH regard to diet, I shall only observe, that nervous diseases may be induced either by excess or inanition. Both of these extremes hurt digestion, and vitiate the humours. When Nature is oppressed with fresh loads of food, before she has had time to digest and assimilate the former meal, her powers are weakened, and the vessels are filled with crude humours. On the other hand, when the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with wind, and the humours, for want of regular fresh supplies of wholesome chyle, are vitiated. These extremes are therefore with equal care to be avoided. They both tend to induce a relaxation and debility of the nervous system, with all its dreadful train of consequences.
BUT the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is, that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labour or suffer diseases, surely no individual has any right to expect an exemption from the general rule.
THOSE, however, who are willing to take exercise, but whose occupations confine them to the house, and perhaps to an unfavourable posture, really deserve our pity, We have in a former part of the book endeavoured to lay down rules for their conduct; and shall only add, that where these cannot be complied with, their place may, in some measure, be supplied by the use of bracing and strengthening medicines, as the Peruvian bark, with other bitters; the preparations of steel; the elixir of vitriol, &c.