The Project Gutenberg eBook of Rules and directions for the employment of injections in various diseases

This ebook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this ebook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.

Title: Rules and directions for the employment of injections in various diseases

Author: Thomas Lewis

Release date: December 6, 2017 [eBook #56137]
Most recently updated: October 23, 2024

Language: English

Credits: Produced by deaurider, Jwala Kumar Sista and the Online
Distributed Proofreading Team at http://www.pgdp.net (This
file was produced from images generously made available
by The Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK RULES AND DIRECTIONS FOR THE EMPLOYMENT OF INJECTIONS IN VARIOUS DISEASES ***

RULES AND DIRECTIONS

FOR THE

EMPLOYMENT OF INJECTIONS

IN VARIOUS DISEASES;

WITH QUOTATIONS FROM DISTINGUISHED

MEDICAL AUTHORS.

Trade Mark

PRINTED TO ACCOMPANY

LEWIS'S IMPROVED PORTABLE SYRINGES,

OR DOMESTIC INJECTING APPARATUS.

BOSTON .... 1857.

Entered according to Act of Congress in the year 1856,

By Thomas Lewis,

In the Clerk's Office of the District Court of Massachusetts.

Printed by Alfred Mudge & Son, 21 School St.

INJECTIONS.

PREFACE.

Heretofore one of the greatest objections to the free use of Injections, as a domestic remedy, has been the inconvenience and clumsy size of the instruments employed for the purpose, and the manner of their construction, such as to render them liable in a short time to get out of repair, and become worthless. It had therefore become a matter of necessity that a new instrument should be introduced, that could be used with ease either for injecting the bowels of children, for female uses, or for self-administration. The new instrument which is herewith offered to the public, termed the Improved Portable Syringe, or Domestic Injecting Apparatus, we have taken great pains with to perfect, so as to overcome the many serious objections entertained against the old ones, and which we flatter ourselves we have succeeded in doing, by constructing it in such a manner as to render it impossible for it to get out of repair, unless by the abuse of the user. Its size makes it extremely portable, so much so that it can be carried in the pocket without the least inconvenience; and being made on the principle of the pump, is capable of injecting any given quantity of fluid without being taken to pieces, or altered in the least, and with any degree of force or rapidity that may be necessary; and in connection with the crooked or angular tube, can be used by an invalid without any assistance or difficulty, therefore making it a very superior and convenient instrument for self use. Also, in connection with the vaginal tube, as a female syringe, and with the small tube for injecting the bowels of children, which is a very difficult matter with the common instruments formerly used for the purpose. One very important feature in this instrument is, that an injection of which gruel forms a part will be found to be as easily administered as one more fluid, therefore rendering it invaluable to physicians and others who have frequently to resort to such an Instrument, and are annoyed to find the instruments with which most families are supplied will not answer the purpose.

This little book of rules and directions, which has been carefully prepared by an experienced physician, and which is herewith presented to our readers as an accompaniment to the Improved Portable Syringe, is not intended as a medical work or treatise on the human system, which are often printed to accompany instruments of the kind, and which few people ever read or care about, but is intended merely as a guide in the administration of the more simple remedies in the form of injections, well knowing that the majority of the people had rather rely on the advice of an experienced physician in all critical cases than their own judgment, formed from reading books of the kind.

Boston, January, 1856.

The Uses of Injections.

Injections, or Clysters, are liquid substances or medicines injected into the lower intestines by mechanical means, for the purpose of promoting alvine discharges, relieving costiveness and cleansing the bowels. They are also sometimes administered to nourish and support patients who cannot swallow aliment, to evacuate the bowels without purging, to affect the system through the intestines, to remove worms from the rectum, to cure other disorders of the rectum, to lessen diarrhœa or dysentery, to alleviate spasms in the stomach and intestines, to produce other medicinal effects in the stomach, when all other curative means are too irritating. Prompt in operation, they are very useful in inflammatory affections of the bladder, womb, liver, kidneys, and lungs; and for the relief of hysterics, croup, determination of blood to the head, and convulsions; also in urethral strictures, urinal retention, flooding after child-birth, and in removing the after-birth, when nature fails to do so. When warm, they are of the greatest service in cases of suspended animation; and for the purpose of nutrition they alone have prolonged life for over ten weeks. Carefully administered, they are always safe.

Authorities upon Injections.

It is not necessary to accumulate the evidence of physicians concerning their utility. Every practitioner of medicine can recall the cases, in which a perfect syringe would have saved hours of pain, and in which he could find only the most inefficient aid from a leaky barrel and a loose piston.

Dr. Pereira, of London, author of one of the best treatises on Therapeutics, says: "Warm water is injected into the rectum to excite alvine discharges, to promote the hæmorrhoidal flux, to diminish irritation in the large intestine, or in some neighboring organ, as the uterus, bladder, prostate gland, &c.; and to bring on the menstrual action. Thrown into the vagina, it is used to allay uterine irritation and pain, and to promote the uterine discharge." And again:

"Cold water is thrown into the rectum to check hæmorrhage, to expel worms, to allay local pain, to rouse the patient in poisoning by opium."

Dr. Thompson, also of London, speaks "favorably of the effects of cold water introduced into the vagina, in uterine hæmorrhage."

Dr. Copland, the editor of the Medical Dictionary, says, that in cases of intestinal spasm or colic, "the spirit of turpentine thus employed is an efficacious remedy, especially when much flatulent distention is associated with spasm."

Dr. Copland also says: "In some cases of lead colic, I have found the colon so enormously distended, from flatus and loss of contractile power, that I could distinguish its form and course, in the different abdominal regions, by the eye, when standing at a considerable distance from the patient; and yet the bowel has been restored to its healthy state by repeated injections containing turpentine, castor oil, &c., aided by stimulating friction on the spine."

In the colic of the young and plethoric, Dr. Charles A. Lee, of New York, says: "A very successful mode of treatment in these cases, is that of gradually forcing up, by injection, a large quantity of some bland fluid until it reaches the seat of obstruction or of spasm, when a speedy evacuation and relief will generally follow. In many instances it will be required to repeat it, before this result takes place; but, in all curable cases, if reasonably applied, more speedy relief may be expected from this means than almost any other."

The following extract from "an oration delivered by Dr. Burne, before the London Medical Society," will show the importance and extensive utility of injections as a means of restoring the alimentary system to its natural state of activity.

"An undue retention of the intestinal excretions is another source of disorder and of disease arising out of civilized life. It is produced by affections of the mind, by indigestion, by inattention to the calls of nature, and mechanical obstruction from organic disease, which last is frequently excited by the retained excretions themselves.

"The undue retention of the excretions takes place in the larger (or lower) intestines, for until the excrementitious matter arrives here, there is no reason to believe that its propulsion is arrested, although it may be less at one time than at another.

"The undue retention of the excrementitious matter allows of the absorption of its more liquid parts, which is a source of great impurity to the blood; and the excretions, thus rendered hard and knotty, act more or less as extraneous substances, and by their irritation induce a determination of blood to the intestines and to the neighboring viscera, which ultimately ends in inflammation and organic change of the bowels.

"It has also a great effect on the whole system; it causes a determination of blood to the head, which oppresses the brain and dejects the mind; it deranges the functions of the stomach, causes flatulency, and produces a general state of discomfort.

