Vickipedia

ANTIPHLOGISTIC (Gr. anti, against, and phlego, I burn), a term applied to remedies, and also to regimen, that are opposed to inflammation; such as blood-letting, purgatives, low diet, &c.

PA’LATE, the, forms the roof of the mouth, and consists of two portions, the hard palate in front and the soft palate behind. The framework of the hard palate is formed by the palate process of the superior maxillary bone, and by the horizontal process of the palate bone, and is bounded in front and at the sides by the alvolar arches and gums, and posteriorly it is continuous with the soft palate. It is covered by a dense structure formed by the periosteum and mucous membrane of the mouth, which are closely adherent. Along the middle line is a linear ridge or raphe, on either side of which the mucous membrane is thick, pale, and corrugated, while behind it is thin, of a darker tint, and smooth. This membrane is covered with scaly epithelium, and is furnished with numerous follicles (the palatal glands). The soft palate is a movable fold of mucous membrane enclosing muscular fibres, and suspended from the posterior border of the hard palate so to form an incomplete septum between the mouth and the pharynx; its sides being blended with the pharynx, while its lower border is free. When occupying its usual position (that is to say, when the muscular fibres contained in it are relaxed), its anterior surface is concave; and when its muscles are called into action, as in swallowing a morsel of food, it is raised and made tense, and the food is thus prevented from passing into the posterior nares, and is at the same time directed obliquely backwards and downwards into the pharynx.

Hanging from the middle of its lower border is a small conical pendulous process, the uvula ; and passing outwards from the uvula on each side are two curved folds of mucous membrane containing muscular fibres, and called the arches or pillars of the soft palate. The anterior pillar is continued downwards to the side of the base of the tongue, and is formed by the projection of the palato-glossus muscle. The posterior pillar is larger than the anterior, and runs downwards and backwards to the side of the pharynx. The anterior and posterior pillars are closely united above, but are separated below by an angular interval, in which the tonsil of either side is lodged. The tonsils (amygdalæ) are glandular organs of a rounded form, which vary considerably in size in different individuals. They are composed of an assemblage of mucous follicles, which secrete a thick grayish matter, and open on the surface of the gland by numerous (12 to 15) orifices.

The space left between the arches of the palate on the two sides is called the isthmus of the fauces. It is bounded above by the free margin of the palate, below by the tongue, and on each side by the pillars of the soft palate and tonsils.

As the upper lip may be fissured through imperfect development (in which case it presents the condition known as hare-lip), so also may there be more or less decided fissure of the palate. In the slightest form of this affection, the uvula merely is fissured, while in extreme cases the cleft extends through both the soft and hard palate as far forward as the lips, and is then often combined with hare-lip. When the fissure is considerable, it materially interferes with the acts of sucking and swallowing, and the infant runs a great risk of being starved; and if the child grows up, its articulation is painfully indistinct. When the fissure is confined to the soft palate, repeated cauterization of the angle of the fissure has been found sufficient to effect a cure by means of the contraction that follows each burn. As a general rule, however, the child is allowed to reach the age of puberty when the operation of staphyloraphy (or suture of the soft parts) is performed—an operation always difficult, and not always successful. For the method of performing it, the reader is referred to the Practical Surgery of Mr. Fergusson. who has introduced several most important modifications into the old operation.

Acute inflammation of the tonsils, popularly known as quinsy, is treated of in a separate article.

Chronic enlargement of the tonsils is very frequent in scrofulous children, and is not rare in scrofulous persons of more advanced age, and may give rise to very considerable inconvenience and distress. It may occasion difficulty in swallowing, confused and inarticulate speech, deafness in various degrees from closure of the eustachian tubes (now often termed throat deafness), and noisy and laborious respiration, especially during sleep; and it may even cause death by suffocation, induced by the entanglement of viscid mucus between the enlarged glands. Iodide of iron (especially in the form of Blancard’s Pills) and cod-liver oil are the medicines upon whose action most reliance should be placed in these cases, while a strong solution of nitrate of silver (a scruple of the salt to an ounce of distilled water), or some preparation of iodine, should be applied once a day to the affected parts. If these measures fail, the tonsils must be more or less removed by the surgeon, either by the knife or scissors, or by a small guillotine specially invented for the purpose.

Enlargement or relaxation of the uvula is not uncommon and gives rise to a constant tickling cough, and to expectoration, by the irritation of the larynx which it occasions. If it will not yield to astringent or stimulating gargles, or to the stronger local applications directed for enlarged tonsils, its extremity must be seized with the forceps, and it must be divided through the middle with a pair of long scissors.

PAIN is an undefinable sensation, of the nature of which all persons are conscious. It resides exclusively in the nervous system, hut may originate from various sources. Irritation, or excessive excitement of the nervous system, may produce it; it frequently precedes and accompanies inflammation; while it sometimes occurs in, and seems to be favored by, a state of positive depression, as is seen in the intense pain which is often experienced in a limb benumbed with cold, in the pain which not unfrequently accompanies palsy, and in the we’ll known fact, that neuralgia is the common result of general debility. Hence, pain must on no account be regarded as a certain indication of inflammation, although it rarely happens that pain is not felt at some period or other in inflammatory diseases. Moreover, the pain that belongs to inflammation, differs very much, according to the organ or tissue affected; the pain, for example, in inflammation of the lungs, differs altogether in character from that which occurs in inflammation of the bowels, and both these pains from that occurring in inflammation of the kidneys.

Pain differs not only in its character, which may be dull, sharp, aching, tearing, gnawing, stabbing, &c., but in its mode of occurrence; for example, it may be flying or persistent, intermittent, remittent, or continued. It is not always that the pain is felt in the spot where the cause of it exists. Thus, inflammation of the liver or diaphragm may cause pain in the right shoulder, the irritation caused by stone in the bladder produces pain at the outlet of the urinary passage; disease of the hip-joint occasions pain in the knee, disease of the heart is often accompanied with pain in the left arm, and irritation of the stomach often gives rise to headache. Pain is differently felt by persons of different constitutions and temperaments, some persons being little sensitive to painful impressions of any kind, while others suffer greatly from slight causes. There even seems to be national differences in this respect; and before the introduction of chloroform, it was a matter of common observation that Irishmen were always more troublesome subjects for surgical operations than either Englishmen or Scotchmen; and the negro is probably less sensitive to pain than any of the white races.

Although in most cases we are to regard pain merely as a symptom to be removed only by means which remove the lesion which occasions it, there are cases in which, although it is only a symptom, it constitutes a chief element of disease, and one against which remedies must be specially directed. As examples of these cases, may be mentioned neuralgia, gastralgia, colic, dysmenorrhoea, and perforation of the intestines; and in a less degree, the stitch of pleurisy, which, if not relieved, impedes the respiration, and the pain of tenesmus, which often causes such efforts to empty the lower bowel, as seriously to disturb the functions of the intestine, and to exhaust the strength.

For the methods of relieving pain, the reader is referred to the articles on the different diseases in which it specially occurs (as colic, neuralgia, pleurisy, &c.), and to those on chloroform, ether, indian hemp, morphia, narcotics, opium, &c.

