Treatment. This should be of two kinds, local and general.
The local treatment of consumption is by the inhalation of vapors and powders into the lungs. It has been practiced, more or less, by individuals, for many years, particularly in Europe; but for some unaccountable reason, the profession generally have never used it, and do not know much about it. I had the honor, some years ago to bring it freshly before the American public, in some articles writ. ten for popular reading, since which time it has been rapidly gaining public confidence, and is now attracting much attention. Conveying the remedy directly to the diseased parts, it strikes the commonsense mind as eminently reasonable and necessary.
I shall speak Of inhalation, therefore, very earnestly, not as a palliative of consumption only, but as far more, as a remedy. After long and patient use, my experience allows me to say, that I know it, in many cases, to be such; and knowing this, I should be criminal not to press it upon the public ; for it is the great multitude of sufferers, pressing fast through the gate of death, who need to hear words of hope.
Consumption a General Disease. It is not denied that consumption is a general disease, needing constitutional treatment; but it has also a local development in the lungs, first in the form of albumlinous tumors, called tubercles, and then, after the softening, breaking down, and discharge of these, in the more formidable shape of ulcerous cavities, which, beginning at the summit, devour the lungs down to the base. Can it be reasonable to apply no remedy directly to this local disease? Not so does our profession deal with other local diseases. To an inflamed skin we apply poultices, cold compresses, solutions of acetate of lead, nitrate of silver, etc.; to leprous or scaly affections, sulphuret of potash bichloride of mercury, zinc ointment, nitrate of mercury ointment, sulphur, creosote, etc.; to weak and inflamed eyes, sulphate of copper, sulphate of zinc, nitrate of silver, and opium; to chronic ulcers upon the skin, tannin, pulverized rhubarb, opium, or cinchona; and to an inflamed throat, nitrate of silver and other articles. These are but specimens of the thousand cases in which we use local remedies. Why, then, when the mucous membrane, which lines the air tubes, becomes inflamed through all its branches, should we neglect, by the inhalation of medicated vapor, to apply a remedy directly upon the whole inflamed surface? Why, when tubercular matter is beginning to be deposited upon the surface of the air cells, and of the small bronchial tubes, should not the vapor go right to those parts, and cause, as it would, the immediate expulsion of this offending and dangerous matter?
Uneducated common sense sees the reasonableness of these suggestions at a glance. Many a person, with pulmonary disease, dies of suffocation, not because there is not muscular strength to expel the matter which is strangling him, but because the lungs below the large pellets of mucus, which plug up the bronchial tubes, cannot be inflated, and have therefore no means of driving out the offending substance. Yet a proper medicated vapor, drawn in with the breath, would either dissolve the mucus, or rouse up the expiring membrane to cast it off.
If the reader were to place one end of a stethoscope directly over the disease upon the breast of a person in the third stage of consumption, and should then ask him to talk, the words spoken would seem to rise up through the instrument, and enter, well articulated, into his ear. This, in technical language, is called pectoriloquy, a word signifying chest talking. It implies a cavity in the lung. If now the patient be asked to cough, a gurgling and splashing sound will be heard. This denotes that the cavity is partly filled with fluid, which is dashed about by the air explosively driven through it by t be portion of lung below. Here we have an excavated ulcer, with all its filthy contents, composed of pus, mucus, serum, and dissolved tubercles, lying in it day and night to aggravate its unhealthy condition. What more reasonable, what more necessary, than that a soothing, alternative, or astringent vapor should be drawn into this cavity, to cause its sides to heal, and its absorbents to remove this fluid? A surgeon who should permit an ulcer upon the surface of the body to remain in that condition without a local dressing would be deemed unfit to practice his profession.
Both in tubercular disease and in simple bronchitis, the bronchial tubes almost always suffer some physical change. The mucous membrane lining these tubes is generally softened. At other times the tubes become enlarged through their whole length, so that many of them, from the size of a quill, reach the bigness of the finger of a glove. In still other cases, the straining produced by coughing causes a tube to belly out at some point, forming a sack, which is generally filled with mucus or purulent matter. At still other times, a tubercle will press against a tube so as to flatten it and convert it into a musical instrument, the air, as it is drawn laboriously through, producing a high or low note, according to the size of the pipe. These physical changes are all produced by causes which the inhalation of a suitable vapor, at the proper time, would almost infallibly remove. How strange that this remedy, so simple, so effectual. so easily comprehended, should have been so little used!