"In civilized life, then, the causes which are most generally and continually operating in the production of disorder and of disease are, affections of the mind, improper diet, and retention of intestinal excretions."

Dr. J. G. Gunn, in his interesting medical work, entitled "Gunn's Domestic Medicine," published in 1850, for the benefit of the people, speaking of injections as a domestic remedy, says:

"Language almost fails to express the great value of this innocent and powerful remedy in very many of the diseases to which mankind are daily and even hourly subject; and I most seriously regret to say that it is a remedy not only too little known but too seldom used, both by physicians and in families. This disregard for the great virtues of injections must either arise from the supposition that the operation is too troublesome, or from a false and foolish delicacy, which forbids the use of an instrument by which the lives of thousands have been preserved in extremely critical circumstances, and with which every mistress of a family should be perfectly acquainted, so as to be able to use when required in sickness. And I do here most positively assert, and that, too, from my own experience, that hundreds to whom I have been called in cases of cholic must have died had it not been for the immediate relief given by injections. I will mention one strong instance to prove the correctness of my assertion. While practising in the State of Virginia, I was called on, at midnight, to attend a stranger, who had arrived but a few moments before in the mail stage. This gentleman was one of the judges of the supreme court in the State of New York. He stated to me that the cholic had been coming on him for a considerable time before the stage stopped. By the time I arrived his misery was so extreme that he repeatedly exclaimed, "I must die unless immediate relief is given me." After administering all the remedies which are usually given in such cases, without any relief, I commenced administering injections of water, pleasantly warm. On the first being thrown up the bowels he experienced more relief than had been produced by all the other remedies I had tried. He felt an immediate exemption from pain, and after two or three more had been given, a copious discharge by the stool followed, and he was entirely restored.

"Injections principally act by exciting the lower portion of the intestinal tube, and sometimes from the effects of sympathy. In the latter case the discharges are generally copious, or in other words, of large quantity; and to produce these full discharges by stool, the injections of warm water, tempered so as to be pleasant to the feelings of the patient, may be frequently administered, and in such quantities as the bowels will bear. I have continued to give these injections of warm water for an hour or more, in many instances, before I could overcome or subdue spasm or cholic, and in cases of great constipation. In fevers and inflammations, injections made of slippery elm bark, which I have frequently directed and administered, tend to cool the whole system, allay the heat and irritation of the bowels, and gently assist the operation of the medicine which has been given. They will also produce a determination to the skin, which means a gentle moisture or sweat. Tepid or warm water always opens the bowels, but the very reverse of this practice is sometimes resorted to in desperate circumstances and with great advantages by some of the most distinguished physicians. In cases of very obstinate constipation relief has frequently been obtained when all other remedies had failed, by an injection of the coldest water, even of iced water. There are many persons who are constitutionally subject to costiveness. This costiveness arises from a variety of causes, such as diseased liver, indigestion, torpor of the bowels, and from improper food being taken into the stomach and bowels, which will generally produce spasms or cholic pains, depression of spirits, &c. All these can be easily remedied by a simple injection of water thrown up the bowels, which relieves them of their load, and the mind and feelings soon experience an agreeable change. You who are always taking medicines to keep your bowels open and whose stomachs are becoming exhausted and worn out by medical drugs, let me entreat you, as a friend and physician, who has witnessed throughout France the great and surprising benefits arising from this simple operation, to abandon the idea of constantly taking medicines for the purpose. In France there is scarcely a family unprovided with an injecting apparatus, which is always used when there is the slightest obstruction or costiveness of the bowels. These people mostly use a simple clyster of milk and water, and sometimes water alone; in summer they use cold water, and in winter, water pleasantly warm. It is to the warm bath and the common use of injections that are to be attributed, in a great degree, the cheerful dispositions, the uniform health, and the practical philosophy with which these people bear the hardships and misfortunes of life. In fact, if you take from a French physician the warm bath and the injecting pipe, he cannot practise medicine with any kind of success. The importance of injections, both in the hands of physicians and families, has become so well known, and is now so highly valued, as to call forth the commendations of the most eminent physicians of both Europe and America. Injections constitute one of the most powerful, innocent, mild, and beneficial remedies known in the science and practice of medicine."

VIEW OF

LEWIS'S IMPROVED PORTABLE SYRINGE,

OR

DOMESTIC INJECTING APPARATUS.

DESCRIPTION.

A—Base of Instrument, connected by a screw, containing a cavity and valve, through which the fluid is drawn into the Barrel.

B—Barrel, containing the Piston or Plunger.

C—Cap, connected with the Barrel by a screw.

D—Piston Rod, surmounted by a metallic handle, terminating within the Barrel by the Piston or Plunger.

E—Metallic Chamber, containing a valve, to which is connected, by a screw, the flexible Tube.

F—Flexible Tube, to the end of which are attached, as they may be needed, the different pipes.

G—Straight Pipe, for injecting the bowels of adults, to be attached to the flexible Tube, when used with an assistant.

H—Crooked or Angular Tube, to be used for self-administration.

I—Small Pipe, for injecting the bowels of children.

J—Female or Vaginal Tube.

DIRECTIONS FOR USE.

For Self-administration.

Attach the crooked or angular tube, H, to the end of the flexible tube, F; place the fluid intended for use in a basin opposite you; introduce the pipe, and sit down upon it, holding the instrument upright in the basin with one hand, and working the piston with the other.

For use with an Assistant.

If the instrument is to be used by an assistant, (as is often the case in sickness by a nurse,) the straight pipe, G, should be used instead of the crooked or angular one.

For Children.

For injecting the bowels of children, use the small pipe, I.

For Female or Vaginal Uses.

Attach the long pipe, J. (See Vaginal Injections.)

The Piston, or Plunger, and the Care of the same.

If the instrument has stood some time without use, or has been kept in a dry or warm place, the leather of which it is composed may have become dry; it should therefore be withdrawn from the barrel and immersed in warm water, (not hot.) It should then, after remaining a short time, be saturated with melted tallow or sweet oil, which will restore the suppleness to the leather and cause it to work easily within the barrel. If the instrument has stood in a very cold place, the leather of course would become chilled. This can be easily set right by merely immersing the barrel of the syringe in a basin of warm water. The interior of the barrel may sometimes become rough by means of matter adhering to it that has been used in the instrument, such as gruel, or other thick injections, and may cause an obstruction to the working of the plunger. The barrel should, therefore, in such cases, be thoroughly washed out with warm soapsuds before returning the plunger to its place. The leather with which this is constructed is prepared in a peculiar manner, expressly for the proprietor, so that it will not dry hard, and can be used for a long time without parting with its oily matter.

N. B.—Extra leathers for the plunger can be obtained of the proprietor, or his agents, and sent to any place by mail. Price 12½ cents.

The Valves.

These consist of small mineral balls, and are operated in an improved chamber or cavity, which allows them to always work well, and are not liable to stick or become wedged, as has been the case with instruments formerly made with this kind of a valve. They are greatly superior to India-rubber valves, which soon, by the action of the fluid, become unfit for use. Should the valves by any means be lost, a common marble, if round, will answer the purpose. ☞ After the instrument has been used for administering any thick injection, it should be thoroughly cleansed by pumping some clear water through it, and all sediment which may remain in the valve chambers, A and E, should be removed, or it may cause an obstruction to the working of the valves.