A’NUS, THE, AND ITS DISEASES. The term anus is applied by anatomists to the lower or (in the case of animals) the posterior aperture of the intestinal canal; the rectum terminating externally in the anus. With regard to its anatomy, it is sufficient to state that it is kept firmly closed on ordinary occasions by the external and internal sphincter muscles, the former of which contracts the integument around the opening, and, by its attachment to the coccyx behind, and to a tendinous center in front, helps the levator ani muscle in supporting the aperture during the expulsive efforts that are made in the passage of the faeces or intestinal evacuations; while the latter or internal sphincter, is an aggregation of the circular muscular fibres of the lowest part of the rectum, and acts in contracting the extremity of the tube. The main function of the levator ani muscle is expressed in its name, it being the antagonist of the diaphragm and other muscles which act in the expulsion of the fasces. The integument around the anus lies in radiating plaits, which allow of its stretching without pain during the passage of the faeces; and the margin is provided with a number of sebaceous glands, which, in some of the lower animals, secrete strongly odorous matters. See ANAL GLANDS. Infants are occasionally born with an imperforate anus, or congenital closure of the rectum. In the simplest form of this affection, the anus is merely closed by thin skin, which soon becomes distended with the Meconium (q. v.). More complicated cases are those (1) in which the gut terminates some distance above the seat of the anus in a blind sac or pouch; (2) where the rectum terminates in the bladder, &c. Fortunately, the closure by a layer of skin is far the most common form of imperforate anus, and the little patient is at once relieved by a very simple surgical operation. If, however, no treatment be adopted, which is too often the case, in consequence of a popular delusion that the affection is incurable, the abdomen becomes distended and hard, vomiting comes on, the vomited matters soon assume a faecal smell, and the infant dies in a few days, either from exhaustion or rupture of the intestines.

Spasm of the Sphincter Ani is by no means a rare affection; it is characterized by violent pain of the anus, with difficulty in passing the fasces. On attempting an examination, the muscle feels hard, and resists the introduction of the finger. It usually occurs in sudden paroxysms, which soon go off; but sometimes it is of a more persistent character. Its causes are not clearly known, and although most surgeons regard it as a special affection, some consider that the spasm is not a disease in itself, but merely a symptom of some slight excoriation or ulceration.

Suppositories containing opium or belladonna introduced during the period of relaxation, are sometimes of use; and if there are ulcers, they must be specially treated. Ulceration occurring as a breach of surface at one or more points around the anus, but not extending within the orifice, is by no means uncommon in persons who are not attentive to cleanliness, and especially in women with vaginal discharges. Strict attention to cleanliness, the patient being directed to apply warm water to the parts at least twice daily with a sponge (which after each operation should be carefully rinsed out), and one or two applications of the solid nitrate of silver, followed by black-wash, will effect a speedy cure. If the ulcer is seated partly without the anus and partly within the rectum, the distress is much more severe, and the treatment often requires the use of a knife. Fissure of the anus is a term applied to an affection consisting in one or more cracks, excoriations, or superficial ulcerations, situated between the folds of the skin and mucous membrane at the verge of the anus, and only slightly involving the rectum. They give rise to intense pain during the passage of the evacuations, and for some hours afterwards to great discomfort, smarting, and itching. The treatment to be adopted is to endeavor to procure regular and somewhat soft evacuations, and to sponge with warm water immediately afterwards, the parts being dried with a soft cloth. One or two applications of solid nitrate of silver will sometimes cure the disease; and an ointment of oxide of zinc, or one containing chloroform, will sometimes serve to allay the irritation and heal the parts.—Pruritus ani, which simply means intense itching and irritation of this part, is perhaps rather to be regarded as a symptom of certain morbid changes rather than as a special disorder; but as it is a very common affection, and is productive of much suffering it must not be passed over. It is often associated with an unhealthy state of the intestinal secretions, or with simple constipation; with a congested state of the mucous membrane; with a disordered condition of the womb; with the presence of thread-worms in the rectum, &c.; and it is peculiarly common in persons whose occupations are sedentary. The affection is often much aggravated by the patient’s being unable to refrain from scratching the parts, which leads to excoriations, ulcerations, thickening of the skin, &c. The symptoms are usually most severe when the sufferer begins to get warm in bed. If the affection arise from worms, or a loaded state of the large intestines, enemata and purgatives will give immediate relief. If unhealthy excretions exist, attention must be paid to the diet, and the occasional administration of a pill containing a grain of calomel and four grains of watery extract of aloes, together with the local application of soap and water to the parts, will often stop the itching. If there are any cracks or ulcers, nitrate of silver must be applied until they heal. To prevent the reappearance of these sores, the patient should bathe the parts night and morning with a strong solution of alum. An ointment composed of a drachm of calomel and an ounce of lard is strongly recommended by Mr. Smith of King’s College Hospital, when other means have failed; who also states that the daily introduction of a well-oiled bougie, made of black wax, will sometimes succeed in very obstinate cases. The other principal affections of the anus are Fistula, Piles, and Prolapsus, which are discussed in special articles.

ANA’TOMY (Gr., a cutting up or dissecting) is the science of the form and structure of organic bodies, and is practically acquired by separation of the parts of a body, so as to show their distinct formation, and their relations with each other. It is generally understood as applied to the human body, while the A. of animals is styled zootomy, and that of plants, phytotomy. The investigation and comparison of the structures of the different kinds of organic bodies is styled comparative A. Theoretical A. is divided into general and special.

general A. gives a description of the elementary tissues of which the systems and organs of the body are composed, as preliminary to an examination of them in their combined state in the various organs : it also investigates their laws of formation and combination, and the changes which they undergo in various stages of life. This branch of study may also be styled Structural or Analytical A., and has been first developed in recent times, especially by Bichat (1801) and Bordeu, who have been followed by J. Müller, Goodsir, Mayer, E, H. Weber, Schwann, Valentin, and many others. In our day, microscopic investigation has been successfully applied to the study of elementary textures. See histology.

special A. (styled Descriptive by the French writers) treats of the several parts and organs of the body in respect to their form, structure, and systematic connection or relation with each other. The arrangement of the several parts and organs in an order deduced from their similarity in structure or use, constitutes systematic A. According to this mode of study, which is essential as an introduction to physiology, A. has been divided, though not with scientific precison, into six branches of study. 1. Osteology, which treats of the bones, including the cartilages of the joints (chondrology).—2. Syndesmology, which describes the ligaments, or bands, that unite the bones of various joints. The bones, with their cartilages and ligaments, form a framework, which supports the external soft parts, and within which the vital organs are suspended and protected from injury; they are also arranged in a mechanical system as instruments of motion.—3. Myology explains the system of the muscles, which, by their contractile power, serve to impart motion to the bones and joints; while, like the bones, they contribute to form the cavities of the body, and to protect the internal organs. Their structure also serves to produce the external shape and symmetry.—4. Angeiology describes the vessels or ducts, with their complex network and ramifications, spreading over most parts of the body, and divided into two great systems : (a), the blood-vessels with the heart, a fleshy organ propelling the blood through the pulsating vessels or arteries, from which it returns to the heart, after circulation through the veins; (b), the lymphatics, by which a certain fluid (lymph) is brought into union with the blood in the organ styled lymphatic glands, and is afterwards passed into the veins.—5 Neurology, or the doctrine of the nerves, describes the nervous system, as divided into, first, the two central masses of the brain and the spinal column; second, the ramifications of nerves running from the brain and spinal column to almost all points of the surface; and lastly, the order of nerves having a peculiar structure, and styled the ganglionic system of nerves.—6. Splanchnology describes the viscera or organs formed by combination of the distinct systems of veins, nerves, lymphatics, &c., and mostly situated in the cavities of the body. These are divided into five groups, viz.: (a), the organs of sensation—sight, hearing, smell, taste, and touch; (b), of voice and respiration—nostrils, mouth, larynx, trachea, and lungs, with the thyroid gland, the thymus gland, and the diaphragm; (c), digestive organs—the mouth, with its salivary glands, the throat, gullet, the stomach, the intestines, with the liver, spleen, and pancreas; (d), the urinary organs— kidneys, ureter, bladder, and urethra; (e), sexual organs of both sexes.