Right at this vital point in the lungs, where the blood runs in a ceaseless current, where the whole of it goes every two minutes to renew its vitality by contact with atmospheric air, we have, in thousands of cases daily occurring, inflammation with roughening or softening of membrane, with its consequent harsh breathing; we have mucus, tough or glairy, to impede and interrupt respiration; we have tubercles in the hard or soft state, adding to the general embarrassment, and not only lessening the vitality of the blood, but disturbing all the sympathies of the system; and yet the practice has been, and is, to attack these central disturbers of life only through the circuitous path of the stomach, lacteals, etc.
I have investigated faithfully the effects of the various substances proposed for inhalation by European physicians, and have explored a wide field of new remedies, not before used, several of which have proved to have qualities of great remedial power.
The chief remedies I employ for inhalation are the following..
Alterative Inhalant, composed of iodine, six grains; iodide of potassium, twelve grains; tincture of ipecac, one ounce; tincture of balsam of tolu, six drams; ethereal tincture of conium, one and a half drams; alcohol, half a pint. These are to be mixed. The dose is one to two teaspoonfuls, to be inhaled ten or fifteen minutes, in about a gill of hot water.
The ethereal tincture of conium is made by keeping a dram of powdered conium in one ounce of sulphuric ether a week.
The above inhalant is used in the tubercular forms of consumption, particularly that of the scrofulous kind, and in many cases of bronchitis.
Expectorant Inhalant. Take pleurisy root, half an ounce; squill, one ounce; ipecac, two dram; black cohosh, two ounces; queen's root, one ounce and a half; American hellebore, two drams; diluted alcohol, one pint. Grind the roots, etc., and add the alcohol. Let the whole stand one week, shaking or stirring daily. Draw off and filter through paper. Two teaspoonfuls make a dose, to be in. haled same as preceding.
This is to be used when the cough is hard and dry, and the expectoration difficult. It makes the raising easy, lessening the soreness of the chest, and the harshness of the cough.
Soothing, Febrifuge inhalant. Take belladonna leaves, half an ounce; black cohosh, two ounces; American hellebore, half an ounce; poke root, two drams; aconite root, one ounce; diluted alcohol, one pint. Grind the roots, etc., add the alcohol. Let the whole stand one week, stirring daily. Pour off and filter through paper. Dose, one to two teaspoonfuls, to be inhaled as the preceding.
This is excellent in all cases where the skin is hot, the pulse quick, the tongue and mouth parched, the chest sore, and the system suffering during the whole or a part of each day, from a general feverish condition. It is proper in all the forms of chest disease.
Astringent Inhalant. Take of wild indigo, one ounce; catechu, half an ounce; Peruvian bark, one ounce; golden seal, one ounce; diluted alcohol, one pint. Mix, and let the whole stand one week, stirring daily. Drain off, and filter through paper. Add two drams of creosote. One to two teaspoonfuls to be inhaled as preceding.
This is to be used when the expectoration is profuse and easy, unattended by fever, either in the latter stages of chronic bronchitis, when the mucous membrane of the tubes is in a relaxed condition, or, in the third stage of tubercular disease, for the purpose of constringing, cleansing, strengthening, and healing.
Antiseptic Inhalant. Take wild indigo, one ounce; belladonna leaves, half an ounce; diluted alcohol, one pint. Mix, and let the whole stand one week. Pour off, and filter through paper. Then add solution of chloride of soda two ounces. Dose, one to two teaspoonfuls, to be inhaled as the preceding.
This is used in cases of gangrene of the lungs, generally distinguished by considerable expectoration having a very fetid smell.
Anti Hemorrhagic Inhalant. Take witch hazel bark, two ounces; black cohosh, four ounces. Grind, and add one pint of diluted alcohol. Let the mixture stand one week, stirring daily. Pour off, and filter through paper. Add to this two drams of creosote. Dose, one to three teaspoonfuls, to be inhaled as preceding.
This is an excellent remedy for bleeding from the lungs. When there is a tendency to bleed, it should be used for a long time. It may frequently take the place of the above astringent inhalant.
For immediate relief give strong solution of salt water.