N. B.—Be careful not to put the instrument away wet, or it will injure the box.

The Flexible Tube.

The reader will observe that the couplings to which the flexible tube is attached are made with a neck, which is inserted into the orifice of the tube, the compression of which, when on, holds it firmly in its place. ☞ If at any time the flexible tube should be injured so as to be unfit for use, a new one can be forwarded by mail to any place, on application to either of the proprietor's agents, and it can be readily attached without the least trouble by any person. Price of Flexible Tube, 25 cents.

Withdrawal of the Piston.

Persons may sometimes withdraw the piston or plunger from the barrel, and on account of its peculiar construction be unable to return it again. Therefore, please observe that it is composed of two round pieces of leather, which are turned in opposite directions over the metallic plates—the upper one turning up, the lower one turning down. With the leathers thus arranged, it is to be introduced sideways into the barrel, and the portion of the lower leather which remains outside of the barrel gradually and carefully pressed in with the thumb nail. ☞ But in so doing be very careful not to cut or injure the leather. N. B.—Silver Plated Syringes, suitable for using nitrate of silver, furnished to order at short notice. (See Nitrate of Silver Injections.)

Peculiarities of the Improved Portable Syringe.

The peculiarity of this instrument, which renders it superior to others heretofore used, consists in the mode of constructing the valves and valve chambers. Many of the celebrated instruments with which the market has been heretofore supplied have been constructed with cylindrical valve chambers, having a flat seat for the valve to rest upon, through which is an orifice for the passage of the fluid. The valve itself consists of a circular piece of India-rubber, the diameter of which is somewhat less than that of the chamber, in order to allow the fluid to flow by it when the valve is raised. There are several serious objections to these valves. The India-rubber in a short time enlarges when in use so as entirely to obstruct the passage of the fluid, especially when a warm injection is used, which quickly softens and moistens the rubber. The valve, too, in such cases, if made so small and light as to avoid this evil, is liable to double or fold up, and is drawn through the orifice in the valve neck into the barrel of the instrument, and thereby entirely stops its working.

In the instrument now offered to the public, these objections are entirely obviated by using for a valve a small mineral ball, which rests upon a concave seat, to which it is nicely adjusted. The ball, being of a material which does not absorb water, never becomes enlarged by use; and it is obvious that it can never be drawn through the orifice into the body of the instrument. It is also a self-adjusting valve, the friction of the ball on its seat having a constant tendency to make them fit together more accurately. The mineral balls are acknowledged to be much more durable than the India-rubber disks; and as an instrument is serviceable only while all its parts are fit for use, it is apparent that the new instrument will last much longer than those which have been constructed in the manner described.

Care and Preservation of the Instrument.

In all cases, after the instrument has been used for injecting any medicinal preparation, gruel, or in fact anything except clear water, care should be taken to thoroughly cleanse it before laying it aside, or it will become foul. This can be easily effected by pumping through it some pure water, which will generally remove all sediment that may be left in the instrument. If an injection containing oil has been used, strong soapsuds will be required to remove the oily matter. If in cleansing the syringe the plunger is withdrawn from the barrel, great care should be taken that the leather is not injured in returning it again. (See Directions for Use.)

As this instrument is composed wholly of the best of Britannia, and not of part lead, like most of the instruments of the kind, it can be easily kept clean and bright as when new, by rubbing it smartly for a moment with a piece of soft flannel or wash-leather. The little trouble occasioned by this process will be amply repaid by the handsome appearance of the apparatus.

Common Injections.

Take of cold or warm water about three quarters of a pint. These are the most simple injections for costiveness, and are generally very effective in their action. Cold water is highly recommended by Dr. Jackson, of Boston, in cases of habitual costiveness, and may be used daily for many years, without injury.

Laxative Injections.

Form I.

Take one half pint of strong soapsuds, made from the yellow bar; or common soft soap is often used, in two gills of warm water. This will be found very active, and is much used in bad cases of constipation, or to hasten the operation of cathartics taken by the mouth.

Form II.

Take of common salt, molasses, and lard, one table spoonful each, to which add one pint of warm water. If this do not operate as effectually as may be desired, the effect may be increased by the addition of a table spoonful of olive oil, or infusion of senna.

Purgative Injections.

Form I.

Take of soft soap one table spoonful, of olive oil one half a pint, to which add a pint and a half of warm water. This is recommended by Dr. Jackson in cases of obstinate constipation.

Form II.

To one pint of water gruel or thin starch add a table spoonful of castor oil, or the same quantity of common lard, and a table spoonful of salt. This is an excellent cathartic.

Form III.

Take of powdered senna two scruples, of soft soap one ounce, to which add a pint of boiling water. This is a very efficient cathartic enema in obstinate constipation, arising from colic, or other more inflammatory conditions of the bowels.

Form IV.

To one pint of warm water add one ounce of castor oil and half an ounce of salt of tartar. Or take of Epsom salts one ounce, of senna leaves half an ounce, to which add one pint of boiling water. Pour the boiling water upon the senna and let it stand for a quarter of an hour; then strain and add the Epsom salts.

Either of these will be found to be very effectual in their operation.

Emollient Injections.

Form I.

Take of molasses and water one pint, to which add one ounce of common lard. This has been found very effectual in cases of dysentery.

Form II.

To one pint of water add one ounce of common dried mallows, and one half an ounce of dried chamomile. Boil together fifteen minutes, and strain.

Starch Injection.

To one pint of water add from four to six drachms of starch. Rub them well together and boil a short time. This is used as an excellent emollient enema in an inflammatory condition of the large intestines, or in irritation of the rectum, but chiefly in inflammatory cases. Flaxseed or slippery elm may be substituted in most cases, if more convenient.

Injection for Piles.[1]

To one pint of water add half an ounce of bruised galls and two large poppy heads. Boil together twenty minutes, and strain. This will be found to be a valuable remedy in severe cases of piles, where the rectum is much inflamed, it being very soothing in its nature.

[1] Piles.—There are two kinds of piles, originating from very nearly the same causes. One is called the bleeding piles, the other the blind piles. The piles are small swelled tumors of rather a dark appearance, usually situated on the edge of the anus or fundament. When there is a discharge of blood from these tumors the disease is called bleeding piles; but when there is only a swelling on the edge of the anus, and no bleeding when the bowels are evacuated, the disease is called the blind piles. Both men and women are subject to piles; but women more particularly during the last stages of pregnancy, in which the womb presses on the rectum in relieving the bowels by stool. These tumors can plainly be felt, as they extend up the rectum an inch or more in severe cases. When these tumors burst and bleed, the patient is much relieved; but when the pain is severe, it is apt to produce fever. Many persons are constitutionally subject to this disease through life. It is generally, however, brought on by costiveness, or irregularity in relieving the bowels. Piles are also produced by sedentary habits, by the use of highly seasoned food, by riding a great deal on horseback in hot weather, by want of exercise, and lastly by the use of spirituous liquors to excess. Injections are much prescribed for their relief, and are found to be highly effective.

Turpentine Injection.

Take of spirits of turpentine one half an ounce, to which add the yolk of an egg and three quarters of a pint of warm water. The injection is to be repeated as often as the case may require.