Special A. may be treated in another mode ; by an arrangement made in accordance with natural divisions, or by imaginary lines dividing the body into several regions—as the head, the trunk, and the extremities. Again, the trunk may be subdivided into neck, thorax, and abdomen ; and in each of the main regions, several subdivisions may be made. This system of arrangement may be styled topographical A., and is also known as surgical A., on account of its importance as the basis of operative surgery. It was the eldest of the Monroes of Edinburgh University who first gave this branch of the study its due prominence. The several parts and organs of the animal body will be found described under their proper heads.

History of A.—It is difficult to determine the date at which this science began to be cultivated, but it is probable that from the earliest times some persons took advantage of favorable circumstances to acquaint themselves with it. The Druids, who were at once the priests, judges, and physicians of the people, demanded from those who came for their advice human victims as sacrifices, and were themselves the executioners ; and it is not unlikely that they availed themselves of these opportunities of acquiring anatomical knowledge. It is probable, says Galen, the Æsculapius, who excelled in the treatment of wounds, dissected animals for the instruction of his pupils. His descendants, that Æsclepiades, cultivated A., or rather zootomy, and founded the three famous schools of Cos, Rhodes, and Cnidos. The rabbins tell us that, although among the Jews the touching of a dead body involved ceremonial uncleanness, they did not entirely neglect A., which they studied from the carefully preserved bones of their ancestors, and the necessary manipulations of embalming. They counted 248 bones, and 365 veins or ligaments, which division, according to the rabbins, has relation to the 248 precepts of the Mosaic Law that command, and the 365 that forbid.

Homer exhibits a certain amount of anatomical knowledge in his description of wounds in the Iliad. Pythagoras first reasoned physiologically from observations made by him when in Egypt, where he witnessed the sacrifices, and also the Egyptian methods of embalming. Alcmeon of Crotona, a disciple of Pythagoras, first dissected animals with the view of obtaining comparative knowledge of human A. Democritus, who frequented the sepulchres, probably with anatomical views, practised zootomy, and was engaged dissecting animals when visited by Hippocrates. Hippocrates II., descended in the eighteenth degree from Æsculapius, and born at Cos in 35 a.m., was the first author who treats A. as a science. He caused a skeleton of brass to be cast, which he consecrated to the Delphian Apollo, with the view of transmitting to posterity proofs of the progress he had made, and of stimulating others to the study of A. Aristotle, who lived 384 b.c., does not appear to have dissected men ; and he states that: the parts of man are unknown to them, or that they possess nothing certain on the subject beyond what they can draw from the probable resemblance of the corresponding parts of other animals. He first gave the name aorta to the great artery.

Diocles (380 b.c.) was the first who treated of the proper manner of conducting anatomical examinations for purposes of demonstration. But no real progress in A. was made, owing to the researches being confined to animals, till the time of Erasistratus, who was born at Ceos about 800 b.c., and who was the first to-dissect human bodies. He obtained from Seleucus Meaner and Antiochus Soter the bodies of criminals, and is said to have dissected some condemned to death while they were still alive. His writings are lost, but fragments are preserved in the writings of Galen. He made many discoveries, among others, of the lacteal vessels. Herophilus, who lived about the same time, was born at Carthage, but carried on his anatomical pursuits principally at Alexandria. He also is said to have dissected living subjects. Parthenius, who lived 200 years b.c., published a book, entitled On the Dissection of the Human Body. In the first c. of the Christian era, the dissection of human subjects was forbidden, under heavy penalties. Rufus the Ephesian, who lived 112 A.D., under the empire of Trajan, taught A. in a more exact manner than had been hitherto done, and devised a more exact anatomical nomenclature. He made use of animals in his demonstrations, and mentions that ‘of old they used for that purpose human bodies.’

Galen (131 a.d.) dissected apes, as being most like human subjects, though he occasionally obtained bodies of children exposed in the fields, or of persons found murdered, which, however, he was obliged to dissect in secret. There was at this time no regularly prepared skeleton, as there was a law at Rome forbidding the use of dead bodies. Galen’s writings show a knowledge of human A. Soranus had extensive knowledge of A., derived from human subjects. Moschion had some anatomical illustrations engraved. Oribasius compiled more than 70 volumes, the 24th and 25th being on A., principally from Galen.

Nemesius, Bishop of Nemesus, a town in Phoenicia, cultivated A. at the end of the 4th c., in which also Meletius lived, who wrote a complete treatise On the Nature and Structure of Man. Theophilus, a monk, published in the 7th c. a good abridgment of the A. of Galen.

A. made small progress among the Arabs, which is accounted for by their religion prohibiting contact with dead bodies. When the great Arabian physician, Rhazes, was about to be operated on for cataract, he discovered that the surgeon was ignorant of the structures of the eye, and refused to submit to the operation. Avicenna (980 a.d.), born in the province of Khorasan, was a good osteologist, and described some structures not alluded to by Galen.

A. was now neglected for a long period, till Frederick II., king of Sicily (1194—1250), made a law forbidding any one to practise surgery without having first acquired some knowledge of A. He founded a chair at the solicitation of Martianus, his chief physician, where the science was demonstrated for five years; students, from all parts crowded to it, and some time after, a similar school was established at Bologna—these two were largely attended, but no very material progress was made in A.

The university of Montpellier was founded by Pope Nicholas IV. in 1284, and the chair of A. was filled by Bernard Gordon, with great distinction for ten years. He published a huge work,, called Lilium Medicinal.

Mundinus, born at Milan, 1815, professed A. there, and is considered the real restorer of A. in Italy. He publicly demonstrated it, and published a work which was the text-book in the academy of Padua two hundred years after its publication. Then came Guy de Chauliac, who first correctly described the humerus. Mathæus of Grado published several anatomical works about 1480. Gabriel de Zerbus, in 1495, published a confused and imperfect, work on A. at Verona. The science continued to be studied by surgeons such as Vigo (1516), Achillinus, and Berenger (Carpi), (1518), who boasted of having dissected at Bologna more than a hundred subjects. Reports were raised that he dissected living Spaniards, and he fled or was exiled to Ferrara.

Andre Lacuna (1535), Charles Etienne, Gonthier (1536), Massa, Driander (1537), Sylvius (1539), Levasseur, and Gesner, were celebrated for A.; but especially Andrew Vesalius, born 1514, who published a great work on A. before he was 28 years of age. He had the misfortune to open the body of a young Spanish nobleman whose heart was found still beating, and was obliged to make an expiatory pilgrimage to Jerusalem. In 1564, the Venetian senate recalled him to succeed, at Padua, the famous Fallopius, who had just died; on his return, he was shipwrecked on the island of Zante, where he was starved to death.

William Horman of Salisbury wrote, in 1530, Anatomia Corporis Humani (A. of Human Body); then came Ingrassias, and others of less note.

Thomas Gemini of London, in 1545, engraved upon copper the anatomical figures of Vesalius, which had appeared in Germany upon wood. Gemini suppressed the name of Vesalius, though using his figures and descriptions. Thomas Vicary, in 1548, is said to be the first who wrote in English on A.; he published The Anglishman’s Treasure, or the True A. of Man’s Body. John Ligæus, in 1555, published an anatomical treatise in Latin hexameters. Franco (1556), Valverda, Columbus, and others, wrote works of great merit on A. In 1561, Gabriel Fallopius professed it with great distinction at Padua, and made many original discoveries.