Object of Inhalants. Being vaporized and inhaled, these articles enter every air cell throughout the lungs. Their object is to soothe and mollify inflamed mucous surfaces, to reduce enlarged bronchial glands which press upon neighboring parts and cause bleeding, to stimulate the absorbents to take up and remove tubercles, to dissolve tubercles out of the pulmonary tissue, to cause ulcerous cavities to expel their mattery contents, and to stimulate their sides to take on a healing process. They should be used from three to six times a day, the inhalation continuing from ten to fifteen minutes.
Other Inhalants. Great numbers of other articles have been used, which I have not space to describe. I will mention, however, that the following are sometimes employed with advantage:
For an Expectorant Inhalant, take alcohol, four ounces; tincture of camphor, half an ounce; tincture of tolu, two drams; naphtha, one dram; benzoic acid, thirty grains; oil of bitter almonds, four drops. Mix.
For an Anodyne Inhalant, take alcohol, four ounces; naphtha, one dram; benzoic acid, thirty grains; chloroform, twenty~ five drops; tincture of henbane, half an ounce. Mix.
For an Astringent Inhalant, take alcohol, four ounces; naphtha, one dram; benzoic acid, thirty grains; chloroform, one dram; tannin, eight grains. Mix.
Mode of Inhaling. For inhaling these, a sponge is fitted into a glass cup, to which a flexible tube is attached. A small quantity of the mixture is poured upon the sponge, and the vapor arising is drawn into the lungs through the tube.
To the expectorant inhalant may be added, occasionally, half a dram of nitric acid.
These latter formulas are the principal ones used by those who practice what is called cold inhalation.
A very common mode of inhaling volatile remedies is by saturating a little cotton, contained in a wire basket, with the desired oil or fluid, and placing it over the mouth and nose. It is to be warn throughout the day. Oil of peppermint, creosote, menthol, oil of eucalyptus, etc., etc., are among the more common remedies thus used.
A good inhaler can be bought of any dealer in surgical instruments.
Constitutional Treatment. The rapid breathing in consumption creates too much oxidation of the blood, so much, that the muscles, especially the heart, are ,usually of a bright red. To prevent the patient from being literally burned up by oxygen, the blood must be de oxydated as fast as possible.
While there is too much of oxygen, there is, at the same time, a deficiency of carbon. Hence the cold hands and feet, and the general inability to bear frosty weather. The little nutritive arteries, in these thin blooded persons, stand shivering and torpid with cold, unable to perform their allotted function of nutrition. There is not fire enough, and fuel must be bad in the form of carbon. Hence one of the advantages of cod-liver oil. This oil, too, as carbon, devours the oxygen of the blood, and prevents its destroying the patient. This idea also explains the fact mentioned by Bennet and others, that in their post mortems they found the evidences of healed ulcers in numerous persons who had been spirit drinkers while living. And Liebig helps the explanation by saying that alcohol, taken into the system, circulates in a free state in the blood, and devours its oxygen. To which I beg to add, that the malaria of intermittent and bilious fever districts, has been pretty satisfactorily proved to be an instable organic body, consisting of sulphur, carbon, and hydrogen, all of which have an affinity for oxygen, and devour it in the system. Consumption is not found in such districts.
As I am here treating of the chemical effects of remedies (and to this test most remedies must finally come), I will mention that tartrate of antimony and potassa arrests the circulation in the pulmonary arteries, which fact gives a complete and luminous view of its power to prevent oxidation. But I am obliged to detract from its merits, by stating that it also retards the circulation in the capillaries of the system generally, and so hinders de oxidation.
Phosphorus. There is an article which has more recently presented itself to the notice of the profession, to which I wish to invite special attention. I refer to phosphorus. This agent, for a time, challenged our notice in the shape of phosphate of lime; but we could never feel sure that this article was dissolved in the fluids of the body. We now use, and with far more marked effect, the hypopliosphites of lime, soda, potash, and iron. These are used in the form of the syrup of the bypopbosphites. The dose is a teaspoonful before each meal. The effect upon tubercular disease is immediate and gratifying.
Need of Phosphorus. Cerebric acid contains nitrogen and phosphorus, and is the peculiar component of the brain and nervous system. By combustion and the changes of oxidation in the brain, the phosphorus of cerebric acid is converted into phosphoric acid; so that every act of the brain produces phosphoric acid. How rapid, then, must be the consumption of the phosphoric element of the cerebric acid, in that highly active and excitable state of the nervous system which I have described as peculiar to consumption. And bow necessary, in order to save the brain from destruction, to meet this increased demand for phosphorus, by introducing it into the system.