Astringent Injections.

Form I.

Take of powdered nutgalls two and a half drachms, to which add half an ounce of walnut leaves and one quart of water. Boil down to a pint and a half, and strain. This is used in cases of leucorrhœa, or whites, and is esteemed a useful remedy.

Form II.

Take of white oak bark one ounce, to which add two pints of water. Boil to a pint, and strain. This is regarded as an excellent remedy by many eminent physicians in cases of leucorrhœa. (See Vaginal Injections.)

Form III.

Take of alum two and a half drachms, and dissolve in one pint of water. This is frequently used in dysentery.

Form IV.

Take of alum two drachms, and of decoction of walnut leaves one quart. Dissolve and mix well together. This compound is found serviceable as a vaginal injection in leucorrhœa.

Form V.

Take of powdered galls one drachm, to which add one pint of water. Boil down to three quarters of a pint, and strain. This preparation has been found very useful in chronic diarrhœa and excessive hemorrhage from piles.

Form VI.

Take of soft extract of rhatany seventy-five grains, to which add one drachm of tincture of rhatany, and a half a pint of water. Dissolve the extract in the water, and strain; then add the tincture. This has been successfully prescribed by many physicians for bleeding piles, fissures in the anus, and chronic dysentery.

Anti-Dysenteric Injection.

Take of solution of acetate of lead from two and a half drachms to four drachms, to which add one pint of water.

For children, from one half to two and a half drachms will be sufficient in a proper proportion of water. This is an effectual injection in acute dysentery.

Injection of Sugar of Lead.

Take of sugar of lead one scruple, and of laudanum forty drops, to which add half a pint of warm water. This is recommended by the celebrated Dr. Davis as a sure remedy in cases of uterine hemorrhage.

Opiate or Anodyne Injections.

Form I.

Take of laudanum fifty drops, to which add five ounces of starch mucilage, and mix well together. The United States Dispensatory, speaking of this invaluable remedy, says that for obstinate vomiting, stranguary affections of the kidneys, bladder, &c., it is the most admirable remedy now in use.

Form II.

Take of laudanum one half a teaspoonful, to which add two ounces of starch mucilage, and mix thoroughly. In dysentery and other painful affections of the intestines, this is considered by the best medical authority to be a certain relief. Dr. Druit directs from one hundred to one hundred and twenty drops to be administered. A whole teaspoonful has been often used in severe cases. The less mucilage used, the more likely is the injection to remain in the rectum. An opiate injection for a child not over a year old may consist of two or three drops of laudanum mixed in three quarters of an ounce of mucilage. Opiate injections should not be administered often, without the advice of a physician.

Form III.

Take of powdered opium four grains, to which add one ounce of lard. Melt with gentle heat, mix thoroughly, and inject warm.

Lime Water and Catechu Injection.

Take of electuary of catechu half an ounce, to which add ten ounces of lime water. This has been administered with most beneficial results in diarrhœa.

Chloride of Soda Injection.

Take of chloride of soda one ounce, to which add from a half pint to a pint of water, and mix well. This is used in vaginal injections in cases of infections produced by the decomposition of a retained after-birth; also to destroy the offensive odor of stools, and to relieve pains in wounds of an unhealthy character.

Irritant Injection.

Take of hot Port wine one pint, and of alcohol five drachms. In cases of colic, where an active and speedy relief of the bowels is desired, this remedy has been highly beneficial.

Anti-Neuralgic Injection.

Take of Venice turpentine one half an ounce, and add the yolk of an egg, three fourths of a grain of extract of opium, and half a pint of water. Make the turpentine and egg into an emulsion, and by degrees add the water, in which the extract must previously be dissolved. An injection of simple water is to be first taken and retained, and then the above administered, which the patient must endeavor to retain. To be taken at first at bedtime, and after a few days twice a day, in cases of obstinate rheumatic affections.

Anti-Spasmodic Injections.

Form I.

Take of castor (not the oil) one drachm, and beat it well with the yolk of an egg; then add a half pint of water. This is frequently given with the best results to women suffering from spasms of the womb, accompanied with hysterics.

Form II.

Take of assafœtida two drachms, to which add from one half to three-quarters of a pint of thin water gruel, and mix well together. This is considered very useful in hysteria, colic, convulsions of children, &c., and for relief of severe pain in the bowels.

Injections for Worms.[2]

Form I.

Take of powdered aloes from ten to fifteen grains, and of starch mucilage one gill. Steep well together, and strain. The same quantity of warm sweet oil or even lamp oil is very useful in these cases, and is known to be a powerful exterminator of pin worms. It may be injected twice a day, if deemed necessary. For this purpose alone, the Improved Injecting Apparatus becomes, in the hands of parents, a valuable means of removing one of the most frightful sources of disease in children.

[2] Worms and their Symptoms.—The worms which mostly infest the human body are the long round worm, the maw or pin worm, the tape worm, and the fluke worm. The long round worm is from four to twelve inches in length, and about as large round as a common pipe stem. This worm is quite common in children, and not unfrequently crawls out at the mouth. It is of a brownish or ash color. The maw or pin worm is generally from two to four inches in length, and of a white color. This worm is most common to children, but is not unfrequently met with in grown persons also. They are frequently found in the intestines in the form of a ball, in such quantities as to prevent the medicines which are usually administered from operating. As a general thing, the symptoms are a bad fetor or smell to the breath, frightful dreams, itching about the navel, pain in the belly, and gnawing about the stomach, itching in the nose, frequent dry cough, with tickling in the throat, constant hunger, and yet the system becomes weak, the head generally becomes affected, face pale and of a yellowish cast. These symptoms, either singly or together, denote worms. Injections are considered a most efficient mode of expulsion, and are much recommended by physicians.

Form II.

Take of sifted wood soot six drachms; to which add half a pint of water. Boil and strain. This injection is useful in destroying thread worms in children. It should be given half an hour before the child goes to bed, and should be administered several days in succession.

Form III.

Take of chamomile flowers half an ounce, of aloes one drachm, of common salt one ounce, and boiling water one pint. Steep the chamomile and aloes for ten minutes; then strain, and add the salt.

Aromatic Injection.

Steeped anise seed or carraway, so commonly given by the mouth to infants, in flatulency, may be used in the form of injections for the same purpose, by making an infusion of the seeds. Take, of the seeds of either one half an ounce, and of boiling water a pint. Steep for fifteen minutes and strain. This may be often repeated, if required.

Yeast Injection.

Take of barley gruel one gill, to which add one gill of yeast. This injection is found extremely efficient in typhoid fever, and useful in preventing the offensive odor of stools in various complaints.

Tobacco Injection.

Take of tobacco leaves from fifteen to twenty grains; to which add one pint of boiling water. Steep for an hour and strain. This injection is recommended in cases of strangulated hernia by many distinguished French and English physicians; and also for obstinate constipation, retention of urine, flooding after child-birth, &c. This injection should be used with the utmost caution, and never without the sanction, or, perhaps, even under the eye of a physician. Lobelia, which is sometimes substituted for tobacco, is liable to the same or more stringent objections, and should be used with the same care.

Quinine Injections.

Form I.