In the 17th c., progress was rapid : Hervey, in 1619, discovered the circulation of the blood, and the microscope was employed to detect the structure of minute vessels. Aselli, in 1622, discovered and demonstrated the existence of the lymph-vessels; and his conclusions were supported by the investigations of Pecquet, Bartholin, and Olaus Rudbeck. The glandular organs were investigated by Wharton, while Malpighi, Swammerdam, and (in the following c.) the illustrious Ruysch, by the use of injections and the aid of the microscope, gave a new impulse to research in the minute structures. Eminent names in the history of A. are numerous in the 18th c. In Italy, which still retained its former pre-eminence, we find Pacchioni, Valsalva, Morgagni, Santorini, Mascagni, and Cotunni; in France, Winslow, D’Aubenton, Lieutaud, Vicq d’Azyr, and Bichat, the founder of General A; in Germany, the accomplished Haller and Meckel prepared the way for greater achievements in the 19th c.; in Great Britain, Cowper, Cheselden, Hunter, Cruikshank, Monro, and Charles Bell contributed to the progress of the science; while Holland was worthily represented by Boerhaave, Albinus, Camper, Sandifort, and Bonn. On the boundaries of the two centuries, we find the names of Sommering, Loder, Blumenbach, Hildebrand, Reil, Tiedemann, and Seller; nearly all connected with practical medicine, which was benefited by their studies in A.

The necessity of a union of theory and practice has led to that zealous study of pathological A. (the dissection and study of structures as modified by diseases) which has recently prevailed. The origin of this branch of A. maybe traced back to ancient times in Egypt, where post-mortem examinations were sometimes made to discover the seat of disease and cause of death. In the medical writings of the Greeks, some anatomico-pathological observations are found. During the general revival of science in the 16th c., many notices of pathological A. occur. In 1507, Benevieni of Florence wrote the first book on this branch of science; and Bonet, in 1679, published his compilation of numerous observations. Still, these were only fragmentary indications of a possible science, and the facts stated were often very erroneously interpreted. Morgagni (1767), who must be regarded as the true founder of Pathological A., was worthily followed by Lieutaud, Sandifort, Hunter, Baillie, and others. Meckel the Younger, in Germany, in his study of malformations &c., paid little or no attention to practical applications of the science. The recent change of direction given to the study of Pathological A., which is now properly regarded as a means towards practical improvements in medicine, must be ascribed to Bichat and the pupils of Broussais, among whom may be mentioned the names of Laennec, Cruveilhier, Louis, Andral, Lobstein, Lebert, Virchow, Bennett, &c. In London and other large towns there are societies devoted specially to the investigation of pathology.

compaRativE A. has always preceded anthropotomy, or dissection of the human subject, but was first treated systematically as a distinct science by Cuvier and his pupil Meckel the Younger. The system proposed by the latter was, unfortunately, never completed. Blumenbach, Tiedemann, Home, Blainville, Geoffrey St. Hilaire, Carus, Oken, Goethe, the German poet, Richard Owen, John Goodsir, and Huxley, must be named as eminent contributors to this branch of science; while, in late years, zootomy and comparative A. have been studied, with an especial reference to physiology, by Muller, Wagner, Siebold, Bowman, Todd, and Allan Thomson.

A. for artists is studied with reference to the effects produced by internal structure on the external form, and describes the organs, especially the muscles and tendons, not only in a state of rest, but also as modified by passion, action and posture. Consequently observation of the nude living form is required in this branch of study, which has been treated of by Errard and Genga (1691); and in modern times, by Lavater (1790), Camper (1792), Charles Bell (1806), Salvage (1812), Mascagni (1816), Koeck (1822), Gardy (1831) Fischer (1838), Salomon arid Aulich (1841), Berger (1842), Seller and Gunther (1850), &c.

practical A. includes Dissection (q. v.) and the making of Preparations. Preparation consists in dividing parts or organs, so that their respective forms and positions may be clearly shown, Organs or parts thus treated are styled Anatomical Preparations of bones, muscles, vessels, nerves, &c. For example, a bone-preparation is made by clearing away all muscular and other adhesions; the whole structure of the bones, thus prepared and bleached, when connected by wires in its natural order, forms an artificial skeleton.

For preparations of parts containing vessels with minute ramifications, injections are employed. Some colored fluid which has the property of gradually becoming solid, is gently injected into the arteries or other vessels by means of a syringe. Formerly, materials which required a certain degree of warmth to preserve their fluidity were used; but as these were attended with inconvenience, a great improvement was made by Shaw and Weber, who introduced the use of linseed-oil and turpentine, which, when mixed with certain metallic compounds in due proportions, form a fluid which, after a time, becomes solid in ordinary temperatures. Quicksilver and colored limewater are also used, for injection of the finer vessels. Preparations are either dried and varnished or preserved in spirit.

A series of such specimens, arranged in proper order, forms an Anatomical Museum. The valuable collections made by Ruysch, Eau, Loder, Walter, John and William Hunter, Meckel, Sommering, and Dupuytren, are all now public property. There is also a splendid collection in the university of Edinburgh, collected and prepared for the most part by John Goodsir. The College of: Surgeons of Edinburgh also possesses a very valuable museum of pathological preparations. As it is impossible to preserve thus all parts in their integrity for any great length of time, artificial copies in wood, ivory, and wax have been made with great exactitude, especially in Florence; and recently Anzou in Paris has employed papier-mache for the same purpose. But, apart from I dissections and preparations of the natural organs, the most general and available assistance in the study of A. is found in anatomical engravings and plates on wood and copper. This assistance was known in ancient times. Aristotle affixed to his works on A. some anatomical drawings, which have been lost. In the 16th c., the greatest artists—Leonardo da Vinci, Michael Angelo, Raphael, Titian, and Dürer—gave their aid in designing anatomical figures; but few of their works, in this department of art, have been preserved. Lately, lithography has been employed. Among the numerous illustrations of A. which we now possess, the old works by Vasal (1543), Eustachius (1714), Bidloo (1685), Albin (1747), Haller (1743-1756), and Vicq d’Azyr (1786-1790), may be mentioned. The present century has supplied works of first-rate excellence by Caldani (Venice, 1801-1814), Mascagni (Pisa, 1823), Langenbeck (Gottingen, 1826), Bourgery and Jacob (Paris, 1832), and Arnold (Zurich, 1838). For general use, we may commend the plates of Loder (Weimar, 1803), Cloquet (Paris, 1826), Osterreicher (Munich, 1827-1830), Weber, (Düsseldorf, 1830), Bock (Leipsic, 1840), and D’Alton (Leipsic, 1848); in Surgical A., the works by Rosenmuller (Weimar, 1805), Pirogoff (Dorp. 1840), and Gunther (Hamburg, 1844), in Pathological A., Meckel (Leipsic, 1817-1826), Cruveilhier (Paris, 1828-1841), Froriep (Weimar, 1838), Albers (Bonn, 1832), Gluge (Jena, 1843—1850), and Vogel (Leipsic, 1843); in Comparative A., Carus (Leipsic, 1826) and Wagner (Leipsic, 1841). Among English works may be mentioned those by Lizars, Jones, and Richard Quain, in Special A.; by Morton and Maclise, in Surgical A.; and by Baillie and Bright in Pathological A.