Mulder regards the fibrin of the blood as the carrier of oxygen; and by this oxidation, the fibrin becomes converted into the binoxide and trioxide of protein, its phosphorus and sulphur (for it contains both) beino, converted into phosphoric and sulphuric acids. Adding phosphorus and sulphur, therefore, as medicinal agents, would seem to be the proper way to supply the fibrin with materials destructive of its freight of oxygen.
It is well known that the salts of phosphoric acid are essential for the formation of azotic compounds, compounds which are necessary to sustain animal life. It should be remembered, too, as collaterally illustrating this fact, that the tribasic phosphates of potash, soda, lime, and magnesia, play an important part in the growth and perfection of plants. They are always found in the seeds of the cerelia, and no mature grains are produced where phosphates are absent from the soil. For the production of abundant grain crops, it is necessary that these salts should exist in the soil, or be applied to it in manures.
It is known, moreover, that in all chronic diseases distinguished by wasting of the tissues, a much larger quantity of phosphates is excreted by the kidneys than in the normal state. Hence there is no healthful growth; and the human organism, like the soil, exhausted of its phosphates by successive croppings, brings nothing to perfection, and needs to have its drained salts re supplied.
I cannot but call attention here to the inorganic substances found in healthy human blood. According to very careful analyses, by Schmidt:
1000 parts of blood corpuscles, contain:
Phosphate of Lime.........0.114
Phosphate of Magnesia.....0.073
1000 parts of liquor sanguinis (serum and fibrin), contain:
Phosphate of Lime.........0.311
Phosphate of Magnesia.....0.222
Iron is omitted. Now, I venture the prediction, that out of these figures, mainly, in connection with those which represent the constituents of the saliva, the bile, the gastric juice, the pancreatic secretion, and the organic compounds of the blood and tissues, are to be evolved within a few years a correct and partially demonstrative system of medication. In consumption, all the inorganic bodies represented by the above figures, with the exception of oxygen, are deficient in quantity. By reflecting upon the proportions of these several bodies, particularly upon the large amount of chlorine and soda in the plasma, and of potassium in the corpuscles, the mind can hardly fail to obtain useful hints. I have not hesitated to make one of these hints the ground of a very free use of alkalies, particularly in the form of bathing.
Sugar of Milk. There is one other medicinal article which I deem worthy to be made prominent, and to be placed side by side with cod liver oil and the hypophosphites. I refer to sugar of milk. It belongs to that class of nonnitrogenized articles which Liebig has denominated supporters of respiration. Its great affinity for oxygen is well worthy to be taken into the account, in considering its value in consumption. So great is this attraction, that, with ammonia and other alkalies, it has the power of reducing some of the metallic oxides. When taken into the stomach, it is rapidly absorbed into the blood, which, being an alkaline fluid, augments its great deoxidating power to a considerable degree. It unites rapidly with oxygen after entering the blood, forming carbonic acid and water. A part of it, however, does not enter the blood in an uncompounded state, but is changed in the stomach into lactic acid; and this, in the blood, becomes an alkaline lactate. But the portion thus changed appears also very useful; for Lehmann says: , We know of no substance which could better act in the blood as food for the respiration, than the alkaline lactates."
Corroborative of these views is the fact that all those kinds of milk, such as goat's, ass's, etc., which contain the largest amount of sugar of milk, have at different times, and in various countries, obtained a reputation for curing consumption. Goat's whey, in which this article abounds, and from which it is largely manufactured, has been celebrated for its virtues in this line. Ancel speaks of it as an excellent remedy; and Pereira says, Sugar of milk, in consumptive cases and chronic diseases of the digestive organs, is a most valuable aliment."
One of the best forms of taking sugar of milk is that of a gruel, which is quite palatable, and may be freely eaten by consumptive persons.