Take of flaxseed tea one gill, to which add from twelve to fifteen grains of quinine. Injected warm, this enema is found to have a powerful and immediate effect in intermittent fevers. It may be repeated every four or six hours, as the case may require.

Form II.

Take of quinine five or six grains, and of sulphuric acid eight drops; to which add half a pint of water. This enema is sometimes used for expulsion of worms from the rectum, and is considered very effective by physicians generally.

Camphor Injection.

Take of powdered camphor five grains, and one gill of gum arabic mucilage, or flaxseed tea. Mix well and administer warm. This is highly esteemed in cases of dysentery.

Ox Gall Injection.

Take of ox gall flesh one ounce, to which add one pint of warm water. This has been strongly recommended by Doctors Clay and Alnatt, of England, for cases of obstinate constipation and hardened fæces. Cases are on record in England where numerous other injections had been used, all of which failed; upon which an injection of ox-gall was administered, and success was the instantaneous result.

Nutritious Injections.

Form I.

In cases where nourishment cannot be taken by the mouth, injections of strong beef tea or broth may be thrown up the rectum, to the extent of from half a pint to a pint at a time. A case is cited where life was prolonged in this manner alone for ten weeks or more.

Form II.

Take of starch or tapioca one drachm. Boil in half a pint of veal broth, without salt, and three yolks of eggs. Beat well together and strain. Administer tepid. This is an admirable support to nature where food is not easily borne upon the stomach.

Nitrate of Silver Injection.[3]

Take of nitrate of silver half a grain, to which add half a pint of water; to be retained after injection several hours, if possible. The strength may be increased to three grains for each injection. Dr. Trask, in his "Notes on Hospital Cases," in his Journal of October, 1850, mentions a case of severe chronic diarrhœa, in which, after using several strong injections of sulph. zinc, sugar of lead, opium, tannin, etc., with no effect, he injected a solution of thirty grains of nitrate of silver, with a common glass syringe. It was not retained a moment, he says, and caused a good deal of tenesmus for some time. After this injection, another of starch and laudanum was immediately administered, and a very decided diminution in the number of discharges followed. The next day but one, an injection of fifteen grains of nitrate of silver was given, followed by the injection of starch and laudanum, and in eight days from the first injection of the caustic, the patient was able to walk about the house.

[3] This injection should never be administered, save by the advice or under the eye of a physician.

Vaginal Injections.

Vaginal injections should first be given in quantities sufficient to thoroughly cleanse the vaginal canal; and then, in quantities of about a gill, should be administered and retained as long as from ten to twenty minutes, if possible. The temperature of the injections may vary with the state of the patient, and be either hot or cold. Warm injections may afford a speedy relief to some, while upon others they have no effect. In cases of leucorrhœa, if copious, injections of tepid water, three or four times a day, will be found to be very beneficial. In falling of the womb, injections of cold water in quantities of a quart at a time, have been administered with good results. In some cases of leucorrhœa an astringent injection may be required. The injection for this complaint mostly recommended by physicians consists of a decoction of white oak bark, (see Astringent Injections,) and can be used warm or cold, as best suits the patient. However, in all cases of vaginal complaints, unless they are very mild, legitimate medical advice should always be had; physicians in regular standing being the most reliable in all critical cases. Application to them should therefore be made at once, or evil consequences may be the penalty of neglect.

TESTIMONY OF EMINENT PHYSICIANS.

From the venerable and distinguished Dr. James Jackson, No. 3 Hamilton Place, Boston.

Boston, December 21, 1855.

I have seen Mr. Lewis's Improved Portable Syringe, and I think it is a very neatly made instrument, and that it is an excellent apparatus for family use.

James Jackson.

From Dr. Nathaniel B. Shurtleff.

Boston, December 5, 1855.

Mr. Thomas Lewis.

Sir: Your Portable Syringe, constructed for medical use, combines so much of the needful with the convenient, that I have no doubt of its proving invaluable in many cases where others, from their construction, will be entirely useless.

Nathaniel B. Shurtleff.

From Dr. Walter Channing.

Boston, December 17, 1855.

Mr. Thomas Lewis.

Dear Sir: I have examined your Improved Syringe, and find it will perfectly answer the purpose for which it is designed, either for self or family use.

Walter Channing, M. D.

From Henry G. Clark, M. D., Surgeon at the Massachusetts General Hospital, and City Physician of Boston.

Boston, December 11, 1855.

Mr. Thomas Lewis.

Dear Sir: I have thoroughly examined the Improved Portable Syringe manufactured by you, and think it one of the very best I have seen.

Yours truly,

Henry G. Clarke.

From Dr. M. S. Perry, No. 16 Rowe Street.

Boston, December 12, 1855.

Mr. Thomas Lewis.

Dear Sir: I received your Improved Syringe, and have examined it very carefully. I think it is all you recommend it to be. Simple and durable in mechanism, and convenient in its form, it is certainly a good family instrument.

Respectfully yours,

M. S. Perry.

Also recommended by the following distinguished physicians of this city:

Dr. Henry J. Bigelow, Surgeon to Mass. Gen. Hospital.

Dr. J. V. C. Smith, Mayor of Boston.

Dr. D. H. Storer, and many others.

From Dr. Theo. Kittredge, Waltham, Mass.

Waltham, December 21, 1855.

Mr. Thomas Lewis.

Dear Sir: Your Improved Syringe, of which I have made a thorough trial, is the most simple and convenient apparatus I have ever seen, and for durability it cannot be excelled. Its simplicity of construction is certainly of the greatest importance, particularly to country physicians, who are frequently under the necessity of repairing their own instruments, and are greatly perplexed by the common apparatus being so often out of order.

Theodore Kittredge, M. D.

From Joseph M. Wightman, Esq., the celebrated Philosophical Instrument Manufacturer, No. 33 Cornhill, who is well known throughout the United States.

Boston, November 8, 1855.

Mr. Thomas Lewis.

Dear Sir: After a thorough trial of your 'Improved Portable Syringe,' during severe sickness in my family, I am gratified to give my decided opinion in favor of its construction, as admirably adapted to the purpose, and also in regard to the excellent workmanship and convenient arrangement of the various parts. These qualities combined with 'Hard Ball Valves,' which operate as well with those injections of which gruel forms a part, as with those more fluid, render it invaluable to those who are obliged to resort frequently to the use of such an instrument for the purpose, and have suffered from having those of other constructions so often out of order as to be a continual source of annoyance and expense.

Yours truly,

J. M. Wightman, 33 Cornhill.

OPINIONS OF DRUGGISTS.

From Thomas Hollis, an old and long-established Druggist, No. 23 Union Street.

Boston, December 3, 1855.

Mr. Thomas Lewis.

Sir: I have examined your Improved Portable Syringe, and regard it as a most admirable instrument. Compact and simple in its construction, it is easily managed, and not liable to get out of order, and is well adapted for all the purposes for which it is intended.

Thomas Hollis.

The following opinion, expressed by the principal wholesale and retail Druggists of this city, shows with what favor the new instrument has been received by the trade generally:—

Boston, November 16, 1855.

The undersigned having carefully examined Lewis's Improved Portable Syringe, are satisfied as to its excellence, and believe it to be superior to any instrument of the kind before offered to the attention of the trade.