ANATOMY (in Law). While the study and practice of A., or the art of dissecting the human body, were necessary to the pursuit of surgical knowledge, there were, until the year 1832, no sufficient legal means in Britain of procuring dead bodies for anatomical purposes; and the consequence was, the evasion, and sometimes even the open violation of the law by persons interested in supplying the surgical profession with subjects for dissection. The high prices, indeed, given for these subjects, may almost be said to have created a lucrative and tempting trade, which led to the most atrocious crimes; and murders, with no other object than the possession of the victim’s body for the surgeon’s knife, were frequently committed. The notorious case of Burke, tried and convicted before the High Court of Justiciary in Edinburgh, in 1828, is a horrible illustration of the state of the law at that time, and of the position in which it placed surgical practitioners. It was believed that Burke and his associate Hare had been the murderers of sixteen persons, whose bodies they sold to the anatomists. It was their practice to inveigle poor people, generally strangers, into their houses, make them drunk and then smother them. Burke, informed against by Hare, was condemned for thus disposing of an old woman, and suffered the last penalty of the law, bequeathing a new verb, to burke, to the English language. To remedy this state of things, an act of parliament was passed on the 1st of August 1832, 2d and 3d William IV. c. 75, the preamble of which, sufficiently disclosing its necessity, is as follows: ‘Whereas a knowledge of the causes and nature of sundry disuses which affect the body, and of the best methods of treating and curing such diseases, and of healing and repairing divers wounds and injuries to which the human frame is liable, cannot lie acquired without the aid of anatomical examination; and whereas the legal supply of human bodies for such anatomical examination is insufficient fully to provide the means of such knowledge: and whereas, in order further to supply human bodies for such purposes, divers great and grievous crimes have been committed, and, lately, murder, for the single object of selling for such purposes the bodies of the persons so murdered: and whereas, therefore, it is highly expedient to give protection, under certain regulations, to the study and practice of A., and to prevent, as far as may be, such great and grievous crimes and murder as afore-said ‘—It is therefore enacted, that the Secretary of State for the Home Department in Great Britain, and the Chief Secretary in Ireland, may grant a license to practice A. to any fellow or member of any college of physicians or surgeons, or to any graduate or licentiate in medicine, or to any person lawfully qualified to practise medicine in any part of the United Kingdom, or to any professor or teacher of A., medicine, or surgery, or to any student attending any school of A., on the application of such party for such purpose, countersigned by two justices of the peace acting for the county, city, borough, or place where such party resides, certifying that, to their knowledge or belief, such party so applying is about to carry on the practice of A.

The act provides for the appointment of inspectors of schools of A., and directs them to make a quarterly return to the Secretary of State, or the Chief Secretary, as the case may be, of subjects removed for anatomical examination to every place in the inspector’s district where A. is carried on, distinguishing the sex, and, as far as is known at the time, the name and age of each person whose body was so removed. The inspectors are further required to visit and inspect places within their respective districts where A. is practised; and for the performance of all these duties, the inspectors are each to have an annual salary not exceeding £100, with a further reasonable sum for their official expenses. By section 7, it is enacted that it shall be lawful for any executor or other party having lawful possession of the body of any deceased person, and not being an undertaker or other party intrusted with the body, for the purpose only of interment, to permit the body of such deceased person to undergo anatomical examination, unless, to the knowledge of such executor or other party, such person shall have expressed his desire, either in writing, at any time during his life, or verbally, in the presence of two or more witnesses, during the illness whereof he died, that his body, after death, might not undergo such examination; or unless the surviving husband or wife, or any known relative of the deceased person, shall require the body to be interred without such examination: while, by section 8, it is declared that the wishes of persons who had expressed a desire that their bodies should be subjected to anatomical examination shall be respected, unless the deceased person’s surviving husband or wife, or nearest known relative, or any one or more of such person’s nearest known relatives being of kin in the same degree, shall require the body to be interred without such examination. Bodies are not to be removed for examination until forty-eight hours after death, and without a certificate by the medical attendant, stating, according to the best of his knowledge or belief, the manner or cause of death. The act contains a number of provisions intended to secure its sufficient administration; but by section 15, it is provided that it shall not extend to or prohibit any post-mortem examination of any human body required or directed to be made by any competent legal authority; and it repeals an enactment in a previous statute, 9 George IV. c. 31, which directed the bodies of murderers after execution to be dissected.

This act of parliament is understood to have met the evil it was designed to obviate; and under it the supply of bodies of persons dying friendless, in poor houses, hospitals, and elsewhere, is stated to have proved sufficient for the wants of the profession.

AMPUTA’TION (Lat. amputo, I lop or prune) is the cutting off of a part which, by its diseased condition, endangers, or may en- I danger, the safety of the whole body. The A. of a limb was in ancient times attended with great danger of the patient’s dying during its performance, as surgeons had no efficient means of restraining the bleeding. They rarely ventured to remove a large portion of a limb, and when they did so, they cut in the gangrened parts, where they knew the vessels would not bleed; the smaller limbs they chopped off with a mallet and chisel; and in both cases-had hot irons at hand with which to sear the raw surfaces, boiling-oil in which to dip the stump, and various resins, mosses, and fungi, supposed to possess the power of arresting hæmorrhage. Some tightly bandaged the limbs they wished to remove, so that they mortified and dropped off; and others amputated with red hot knives, or knives made of wood or horn dipped in vitriol. The desired power of controlling the hæmorrhage was obtained by the invention of the tourniquet (q. v.) in 1674′by a French surgeon Morell. The ancient surgeons endeavored to save a covering of skin for the stump, by having the skin drawn upwards by an assistant, previously to using the knife. In 1679, Lowdham of Exeter suggested cutting semi-circular flaps on one or both sides of a limb, so as to preserve a fleshy cushion to cover the end of the bone.. Both these methods are now in use, and are known as the ‘circular’ and the ‘flap’ operations: the latter is most frequently used in this country.

A ‘ flap’ amputation is performed thus : The patient being placed; in the most convenient position, an assistant compresses the main artery of the limb with his thumb, or a tourniquet is adjusted over it. Another assistant supports the limb. The surgeon with. one hand lifts the tissues from the bone, and transfixing them with a long narrow knife, cuts rapidly downwards and towards the surface of the skin, forming a flap; he then repeats this on the other side of the limb. An assistant now draws up these flaps, and the knife is carried round the bone, dividing any flesh still adhering to it. The surgeon now saws the bone. He then, with a small forceps, seizes the end of the main artery, and drawing it slightly from the tissues, an assistant ties it with a thread. All the vessels being secured the flaps are stitched together with a needle and thread, and a piece of wet lint is laid over the wound. An expert surgeon can remove a limb thus in from 30 to 60 seconds.

A’NGER is displeasure or vexation accompanied by a passionate desire to break out in acts or words of violence against the cause of the displeasure; which must, of course, be a sentient being capable of feeling the infliction. Like most other emotions, it is accompanied by effects on the body, and in this case they are of a very marked kind. The arterial blood-vessels are highly excited; the pulse, during the paroxysm, is strong and hard, the face becomes red and swollen, the brow wrinkled, the eyes protrude, the whole body is put into commotion. The secretion of bile is excessive, and it seems to assume a morbid consistency. In cases of violent passion, arid especially in nervous persons, this excitement of the organs soon passes to the other extreme of depression; generally, this does not take place till the A. has subsided, when there follows a period of general relaxation. The original tendency to A. differs muck in individuals according to temperament; but frequent giving way to it begets a habit, and increases the natural tendency.
From the nature of A., it is easy to see that it must be—often at least—prejudicial to health. It frequently gives rise to bile-fever, inflammation of the liver, heart, or brain, or even to mania. These effects follow immediately a fit of the passion; other evil effects come on, after a time, as the consequence of repeated paroxysms—such as paralysis, jaundice, consumption and nervous fever. The milk of a mother or nurse in a fit of passion will cause convulsions in the child that sucks; it has been known even to occasion instant death, like a strong poison.
The controlling of A. is a part of moral discipline. In a rudimentary state of society, its active exercise would seem to be a necessity; by imposing some restraint on the selfish aggressions of one individual upon another, it renders the beginnings of social co-operation and intercourse possible. This is its use, or, as it is sometimes called, its final cause. But the more social intercourse comes to be regulated by customs and laws, the less need is there for the vindictive expression of A. It seems an error, however, to suppose that the emotion ever will be—or that it ought to be—extirpated. Laws themselves lose their efficacy when they have not this feeling for a background; and it remains as a last resource for man, when society, as it does every now and then, resolves itself into its elements. Even in the most artificial and refined states of society, those minor moralities on which half the happiness of social intercourse depends, are imposed upon the selfish, in great measure, by that latent fund of A. which every man is known to carry about with him.