Creosote, Guaicol, etc. Modern researches having proved that consumption, as well as many throat and other diseases are propagated by germs or bacilli, as explained on page 269, medical investigators have for a long time been seeking some agent that would destroy these germs without at the same time injuriously affecting the human system. A few years ago Dr. Robert Koch, a celebrated German scientist, who had long been investigating the consumption, cholera, and other microbes, thought he had discovered a lymph that would destroy or at least counteract the consumption bacillus; but unfortunately it proved a failure. Creosote, carbolic acid, guaicol and similar drugs kill the germ when outside the body, and for this reason most therapeutists of to day use these remedies in as large a quantity, and for as long a time as the system will tolerate. At all events, whatever may be the outcome of the custom at present in vogue, creosote certainly arrests the rapid proliferation of germ life in the lungs, improves the appetite and digestion, lowers the temperature, and apparently helps the patient. The only offset to the use of this class of remedies lies in the fact that one cannot thoroughly disinfect the blood sufficiently to kill these germs completely. Creosote made from Beachwood, taken in three drop doses with a wineglass of milk, after food, three times a day, is the usual form of administration. This dose should gradually be increased till ten and even twenty drops are taken at a time. The carbonate of creosote is a more elegant and perhaps more effective form of the drug. This medicine may also be procured in the form of capsules and pills.
By Dr. Cyrus Edison's recently discovered product of carbolic acid, asepsin, it is claimed that seventy per cent of consumptive cases can be cured. It can only be administered as a hypodermic injection, however, at the hands of an experienced practitioner.
The Cough. The best article I have ever used for this is the Pulmonic Cherry Cordial." I was five years in compounding this article to suit me, and I believe it to be the very best cough preparation ever made. Dose, from one to two teaspoonfuls.
Pulmonic Cherry Cordial. Wild cherry bark, ground, 10 pounds ipecac root, 20 ounces; bloodroot, 24 ounces; squill root, bruised, 12 ounces; pulverized liquorices root, 5 ounces; cocbineal, bruised, 2 ounces; anise seed, 32 ounces; fennel seed, 8 ounces; orange peel, 16 ounces; acetate of morphine, 12 drams; alcohol, 8 gallons ; water, 8 gallons; pulverized. white sugar, 40 pounds; sulphuric acid, 1 ounce.
Directions for making. Grind all the articles to a coarse powder except those directed to be bruised or pulverized, and put them all to the alcohol except the wild cherry bark, the water, the sugar, and the sulphuric acid. Let them stand one week, shaking or stirring thoroughly twice a day. Then, having kept the wild cherry bark two days in a covered vessel, with water enough upon it to wet it through, place it in a percolator, and run eight gallons of water through it. Add this to the alcohol and other ingredients. Let the whole stand three days longer, stirring as before, twice a day. Draw off, and filter through paper. Now add the sugar, and lastly the sulphuric acid. The acid is intended mainly to improve the color, by acting chemically upon the cochineal. The color is a fine cherry red, tinged with orange.
I have given the directions for making sixteen gallons this being the smallest quantity in which I make it. Any person can easily make the calculation for reducing the quantity. The assertion previously made that this is the ̉best cough preparation ever made," I see no cause to modify in the smallest degree. Were it kept in every apothecary shop, and were physicians to prescribe in pulmonary complaints,' adding a little syrup of squills or wine of ipecac when a more expectorant effect is wanted, or a little morphine if greater narcotism is sought, it would save them much trouble in compounding cough syrups, and give them much more satisfactory results. I have compared its effect, again and again, with the best other preparations in use, and I pledge my word that it will succeed in twice as many cases as any other compound that may be chosen. Let physicians try it; and I will be responsible for ever hair's breadth in which they find this proportion of successful results abridged.
When a more quieting effect is needed, a little morphine may be added to this preparation; if a more expectorant influence is required, add a few drops of the tincture of veratrum viride. For the great majority of cases, it will be found to be right without any addition. When this is not at hand, any of the preparations (108), (112), (109), (113), (110), etc., may be used. Another good preparation is Dr. King's consumption cure.
Night Sweats. The very best preparation for these sweats is a compound of the oxide, of zinc, one dram; extract of conium, half a dram; to be made into thirty pills, of which one or two are to be taken every night. The sponge bath also does much to check these sweats, and vinegar baths (369). Atropia, 1/100th of a grain on retiring, and especially Agaricin, 1/6th grain, will cause the sweats to stop absolutely.
Diarrhea. This is a most exhausting symptom in the latter stages of consumption. The only remedy which has much effect in controlling it is the tris nitrate of bismuth. This should be given in closes of thirty grains immediately after, or at the time of each meal. These doses are much larger than used to be given; but they will do no harm. Given to this extent, I find the bismuth very effectual.