Henshaw, Edmands & Co., | 36 India Street.
Reed, Cutler & Co., | 33 India Street.
Brown & Knapp, | 49 India Street.
Brewers, Stevens, & Cushing, | 90 and 92 Washington St.
Charles T. Carney, | 138 Washington Street.
Wilson, Fairbank & Co., | 43 and 45 Hanover Street.
Reed, Austin & Co., | 34 India Street.
Thayer, Hovey & Co., | 6 Faneuil Hall Square.
Carter, Colcord & Preston, | 86 Hanover Street.
Weeks & Potter, | 154 Washington Street.
A. L. Cutler & Co., | 43 India Street.
B. O. & G. C. Willson, | 18 Central Street.
Smith & Melvin, | 325 Washington Street.
Joseph T. Brown, | Corner Bedford and Washington Streets.
Thomas Restieaux, | 29 Tremont Street.
J. W. Phelps,  | 68 Tremont Street.
Henry D. Fowle, | 71 Prince Street.

OPINIONS OF THE PRESS.

From the Boston Medical and Surgical Journal.

The editor of the Boston Medical and Surgical Journal, under date of Dec. 6, 1855, speaking of Lewis's Improved Portable Syringe, says:—

"Portability, durability, neatness, and efficiency are qualities which render any apparatus as nearly perfect as possible, and they are certainly possessed by this. The piston moves admirably, and its action requires hardly any more exertion from the person working it than does that of the elastic bottle attached to certain of these instruments.

"There is a great convenience, it is true, in avoiding the use of the pump, as is effected by Dr. Mattson in his arrangement, and the stream of fluid is thrown (or can be) more continuously; but the lasting nature of the metallic chamber and rod, together with the ease of working the latter, are equivalent excellences.

"This apparatus is adapted to both rectal and vaginal uses, and a small pipe is added for use in the case of children.

"One great advantage claimed by the proprietor, and which commends itself at once to the judgment, is the simple construction, and more than that, the lasting nature of the valves. A ball, accurately fitting, supplies the place of the leather or India rubber valves most commonly employed. It is evident that an important object is here attained; the valves cannot get out of order. If, in taking the syringe apart, the ball should accidentally drop, it tells its story as it falls, and is instantly replaced; no renewal is needed, except there be actual loss, when a common marble, if round, will answer the purpose.

"There are many occasions when it is necessary to use a thick, tenacious fluid for injections; for such purposes, this syringe can have no rival. With delicate flapping valves, these substances would decidedly interfere, and continual change and repair be demanded. With this simple and efficient arrangement, we can hardly conceive it possible for the instrument to get out of working order. In cases where it is imperative to give nourishing enemata, such as gruel, broths, &c., the above conditions are absolutely essential to success, and also to the final integrity of the apparatus.

"As a general thing, the more simple the machinery, the easier its use, and the more universal its application. Complicated arrangements, while they are far more readily disordered, puzzle the unskilful, and sometimes even foil the accustomed hand: their fate is, commonly, to be thrown by in disgust.

"Those who need such aids (and there are few who do not, occasionally, at least,) cannot do better than to supply themselves with this instrument. Every family should possess effectual artificial means of this description, to meet those exigences to which the sluggishness of nature or disordered health may give rise. Were enemata more used in this country, we could safely dispense with much purgative medicine given by the mouth; and when this can be done, we are sure that physicians as well as patients will gladly embrace the opportunity.

"Printed directions accompany each box which contains the syringe. For travellers it is perfectly adapted, not only from its compactness, but from the ease of cleansing it. It is afforded at the very reasonable price of three dollars and fifty cents, and it deserves a large sale."

From the Boston Daily Journal, Dec. 18, 1855.

"Lewis's Improved Portable Syringe.—This is a new and beautiful instrument, which is worthy the attention of Physicians and families, and which we are confident will come into general use for the purposes for which it is intended. It is perfectly simple in its construction, and very efficient in its action, and it can be used by an invalid without any assistance or difficulty, and is not in the least liable to get out of order."

From the Boston Daily Chronicle, Dec. 5, 1855.

"Valuable Medical Invention.—The attention of physicians and others interested, is called to an Improved Portable Syringe, invented and sold by Mr. Thomas Lewis, No. 166 Washington street, of this city. We have seen the instrument alluded to, and although there are many now in use for the same objects, yet we have the authority of several of our first physicians for saying that none approach this invention in perfectedness of plan or execution. The syringe is plainly and simply constructed, not liable to get out of order, and can be used with the utmost facility by the invalid. Directions for its use are plainly and amply set forth on the case, and each instrument is fully warranted."

From the Boston Daily Evening Telegraph, Dec. 3, 1855.

"Portable Syringe.—Our attention was called a few days since to an improved Portable Syringe for domestic use, which is of great value. It is superior to any other which has yet been invented, and must, we think, be preferred by physicians and others who are obliged to use such an instrument. While it is very simple in its construction, it is perfectly adapted for the purposes for which it is designed. Its size is such as to make it a very portable and convenient apparatus for traveller's use."

From the Worcester Mass. Journal of Medicine, April, 1856.

Lewis's Improved Portable Syringe: We take occasion to call the attention of our readers to the "Domestic Injecting Apparatus" manufactured by Thomas Lewis, No. 166 Washington Street, Boston. It is decidedly the best construction of metalic syringe that we have ever seen. It has many important advantages over any other form of syringe. Its construction is such that the valvular apparatus seldom gets out of place. It is small and convenient, enclosed in a neat box, and may be conveniently carried in almost any way. The objections commonly urged against the metalic syringe, are in this improvement wholly obviated. Its long flexible tube allows a convenient self-application. Persons having the syringe need not the aid of an assistant.

Connected with the syringe are full directions with reference to its use, and the advantages to be derived from it. The mass of people are but little aware of the great benefits derived from the frequent use of common water injections. This want of practical knowledge arises more from the want of a good instrument than any other cause. We can strongly recommend Lewis's Improved Syringe in this particular. Physicians themselves would always find it advantageous to recommend a good instrument of the kind to their patients.

From the New Hampshire Journal of Medicine.

Lewis's Improved Portable Syringe, which is advertised in this number, will be found on examination and in use to be one of the most perfect instruments in the market. It is so simple and its several parts fit with so much accuracy that there is little chance of its getting out of repair, and its price is so low as to place it within the reach of every family who desire an injecting apparatus.

From the Boston Weekly Dispatch.

Improved Portable Syringe, or Domestic Injecting Apparatus; manufactured by Thomas Lewis, Boston.—There has been a great variety of attempts to perfect an instrument of this sort for Domestic Use. The French have led the way. We remember, while in Paris, to have examined a great variety of Syringes, and also while in England. Before leaving Liverpool, we paid £1 for one, which we supposed would never need repair; but it has failed. We have taken great pains to secure the best article in this country; for, to a dyspeptic such as we have been for twenty years, the Syringe is invaluable. In passing through Washington Street, we accidentally met with the instrument now on our table, and which we have tried with complete success. We think we must say that Mr. Lewis has really met the want of the community in producing a Syringe at once portable, simple, and combining all that will be desired. We understand that Dr. Jackson and other eminent physicians of our city have recommended it for general use. We trust Mr. Lewis will be amply rewarded for his excellent labor in the extensive sale of his instrument. Call at 166 Washington Street.