ANTI’PATHY is the term applied to a class of cases in which individuals are disagreeably affected by, or violently dislike, things innocuous or agreeable to the majority of mankind. These peculiarities are no doubt sometimes acquired in early life by injudiciously terrifying children with some object, the mental impression becoming permanent. A large class of persons have an A, to animal food, and from childhood refuse to taste it. In others, again, the aversion is limited to one kind of meat, as veal or pork; others are averse to eggs or milk. Nor is this feeling a conscious caprice, which an exertion of the will might remove; for it is generally found that contact with the object of the A. is resented by the bodily economy, and symptoms of poisoning are rapidly produced. Some are affected with these symptoms who have no mental aversion to the article. We read of a countess who had a liking for beef-udder, but directly it touched her lips they became swollen. There is also the case of a boy, who, ‘if at any time he ate of an egg, his lips would swell, in his face would rise purple and black spots, and he would froth at the mouth.’ Some medicines affect particular persons dangerously, even when given in very minute doses: a single grain of mercury has been known to induce a profuse salivation, with destruction of the jawbones. On others, medicines have a peculiar effect—astringents my purge. Every summer, in Great Britain, persons may be seen with the most distressing irritation of the nasal and palpebral mucus membranes, produced by the exhalations arising from the fields during the inflorescence of the hay-crop. In others, an asthmatic condition is induced by the same cause. The air of some places has a similar influence on individuals: one gentleman was always attacked with asthma if he slept in the town of Kilkenny, and another rarely escaped a fit of that complaint if he slept anywhere else.

The most remarkable antipathies are those affecting the special senses. Nearly all persons have a loathing at reptiles, but some few faint on seeing a toad or lizard, others on seeing insects. ‘ The Duke d’Epernon swooned at sight of a leveret—a hare did not induce the same effect. Tycho Brahe fainted at sight of a fox, Henry III of France at that of a cat, and Marshal d’Albert at a pig.’—Millingen.

Hearing a wet finger drawn on glass, the grinding of knives, or a creaking wheel, is sufficient to produce fainting in some. Smelling mink or ambergris throws some into convulsions; and we have seen how articles of food affect others—often, no doubt, owing to perverted taste. The touch of anything unusually smooth has the same effect sometimes. Zimmerman records the case of a lady who was thus affected by the feeling of silk, satin, or the velvety skin of a peach.—This subject is also noticed under idiosyncrasy.

WEA’NING, and FEEDING IN INFANCY. The propriety of mothers nursing their own children is now so universally acknowledged, that it is the duty of the physician less frequently to urge maternal nursing than to indicate those cases in which it becomes necessary to substitute another mode of rearing the infant. ‘ Women,’ says Dr. Maunsell, ‘who labor under any mortal or weakening disease—as phthisis, hæmorrhages, epilepsy—are obviously disqualified from the office of nurse. Some who are in other respects healthy, have breasts incapable of secreting a sufficient supply of milk. In other instances, the breast may perform its functions well, but the nipple may be naturally so small, or may be so completely obliterated by the pressure of tight stays, as not to admit of its being laid hold of by the child. These are actual physical hindrances to nursing. Again, women may, and, in the higher classes, frequently do, possess such extremely sensitive and excitable temperaments, as will render it imprudent for them to suckle their own children. Frightened and excited by every accidental change in the infant’s countenance, and inordinately moved by the common agitations of life, such persons are kept in a state of continual fever, which materially interferes with the formation of milk both as to quantity and quality. Women, also, who become mothers for the first time at a late period of life, have seldom the flexibility of disposition or the physical aptitude for the secretion of milk, required to constitute a good nurse.’—A Treatise on the Management and Diseases of Children, 4th ed., 1842, pp. 39. 40.

In ordinary cases, the child should be put to the breast as soon as the latter begins to contain anything; and when the secretion of milk lias fairly commenced, it will require no other food until the seventh or eighth month, provided the mother be a good nurse. During the first five or six months, the infant should be put to the breast at regular intervals of about four hours; afterwards, when the teeth are beginning to appear, the child need not suck more than four times in the twenty-four hours, some artificial food being given to it twice during the same period. This at first may consist of soft bread steeped in hot water, with the addition of sugar and cow’s milk; and subsequently a little broth, free from salt and vegetables, may be given once a day. The spoon is now the best medium o£ feeding, as the food should be more solid than could be drawn through the sucking-bottle. The time of weaning should be that indicated by nature, when, by providing the child with teeth, she furnishes it with the means of obtaining its nourishment from substances more solid than milk. If the infant has been gradually accustomed to a diminished supply of maternal and an increase of artificial food, weaning will be a comparatively easy process; and much of that suffering both to parent and child will be spared, which commonly ensues when a sudden change is made. In ordinary cases, the period of weaning varies from the seventh to the twelfth month; sometimes the child is kept at the breast for a much longer period, from the popular idea that lactation prevents pregnancy, but such unnaturally prolonged lactation is usually injurious to both mother and child.

In those cases in which it is inexpedient or impossible for a mother to suckle her own child, the choice of a wet-nurse becomes a subject of much importance. Upon this subject, Dr. Maunsell lays down the following important practical rules: ‘The great thing we have to look to is to ascertain that both the woman and her child are in good health; and of this we must endeavor to judge by the following signs: The woman’s general appearance and form should be observed, and they ought to be such as betoken a sound constitution. Her skin should be free from eruptions; her tongue clean, and indicating a healthy digestion; her gums and teeth sound and perfect; the breasts should be firm and well formed—not too large or flabby—and with perfect, well-developed nipples. We should see that the milk flows freely, upon slight pressure; and we should allow a little of it to remain in a glass in order that we may judge of its quality. It should be thin, and of a bluish-white color; sweet to the taste; and when allowed to stand, should throw up a considerable quantity of cream. A nurse should not be old, but it is better that she should have had one or two children before, as she will then be likely to have more milk, and may be supposed to have acquired experience in the management of infants. Having examined the mother, we must next turn to the child, which should be well nourished, clean and free from eruptions, especially on the head and buttocks. We should also carefully examine its mouth, to ascertain that it is free from sores or aphthæ. If both woman and child bear such an examination, we may with tolerable security pronounce the former to be likely to prove a good nurse.’—Op. cit., pp. 44, 45. In one respect, we differ from this eminent physician. He holds that ‘ the more recently the nurse’s own confinement has taken place, provided she has recovered from its effects, the better.’ Supposing a nurse is required for a new born infant, this rule holds good; but provided a nurse is required for an infant of three or four months old (for example), it is preferable to obtain a nurse whose milk is of that age. We believe it to be a general physiological law that the age of the milk should correspond to the age of the infant; that is to say, that an infant taken at any given age from its mother, before the normal period of weaning, should be provided with a nurse who was confined about the same time as its own mother.