Iron. This preparation, in some of its forms (316), (73), (159), (102), is almost always needed in consumption. If the scrofulous habit be strongly marked, give syrup of iodide of iron, in thirty drop doses, three times a day. It should be taken in a glass of water. To the feeble administer Gucle's pepto mangan in teaspoonful doses three or four times daily. This is one of the simplest and most efficacious forms of iron we have.
External Irritants. These are needed where there is much inflammation and soreness of the chest. Blisters should very seldom be used. Croton oil, from two to half a dozen drops, rubbed over the sore part, generally answers very well. Sometimes the mustard paste, applied to the extent of producing redness, two or three times week, is sufficient. Nitric acid, reduced with water to a strength little above the strongest vinegar, answers a good purpose for keeping up an irritation.
Atmospheric Inhalation. It has been said by Laennee and others, that asthma has sometimes the effect of arresting tubercular consumption. Dr. Ramadge thought this was effected by an expansion of the vesicular structure of the lungs; and he reasoned that the same expansion, by mechanical means, would secure a similar end. To effect this, he made his patients take long breaths through a tube constructed for the purpose.
It is manifest that the philosophy of atmospheric inhalation was not understood by Dr. Ramadge, nor has it been by any of his follower,, in this country.
Rokitansky thinks the tubercular habit depends upon the excess of fibrin in the blood; and says that the reason of consumption being arrested by pregnancy is, that this condition offers a mechanical obstacle to the transmission of blood through the lungs, thus preventing its excessive oxidation, and keeping it in a venous state. This destroys the fibrinous condition, on which he thinks tuberculosis depends.
Now this is precisely what is clone by atmospheric inhalation. The trachea divides, on its entrance into the lungs, into two branches, which again divide and subdivide until the tubes become smaller than can be seen, each terminating in a minute air cell. Over this entire surface the air is intended to be brought into communication with the blood for the purpose of oxidating it. By forcible inhalation, the air vesicles are inflated to the extent of their capacity, by which means the extreme branches of the pulmonary arteries are so flattened between these extended cells, as to be able to convey but a small amount of blood, and but little is oxidated. This furnishes a mechanical obstruction to the transmission of the blood, and secures the defibrination of which Rokitansky speaks.
This is my view of the philosophy of atmospheric inhalation. The benefit results, not from a larger amount of oxidation, as is generally supposed, but from a smaller. Asthma does the same thing by precluding spasmodic contraction of the extreme bronchial tubes, and preventing air from entering the cells.
The same end is gained in part by certain kinds of employment, as glass blowing, playing upon wind instruments, and the like. Writers of distinction mention cases of recovery from incipient consumption by a vigorous use of the lungs in singing. Dentists subject their lungs to a similar process of expansion in the use of the blow pipe; the writer has known several instances in that profession, in which recoveries have taken place.
The Conclusion to which I come is, that atmospheric inhalation may be used with great advantage in some cases, but should never be resorted to except under the direction of a competent physician. In a congested state of the lungs, with hemorrhagic tendencies, or with inflammation and soreness, it is well fitted to produce fatal bleeding and is of course dangerous.
External Use of Water. As a relaxation from severe exertions, the ancients had frequent recourse to bathing. Those who contended in the race, throwing the javelin, and wrestling, at Rome, plunged into the Tiber while warm and panting with their efforts. That this promoted prowess and physical endurance, none can doubt.
Louis, the great French authority on pulmonary diseases, lays down several rules to be observed by consumptive patients, and particularly mentions cold bathing.
Few things give tone to the capillaries of the skin like cold water, systematically applied. It rallies the powers of the constitution, and improves assimilation. And by it another object is gained of scarcely less importance, that of guarding the system against taking cold. Those in the daily habit of applying cold water to the whole person seldom suffer from colds and catarrhs; they generally become hardened so as to endure the assaults of the elements.
Consumptive persons should generally use the sponge bath, with cold water, if it can be endured, otherwise the tepid bath, to be followed, in all cases with brisk rubbing, with a coarse towel. If a sense of chilliness and discomfort follows the bath, a large portion of the water must be squeezed from the sponge, so as to use but very little, and the washing must be speedy, and the rubbing more lively than usual, beginning with tepid water, and gradually lowering the temperature till it can be borne cold. A large teaspoonful of saleratus to each quart of water should be used.
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