From the Boston Advertiser.

We were shown to-day, an instrument manufactured by Mr. Thomas Lewis, 166 Washington Street, which in its operation is superior to any we have ever seen before. It is simple and effective, dispensing altogether with Leather or Rubber valves, (which are so liable to get out of order,) and instead round mineral balls are used, these, by the peculiar construction of the parts, can never get out of place, or wear so as to prevent its perfect operation at all times.

It is so constructed that it may be used without assistance, and is well adapted to children, as well as adults. The importance of every family having one of these instruments is fully set forth by the testimony of the medical faculty of this city, which is furnished in a small book, which contains full directions, receipts, &c.

LEWIS'S
IMPROVED
ELASTIC SYRINGE.

View of Lewis's Improved Elastic Syringe.

DESCRIPTION.

A—Elastic Bag.

B—Metallic coupling, joined to C by a screw.

C—Metallic Valve Chamber, containing a Valve.

D—Metallic Tube through which the fluid is drawn into the Instrument.

E—Metallic Valve Chamber, (discharge valve,) containing a Valve to which is connected by a screw, the flexible tube.

F—Flexible Tube to which is attached as they may be needed, the different Pipes.

G—Pipe for Injecting the Bowels of Adults.

H—Small Pipe for Injecting the Bowels of Children.

I—Vaginal Tube, (for Female Uses.)

DIRECTIONS FOR USE—FOR SELF-ADMINISTRATION. The Elastic Bag A should be clasped by the right hand, the end of the metallic tube D resting in the basin containing the fluid intended for use, the left hand being employed in directing the terminal tube G. By compressing the Bag with the hand and then loosening the grasp, it will immediately fill itself with the fluid. By the next compression of the hand upon the Bag, the fluid thus drawn into the Instrument will be forced through the Flexible Tube, and out of the terminal Pipe. By this means either a large or small quantity of fluid can be used without any difficulty or any alteration of the Instrument whatever.

For Injecting the Bowels of Children. Use the small Pipe H.

For Female Uses. Attach the Pipe I. (For further particulars see Pages 22 to 37 inclusive.)

The Valves, and the care of the same. These consist of small Metallic Balls, and are operated in an Improved Chamber or cavity, which allows them to always work well in any position, and without that liability to stick and become wedged, which is the case with all valves of different form. They are pronounced by the most eminent judges to be greatly superior to the flat India Rubber or Leather Valves,which are so soon acted upon by the fluid as to become utterly useless as well as being often drawn into the body of the Instrument, thereby preventing its working, and causing great perplexion.

N. B. After using any thick injection, all sediment which have collected in the Valve Chambers, C and E, should be thoroughly removed, as it may cause an obstruction to the workings of the Valves.

☞ Be careful and not put the Instrument away wet, or it will injure the Box.

The Flexible Tube. The reader will observe that the couplings to which the Flexible Tube is attached is made with a neck which is inserted into the orifice of the tube, the compression of which, when on, holds it firmly in its place. If the Flexible Tube should at any time be injured so as to be unfit for use, a new one can be obtained of the Proprietor, or his Agents, and forwarded to any place by Express or Mail, and it can be readily attached by any person.

N. B. Price of Flexible Tube 25 cents.

☞ For Formulas for injections, see pages 22 to 37 inclusive.

BUSINESS NOTICE.

LEWIS'S IMPROVED PORTABLE SYRINGE,

Or Domestic Injecting Apparatus;

IS MANUFACTURED AND FOR SALE BY THE PROPRIETOR,

THOMAS LEWIS,

No. 166 WASHINGTON STREET,

BOSTON.

MARK WORTHLEY, 166 Washington Street, } AGENTS.
B. S. CODMAN & CO., 57 Tremont Row,       }

BOSTON, MASS.

☞ All orders directed as above will receive prompt attention.☜

☞ Also for sale by the Druggists generally throughout the United States and the Canadas.

☞ All Instruments manufactured by the subscriber are put up with great care and attention and warranted perfect in every respect; they are accompanied by a Book of Directions for use, stamped with the Proprietor's Patent Trade Mark. None are genuine unless so stamped, and all persons are hereby cautioned against infringing on the same.

T. LEWIS.

Transcriber's Notes

1.Simple typographical errors were silently corrected.

2.Some illustrations have been moved for reader text continuity.

*** END OF THE PROJECT GUTENBERG EBOOK RULES AND DIRECTIONS FOR THE EMPLOYMENT OF INJECTIONS IN VARIOUS DISEASES ***

Updated editions will replace the previous one—the old editions will be renamed.

Creating the works from print editions not protected by U.S. copyright law means that no one owns a United States copyright in these works, so the Foundation (and you!) can copy and distribute it in the United States without permission and without paying copyright royalties. Special rules, set forth in the General Terms of Use part of this license, apply to copying and distributing Project Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ concept and trademark. Project Gutenberg is a registered trademark, and may not be used if you charge for an eBook, except by following the terms of the trademark license, including paying royalties for use of the Project Gutenberg trademark. If you do not charge anything for copies of this eBook, complying with the trademark license is very easy. You may use this eBook for nearly any purpose such as creation of derivative works, reports, performances and research. Project Gutenberg eBooks may be modified and printed and given away—you may do practically ANYTHING in the United States with eBooks not protected by U.S. copyright law. Redistribution is subject to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free distribution of electronic works, by using or distributing this work (or any other work associated in any way with the phrase “Project Gutenberg”), you agree to comply with all the terms of the Full Project Gutenberg™ License available with this file or online at www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™ electronic works

1.A. By reading or using any part of this Project Gutenberg™ electronic work, you indicate that you have read, understand, agree to and accept all the terms of this license and intellectual property (trademark/copyright) agreement. If you do not agree to abide by all the terms of this agreement, you must cease using and return or destroy all copies of Project Gutenberg™ electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg™ electronic work and you do not agree to be bound by the terms of this agreement, you may obtain a refund from the person or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be used on or associated in any way with an electronic work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg™ electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg™ electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg™ electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the Foundation” or PGLAF), owns a compilation copyright in the collection of Project Gutenberg™ electronic works. Nearly all the individual works in the collection are in the public domain in the United States. If an individual work is unprotected by copyright law in the United States and you are located in the United States, we do not claim a right to prevent you from copying, distributing, performing, displaying or creating derivative works based on the work as long as all references to Project Gutenberg are removed. Of course, we hope that you will support the Project Gutenberg™ mission of promoting free access to electronic works by freely sharing Project Gutenberg™ works in compliance with the terms of this agreement for keeping the Project Gutenberg™ name associated with the work. You can easily comply with the terms of this agreement by keeping this work in the same format with its attached full Project Gutenberg™ License when you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern what you can do with this work. Copyright laws in most countries are in a constant state of change. If you are outside the United States, check the laws of your country in addition to the terms of this agreement before downloading, copying, displaying, performing, distributing or creating derivative works based on this work or any other Project Gutenberg™ work. The Foundation makes no representations concerning the copyright status of any work in any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other immediate access to, the full Project Gutenberg™ License must appear prominently whenever any copy of a Project Gutenberg™ work (any work on which the phrase “Project Gutenberg” appears, or with which the phrase “Project Gutenberg” is associated) is accessed, displayed, performed, viewed, copied or distributed:

This eBook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is derived from texts not protected by U.S. copyright law (does not contain a notice indicating that it is posted with permission of the copyright holder), the work can be copied and distributed to anyone in the United States without paying any fees or charges. If you are redistributing or providing access to a work with the phrase “Project Gutenberg” associated with or appearing on the work, you must comply either with the requirements of paragraphs 1.E.1 through 1.E.7 or obtain permission for the use of the work and the Project Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted with the permission of the copyright holder, your use and distribution must comply with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed by the copyright holder. Additional terms will be linked to the Project Gutenberg™ License for all works posted with the permission of the copyright holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg™ License terms from this work, or any files containing a part of this work or any other work associated with Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this electronic work, or any part of this electronic work, without prominently displaying the sentence set forth in paragraph 1.E.1 with active links or immediate access to the full terms of the Project Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary, compressed, marked up, nonproprietary or proprietary form, including any word processing or hypertext form. However, if you provide access to or distribute copies of a Project Gutenberg™ work in a format other than “Plain Vanilla ASCII” or other format used in the official version posted on the official Project Gutenberg™ website (www.gutenberg.org), you must, at no additional cost, fee or expense to the user, provide a copy, a means of exporting a copy, or a means of obtaining a copy upon request, of the work in its original “Plain Vanilla ASCII” or other form. Any alternate format must include the full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying, performing, copying or distributing any Project Gutenberg™ works unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing access to or distributing Project Gutenberg™ electronic works provided that:

• You pay a royalty fee of 20% of the gross profits you derive from the use of Project Gutenberg™ works calculated using the method you already use to calculate your applicable taxes. The fee is owed to the owner of the Project Gutenberg™ trademark, but he has agreed to donate royalties under this paragraph to the Project Gutenberg Literary Archive Foundation. Royalty payments must be paid within 60 days following each date on which you prepare (or are legally required to prepare) your periodic tax returns. Royalty payments should be clearly marked as such and sent to the Project Gutenberg Literary Archive Foundation at the address specified in Section 4, “Information about donations to the Project Gutenberg Literary Archive Foundation.”

• You provide a full refund of any money paid by a user who notifies you in writing (or by e-mail) within 30 days of receipt that s/he does not agree to the terms of the full Project Gutenberg™ License. You must require such a user to return or destroy all copies of the works possessed in a physical medium and discontinue all use of and all access to other copies of Project Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of any money paid for a work or a replacement copy, if a defect in the electronic work is discovered and reported to you within 90 days of receipt of the work.

• You comply with all other terms of this agreement for free distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™ electronic work or group of works on different terms than are set forth in this agreement, you must obtain permission in writing from the Project Gutenberg Literary Archive Foundation, the manager of the Project Gutenberg™ trademark. Contact the Foundation as set forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable effort to identify, do copyright research on, transcribe and proofread works not protected by U.S. copyright law in creating the Project Gutenberg™ collection. Despite these efforts, Project Gutenberg™ electronic works, and the medium on which they may be stored, may contain “Defects,” such as, but not limited to, incomplete, inaccurate or corrupt data, transcription errors, a copyright or other intellectual property infringement, a defective or damaged disk or other medium, a computer virus, or computer codes that damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right of Replacement or Refund” described in paragraph 1.F.3, the Project Gutenberg Literary Archive Foundation, the owner of the Project Gutenberg™ trademark, and any other party distributing a Project Gutenberg™ electronic work under this agreement, disclaim all liability to you for damages, costs and expenses, including legal fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a defect in this electronic work within 90 days of receiving it, you can receive a refund of the money (if any) you paid for it by sending a written explanation to the person you received the work from. If you received the work on a physical medium, you must return the medium with your written explanation. The person or entity that provided you with the defective work may elect to provide a replacement copy in lieu of a refund. If you received the work electronically, the person or entity providing it to you may choose to give you a second opportunity to receive the work electronically in lieu of a refund. If the second copy is also defective, you may demand a refund in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied warranties or the exclusion or limitation of certain types of damages. If any disclaimer or limitation set forth in this agreement violates the law of the state applicable to this agreement, the agreement shall be interpreted to make the maximum disclaimer or limitation permitted by the applicable state law. The invalidity or unenforceability of any provision of this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the trademark owner, any agent or employee of the Foundation, anyone providing copies of Project Gutenberg™ electronic works in accordance with this agreement, and any volunteers associated with the production, promotion and distribution of Project Gutenberg™ electronic works, harmless from all liability, costs and expenses, including legal fees, that arise directly or indirectly from any of the following which you do or cause to occur: (a) distribution of this or any Project Gutenberg™ work, (b) alteration, modification, or additions or deletions to any Project Gutenberg™ work, and (c) any Defect you cause.

Section 2. Information about the Mission of Project Gutenberg™

Project Gutenberg™ is synonymous with the free distribution of electronic works in formats readable by the widest variety of computers including obsolete, old, middle-aged and new computers. It exists because of the efforts of hundreds of volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the assistance they need are critical to reaching Project Gutenberg™’s goals and ensuring that the Project Gutenberg™ collection will remain freely available for generations to come. In 2001, the Project Gutenberg Literary Archive Foundation was created to provide a secure and permanent future for Project Gutenberg™ and future generations. To learn more about the Project Gutenberg Literary Archive Foundation and how your efforts and donations can help, see Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit 501(c)(3) educational corporation organized under the laws of the state of Mississippi and granted tax exempt status by the Internal Revenue Service. The Foundation’s EIN or federal tax identification number is 64-6221541. Contributions to the Project Gutenberg Literary Archive Foundation are tax deductible to the full extent permitted by U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up to date contact information can be found at the Foundation’s website and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread public support and donations to carry out its mission of increasing the number of public domain and licensed works that can be freely distributed in machine-readable form accessible by the widest array of equipment including outdated equipment. Many small donations ($1 to $5,000) are particularly important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws regulating charities and charitable donations in all 50 states of the United States. Compliance requirements are not uniform and it takes a considerable effort, much paperwork and many fees to meet and keep up with these requirements. We do not solicit donations in locations where we have not received written confirmation of compliance. To SEND DONATIONS or determine the status of compliance for any particular state visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we have not met the solicitation requirements, we know of no prohibition against accepting unsolicited donations from donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot make any statements concerning tax treatment of donations received from outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation methods and addresses. Donations are accepted in a number of other ways including checks, online payments and credit card donations. To donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg™ electronic works

Professor Michael S. Hart was the originator of the Project Gutenberg™ concept of a library of electronic works that could be freely shared with anyone. For forty years, he produced and distributed Project Gutenberg™ eBooks with only a loose network of volunteer support.

Project Gutenberg™ eBooks are often created from several printed editions, all of which are confirmed as not protected by copyright in the U.S. unless a copyright notice is included. Thus, we do not necessarily keep eBooks in compliance with any particular paper edition.

Most people start at our website which has the main PG search facility: www.gutenberg.org.

This website includes information about Project Gutenberg™, including how to make donations to the Project Gutenberg Literary Archive Foundation, how to help produce our new eBooks, and how to subscribe to our email newsletter to hear about new eBooks.