A wet-nurse should be very much preferred to any kind of artificial feeding; but peculiar cases may occur in which it is impossible to procure a nurse; or an infant whose mother is incapable of nourishing it may be the subject of a disease that may be transmitted through the infant to the nurse. In these cases, a food must be provided as nearly as possible resembling the natural food; and this is naturally sought for among the food of animals. The milk of the cow is most commonly used, in consequence of its being the most easily obtained; but ass’s milk more nearly resembles human milk, as is shown from the following comparative analyses by Professor Playfair :

The most important difference between cow’s milk and woman’s milk is the great excess of casein in the former. The former fluid may, however, be made to resemble the latter in composition in either of the following ways : (1) On gently heating cow’s milk, a membrane of casein forms on-the surface; by removing two or

three of these membranes as they form, we can reduce the quantity of casein to the desired extent; or (2) we may dilute cow’s milk with twice its bulk of pure water, and add a little sugar. This food should be administered at a natural temperature (of about 98°) through a sucking-bottle; and as the child grows older, it will soon be able to take natural cow’s milk without inconvenience. The nature and importance of the mixture of milk and farinaceous food known as Liebig’s Soup for Children, are described under SOUP.

The rules regarding the times &c. of feeding are similar to those laid down for suckling. Assuming that the infant, whether brought up at the breast or artificially reared, has been safely weaned, we have to consider what rules should be laid clown regarding its food subsequently. For some months after weaning the food should consist principally of semi-fluid substances, such as milk thickened with baked flour, or pap, to which a little sugar should be added. Light broth’s may also be administered, especially in the occasional cases in which milk seems to disagree; and bread and butter may be tried in small quantity. We shall con-elude this article with the following ‘ model of a suitable diet for children,’ which cannot be too strongly impressed upon the minds of all young mothers. ‘A healthy child, of two or three years old, commonly awakes hungry and thirsty at five or six o’clock in the morning, sometimes even earlier. Immediately after awaking, a little bread and sweet milk should be given to it, or (when the child is too young to eat bread) a little bread-pap. The latter should be warm; but in the former case, the bread may be eaten from the hand, and the milk allowed to be drunk cold, as it is well at this meal to furnish no inducement for eating beyond that of hunger. After eating, the child will generally sleep again for an hour or two; and about nine o’clock it should get its second meal, of bread softened in hot water, which latter is to be drained off, and fresh milk and a little sugar added to the bread. Between one and two, the child may have dinner, consisting, at the younger ages, of beef, mutton, or chicken broth (deprived of all fat), and bread. When a sufficient number of teeth are developed to admit of chewing being performed, a little animal food, as chicken, roast, or broiled mutton, or beef, not too much dressed, should be allowed, with a potato or bread, and some fresh, well-dressed vegetable, as turnips or cauliflower. After dinner, some drink will be requisite; and a healthy child requires, and indeed wishes for nothing but water.

Light, fresh table-beer would not be injurious to a child of four or five years old, but it is unnecessary. Between six and seven o’clock, the child may have its last meal of bread steeped in water, &c., as at nine o’clock in the morning. A healthy child which lias been in the open air during the greater part of the day, will be ready for bed shortly after this last supply, and will require nothing more till next morning. Similar regimen and hours may be adopted throughout the whole period of childhood; only as the fourth or fifth year approaches, giving, for breakfast and supper, bread and milk without water, and either warmer cold, according to the weather or the child’s inclination. The supply of food upon first awakening in the morning may also be gradually discontinued, and breakfast be given somewhat earlier.’ —Op. cit., pp. 80, 81.

PO’SSET, a dietetic preparation, made by curdling milk with some acidulous liquor, such as wine, ale, or vinegar. White wine or sherry is usually preferred, but sometimes old ale is used. The milk is boiled; and whilst it is still on the fire, the acidulous matter is added; if sherry, about a wine-glassful and a half to the pint of new milk is the proportion; or twice the quantity if ale. A teaspoonful of vinegar or of lemon-juice is sometimes used instead; one or two tablespoonfuls of treacle are added, to sweeten. Taken at bedtime, it is used for colds and coughs.

INDIGE’STION, or DYSPE’PSIA, is term somewhat vaguely applied to various forms of disease of the stomach or of the small intestines in which the natural process of digesting and assimilating the food is deranged.

The symptoms of indigestion are by no means constant in all cases. There is often anorexia (or want of appetite), but occasionally the appetite is excessive, and even ravenous. Nausea not unfrequently comes on soon after a meal; while in other cases, there is no nausea, but after the lapse of a couple of hours, the food is vomited, the vomited matters being very acid, and often bitter, from the admixture of bile. In severe cases, the vomiting has been known to occur after every meal for several months. Flatulence, relieving itself in eructations, is one of the standard symptoms of this affection, the gas that gives rise to this symptom being sometimes evolved from undigested matters in the stomach, and sometimes being apparently secreted by the walls of that viscus. It is very apt to occur in dyspeptic patients if they have fasted rather longer than usual. Cardialgia (popularly known as heartburn), Pyrosis (q. v.), or water-brash, and Gastrodynia (commonly designated spasm or cramp of the stomach, and coming on at uncertain intervals in most severe paroxysms), are other somewhat less common symptoms of indigestion.

The treatment of indigestion is more dietetic than medicinal. The quantity of food which can be dissolved by the gastric juice and intestinal fluids being limited (see DIGESTION), 1′are should be taken that this quantity is not exceeded; moreover, the meals should not succeed each other too rapidly. Mr. Abernethy, who was a great authority on this subject, laid great stress on the principle, that the stomach should have time to perform one task before another was imposed upon it, and he always recommended his patients to allow six hours to intervene between any two meals. With regard to the nature of the food best suited to dyspeptic persons, it may be safely asserted that a mixture of well-cooked animal and vegetable food is in general more easily digested than either kind taken exclusively. Mutton, fowls, and game are the most digestible kinds of animal food; and pork and all cured meats, such as salted beef, ham, tongue. &c., should lie avoided. Raw vegetables, such as salads, cucumbers, &c., must also be prohibited. In most cases, dyspeptic persons would probably do well to avoid all stimulating drinks; but in some cases, a little cold, weak brandy and water, or a glass of old sherry, or a little bitter ale, may be taken with advantage. But upon all points of eating and drinking a sensible patient must be mainly influenced by his own experience. The unquestionable benefit which dyspeptic patients often derive from a visit to a hydropathic establishment is due perhaps not so much to any specific action of the water, as to the well-regulated diet, the withdrawal of the mind from personal cares, and the change of scene. A six weeks’ or two months’ tour among the mountains of Scotland or Switzerland will in the same way often do a dyspeptic patient more good than he could have experienced from any amount of physicking at home.

A few words must be said regarding the mode of treating the most urgent of the individual symptoms. Loss of appetite may be remedied by the employment of bitters, such as quinine, gentian, chiretta, &c., or of mineral acids, or of both combined. Nausea and vomiting may be treated with hydrocyanic acid, chloroform, and creosote in very small doses. Two or three drops of dilute hydrocyanic acid in an effervescent draught are often an effectual remedy. In intense vomiting, the amount of food taken at a time must be reduced to the lowest possible limit. A tablespoonful of milk, mixed with lime-water, will sometimes remain on the stomach after all other kinds of food have been rejected. There is no better remedy for flatulence than peppermint-water; if it fails, a drop of cajeput oil on a lump of sugar may be tried. When the eructations are attended with an odor of rotton eggs—that is to say, when sulphuretted hydrogen is evolved from the decomposition of matters in the stomach—an emetic is the best cure. The remedies for the pain in the stomach vary with the character of the pain; bismuth, nitrate of silver, and opium are often serviceable, but should not be taken without advice. A teaspoonful of the aromatic spirit of ammonia in a wineglass of camphor-mixture, often gives instantaneous relief, audit not too often resorted to, can be taken with impunity.

ABSINTHE is a spirit flavored with the pounded leaves and flowering tops of certain species of Artemisia (q. v.), chiefly wormwood (A. Absinthium), together with Angelica-root, sweet-flag root, star-anise, and other aromatics. The aromatics are macerated for about eight days in alcohol, and then distilled, the result being an emerald-colored liquor. Adulteration is largely practised, even blue vitriol being sometimes found in so-called A. The best A. is made in Switzerland, the chief seat of the manufacture being in the canton of Neufchatel. It is chiefly used in France, but is of late largely exported to the United States. When to be drunk, the greenish liquor is usually mixed with water. The evil effects of drinking A. are very apparent; frequent intoxication or moderate but steady tippling, utterly deranges the digestive system, weakens the frame, induces horrible dreams and hallucinations, and may end in paralysis or in idiocy.

ABO’RTION is the term used in Medicine to denote the expulsion of the product of conception (the impregnated ovum) from the womb before the sixth month of pregnancy. If the expulsion takes place after that date, and before the proper time, it is termed a premature labor or miscarriage. In law, no such distinction is made. The frequency of abortion as compared with normal pregnancy is very differently estimated by different writers ; but the best evidence leads us to the belief that abortion is of far more common occurrence than is generally supposed, and that it takes place on an average in one out of every three or four cases of pregnancy. The following are amongst the causes predisposing to this accident: (1) A diseased condition of either parent, and especially a syphilitic taint. (2) A peculiar temperament on the part of the mother. Those women who present a strongly-marked nervous or sanguine temperament seem to abort with singular facility; and the same tendency is observed in those in whom the catamenial or monthly discharges is abundant or excessive. Again, very fat women, while they have a tendency to sterility, are liable to abort when pregnancy does occur. Any cause interfering with the normal oxidation of the blood�as, for instance, the constant breathing of impure air, may provoke abortion�a fact excellently illustrated by the experiments of Brown-Sequard on pregnant animals (rabbits),when he showed that the application of a ligature to the windpipe excited uterine contractions, ending, if the experiment were continued long enough, in abortion, but ceasing if air was freely readmitted into the lungs. Change of climate, as from India to England, certainly predisposes to this accident; and it has been observed by various writers that great political events, the horrors of war, and famine, exert a similar action. The marvelous events that occurred in Paris in 1848 were speedily followed by an extraordinary number of abortions and of still-born children ; and a similar fact had been previously noticed by the elder Nagele and Hoffmann ‘during the famine of 1816 and during the siege of Leyden. Nor can there be a doubt that, amongst the causes predisposing to abortion, must be included the employment of such corsets and other garments as by their tightness interfere with the circulation of the blood, and alter the natural position of the womb and of the abdominal viscera. Many diseases supervening during the course of pregnancy, especially the eruptive fevers (as small-pox, scarlatina, &c.), almost invariably lead to abortion of a very dangerous character : and it has been known from the time of Hippocrates that intermittent fevers have this effect. Amongst the direct causes of abortion may be placed blows on the abdomen, falls, any violent muscular efforts, too long a walk or ride on horseback (indeed, women with a tendency to abort should avoid horseback during pregnancy), a severe mental shock, &c. Moreover, the death of the f�tus from any cause is sure to occasion abortion.

The symptoms of abortion vary according to the state of pregnancy at which it is threatened, and according to the exciting cause. Many of these resemble those of congestion of the womb, such as a sensation of weight or painful pressure in the region of the loins or sacrum, extending to the bladder and rectum (with or without Tenesmus, q.v.); these symptoms being aggravated by standing or walking, and being accompanied by chills, accelerated pulse, loss of appetite, and a general feeling of discomfort. A discharge of serous fluid, sometimes slightly tinged with blood, is then observed. The feeling of weight is replaced by pains, leading to the expulsion of the ovum, which, during the first two months, is so small as commonly to escape detection. In more advanced stages of pregnancy, the pains are more severe, the discharge is more abundant, and consists chiefly of blood; and after more or less time, the product of conception escapes either in whole or in part. In the former case, the patient has little further trouble ; in the latter, h�morrhage will probably continue, and the parts retained may putrefy, and give rise to serious symptoms. After about the commencement of the fourth month, the symptoms gradually approximate to those presented in ordinary parturition.

In the treatment, of abortion, prophylactics (or the guarding against causes likely to lead to it) hold the first place. Women liable to this affection should, on the slightest threatening, assume as much as possible the horizontal position, avoiding all bodily exertion or mental excitement. They should use non-stimulating foods and drinks, and keep the bowels open by gentle aperients� such as manna and castor-oil, and carefully-avoid aloes and other medicines irritating the lower bowel. Moreover, a separate bed-room must be insisted on by the physician. We shall only enter into the curative treatment so far as to state that if it is deemed necessary to check h�morrhage before professional aid can be called in, cloths soaked in cold water may be applied locally (care being taken to change them before they grow warm), and iced water containing an astringent, such as a little alum, may be given internally. Further proceedings must be left to the medical attendant.

There are occasional cases (as where the outlet of the pelvis is very contracted) in which it is necessary to induce abortion by professional means, but it would be out of place to enter into this subject in these pages. It cannot be too generally known, that all attempts at procuring criminal abortion, either by the administration of powerful drugs, or the application of instruments, are accompanied with extreme danger to the pregnant woman.

A’MBULANCE, a military term which is somewhat differently applied in different countries. In France, an A. is a portable hospital, one of which is attached to every division of an army in the field, and provided with all the requisites for the medical succor of sick or wounded troops. Such an A. is stationed at some spot removed from immediate danger; and soldiers are sedulously employed after a battle in seeking out those who have fallen, and conveying them to the A. Baron Larrey, during the great wars of the First Napoleon, brought this department of medical business to a high degree of efficiency, and set an example to the rest of Europe. When England engaged in war with Russia in 1854, the A. arrangements, like many others relating to the army, were in a very imperfect state. In the English army, A., strictly speaking, means a field hospital with all its wagons, litters, tents, cooking canteen, &c-; but sometimes the name is applied to a four-wheeled wagon or a two-wheeled cart fitted up for the reception of wounded men. When Lord Raglan was about to be sent out with the army, Dr. Guthrie, President of the College of Surgeons, devised a new form of A. cart; while Dr. Andrew Smith, Director-general of the Army and Ordnance Medical Department, invented a new A. wagon.

Annexed is a figure of Dr. Guthrie’s A. cart. The badly wounded were laid on it at full length, while those slightly hurt sat in front and rear, and on the sides. A stretcher is slung from the top for the accommodation of the former. The back-board is let down for cases requiring amputation. The hospital chests are lashed underneath. Many of Smith’s A. wagons and of Guthrie’s A. carts were at once made and sent out to the East; but they were not at the proper place when most wanted. After the battle of the Alma, the English were almost entirely destitute of means for conveying their wounded down to the beach; but the French had for this purpose a large number of camlets, suggested to them by their experience in Algeria. Each of these consists of two easy-chairs, slung in panniers across the back of a mule; and it is accordingly available along tracks where no wheel-carriage could pass. These cacolets have since been adopted in the English army, as well as improved, hand-litters, wheeled-litters or barrows, and ambulance wagons on a more modern model than those of Smith and Guthrie, but having the same general character. The American War, the wars of 1866 and 1870, and above all, the growth of volunteer aid societies under the influence of the Geneva Convention of 1866 (which gave to the wounded and their attendants the privileges of neutrality), have largely developed the ambulance equipments of every European army. Every international exhibition now contains an immense number of designs for the safe transport of the wounded. The most remarkable step taken in this direction has been the organization of railway ambulances. Trains of carriages either built for the purpose, or adapted from the ordinary rolling stock, can now be fitted up as moving hospitals, with their staff of surgeons and attendants; and by means of these railway ambulances the wounded can be safely and rapidly removed from the encumbered field hospitals to the permanent hospitals of the great cities of their own country. All the fittings for thus adapting railway trains to hospital purposes are now kept permanently m store in many of the countries of the continent.